My Musings

Basil Marceaux.com speaks on GUN CONTROL

2010-08-28T09:06:00.000-07:00

This is an incredible clip. I've come to love this guy. There are so many frighteningly brilliant quotes, you will need to watch it several times to catch them all. Watch.

He introduces himself as a website, then as the governor of Tennessee (he is, of course, neither).

"I chose this location because I like it a lot." Compelling reason.

"Many people have died from gun control." Oh really? How's that?

What exactly is a "nut cake"?

"I want us all, in a group of 25 or more, to come to Nashville with your guns and tell me I'm doing wrong and then we'll sit down at the table and discuss it." Speechless.

"I'm basilmarceaux.com"

"I'll see you at the polls.....Amen."

Dumpster fires like this don't come along all that often. Looks like a walrus, only slightly more articulate, running for the highest office in the state of Tennessee. I hope he wins.

Hippies

2010-07-27T21:07:00.001-07:00

Recently wrapped up a lovely 30-hour shift (I was asleep for one of those hours) during which I was paged about every 20 minutes, and called on to take care of 2 seizures and one stroke in patients I was cross covering on (which means they’re patients I’ve never seen before and know nothing about). It’s frightening, but fortunately I have back-up from more experienced residents. But it’s stressful and in order to unwind, you have to force yourself to get out and do stuff when you’re not at the hospital, even though the only thing you usually feel like doing is sleeping and loafing.

So Ash and I went to the lake today. The UW campus is right on Lake Washington and they rent canoes there for cheap. So we went out for a little paddle today. There’s a floating freeway that connects Seattle to it’s posh suburb, Bellevue. You can paddle under the overpass and there are some little marshy areas with tons of birds, shrubs, and tons of little banks with people relaxing on the grass, drifting on blow-up rafts, or swimming with their dogs.

Ash and I made a little lap around these areas and were on our way back under the freeway toward the university. We’re paddling along and look off to our left to one of the little areas where people were swimming and we see about 6 people, with gray hair—more of it on their chests than their heads—and they’re butt ass naked. It was about 2 p.m. This is about 200 yards from a very busy freeway and along a route well-trafficked by canoes, kayakers, and lots of boats—many with children in them.

Never seen that at Utah Lake. I didn’t actually see one, but I have to believe there was a decent sized water bong hiding up in the weeds somewhere, or some massive hand-rolled splithes, or maybe some peyote. I also have to believe some of these same folks were, many years ago, free lovin’ and dropping acid and following Jimi Hendrix and Janis Joplin across the country in sweaty VW buses packed with other people who looked like they would smell bad. I was tempted to snap a picture. I can’t imagine they would have minded. There they were, standing in the water, just ankle deep, in all their glory. Pretty awesome. Seattle is different.

Seattle

2010-07-21T13:49:00.000-07:00

Got about a month under our belts in a new city. It’s been a whirlwind for Ash and me over the past few months. I graduated from medical school at the end of May and a week later, Ash and I got married. We went to Costa Rica for our honeymoon, came home and packed for a week, and then moved to Seattle. Just a couple of minor milestones for one month.

My parents helped us pack up the ole U-Haul and Ash's parents were an enormous help with the actual move. They drove our car up and helped us unload and get settled in. Pretty lucky to have supportive families.

I started residency at UW at the end of June and so far so good. I love Seattle. The Seattle summer temperatures are much more suited to my taste than Utah summers. It doesn’t get so bloody hot here. We live about 3 blocks away from Lake Union, for those of you who know the area. We’ve got a little view of the lake from our balcony and we’re loving living this close to water. We often walk down to the marina and sit on the bench and read while we watch all the boats and the seaplanes that come and go. We’ve become friendly with a couple of the neighborhood drunks that hang out on the benches at the dock. They complimented me on my sunglasses the last time we saw them. We’re hoping that if we go to the marina often enough some of the people with boats there will befriend us and take us sailing.

The city is beautiful, but there are a few things that we’ve noticed that will taking some getting used to. There isn’t a lot of space. You notice this the most when you’re driving. Roads here certainly weren’t built wide enough for a horse and buggy to make a U-turn like good ole SLC. In fact, most of the roads in our neighborhood are not wide enough for two cars traveling in opposite directions to pass each other. If you see another car coming down the road, one of you has to find a driveway, or an empty parking slot (a rare thing) to pull into so the other car can pass. I often find myself looking around for ONE WAY signs, convinced that I’m going the wrong way on a one-way street—nope. Quite a feat of civil engineering. Addresses are also neat here. As is the case in many cities, different streets can share the same name. There is a cockamamie quadrant system that is apparently “pretty easy, once you get used to it”. I don’t buy it yet. We’ll see.

Whoever is in charge of the street signs in the city should unquestionably be fired. The signs are small, usually posted to low, at angles not conducive to reading, and in locations that ensure that you will not be to see the sign in time to be able to change lanes to make your turn. I seem to cuss more than usual when I drive here.

People don’t really speed here. On the freeway you rarely see people going more than 65 mph (speed limit is 60). When I was at home, I felt that I wasn’t speeding until I was doing at least 10 over on the freeway. Perhaps the lack of speeding is due to the higher volume of cars. Traffic sucks here, but we’re fortunate to live very close to where I work so I can avoid most of the really congested roads. I’m close enough to ride my bike to all three hospitals I’ll be working at.

That brings me to another cool thing about Seattle. People ride their bikes a lot here. Bike lanes are far more abundant than most other cities I’ve been to and there are a lot of trails and paved bike paths (most of which I haven’t had time to explore yet…someday). And drivers are much more aware of cyclists and pedestrians than what I’m used to.

Apparently Seattle is considered the most literate city in the US with a higher percentage of college grads than any other major city in the US. It’s an interesting dichotomy because there’s a decent-sized homeless population as well which makes for a rather interesting juxtaposition. We've already identified a few of the guys that crash in our neighborhood in the park nearby or in front of some office buildings. It's pretty heartbreaking to see.

In our outings around town to stores, shops, parks, etc, I’ve noticed a far more liberal standard of what’s considered an acceptable level of B.O. than what I’m used to. Maybe it’s that people bike more here, but I’ve definitely encountered many a funk on some people who seemed hygienic from a distance, but have been quickly disabused of that notion when I’ve wandered into their waft zone. Deodorant folks.

I’ve been pretty busy working in the ER this month so we haven’t had a ton of time to go exploring but there is a lot of cool things to do close by. When I’m not at work, I pretty much feel like loafing and sleeping. We did rent a canoe last week and paddled around Lake Washington for a couple of hours, which was awesome. Ash is a good sport about my crappy schedule and general lethargy. She has been taking excellent care of me and is pretty much dominating at being a wife—not a surprise to those that know her.

We like our apartment cause it’s fairly roomy for these parts. We have a guest room and a guest bathroom if anyone is interested in visiting Seattle for any reason, we’d be happy to put you up. We live about 2 miles from downtown and about two miles from the UW campus and we have great access to public transit from our neighborhood. You can make a quick weekend trip out of it. Our first guests arrived yesterday. Ash's sister, Chrissi, and her adorable daughter, Ali, flew in last night. It's nice to have familiar faces around so when I say that we'd be happy to put you up, I sincerely mean it--call me if you'll be in the area or if you want a relatively cheap get away.

I hope to get more stuff up at some point—from the wedding and honeymoon, but who knows what my schedule will allow, so it may be awhile. In short, we're alive and well enjoying married life and a new city.

Debriefing the ME

2010-04-12T21:33:00.000-07:00

Months have passed since I finished my rotation at the medical examiner, yet I continue to think about my experiences there pretty regularly. Although I’ve definitely had some emotionally intense experiences on most of my rotations, no single rotation can compare to the heaviness and sadness that I saw day in and day out at the ME. Since I’ve had some time to think about it a little more, I felt like writing something of a summary of my experiences—sort of a debriefing.

One thing I’ve realized is that you’ll never forget the first time you see someone who has taken a shotgun blast to the face. It’s impossible to capture the horrific carnage and the surrealism of it with words. It’s easily the most violent and disturbing thing I’ve ever seen. At the risk of sounding too cavalier or insensitive, I will tell you that “blowing your head off” is a pretty accurate description when it comes to shotguns (rifles in general, really). It’s particularly unsettling when it’s someone who has done it to him/herself. One woman in particular, still haunts me. I’m not sure if it’s because she was the first person that I ever saw who had done this (unfortunately, she wasn’t the last), or if it was other things about her case, but I’ve thought of her and her family nearly every day since it happened.

She was younger than me, married, and had children and seemed to have a lot going for her. Aside from the obvious fact that the majority of her head above her upper teeth was gone, there were other things about her autopsy that really got to me. One was the very faint and subtle stretch marks on her breasts from breast feeding her children. It’s small details like this that get you.

She also smelled nice—from a very feminine-smelling perfume or lotion. Another disturbing thing was the fact that if you looked at her from the neck down she had a perfectly healthy looking body and still had normal color. If you covered her head and looked only at her body, you probably would not have guessed that she was dead. One of the investigators was able to get a photo of her and I was stunned to see what a beautiful girl she was. In the condition we saw her in, it was simply impossible to know. Although a total stranger to me, it has been difficult to wrap my head around the catastrophic loss of a beautiful young mother in such a violent, permanent, self-inflicted way.

I saw 3 hangings that were all ruled suicides. The bodies did not look as bad as I was expecting based on what I had seen on TV and in movies. Sometimes in Hollywood, they make the face look super bloated and the tongue look swollen. I learned that the reason that the tongue sticks out is not due to swelling. The tongue often does protrude but it's because the rope (or whatever they use) puts mechanical pressure on the lower portion of the tongue and causes it to go up and out. (If you take your finger and push underneath your chin about an inch behind the bony tip of your chin, you can sort of feel why this would happen). Once the body is cut down, the tongue often returns to a fairly normal position. The ligature (rope, cord, etc) did leave a pretty deep rut (for lack of a better term) in the skin and soft tissue of the neck on all of the people I saw who had hanged.

I saw more overdoses than I can count. Some on illicit drugs, others on prescriptions. The autopsies for these are straightforward and pretty normal from a pathology standpoint. I saw some car accident victims that had too many fractures to count, and a man who had fallen about 25 feet and bounced off some scaffolding several times on his way down that was quite a wreck. Two men who had stabbed themselves to death. One man stabbed his neck and his heart with a kitchen knife. The other stabbed himself 17 times in the neck, chest, and abdomen with a bayonet. He actually survived in the ICU for a few days before we got him. As you might imagine, he was a mess.

Although most of the things you see in the ME are fairly depressing, occasionally things happen that you can’t help but laugh at. Like the man who was found dead on top of a blow up doll (you can imagine). I felt a little guilty laughing about it, but I think you can recognize that it’s sad someone is dead and still find some sliver of humor in the way it happened.

There was absolutely nothing funny about the dozen or so gun-shot suicides I saw during the month I was at the ME. I was struck by the irony of the scene photos of one of these cases. The guy was roughly my age and had shot himself in his parked car. I didn’t notice this initially because there were more attention-grabbing areas of the photo (as you might imagine) but I found it strange that he was wearing a seatbelt. Perhaps it was just the result of habit. But how strange to buckle up and then put a round through your head.

Another memorable case was a young guy playing Russian Roulette in front of his friends. He lost. One in six odds might not sound too bad, but when you’re talking about death, those are damn terrible odds. In Utah, someone who gets killed playing Russian Roulette is ruled a suicide, not an accident. This often really pisses off family members of the decedent.

Another man shot himself in the driver's seat of a stolen car he had parked in the lot of a shop in an industrial part of town. Among the reams of paper that he had in his car (tons of rants about politics, government, etc), he had written that he wanted to wait for the sunrise before he shot himself. We also found among his writings, a note that said he was considering going on a shooting spree before he killed himself. We found three other loaded mags in his bag so if he was a good shot, he could have taken out 17 others and still had a round to kill himself.

As you would probably guess, there were more males who killed themselves with guns than females, but it was closer than I would have predicted. I was definitely surprised by how many women we saw. The oldest person I saw that had taken their own life was 76. The youngest was nine—not a typo. A nine year old. That takes the cake for the most horrific thing I saw there. With a kid that young, we wanted to believe that it must have been an accident. But the placement of the gun and the fact that it was witnessed by a friend made it pretty clear that it was intentional. I imagine that the kid who witnessed this has a very slim chance of living a normal life. Not something anyone should have to see at any age, but at nine? Good lord.

I helped undress the body and was the one who checked the pants’ pocket. I welled up and had to leave the room for a minute or two when I pulled out an empty fruit snacks wrapper from the pocket—just a little kid. It’s those little details that I found the most haunting because it sort of puts things into context and makes it more real. This little child had been at school eating fruit snacks just a few hours before committing suicide. Although I’d like to, I doubt that I’ll ever be able to erase the image of that mangled little body and that wrapper.

Without question, the most sobering month of my life. So many things to think about, so many images I’ll never be able to get rid of, yet I’m glad I did it. And I’m very glad that I didn’t end up seeing anyone that I knew. Seems an odd thing to thank people for not dying, but I suppose that I should thank everyone I know for not dying that month, hard enough with strangers.

Back to Sleep

2010-03-24T09:40:00.000-07:00

Most mothers are probably familiar with the Back to Sleep campaign aimed at getting moms to put their babies to sleep on their backs. I realize that some mothers have been around long enough to see medicine flip-flop on the advice we, as a profession, offer in regards to the safest way to put your baby to bed. All I can say is that we, as a profession, are wrong sometimes and we do the best we can based on the data available. Currently, the recommendation is to put babies to sleep on their backs, IN THEIR OWN BED!

After a month in the medical examiner, I’m completely behind both of those recommendations. Performing an autopsy on a baby is horrific. Performing an autopsy on a baby that has nothing physically wrong with it and is dead because mom or dad smothered their child is about as heart-wrenching as it gets. I had some variation of that experience a few times during my month there.

There was one case that is fairly representative. It was 2 month old girl. Mom went to sleep with baby on her chest. At some point after a feeding, she had baby beside her with a barrier of pillows and a comforter, presumably to keep dad from smothering baby. When her husband woke up to go to work, he noticed that baby was not breathing, but was still quite warm. Their efforts to resuscitate were unsuccessful as were the efforts of the paramedics. I can’t imagine the horror of an event like this. Based on the body temperature, the baby probably had not been dead long when they discovered her. Apparently the barrier mom had constructed to protect the baby actually ended up impeding her breathing somehow.

She, no doubt, had many of the same thoughts that parents who often do this do: “I would wake up.” “I would feel it if I rolled over.” “I put the baby on my side of the bed so he won’t rollover on her” and on and on. Fact is, it happens and it is awful. The funeral home that brought that baby’s body to us did not show up for a long time after the baby died because mom would not let go of her. That poor mother held her decomposing baby for almost 36 hours before the mortician was finally able to get her to turn her over so he could bring the body to the ME for an autopsy.

I don’t have kids so I’m not going to pretend that I know what it’s like to be up with a colicky, vomiting baby that won’t stop crying. All I know is that those parents were good people who loved their child and never thought it would happen.

As I watched, in horror, as these tiny bodies were dissected, I was hoping that the ME would find a major heart problem or some other abnormality that would explain the child’s death. Something, anything that might help with the parents’ guilt. I saw a handful of autopsies on infants during my month at the ME, unfortunately, none of them ever revealed anything wrong with the baby.

Please put your baby to sleep on its back in its own bed.

One Eight Seven

2010-03-16T07:27:00.000-07:00

In case you missed the significance of the title, 187 is the police code for homicide (actually I think it’s specifically the LAPD code for homicide made famous by the likes of Snoop and Dre--"Cause it's 1-8-7 on an undercover cop"). If you haven’t read the previous post (and it was a tad lengthy so it’d be understandable) you may want to do that or this one won’t make a ton of sense. I thought I’d write a little about homicides because they are a little different from other autopsies.

The first case that I was a part of was a guy that was actually killed by the police. Which highlights an important point about homicides in the medical terminology versus legal terminology—which is different. In medical terms, a homicide is when someone intentionally kills another person. In this case, the cop who shot the guy did so intentionally because the guy was trying to run him over in a car. That cop was well within his legal rights to use deadly force and will not be charged with homicide, but from a medical standpoint, the death is still categorized as a homicide. It’s a pretty important semantic distinction that can get confusing to people who don’t realize that the word “homicide” means two different things to a doctor and a lawyer.

I didn’t ever respond to the scene of a homicide so I’m not sure how different it would be from the other scenes I went to. One difference is that it’s a crime scene and is taped off with the yellow tape we all recognize from TV (I did actually go to the scene of a suicide that was cordoned off like that and we actually had to sign in to the scene before we were allowed to cross under the tape—sort of surreal moment). Another difference is the amount of photographs. If it’s a homicide there will inevitably be a lot more photos. The police are also taking their own photos and collecting evidence for their own lab. They usually have someone from their crime lab that is conducting an investigation simultaneously with the ME investigator.

The hands of the body are wrapped in brown paper bags that are taped up around the wrist. This is to preserve any evidence (blood spatter patterns, tissue from an assailant that might be under the victim’s fingernails, etc) so the doc can collect/document that evidence at autopsy (this is also often done with suicides).

The body arrives at the ME in a body bag with the zipper temporarily locked with a zip-tie. This is to ensure that the body isn’t tampered with in any way en route to the ME. The odds of this happening are extremely low, but creative defense attorneys will latch on to just about anything. But aside from the legal reasons to do it, it’s a good idea from a forensic standpoint anyway.

When the autopsy is to begin, the first photograph taken is of a watch placed by the sealed body bag to show that the body did in fact arrive in a sealed bag, and the watch is to show what time the autopsy began (yes this could easily be faked if someone wanted to by resetting the watch to a different time so I’m not entirely sure why they bother with it). Once the body is out of the bag and on the table, a bunch of ‘as-is’ photos are taken. The ME is often doing his external exam while these photos are being taken. This usually entails looking closely at the clothing and any visible injuries while the body is still clothed.

The next step is often the hands so the paper bags are removed at this point. He looks for defensive wounds, blood spatter, etc. The fingernails are clipped into evidence bags in homicides because there is a reasonable chance that the perpetrator’s DNA can be obtained from the victim’s nails if there was a struggle of any kind. Extensive sets of fingerprints are also taken from homicide victims (normal autopsies they usually just get thumb prints from both hands unless it’s a baby in which case they get footprints too). From there, the clothing is removed piece by piece and taken to a separate table for photographing (in a regular autopsy, clothing is not photographed individually, just cataloged and described in the report). These photos are frequently a part of the prosecution’s exhibits if the case goes to trial (which means the photos will be scrutinized and attacked by the defense attorney so you want to get good photos).

I had the opportunity to go to court with one of the doc’s who was an expert witness for the prosecution in a homicide case from about 5 years ago. On the stand, he described the murdered girl’s autopsy findings. He explained the injuries as the jury looked at the autopsy photos. The prosecutor also had him draw the injuries on a body diagram for the jury to see (cuts in red ink, bruises in blue). He explained the toxicology results and gave his opinion about how the attack might have occurred (the girl had been sexually assaulted and had several non-fatal cuts on her neck and then was strangled to death with her own belt).

The defense attorney’s cross-examination was not nearly as dramatic as I was expecting. The only point he really contended in his cross was the range for the time of death. His skepticism was definitely warranted. Time of death is one of the more difficult things to really pin down. It is no where near an exact science. Liver temperature is often used to estimate it, but there are tons of variables that you can’t account for. In this girl’s case, her body had been in a car for several hours in 44 degree weather so her body would have cooled significantly faster than a body at room temperature (the formulas for estimating time of death using liver temperature are usually based on room temperature). The best the ME can do is provide a range (usually of several hours) when the death likely occurred.

The courtroom stuff was all fairly interesting, but not nearly as dramatic as you see on TV. I was tempted to jump up during the cross-examination and shout something like, "Your Honor, I object, he's badgering the witness!" just to spice it up, but decided better of it. I was in the courtroom for about 30 minutes total, just long enough for the ME to testify. We heard that the guy was convicted about one week later (his DNA was at the scene, on the belt that was found around her neck—tough to get an acquittal if your DNA is strewn about the crime scene…unless you’re OJ).

One other point that I thought was interesting. They did not find the perpetrator's semen at the scene or at autopsy (they use the black light test similar to the way it's portrayed on TV). But that obviously doesn't rule out a sexual assault. There are reasons why there may not be any physical evidence of a sexual assault. For example, the assault could have taken place post-mortem and the perpetrator may have been wearing a condom. It's also possible that the scene looks like there was a sexual assault when there wasn't. For example, this girl was found with her pants and underwear around her thighs so it looked like an assault had taken place, and indeed, it may have. But it's also possible that the perpetrator started down that road but then got spooked and took off. Unfortunately, there isn't always a definitive answer.

Once all of the clothing has been removed and the body photographed, the autopsy proceeds much the same way that any other autopsy would. There might be a few extra tests if the ME knows that the case is likely to end up in the courtroom. For example, if there is a gun involved in the case, the ME will typically collect samples from the hands of the victim to analyze for gun shot residue. This test is pretty much worthless from a forensic standpoint. All it definitively tells you is that the victim was around when a gun was fired (if the victim is in the autopsy suite because he/she has a bullet in their head/chest it seems pretty obvious that they were there when a gun was fired). The test will not tell you who fired the gun. In other words, if the dead guy fired the gun himself or if someone else fired the gun at him, he will have gunshot residue on him. Why do the test then? Lawyers. If you didn’t do the test, a defense attorney would likely try to use that to discredit the ME and their techniques, so the ME’s order that test (which is paid for by your tax dollars) simply to appease attorneys. [Lest I come across as someone who hates attorneys, I should probably mention that I actually respect the vast majority of attorneys (even defense attorneys), but there are some defense attorneys who will, no doubt occupy the hottest seats in hell, probably alongside the doctors who similarly soil their profession with unethical conduct].

Another significant difference in a homicide autopsy is the presence of law enforcement. One of the detectives on the case will usually be there. They often come for suicide autopsies as well. And they’re often there for what are known as bogus-ides. That is an autopsy that is thought to not really be a homicide (bogus) but is conducted as if it were a homicide because the police haven’t been able to rule out a homicide (this is almost always a suicide that has something unusual about it at the scene—e.g. the entry angle of the bullet is not typical or is in an unusual location, someone else was in the room when the person shot him/herself and homicide can’t be ruled out, etc).

Homicide autopsies although interesting, are also pretty unpleasant because you know that someone else did this to them. It’s a sobering reminder of the violent society we live in. I once heard a quote that I thought of during pretty much every homicide case that I was a part of: “Civilization is a cloak that humans wear awkwardly.” Unfortunately, that’s true far too often.

I certainly can’t divulge specifics of the homicide cases that I witnessed, but several of them were covered on the news. That’s another odd thing about working at the ME—you can often anticipate what’s going to happen at work the next day by watching the evening news. It was very interesting to follow what the news reported and compare that to the findings at autopsy. Sometimes accurate, sometimes not. That leads to another diatribe that I will save for another day (i.e. the news programs are all-too-often selling a product, not reporting objective news…). I will say that when it comes to the details offered by the media (newspaper, TV news, internet) take what you hear about homicides and suicides with a grain or two of salt. I think most people sense this intuitively, but I personally saw more than one example of media reporting things that I know were absolutely false or grossly exaggerated.

Busy week this week with the match coming up, but I hope to do at least one more post, probably about babies. It will be unpleasant, but, in my opinion, important.

The OME

2010-03-05T07:52:00.000-08:00

I did a rotation at the Office of the Medical Examiner (OME) fairly recently. The ME is the forensic pathologist (actually it’s 4 docs) that do the autopsies for the State of Utah. As you might imagine, it’s a pretty fascinating place to work. They do, on average, six autopsies per day. About 25% of their caseload is due to drug overdoses. That’s not a typo, one out of every four cases they handle is someone who either intentionally or accidentally (the majority) overdosed on something (usually narcotics—heroin, Lortab, OxyContin, Percocet, methadone—or stimulants, like cocaine). If that doesn’t sound like a lot to you, it is. It works out to be ~50 per month. That’s nearly two people a day. It’s way too many—big problem in this state.

Many of the cases the ME ends up taking are unattended deaths, meaning unwitnessed by anyone and not necessarily expected given the person’s age and state of health in the time just prior to their death. This includes the unsavory category of what’s known as a “decomp” which is short for a decomposed body—someone that has been dead for a while before they’re found. They arrive to the OME in various stages of decay from a little bit stinky to, as they say in the office “more maggots than person” (I saw some partially decomposed bodies, but no maggots). I did see some pretty good examples of mummification, which is when the tissue starts to dry out and shrivel and feels a little bit like driftwood (you usually see it in the extremities and face first, which are the only places I ever saw it).

Of course, they handle all of the suicides and homicides as well. They will also handle many deaths that occurred when someone was at work as these cases can end up in litigation and injuries have to be documented by a doc. They’ll investigate traffic accidents if the police ask them to. And, my least favorite cases, babies that die unexpectedly (meaning they didn’t have any known medical problems where death at a young age would be expected).

It’s not nearly as sexy as all the CSI-type TV shows would make you believe, but it’s pretty damn interesting. Here’s how it works. When someone is found dead and they’re obviously dead, it’s almost always law enforcement that hears about it first (if there is any doubt about whether someone is dead or not, EMS might get dispatched to the scene and the person will be pronounced dead at the scene by EMS or they may go to the hospital where they’re pronounced dead by a physician). The cops go check it out and they’re usually the ones who call the ME’s office. The ME has 4 full-time investigators based out of the OME (which is just south of the Moran Eye Center) and several more part-timers that live in various parts of the state. The investigators talk with law enforcement on the phone and if it sounds like an ME case, they’ll go out to the scene to check it out. The investigation is usually pretty straightforward. They look at the body, what’s around it, look for signs of foul play, anything that might be a clue about cause of death (weapons, drugs, etc), take pictures, and talk to law enforcement or anyone else who knows anything about the case.

If it’s not a homicide, the scene investigations are usually less than an hour. Once they’ve concluded their investigation, an independent company comes to transport the body from the scene to the OME where the autopsy is performed. The company in Utah is called Independent Professional Services—how’s that for a euphemism? I don’t imagine that they have any marked vehicles, but if you ever see that on the side of a truck/van, you may want to try to peek in the back window.

The first scene I went to was a small apartment of a 50-something year old man that hadn’t been seen by his neighbors for a couple of days and had been unreachable by phone according to friends. Friends finally called the landlord who was unable to get a response knocking on the door, but it was locked so she knew he was in there. The guy had put a sign on his door that said he wasn’t feeling well and did not want to be bothered, which was not unusual for him when he wasn’t feeling well. She unlocked the door and was immediately greeted by two very hungry cats. (If you're like me, your first question to the investigator at this point would be Do the animals ever start to eat the body? Dogs, sometimes. Cats, not usually. I did not see any bodies that had been disturbed by animals in anyway.) The man was sprawled out on his back in bed with no covers on him. The room was a bit stinky, but mostly due to the kitty litter (but a body that has been dead for about 2 days in a room that's about 80 degrees does have a bit of a funk). He also had a bit of vomit coming out of his mouth, which didn't help either.

As most people probably know, there is a ton of bacteria in your GI tract. When someone dies, the bacteria in your gut continue to essentially have a toga party—reproducing liberally. As they do so, they produce methane (and other gases). This causes bloating and as this gas continues to accumulate in the abdomen, it is not uncommon for this expanding gas to cause stomach contents to slowly migrate back towards the mouth. This guy was actually bubbling a little bit at the mouth as the gas bubbled up through the vomit (nice imagery, I know). So yes, dead people vomit. They can also fart and poop after death (which I saw multiple times—you think live people’s farts stink…lordy). [Anyone interested in learning more about what can happen to human cadavers after death should read the extraordinary book, Stiff, by Mary Roach. Fascinating read, very informative, also hilarious.]

Inside the apartment, there were no signs of foul play. The guy was very obese (plus his belly was pretty bloated) and eyeballing him, I guessed that he had died of a heart problem (I was wrong). One thing the investigators do at every scene is look for medications or illicit drugs. This guy had a few meds and a small weed pipe, but nothing that made us think he had OD’d. The investigator snapped a bunch of pictures, bagged up his meds, and then the body movers came and slung this guy on a gurney—he was pushing 400 pounds, so it was no small feat.

When we get bodies at the ME, they are in fact placed on the large stainless steel tables you see on TV. They get weighed and have their height measured. After some intake paper work, the body is moved to the autopsy suite (or the fridge if it’s not their turn yet--in Utah, it's a huge walk in fridge with many tables with bodies on them, not individual drawers like you see on TV sometimes). Next, a ton of ‘as is’ pictures—meaning the body is photographed in the position and clothing that it comes in. Then we undress the body (which can take some doing because of rigor mortis) and the doc conducts the external exam. He (or she, there is one female doc in the OME, but it’s easier to just say ‘he’) notes any tattoos, scars, wounds, or anything else that seems relevant. While he’s doing this, the rest of us are removing any jewelry. [Quick aside: it is really eerie to remove a watch that’s still ticking from a dead body—weird feeling I never got used to.]

Usually after the doc is done with his external exam, the deiner (an autopsy assistant—deiner is the German word for waiter or server) begins with the classic Y incision in the chest. The depth of subcutaneous fat is measured. Then the deiner dissects back the skin on the chest and stomach and then cuts off the front part of the rib cage with a pair of loppers (the kind you use to trim tree branches—seriously, they buy them at Home Depot). The sound is pretty unpleasant. It hurts to listen to, until you get used to it. From there, the internal organs are removed in a specific order, mostly because it’s more efficient to document if you always do it in the same order. Usually the heart first, then both lungs, liver, spleen, bowels, kidneys, and possibly others depending on the case (optional stuff like uterus, prostate, bladder, etc). The organs are weighed, and then the ME dissects them one by one looking for something amiss that might explain why the person is dead.

It’s uncanny how much the autopsy suite resembles a commercial kitchen. Stainless steel everywhere, sinks, large bowls, colanders, fine cutlery, ladles, strainers, cutting boards, garbage bags. It’s actually pretty unsettling at first.

Back to the big fella that died in his apartment. When someone has been dead for a couple of days before they’re found and their belly is full of gas, you have to exercise caution when you cut them open. It’s best to start with a small incision, preferably one that is not directly inline with your face. When a body is pretty bloated and you cut into the abdominal cavity, there is an audible whoosh as the gas escapes from the belly (sounds a little bit like uncapping an inflated air mattress). If they’re really bloated, small bits of fat and other bits of tissue can become projectiles as the gas escapes, which is why you don’t want to have your face directly over the incision. I heard (and smelled) plenty of this gas escaping from several bodies, but did not see any projectiles during my month there. One of the docs told me that he has seen bits of tissue get launched into the ceiling (it’s a 12 foot ceiling). Rather impressive, I imagine.

The smell in a situation like this is, as you would imagine, horrific. Us rookies frequently have to back away from the table, and on a couple of occasions leave the room, in order to keep from vomiting. Although I had some close calls, I managed to observe 100+ autopsies without puking or passing out.

Other things that happen during the autopsy (this is all pretty much going on simultaneously as several people are working on the body at once), blood is drawn by sticking a rather large needle either in the inferior vena cava or directly into the heart. Urine is drawn by putting a needle directly into the bladder, and vitreous humor (eye juice) is drawn by sticking a needle into the white part of the eye. Getting the vitreous is a med student job so I did it several times during the rotation. Sticking a needle into an eye—even the eye of a dead person—is a little uncomfortable the first few times you do it. It’s just one of those things that doesn’t feel or look right, like looking at a compound fracture. All the fluids are then sent for toxicology to determine the drugs, and the levels of those drugs, that were in the person’s system.

As the doc is dissecting organs at a separate table, the deiner is working on “popping the top” which means peeling back the scalp and cutting off the top of the skull. One of the more unsettling things for the outside visitors (cops, lawyers, etc). The people who haven’t seen autopsies before don’t really like this part very much—understandably so. It’s pretty hard to capture in words how weird this looks.

An incision is made starting just behind one ear and then moving around the back of the skull (at about where the neck muscles attach to your head) all the way to the other side just behind the other ear. Then the scalp is peeled off the skull in the direction of the body’s face. When it’s peeled back (or forward?) all the way, the scalp covers the entire face and the skull is almost completely exposed from the forehead all the way back to the back of the neck. The deiner then uses a bone saw (looks a lot like the saws used to remove casts, and like cast saws, it oscillates rather than rotates) and cuts through the skull in a ring pattern. The area they cut is pretty much the area that would be covered by a headband (it’s obviously not that wide, but that’s basically the pattern). They then use a little tool that looks a bit like a chisel and “pop the top” and the top of the skull comes off completely. They use a scalpel and cut the brainstem from the spinal cord, cut a few other small nerves, and pull the brain out. I’m not sure what this says about me or what to make of it exactly, but that was always my favorite part of the autopsy.

If you’ve never handled a fresh brain (I imagine that’s most of you) it is surprisingly soft, and actually feels a bit different from a brain that has been chemically fixed (in case any of you have felt fixed brains in anatomy or neuro labs). The consistency is similar to a few foods that I can think of, but lest I permanently ruin those foods for you, I will keep them to myself. I sill eat them, but I must admit, the experience is now different. The brain is then sliced into sections, again, looking for anything amiss. Small samples of all the organs are saved in a little jar of formalin (fixes the tissue) in case the doc wants/needs to come back to reexamine anything. The doc may also send samples of tissue for histology (you look at small samples of the organs under a microscope) depending on what they do or don’t see during the autopsy.

Unless there is something really unusual, the average autopsy takes about 45 minutes (obviously, there is some variability depending on the doc and the size of the body). If the case is a homicide it will take much longer as more photos have to be taken, all clothing is evidence so you have to be much more careful removing it, photographing it, and bagging it. Homicides usually require more tests too, which means more specimens, etc. In some cases, autopsies are actually less than 45 minutes. For example, when it’s a suicide and they used a gun and it’s pretty obvious what killed them, the full autopsy isn’t performed. You take pictures, recover a bullet if you can, but you don’t always have to open up the chest and belly if someone shot him/herself in the head (this is true of hangings as well).

I’ll try to write about homicides and suicides in a future post as this one is pretty long already. I’ll also hopefully find time to write about some of the amusing things that happened, and some of the absolutely heartbreaking things I saw.

As for our big fella, the doc didn't determine his cause of death during the autopsy. This is not uncommon. In cases like that, the death is signed out as 'pending' and the doc waits for all of the tests to come back (usually a couple of months). At that time, an official cause of death is named, which might be 'undetermined'. Incidentally, this fella's family put in his obituary that he had died of a heart problem. While it ultimately may prove to be the case, that certainly was not obvious on autopsy. One unexpected skill that I improved during this rotation was an ability to read between the lines of some obituaries.

This rotation was by far the most fascinating rotation I've done in all of medical school. It was the most thought-provoking, and the most disturbing. I'm personally not a drinker, but doing a month in the medical examiner's office could certainly make you consider it. Unforgettable.

Uplifting

2010-01-11T20:10:00.000-08:00

I was a bit nervous the first time I called out, “Mr. Finnigan?” into the packed VA waiting room. His appointment was supposed to start 50 minutes ago but we’d fallen behind and waiting isn’t one of those things people are usually happy to do more of, like sleeping or eating or taking a vacation.

No response. “Mr. Finnigan?” I try again, doing my best to sound confident, official. “Right here,” he says as his wife sets a magazine on the chair next to her and grabs her coat. Mr. Finnigan grabs the rims of his wheel chair and begins wheeling himself in my direction. A small patch on his black leather vest reads “ICEMAN” and I’m thinking about what Maverick jokes I could make when I notice that the patch is sewn on just above a weathered Purple Heart pinned to the vest and I decide to bag any jokes. He has a stern look about him and I can’t tell if this expression is his baseline or if he’s just pissed about the wait—I would be.

He backs himself into place in the exam room and I introduce myself. He shakes my hand with a firm grip and says good-naturedly, “Call me Levi, or Sergeant. None of this ‘mister’ shit.” His problem is a relatively straightforward one and there has been no change in his condition since his previous visit—as long as he takes his medication, this problem doesn’t bother him. He’s here basically to renew his prescriptions. During the course of our conversation, I discover that he was in an elite fighting unit during the Viet Nam war. He was shot three times and proudly tells me that “he’s living evidence that they couldn’t shoot worth shit.” He lost most of the function in his legs from a grenade blast that peppered him with shrapnel and has had him wheelchair bound for nearly 40 years. A little in-your-face and a lot coarse, this proud recipient of four Purple Hearts is irresistibly likeable and commands respect. Although he’s sitting in his wheelchair, it still sort of feels like he’s the tallest guy in room.

He’s here and he’s only in the Neurology clinic once a year, so I do a few basic neuro exams on him that don’t really have anything to do with why he’d made the appointment. One of those things is testing the strength in his legs. He is able to ride a recumbent exercise bike and says he does so for at least half an hour everyday because “Rangers always push shit beyond what you should.” He can ride that bike and wheel himself around without too much trouble, but because of the damage to his spinal cord, extending his legs at the knee is very difficult for him. Toward the end of my exam, I hold my hand out about 18 inches in the air and ask him to kick his leg up to my hand. He bites down and gives it everything he’s got. His initial kick gets his foot about 8 inches into the air, still about 10 inches short of my hand. He’s holding his breath and pushing with all his might. Sweat beads on his forehead and his face is bright red. After 30 seconds or so, his breath explodes out of his mouth and his foot drops about an inch. He takes a deep breath in, regroups, and keeps kicking his leg in the air. I’m coaxing, encouraging, trying to will his leg upward. He keeps pushing and slowly, very slowly his foot is moving upward about an inch every 10 seconds or so.

“Kick! Kick! Kick! You’ve got this. Keep going.”

His hands are white from the death grip he has on the arm rests of his chair. He absolutely will not give up, so I keep my hand where it is. Finally, his toe reaches it. He exhales and his leg drops to the ground.

I scoot my stool to the other side of his chair, hold my hand out at the same height and nod at his other leg and say, “Now this one.”

“Boy doc, you’re really going to work me, aren’t you?”

“Yep. We only see you once a year so we’ve got to work you.”

With no more than a five second rest, he starts the whole process over, kicking the other leg up. This leg is perhaps a touch weaker, or maybe he’s just tired. Regardless, it takes him a bit longer to kick this one up. He’s sweating, red in the face, and completely out of breath when the toe of his shoe hits my palm. I don’t see it clearly because of the tears brimming on my lower eyelids, but I feel the toe of his shoe hit my hand. These sudden and unexpected emotions really catch me off guard and, in the moment, I have a hard time processing what would, later, make a lot of sense to me.

Part of it, no doubt, is the deep respect I hold for those who serve in the military. But there was also something palpably and uniquely special about this guy. I think it was his simple no-quit attitude that was so moving. This is a guy who’s not afraid to get back into the fray. A guy who simply plays the hand he gets dealt without a lot of fuss. You can shoot him up over and over or nearly blow him apart with grenades, and he’ll keep fighting till he’s dead or the mission is accomplished. I’m certain that it will be the most inspiring leg-lift I’ll ever see, simply because for him, and for me, it was about much more than just lifting a leg.

I love taking care of Vets.

She Said Yes

2009-12-19T16:28:00.000-08:00

To anyone who may have missed it on Facebook (still struck by the similarities between Facebook and viruses, but that’s another post), Ash and I are officially engaged. Not much of a shocker to those who know us. I’ve gotten a few “FINALLY’s!” to which I have responded by biting my lip and resisting the urge to launch into lectures about presuming to know about others’ important life decisions better than the people actually making those decisions. Fortunately, Ash and I have been on roughly the same page about the evolution of our relationship and the timing of the proverbial next step, whatever that might be at the time. Things have happened at a pace that, to me, has felt completely natural and comfortable. As for Ash, I wouldn’t presume to speak on her behalf about how she’s felt about things along the way, but I think I can safely say that we’re both very happy about where we’re at.

Thanks to her intelligence and intuition—and a few not-so-bright comments by undoubtedly well-intentioned people with insider info, me being one of them—Ash wasn’t very surprised by it. Fine with me. I don’t particularly care for most surprises. But she likes them sometimes so my only regret is that I wasn’t more clever and more careful about who knew what in the months and weeks leading up to it.

But that’s neither here nor there. The details. I’ve been on the interview trail checking out potential residency positions for the past couple of months. As Ash and I will be hitched before I start residency, she has come on some of the trips with me to check out different programs/cities.

Most recently we were in Seattle at the University of Washington. Neither of us had ever been before, and we loved it there. Seattle happened to be going through a record cold spell so that was sucky, but the nice side effect of the cold air squatting on the city was that the sky was clear the whole time we were there and we could actually see the city.

We did many of the typical touristy things—Space Needle, Pike’s market, the Seattle Aquarium, the Michelangelo exhibit at the art museum, a very nice restaurant with locally grown food called Tilth, some novelty shops, and generally had an awesome time.

From Seattle, we flew to Chicago and after a couple of hiccups getting from O’Hare to our hotel using public transit, we settled in to our temporary digs in downtown Chicago. I had an interview at Northwestern the next morning so we didn’t do much that night. The interview went fine and isn’t terribly interesting to hear about. Probably the only thing of note here was that it was on my birthday. The next couple of days we spent some time with Ash’s sister who lives there, did many of the touristy things like the river boat architecture tour, shopping on Michigan Ave, etc.

Saturday evening we walked to Millenium Park on the shore of Lake Michigan which is were I actually proposed. I’d had the ring in my pocket all day. It was just after sunset and it was getting dark fast (as it tends to do in Chicago around 4 pm this time of year) and it was freezing cold. There were big ice chunks in the little marina we walked by that made me think of one of my favorite shows, Deadliest Catch. Other than the Canadian Geese, and an occasional jogger, we were pretty much alone. That’s when I kicked into darling mode. We were sitting on a little bench looking out at the water which, except for the absence of the strong salt smell, looks pretty much like the ocean. I pulled out the ring, knelt down, said some things that really aren’t anyone’s business but included “I love you” and “Will you marry me?”

Fortunately, she said yes. I was significantly less nervous than I thought I would be. I was definitely less nervous than I was when I asked for her Dad’s blessing before going on the trip (probably because I was significantly more confident in getting a ‘yes’ from Ashley than I was in getting one from her dad).

I had some dinner reservations at a swanky joint in north Chicago, but after looking at the menu online, Ash decided that she’d rather go somewhere with food she’s heard of that was more reasonably priced. We ended up at pretty casual deep dish pizza joint that was recommended by my brother, Chad. My kind of girl. Other than the ridiculously long wait, it was awesome. Some of the time we spent waiting outside, we watched an older gentlemen who was clearly mentally ill—probably schizophrenic if I had to guess. He was definitely behaving oddly, but wasn't hurting anyone in any way. Ash and I were little sad by how poorly he was treated by some of the folks around us that night.

The next day, we went to the Bears Packers game that Ash had gotten tickets to for my birthday. I’ve been a long-time Bears fan and neither Ash nor I had been to an NFL game before. It was awesome, despite the Bears’ loss. We had good seats and it wasn’t as cold as we were expecting.

To say that it was a memorable trip would be a gross understatement. Ash was an unbelievably good sport about some of the negatives on the trip—the cold, my interview, etc. She’s been saintly patient with me and my many quirks over the course of our relationship. That’s one of the things I dig most about her, she’s pretty content to let people be who they are. She has so many strengths that happen to be weaknesses of mine. I admire her for her kindness and friendliness (among many other things) and I’m grateful to have her in my life. I love her deeply and I’m excited about the life we’re building together.

We don’t have a date yet, but we will soon. We'll be sure to keep everyone posted.

Thanks to everyone who has been/continues to be a support to Ash and I, we’re pretty damn lucky.

Surprise Attack at Mile High

2009-12-04T09:35:00.000-08:00

One of my favorite writers, Anne Lamott, said that to write well, you have to “write as if your parents are dead.” Fortunately, mine are still alive. But, in order to write things like what I’ve posted below, I have to pretend that they’re not. I wrote this for another purpose, and hesitated to post it here for reasons that will become obvious. But since it was already complete and since some of the people who have read it seemed to enjoy it, and because I feel that posting it will be oddly cathartic, even liberating, I post it here. Although I, like Anne Lamott, worry that “Jesus drinks himself to sleep when He hears me talk this way.” If you’re offended by potty talk and the word shit or you’re one of those people who constantly says things like overshare or TMI (too much information) you should stop reading now.

Unfortunately, all that follows is true. It happened about a month ago.

“Arriving at Invesco Field on right,” drones the monotone female voice from my Garmin. Scottie maneuvers our black Kia Optima that we rented around the periphery of the parking lot to the stadium and we talk about his love of the Broncos when he was younger and the lameness of the name Invesco Field at Mile High. We’re in Denver to interview for residency positions in the Psychiatry program at the University of Colorado, Denver. But the interviews were yesterday, so we’re hitting a few tourist sites just enjoying our last day in the city. We pull into the lot south of the stadium. I’m looking up at the enormous white bronco rearing on its hind legs above the south end zone. As we drive closer, I lean to my left to execute a classic leg-lift. This is a move I’ve done thousands of times. I can do it in my sleep. In fact, sometimes I do. You lean a little to one side, lift the opposite side hip/upper thigh to release a fart. It’s a move with a dual purpose. One is to partially spare your car’s interior from the furious blast of methane from your butt. The other is to allow more of the stench to reach whoever is in the vicinity so they can partake of your offering as well. It’s a rental car so I’m not too concerned about searing the seat with rank farts. I am, however, pretty interested in fogging up the car and forcing Scottie to roll down his window—a submission that is satisfying and funny.

Leaning left, release…oh noooooo…was that…wet? I freeze. Maybe it’s one of those farts that just feels wet initially. Sometimes if you move a little you realize that your nervous system is merely playing a cruel joke on you, like the amputee who continues to sense pain in a limb that’s no longer there. I wiggle. Pleeeeease be phantom moisture. This. Is. Not. Happening. Lord, you’ve got to be kidding me.

I’ve just shit my pants.

We pass a Port-A-Potty. “Scottie, stop. I think I need to poo.” I get out of the car and do that wide-leg waddle—the one that you do when you’re nursing a bad case of swish-ass—over to the john. Pad-locked. Shit. “Dude, I think I just shit my pants.” Scottie says nothing but erupts into uncontrollable laughter. He looks like he’s been poisoned and is in the throes death—violently rocking back and forth, slapping the steering wheel. Laugh. Gasp for air. Laugh so more. “Glad you’re enjoying this. Ass!” He doesn’t hear me. He’s whooping, wailing, and at this point, crying tears of joy. For the two of us, this is simultaneously the highlight and low-light of the trip, depending on the status of the underwear you happen to be wearing.

This is exactly the fourth time that I’ve pooed my pants as an adult. The first, and probably most alarming, was when I was 18. I pooed the bed. Yes, pooed the bed. Asleep. I’m a Freshman in college. My friends and I have had our own place for a few months and I’m really settling in to my own. I’ve got my own comfortable room. I’ve recently purchased a new pack of boxers—all white, and I’m wearing a pair. This makes the poop really pop, but I’m getting ahead of myself.

I finish up some homework. Watch a little TV while I polish off a box of Honeycomb before calling it a night. A pretty standard night. I feel fine and I go to sleep easily. Around 2 AM, I awake. I’m groggy, so it takes a few seconds for me to realize that I’m wet…and warm. What the hell? My first thought is of my roommates. I assume they’ve played a prank. Maybe they had my hand in a bowl of warm water trying to get me to pee the bed, and the water has spilled. But my hand is dry. I lean up and flip on the light and look down at my boxers—code brown. WTF? How does that happen? Pee the bed? Maybe. But poo? That’s the stuff of case reports. Stuff you hear about serial killers that are profiled on A&E. He frequently killed animals, set fire to churches, and unknowingly defecated in his sleep. Fortunately, it proved to be an isolated incident, though still an engima. I wouldn’t shit my pants again for another 18 months, and next time, I’d be awake.

This time, I’m a missionary high in the Andes mountains. Working in a city called Juliaca. Because it’s a pretty miserable place to live, I’ve dubbed it Juli-caca—foreshadowing if I’ve ever heard it. It’s late morning and my companion and I have just wrapped up a discussion with someone and we’re heading back to our apartment on foot. We’ve got about two miles to walk. We’re cutting through a field that we often use as a shortcut when I feel the uneasy gurgling in my belly that is an all-too-familiar harbinger of trouble. I almost take my companion up on a standing offer to poo in that field for the tidy sum of 10 Soles—about $3.50 USD. I need to go. I always carry TP in my backpack for occasions such as this. And, I’m going to get paid for it. But after a short deliberation, I opt for decency and privacy and convince myself that I can make it back to our apartment in time. I almost do.

I’ve been saddling my sphincter with an impossible task for the past 20 minutes. 50 yards from our apartment, that little ring of muscle succumbs to fatigue and will contract no more. And I’ve pooped my pants for the 2nd time as an adult.

One of the nicest things about Juliaca is that running water is only available from about 6 AM to 11 AM. It’s about quarter to noon. No shower for me today. Just cleaning up with some one-ply TP and a bucket of ice cold water that we fill each morning so we can flush the toilet after 11 AM. Awesome experience. One that I naively assume will go down as the worst pants-pooping experience of my life.

Shat pants #3 is on Christmas Day 2001. I’m still a missionary and I’m in my apartment on the phone with my family. This one is pretty standard. I think it’s a fart. It’s not. I cut the phone call a little short, go take off the soiled underpants, shower, put on some clean ones, move on, no biggie.

Back to Denver and shit-pants #4. Fortunately, it’s the last day of our trip. We’ve already checked out of our hotel so we have our luggage with us. “Pop the trunk!” I dig through my bag, find some underwear, a pair of shorts, and my shaving kit. I also grab an old folder to put on my seat. I’ve definitely touched cotton at this point. But will the cotton hold? Is the osmotic gradient of my drawers such that the mess will still be contained? Questions I can’t answer at this point. I throw the folder on the seat and climb back into the car. Scottie is still struggling to breathe. I’m unwilling to sit down completely so I assume that position you do when you’re riding shotgun in someone’s car while you’ve got on a wet swimming suit. You lock your knees and push your feet against the sloped part of the car’s floor with your butt a few inches off the seat and your back tight against the back rest, wedged. I’m tall enough that this requires me to also crane my neck with my ear pushing against the roof. Comfy.

The parking lot has several other outhouses for the Bronco faithful that come early to tailgate before games. “Let’s try those ones.” Scottie, still unable to speak, puts the car in drive and we troll around the parking lot looking for an unlocked can. No luck. They’re all locked. Dammit. We park for a second. Assess our options. The team store at the stadium is open. There are dozens of kids running from the ticket office—presumably a field trip. “You could try the team store. It says it’s open.” “Yeah, but what if I have a visible poop stain? And what am I going to do, walk in there with shorts and underwear, then walk back out with my pants?” Nope. Not doing it here. “We gotta go somewhere else.”

We spot a Denny’s nearby and start towards it. En route, we pass another parking lot that has two Port-A-Potties and we happen to see a guy go into one. Yes! They’re open. “Drive up there. Those ones are open.” We pull up right next to the two shitters. I get out. Scottie confirms that I do, indeed, have a visible shit stain on my pants and as soon as he sees it I’m not sure if he’s laughing, or having a seizure. Frankly, I don’t care at this point. Humiliated, I waddle into the Port-A-Potty and get down to business. This is no small accident, it’s a GD mudslide. It’s immediately apparent that the underwear can not be salvaged. I make an executive decision and throw them in with the pee and poo and TP, expecting them to sink. They don’t. As I’m using Purel and one-ply TP (which guarantees an abundance of chode snow) to clean my taint, I hear a diesel engine pull up right beside the door. There is no lock on the damn thing, so I’m standing there naked from the waist down, one foot on the floor, the other on the seat of the toilet holding the door shut with both hands, certain this guy is going to try to open the door. I hear Scottie. “My friend is in there. He’s not feeling well.” I relax a little and go back to the unsavory job at hand. A few moments later I hear some laughing—Scottie and the voice that clearly belongs to whoever is in the truck.

I finally finish up. I’m feeling much better. I’m down a pair of underwear, a bottle of Purel, and my dignity, but otherwise feeling fine. I open the door and confirm my fear that this is the guy that pumps the shitters when they’re full. I see the tank in the bed of his truck and the hose he’s planning to use to pump the toilet. My eyes get big, my lips purse, nostrils flare a bit. No way is that hose big enough to handle my underwear. Shit! We gotta get out of here.

The guy’s tiny, maybe 5’2” 130 lbs. If I had to guess, he’s originally from Southeast Asia. His English sucks. When he sees my shaving kit and my pants rolled up in my hand, he too, loses it. Up until then, he thought I was just sick. When he sees my pants and supplies, he realizes I’ve shit my pants and he loves it. That sets off Scottie again and the two of them are laughing it up. It’s a real low point when one of your best friends and a tiny stranger who speaks no English and pumps the shitter for a living are having a good laugh at your expense.

I hop in the car as Scottie is snapping photos with his cell phone and fanning the flames of laughter with the shitter-pumper. “Dude, we gotta go.” Uproarious laughter. Just as one of them gets it under control, the other loses it and sets off another round of guffaws. F-you both. “Scottie, we gotta go!” It’s only a matter of minutes before that little hose gets clogged with my undies and as much fun as it would be to laugh at this little guy trying to get my shitty underwear out of his clogged hose, I don’t want to be around when it happens. Scottie finally shuts his door. I tell him that I tossed my underwear in there, he gets it, and we speed away.

Fortunately, I managed to make it back to SLC without pooping my pants again, although not without another solid 15 minutes of hard time in the restroom at the Denver Museum of Contemporary Art. Certainly an experience I won’t soon forget. Scottie can still hardly speak about it without having a complete come-apart. Would that I can remember the surprise attack at Mile High as the final time I shit my pants.

Parkour!

2009-10-16T13:20:00.001-07:00

Those of you of who've seen that particular episode of The Office will appreciate this guy's unbelievable athletecism. I can't stop watching this video. I think he may be Jason Bourne.

Wren

2009-09-17T19:32:00.000-07:00

Ironically, Wren, actually does look like a bird. Her hair is cut so haphazardly, the shocks that shoot wildly from her scalp in all directions look like rustled feathers. Her face and neck bear the scars of a bad burn. The punctate tracheostomy scar on her throat suggests that Wren’s burns landed her in the ICU for some time, but they're healed now, physically anyway. The wounds on her arms and legs look suspiciously self-inflicted. Flesh picked at, partially healed, then picked at again. My guess is meth bugs—the most noxious of imagined insects. Wren says they’re from the “runoff”.

The men who live in the apartment above her have a meth lab. The toxic sludge leftover after each batch of meth cooked is drained down a tube into Wren’s apartment. It’s runoff. The runoff causes the wounds on her arms and legs. She can’t call the police because the men will kill her if she does. Plus, they’ve got surveillance on her apartment. Every couple of days, the same trucks show up in a parking lot across the street in the middle of the night. During the course of a week, several of the same cars come to the same parking lot during the day. People get out and pretend not to see Wren looking out her window, but she knows they see her, and she’s afraid.

A friend finally convinces Wren to go to the emergency room to get help with her wounds and the crippling fear she feels. She brings several jars of the runoff with her to the emergency room—evidence.

After listening to Wren’s story, the doctor turns to Wren’s friend and asks her what she found when she went to Wren’s apartment. Light switch and outlet wallplates had been unscrewed and the wires pulled out. The place was filthy and so was Wren. What little food remained in the fridge was rotten. The bottles and bottles of runoff were all over the apartment.

The runoff, as it turned out, was urine. The meth lab upstairs did not exist. The outlets and switches did not contain tiny microphones. There were pipes coming from the apartment above into Wren’s kitchen, much like there are visible pipes that course from floor to floor in any old building. The parking lot across the street belongs to a 7-11. The trucks in the middle of the night, deliver frozen burritos, Mambas, beer, and Slurpee syrup. Regular customers drive there a couple of times a week to get coffee, a doughnut, some gas--in the same cars, with the same plate numbers. The only drug in her system was Adderall.

Confront her with the improbability of her story, and Wren simply does not have the capacity to process it. Punch holes in her story and it does not matter. For Wren, it’s absolutely real. She has a delusional disorder, and they are called “fixed” delusions for a reason.

It’s an interesting disorder, not just because you hear wild stories. Patients with this are often highly functional (not so much in Wren’s case), highly educated, and by all accounts, otherwise normal people. University professors, engineers, teachers, business people, the whole spectrum. It tends to show up later in life than most other mental disorders. It’s also common to have olfactory hallucinations. That is, they smell things that aren’t there. One patient I’ve heard about was convinced that she had rank B.O. (she did not). Anytime someone scratched themselves or coughed around her, it was a reaction to her stench. This is another common feature of the disorder. Patients will find common benign occurrences that reconfirm the correctness of their theory. See, did you see that guy scratch himself, I told you I smell. See, that car with the same license plate number is back again.

It’s also a sad disorder because it’s tough to treat and people who are highly functional and, with the exception of their delusion, quite normal folks, can go into a tailspin. Wren’s probably got one more shot on the outside. If she comes back in contact with the mental health system in the next few months (and she probably will), she will very likely end up in the State mental hospital long-term.

Minding your own business is exceedingly dangerous...

2009-08-21T18:51:00.000-07:00

That's the only thing I can conclude as I spend more time in the emergency department. Anyone who's ever worked in the ED knows exactly the kind of patient I'm talking about. They're usually male. When you first meet him, he usually reeks of alcohol. He's managed to get blood, dirt, or both all over himself, is still actively bleeding from at least one or two places, and always has to pee. He often requires at least stitches and x-rays, often more than that. His story inevitably begins with "I was just minding my own business, when all of a sudden..." Also, as a rule, they only had "a couple of beers". Never mind the blood alcohol level sufficient to give an elephant a decent buzz, it was two beers. Honest.

I saw this guy last night, but not in the ER. It was an interesting experience. It starts with the Iron & Wine show at the Gallivan Center. Ash likes em a lot so we went to the show. Afterward, she had to run to work and I'm waiting by the Carl's Jr. downtown to meet up with my friends who are my ride home. As I'm waiting I see a fight break out on the street corner. The details of how it happens are similar to most other fights I've seen. One guy calls another guy's girl a blankety blankin' blanker. That guy's having none of it, some gesturing, a slew of F-bombs and other choice words, some posturing and chest-puffing as the two meat heads inch closer and closer neither really wanting to fight, both unwilling to back down. Eventually there is no space between them and they're so close that you wonder if they're going to fight or kiss each other. Inevitably, one bumps the other. The other guy pushes back, some jostling, some punches, girls screaming, dumbasses hooting and egging it on. You get the idea. The interesting thing to me about this fight was that the little guy was clearly the victor. He was probably the instigator initially--he said something to insult the other guy's girl--but the big guy threw the first punch. The little guy happened to land one just right and dropped the bigger guy like a rock, and as they say, big tree fall hard.

I saw the big guy fall, but due to the surrounding crowd, I couldn't see how he landed. Naturally, I continue to move closer to the action and when I get close enough, I see the big guy face down on the sidewalk with a fairly impressive pool of blood accumulating on the pavement. Perfect. In situations like this, I know that odds are I've got more medical training than anyone in the immediate vicinity and I feel obligated to take a look at the guy though I'm pretty sure there's little I can do for him outside of the hospital. Fortunately there are a couple of EMTs nearby that are johnny-on-the-spot and end up doing most of the work. One of the EMTs and I help this kid sit up so we can take a look at him and survey the damage. He's got a pretty good gash on his forehead that he likely got when he hit the pavement, but other than that he's okay. Fortunately, a cop happened to be driving by just as the fight broke out and the whole thing doesn't last more than a minute.

I gladly let the EMT take the lead on wrapping a shirt around this guy's head--I'm not anxious to touch the guy without gloves because in situations like this I can't help but wonder what incurable viruses might be living in this guy's blood. The cops get things under control and this guy's bleeding is reasonably controlled and he has plenty of booze on board to keep the pain to a minimum so I don't stick around long. I'm anxious to get home cause it's getting late and I had to work this morning.

I rolled in to my shift at 7 am. I was chatting with the docs who were on last night and just finishing up their shifts.

Me: Did you guys happen to see a drunk guy in his 20s with a big gash on his forehead last night?
Doc: Yep, how'd you know?
Me: I saw him get the crap kicked out of him last night.

I tell the story

Doc: That's funny. He told us he wrecked his bike and someone landed on him.

That's another classic from patients like this. No one comes in and says, "I got my ass beat by a guy half my size." They either got attacked by 3 guys who were huge or they had some sort of accident that would have happened even if they hadn't had those two beers. Way too unmanly to admit that you lost a one-on-one fight. I can't say I blame them for lying. I'd probably do it too.

Anywho, if you decide to mind your own business after you've had a couple of beers know that you're taking your life in your hands. Drink and mind wisely.

Spoke too soon

2009-08-17T20:48:00.000-07:00

Ask and ye shall receive. I was sort of whining about the relative lack of interesting ER stories thus far, then a few came in the span of a couple of recent shifts.

Saw a gentlemen with a rash that looked like someone had taken a belt sander to his arms and belly, then drizzled honey all over him--pretty nasty. I didn't have a damn clue what it was. Rashes are a personal weak point for me. I usually can't tell what the hell it is, nor can I describe it using the million words dermatologists use to describe the same 5 things. Talking on the phone with a dermatologist is always a treat. Honestly, I don't know if they're vesicles or pustules, macules, or plaques. Yes, it's weeping some nasty yellow fluid. Just come take a look at the damn thing, will ya?

Then a gal came in complaining of vaginal itching/burning--awesome. Fortunately for me, these cases are frequently assigned to med students. I realize that a pelvic will always be much worse for the woman than it is for me, but it ain't no party on my end either. After my OB rotation, I had set a personal goal of never performing another pelvic exam for the rest of my career--foiled. I almost made it a year. I'll spare you the details, but let me tell you that doing a pelvic exam on a lady that's just over 5 feet and just shy of 300 pounds is probably something best left to people more experienced than I am. The instruments I had were woefully inadequate for the task at hand--couple of gardening spades would have come in handy. Anyway, I'll save you further details, but lordy there's some bad stuff that can go on down there. Pretty glad that my genitalia isn't the perfect breeding ground for microorganisms.

I got to sew up a little laceration on a lady's thumb. I really enjoying sewing and I'm actually getting a little faster, which is pretty satisfying. I don't feel like I'm good at it yet, just less sucky than I used to be.

Just as I was finishing up with that, we had a patient come in bad shape. He was a young guy that had drowned. I think he'd been under for 10 minutes or so before he was pulled from the water. I never heard the details of what had happened because I walked into the trauma bay after the team had been working on him for several minutes. If you walk in and see someone doing chest compressions, things are not going well. I've discovered that if you're a young, tall, male and you happen to be around when someone is getting CPR, you better grab some gloves quick cause you're going to be wailing on someone's chest in short order. Sure enough, I was immediately worked into the chest compression rotation. I'd been in the room all of 90 seconds before I was doing compressions on the guy and singing the Bee Gees in my head--never a fun job (if you do compressions to the beat of the Bee Gees' song Stayin Alive, you'll be going at about the right pace--not making it up, there've been studies published about it). I try not to look at someone's face as I do compressions on them, but it's hard not to. This guy was blue, eyes open, cold, lifeless, younger than me--in a word, shitty.

I'd been in there for about 15 minutes when his pulse returned. There's no good outcome in situations like this. Do you keep trying knowing that if he lives he's unlikely to have much brain function left, or do you let a guy in his 20s die? Trying to decide which is the lesser of two evils is a tough call for any doc. I was secretly glad that I didn't have to make the call. There's a lot of gawking that goes on in the trauma bay--lots of people there that probably don't need to be. I try to go to as many as I can, learn as much as I can, stay out of the way, and leave if things are too chaotic or if there isn't anything left to learn by being there. I left before I knew what happened with this guy. Not sure if he lived or not, but I know that whatever happened was bad.

ER

2009-08-15T17:04:00.000-07:00

Well into my ER rotation now. I'm surprised at how few great stories I have to tell. I've been seeing a lot of bread and butter ER things, but nothing unbelievable. Seems like 1/3 of the people we see have abdominal pain that we often don't find a good reason for. I've seen a few cool fractures, a handful of burns, some people with weird neurologic symptoms, a few gnarly traumas, and I've sewn up some pretty good lacerations, which is pretty fun.

We had a huge guy in the other night (he was about 6'5", 250 lbs) who had the most violent seizure I've ever seen. He damn near flopped out of the bed. He's had a seizure disorder for many years so it's not unusual for him to seize, but it was pretty unsettling to watch/wrestle. It took several of us to keep him from thrashing out of the bed.

I've discovered that I love seeing Psych patients (no shortage of them in the ER). They're usually pretty sad situations. Had a guy in his late 50s come in after his family discovered that he'd fired up a couple of diesels in the garage at work with the garage door shut. He was a pretty normal guy--married, kids, job. Until the last year or so, he'd been very successful in his business. He recently upgraded a whole bunch of his equipment by taking out massive loans and then the economic downturn hammered his business and he's in the financial hurt locker. Very sad that it got to the point it did. He's wife had a hunch that something was wrong and called him at work, otherwise he likely would have been heading to a mortuary instead of the ER.

There was a gal that came in not too long ago (I didn't personally take care of her, but one of the residents I'm working with did) who "lost" a sex toy in her lady orifice. Apparently it had more than one working part and somehow a piece of this toy decided not to come out. She figured she'd better come to the ER to get it out cause she wasn't able to retrieve it herself. She didn't have a good explanation as to why she decided to wait for a month before coming in. No, not a typo, she waited for one month. FYI, as a general rule, if something has not come out on its own in 24-36 hours, odds are it's not going to. Go to the hospital. Better yet, don't put stuff in there that may not come out.

The ER is definitely an interesting place to work. Time goes by quickly, and you can see some cool stuff. You also can't beat the job security because, as they say, there is no cure for stupid. But it's not for me.

A Happier Post

2009-07-16T16:24:00.000-07:00

'Bout two weeks into my ICU rotation and it has been a wild ride for me so far. I thought I'd post a little about something positive, since the tone of the last post was overwhelmingly gloomy.

I mentioned the young guy who rolled his car and ended up as an organ donor in the last post. One of the surreal things about a surgical ICU is that the patients that got that kid's organs are also now patients of ours in the ICU. I'm personally assigned to the guy who got his heart. This guy was born with a heart defect that often prevents people from getting very old or very big. He's an unusual case for this particular type of heart problem because he's in his 40s and he's a large man. That's made it tough for him to get a heart because he needs a heart from a big donor--like the kid I mentioned in the last post.

He has been on the transplant list for about 3 years. Because a heart transplant is such a big surgery, it's not uncommon for patients to be sedated for a few days after the surgery, and this guy has been. He's also intubated, so even if he was awake, he wouldn't be able to talk to me. So until yesterday when I got the chance to talk to his sisters for a few minutes, I really didn't know much about him except what I was able to read in his chart, which is mostly dry medical jargon. You don't get a lot of the social history that puts all of the medical information into a human context, unless you're able to talk with your patients or their families. His sisters told me that he'd been going down hill physically for the several years, but only within the last few months had he become discouraged and psychologically defeated. For most of his life, and particularly in the last 3 years when it became apparent that he would need a transplant, he had had an overwhelmingly positive attitude about his condition. They told me how worried they've been for him lately because he was getting so discouraged and was losing his will to keep fighting.

It was quite a contrast to talk to this man's family about the excitement and relief that they felt when they finally--after 3 years of hoping and waiting--got word that he was going to get a new heart. It's a surreal experience to see one family wracked with grief over the tragic loss of their son, brother, husband and then two days later see the beneficiaries of this tragic accident and the joy those families experience (we've also been taking care of the two patients who got this kid's kidneys; they are both younger than 20 and doing very well with their new kidneys).

This guy is certainly not out of the woods yet, but he's got a great shot of making a good recovery and having a pretty good quality of life once he recovers.

I think of the face of the donor every morning when I go in to see this man. It's weird to feel so happy for the guy who got a new heart, and simultaneously feel sad for the kid who died and his devastated family. ICU's are a strange melting pot of emotion.

I would hope that anyone who isn't a donor, will consider becoming one. Sometimes it's the only silver lining to horrible accidents that claim lives. I doubt that it's much comfort to the family of this kid that was killed so soon after his death, but hopefully someday it will be--his death has dramatically improved the lives of at least 3 families (probably more, I'm not sure what happened with his other organs).

Also, very much worth the time it takes to create a living will. You can download forms on the Internet and fill in the blanks. Makes it a lot easier on you and your family if it's clear what your wishes are should you get in an accident or get really sick and end up on a ventilator in an ICU.

Some Perspective

2009-07-07T17:57:00.000-07:00

New stories from another rotation—the surgical intensive care unit (SICU pronounced sick-you for short). It is a daunting and often depressing place. I’ve never been around this many sick patients. This time of year, the SICU is full of patients that have been in really bad traumas, some due to back luck, some due to carelessness.

A few quick examples of the heart-wrenching stories of some of our patients. We’ve got a teenager who was riding in the car with one of his buddies. He happened to be hanging his arm out the window as many of us probably do on hot summer days. They were T-boned by another car that ran a light and this kid lost his arm from the elbow down. Some of the best surgeons in the western US tried for 10+ hours to save his arm—no dice. Unbelievably sucky. I suppose you can always be a glass-half-full kind of guy and think that he’s lucky to be alive, but I would not recommend saying that to a teenager who’s just lost his dominant hand. Life-changing is a gross understatement.

We had another man who rolled a tractor. His injuries were pretty devastating. He was in a coma on a ventilator while the family gathered. His injuries were inoperable and, ultimately fatal. The docs and nurses I work with were able to keep him alive long enough for his children to fly in from various parts of the country. When they arrived, he was taken off the ventilator and died within the hour. It was a rather unsavory experience for the first day of a rotation.

We’ve got another lady who’s in her 30s. She rolled her car recently and was not wearing a seat belt. She and her young daughter were ejected from the car. She fractured a vertebra and is now paralyzed from about the belly button down. I was in the room when she asked my attending when she would be able to feel her feet again. He did his best to gently but directly inform her that she wouldn’t. I’ve rarely heard cries like the ones that ensued. She was, understandably, inconsolable.

Fortunately, her daughter had surprisingly few injuries. She did have some, but she should recover completely. This woman is now tasked with taking care of 3 kids under the age of 10 without the use of her legs. For the love of God, buckle your damn seatbelt folks—EVERY TIME you ride in a car. I don’t care if you’re driving 200 feet to the neighbor’s house. It is simply not worth it. I always forget or It’s uncomfortable are phrases that must seem pretty ridiculous to the paralyzed.

I got a little teary-eyed as we stood there and watched this woman wail as she tried to wrap her head around the fact that she will not be able to use her legs again. And she’s a complete stranger. I don’t think I could handle it if someone I know shows up in the ICU, so please buckle up and stay off of motorcycles and ATVs. I can’t even put into words how dangerous those things can be. ICUs all over the US will fill up this month and next with patients whose lives will never be the same because of motorcycles and ATVs. So dangerous. No one thinks it will happen to them. It happens, and it's devastating to the whole family. You can do everything right and still get killed or permanently maimed. Not worth it if you ask me.

A Good Turn

2009-06-11T10:03:00.000-07:00

Nice experience at Home Depot recently. I was there picking up a few things to build my square foot garden. For those unfamiliar with the concept, a square foot garden is basically a wooden box with a special mixture of soil that you can put anywhere (patio, back deck) instead of in the furthest corner of your yard like most gardens. I made one last year but I’m not completely happy with the design/function so I built my 2nd generation square foot garden this year.

The most cumbersome item I picked up at the Depot was a 2x12 plank of Douglas Fir that is 16 feet long—that’s a pretty long board to haul around. I was putting it on top of my Mom’s Durango that I had borrowed, when a nice guy named Cliff, walked by and offered to help me with it. I actually already had it on the roof of the car when he offered to help. My plan was to lash that sucker to the luggage rack and drive it home which is only about a mile from the Home Depot off of 33rd and Highland. But Cliff was having none of it.

He insisted that I was going to “scratch the hell out of the roof” on the ole Durango and he was adamant that we take the board in his truck as he had lots of “experience hauling 16 footers”.

He was on his way in to Home Depot, but he assured me that he only had to grab a couple of parts and he’d be right out. I hung out for a few minutes unitl he came back outside. We loaded up the board in his truck and he followed me to my house and helped me unload it. We chatted for a bit about square foot gardening and then he was on his way. Very nice guy.

Inexplicably, I failed to ask him for a business card. A guy like this is the guy I want to hire for my next building project, which for me won’t be for some time since I’m completely broke and don’t own a home or land and therefore have very little need for a builder of any kind. Nevertheless, I was bummed out that I didn’t get his card, so I tried googling him to find a phone number—no luck.

Fortunately, I saw him on the road the other day and he has his name and phone number in lettering on his truck window. I was trying to drive along side him and enter in his name and number into my phone and it got a little dicey. It involved a lot of speeding up, and slowing down, and a few close calls, but I got his info. I figure since he drives around with it on his truck I’m okay to post that info here. Anyway, his name is Cliff Guenther and his number is 801.493.5085. That’s a cell number. He also had his home phone on the window, but I figured I’d pushed my luck enough so I didn’t enter that one in to my phone.

Just thought I’d pass along his info in case anyone is looking for a good guy to do some building. I honestly don’t know what kind of building he does, but I got the sense that he did things like decks and sheds, and he mentioned that he’d helped his son put in a pool. Anyway, a guy who insists on helping a total stranger and has his home and cell phone number on the window of his truck is the kind of guy I want building stuff for me. Give him a call if you need some stuff built.

Illegitimis non est carborundum

2009-04-26T11:29:00.000-07:00

I first heard this phrase from a doctor who is also my dad’s cousin. He’s a very energetic guy and he enthusiastically taught me this phrase at a family function shortly after I was accepted to medical school.

In dog Latin, it means “Never let the bastards grind you down”. (No idea what the difference is between dog or pig Latin, nor do I know why corrupted forms of Latin are always named after animals). At the time, it didn’t make a lot of sense to me, but it was one of those exchanges that ended with a wry smile, from a man that has the wisdom to match his gray hair, that knowing smile which seemed to say “give it a few years and you’ll know exactly what I’m talking about.”

Some background. 3rd year is the first year you get turned loose to try to take care of actual patients (at least at my school). I say ‘try’ because we don’t know enough to do it without help. It’s a year of tremendous learning and growth. I liken it to going to a job interview or a tryout everyday. You’re constantly being pushed by your superiors to see what you know. Not usually in a malicious way. They need to know what you know before they can really teach you anything. But it’s tough to be face-to-face with your inadequacies everyday, and it gets really old being the dumbest, least experienced person on the team.

It’s a year of intense physical and mental punishment, and relentless stress—there is always something looming, ominously in your future. An assignment you have to finish, a test you have to study for, a disease process to master, a differential diagnosis to develop, or plan to formulate. It’s not a ‘woe is me’ situation. I signed up for this. I’m glad I did. I know I’m fortunate to be here, but sometimes it’s sucky. It wears you down.

An example to illustrate. As I write this, it’s Friday night. My girlfriend is at a sports bar with several of her friends. They invited me to go out for a night of food, hanging out, watching playoff basketball, dancing, generally having a good time. I turned it down with almost no hesitation. I’m sitting at home, alone on my couch in a hoody and B-ball shorts with a Coke and my laptop. I’d rather not move tonight. That’s 3rd year. Don’t ask me to do anything. I want to turn off my brain, watch TV for a while, and then sleep. For a week, if possible.

On to the bastards.

Often the bastards that get you down are attending physicians. I nearly punched mine in the face the other day. It was while I was presenting a patient to him, and I’ll explain why in a bit. But first, “presenting” is a skill that you work hard on during 3rd year. Briefly, it is a verbal presentation of the salient points distilled from the mountain of information you glean from a patient after you’ve interviewed the patient, performed a physical exam, and reviewed any labs or imaging that you have on that patient. Once you’ve gathered all of this information, decided what is and is not important, and done your best to figure out what’s causing the patient’s problems and what you plan to do about it, you get five minutes to explain all of that to your attending physician. There is a very specific format that you’re supposed to follow that I won’t bore you with here. Basically, your presentation is what you think is going on with this patient. It’s your chance to make your case. This is what the patient told me, this is what I found on exam, these labs and images suggest this, this is what I think he/she has, and this is what I want to do about it.

By the end of your 3rd year, you’ve presented hundreds of patients to dozens of different attendings—all of whom think that their way of presenting is best. You get a ton of feedback on how to do it right—much of it contradictory. By the time you reach my stage of the game, you’re pretty much broken. You no longer care what the “right” way to do it is. The right way is how ever your current attending wants it. Idealism is locked in a war of attrition with pragmatism and each day is an exercise in survival.

So I’m presenting a patient to my attending. I start out like you usually do. This is a 45-year old female with a history of Crohn’s disease on immunosuppressive medication with a history recurrent abscesses, who presents today with what appears to be another abscess on her back. She was hospitalized—at this point my attending interrupts me. He's annoyed, and he wants to know why a hospitalization one month ago is relevant. He goes off on how I’m wandering around, jumping from one point to another, has a little temper tantrum about how I shouldn’t mention the hospitalization until later in my presentation. He actually asks me if I’ve ever presented before. That’s beyond condescending, and my fist actually clenched involuntarily. I thought the hospitalization was very relevant given that we worry about different bugs causing infections if someone has been in contact with the health care system recently. There are a lot of nasty bugs that grow in hospitals—the kind of bugs that aren’t killed easily by antibiotics. Anyway, we argued for a few minutes about what is and isn’t relevant to a presentation and about the best way to present.

Illegitimis non est carborundum. Keep your head down and just keep plowing through it—torpedoes be damned! There’s always another hoop just ahead and you don’t have much of a choice but jump through it. Illegitimis non est carborundum. I get it now, and I’ll keep jumping, but the bastards will not win.

Quirks

2009-04-17T16:01:00.000-07:00

People do weird things. I’ve been hyper-aware of some of those things lately. I offer them here 1) because I’m baffled by some of those things, 2) I’d like for these things to stop, and 3) I think it’s funny.

Recently, I’ve worked with two different doctors who are pathological winkers. Voluntary winking makes me very uncomfortable. I don’t know what the hell it means, but I know it’s weird. Winking can be an entirely uninterpretable expression, or it can be excusatory. I’ll elaborate.

Dr. #1 is a very friendly doc who really wants to be seen in the eyes of the residents and med students as an attending that is still young and still hip. She means well and, overall, I like her. But the damn winking has to stop. She’ll make a very straightforward, normal comment and then immediately wink at you with one eye. WTF? I wasn’t at all unsure about what you meant by what you just said, that is until you closed with a wink. Now, I have no idea what you meant. Did I miss something? Is there some secret that I’m privy to and I’ve forgotten? Is this a joke and the wink was your way of telling me that? Do you have a rogue eyelash scratching your cornea? Why the hell are you winking at me? Her wink is the uninterpretable wink. Just confuses things. If the uninterpretable wink is part of your repertoire, I urge you stop.

Dr. #2 is a dick. His job entails supervision of other docs and students. He’s extremely bright. The guy knows a ton about medicine, but he’s abrasive, and I don’t know if he realizes it. He’s almost universally disliked by the people he supervises, mainly because he’s so condescending. He makes no effort to hide the fact that he thinks you’re an idiot. One of those guys who puts out a strong if-you’re-not-me-then-you’re-an-idiot vibe. He also usually won’t pass on an opportunity to make you feel like a dumb ass in front of your peers—very endearing. His wink is an excusatory wink. He seems to think he can say whatever the hell he feels like, no matter how rude or condescending, as long as he follows it with a wink. It seems that in his mind, the wink softens the meanness and makes whatever he just said a joke between two buddies, and therefore okay. Not okay. We’re not buddies. Please don’t wink at me.

I once heard a comedian do a bit about the phrase “God bless him”. The joke was that you can say anything you want, no matter how mean, directly to, or about anyone as long as you followed your rude comment with “God bless him”. He’s the most unintelligent, unattractive, waste of space I’ve ever been around, God bless him. It’s a pretty funny bit. That line might actually work to excuse horrifyingly rude comments, but winking doesn’t. If you’re a dick, don’t fool yourself into thinking that winking makes you not a dick.

If you’re some smoking hot, scantily clad woman showing off what God gave you, I’d welcome a wink, but that’s about it. Most of the time, I’d prefer that people not wink at me.

Another weird quirk that I’ve noticed lately involves controlling the volume of your voice. Some people have really weird habits. A woman I know whispers for no apparent reason. In the course of totally normal, harmless conversation, she’ll just whisper. No secrets or sensitive information to impart, not saying anything that might hurt others’ feelings, we’re standing in the hallway of a very busy, very noisy hospital, no conceivable reason to bust out the six inch whisper, but she does it anyway. I’m frequently left so distracted by the fact that she’s whispering for no reason that I miss what she’s saying. Why the hell are you whispering? What did you just say? Makes no sense. Sometimes I feel like grabbing her shoulders, shaking her vigorously and screaming in her face.

At the other end of the spectrum, you’ve got people who seem completely incapable of whispering or even speaking quietly at times when it’s entirely appropriate to do so. Turns out the whole bus didn’t need to hear you squawking into the phone about how you can’t this weekend because you have to go visit Jason who’s in jail again for his most recent DUI.

Libraries are appropriate places for whispering, churches too. Any meeting where one person is clearly speaking to an audience (large or small), or when you’re around people who are asleep. These are times when you might want to tone it down a bit. Do these people not hear how loud they’re being? Are they so enamored with the sound of their own voice that they just don’t care how loud or rude they’re being? This is true, not just of speech, but of laughter as well. Nothing is that funny. Volume, folks. Mind the volume. I don’t get it.

I’m sure that I do things that bother people, but for God’s sake, don’t wink at me, and please speak at a level that’s appropriate for the situation. It seems like those things should be common sense. Apparently not.

With a rant like this about things this petty, perhaps I’m the dick. Maybe so. But this is me, not winking after being a dick;) See what I mean?

Sobering

2009-04-11T09:32:00.000-07:00

Back on internal medicine again…not exactly my favorite service to work on for a variety of reasons but that’s for another post. I've had some experiences recently that I’ve been thinking about a lot. In medicine, you periodically run in to people with diseases that give you pause and affect you deeply. We recently admitted a couple of guys who fit this bill. I’ll call the first one Jake.

Jake came to the emergency room because he’s been having pain in his back for several months that is getting worse. We got the call from the ER docs that they had a patient with some compression fractures in his back that they wanted us to admit to the hospital. You usually see compression fractures in little old ladies with osteoporosis, or sometimes in people who have fallen hard on their butts—like a snowboarder or something like that. Jake had no history of any injuries that could account for these fractures.

When we get calls from the ER about a patient, the first thing we do is pull up the patient’s labs and imaging in the computer so we have an idea of what we’re dealing with before we see the patient.

Unfortunately for Jake, less than a minute of skimming through his lab values and the x-rays and CT scans he had done in the ER made it pretty clear that he has serious disease brewing in his body. He had the kind of labs that give you a pit in the stomach as you realize something is very wrong. At this point in a patient’s workup, it’s hard to be mindful that this patient—who at this point is a name, some bad lab values and some x-rays that don’t look good—is somebody’s son, husband, father, brother, friend. He becomes a person to you when you step into the room to introduce yourself and you see his face and see those that love him sitting around his bed anxiously awaiting news from the somber-faced doctors with their white coats and clipboards.

Just before we walked into Jake’s room in the ER, I had the thought that the next half hour was going to suck for everyone involved.

Jake’s lying on his back with the light’s off in the room. He’s looking up at the ceiling. There’s a term in medicine (actually I think it’s a psychology term originally) referred to as Gestalt. Basically, it’s your impression or interpretation of something—some combination of sensory inputs your brain sorts through and interprets. You can sort of think of it as a gut-feeling. Your Gestalt almost immediately separates people into one of two categories: sick or not sick. Jake was sick.

He was stark white from anemia—no blood test needed. His wife was holding his wrist with one hand, holding a tissue in the other. Her mom and his mom were on either side of the bed. All were in tears, frightened looks on their faces. In times like this, you can feel a tension in the room as everyone realizes—from body language, facial expressions, carefully chosen words—that bad news, life-changing news, is imminent. They know we’re thinking something. They know it’s bad. They want to know what it is. They know we’re not going to say what we’re thinking until we’ve asked a lot of questions, done a physical exam, talked about labs, and x-rays, and CT scans. I know we’re about to tell this guy and his family that we’re very suspicious that he has a bad form of cancer. At times like this, I literally feel a little nauseated when I think about the blow this news is going to be to the people in front of me—and I’m not even the one who has to tell them. Not exactly a med student job.

After brief introductions, we started in with the questions. He first noticed something wrong last fall—pain in his back that wouldn’t go away. He describes it. Tells us about the other doctors he’s been to. He describes how things have steadily gotten worse and that he simply can’t take the pain anymore—pain that is now in his chest and his belly (the pain in his bones like his back and sternum is from the cancer chewing up his bones; pain is his belly is from the excessive amounts of calcium in his blood—calcium released from the bones as the cancer chews them up). He knows that the way he’s been feeling is not at all normal. He’s lost 30 pounds and four inches of height over the last couple of months—four inches. (Big, unintentional weight loss is a red flag for cancer—never ignore it). As he rolls out his story before us, it only reinforces our initial fears—this guy’s in big trouble.

I won’t belabor the details of the unsavory experience of taking a history and doing an exam on a patient who’s just found out that he’s got a disease that is likely to kill him sooner rather than later. Needless to say, it sucks. Of course, at that point, you don’t have a final diagnosis. We were pretty sure we knew what he has, but you don’t tell patients that they have something until you have the definitive tests to prove it—in this case, a bone marrow biopsy. We have since gotten the definitive diagnosis and Jake does indeed have cancer, multiple myeloma to be more specific. It’s a cancer that starts in a type of cell in the bone marrow called plasma cells. Plasma cells make antibodies so cancers like myeloma are ironic in a way. The cells that are supposed to be making antibodies to protect you from all the nasty bacteria and viruses out there turn on you and you become a victim of friendly fire. Your immune system gets all out of whack and guys like Jake can die from an infection that would be no big deal for a healthy person to fight off.

I haven’t able to find data on the prognosis for Jake because myeloma is extremely rare in patients younger than 40. Jake is 26. Twenty-six. That’s younger than me. This guy was playing in an indoor soccer league and rock-climbing 4 months ago. He’s been married for less than a year. Now, he’s at the Huntsman doing chemo and probably preparing for a bone marrow transplant. Hopefully he’ll do well. He’s got an aggressive cancer, which, although counterintuitive, is sometimes a good thing for chemo. Many of the chemo drugs work on rapidly dividing cells—which is exactly what cancer cells are. Jake’s a tough guy and he’ll give it a hell of an effort, but the deck is definitely stacked against him.

The second patient that’s given me pause came in to the hospital about one week after Jake. I’ll call him Greg. Greg is from another state and was sent to Utah for care after his primary care doc became very suspicious of his symptoms.

Greg had chest pain that was making him short of breath. His doc got a chest x-ray which revealed badness. It’s bad if it looks there’s a snowstorm in your chest on an x-ray. When he got here, we did a few lab tests and got a CT. He had a pulmonary embolism (PE)—a clot in his lungs that, for most people, starts as a clot in the legs, breaks off and travels to the lungs. Not Greg’s clot. His formed in his renal vein—the vein that drains your kidney. It’s fairly unusual for a clot to form there—especially in a young, presumably healthy patient. Until about 3 weeks ago, Greg seemed the picture of health. He plays baseball and football at his high school. He was showering a few weeks back when he noticed that his left testicle was pretty big and felt rubbery—like a racquet ball; for those of you’ve who’ve not felt one before, testicles should not feel like racquet balls.

Greg is 17 and he has metastatic testicular cancer, like Lance Armstrong. It’s in his lungs and probably in several lymph nodes around his aorta, but fortunately not in his brain. The cancer is also what caused his clots (cancer makes you more prone to clot formation) which led to the pulmonary embolism (the left testicular vein drains into the left renal vein which is where his clots formed). He will have an orchiectomy (surgery to remove his testicle) soon. He’ll also be starting chemo very soon.

One of the things most people elect to do when they’re diagnosed with testicular cancer is bank sperm. Once you blast your boys with toxic chemo drugs, they may not ever be up to the task of producing viable sperm, so banking sperm is a good idea if you’d like to have children someday. You want an awkward conversation, talk to a 17-year old with cancer in his nuts about banking sperm while his parents are in the room—that’s a lot for a kid to deal with. Greg happens to be an amazing kid and he’s handling all of this remarkably well.

For the love of God, do not ignore pain in your bones or your balls. Most of the time it won't be cancer, but it happens, even to young people. Sobering, when your patients are locked in a death-match with cancer and they're younger than you. F-you, cancer. F-you.

Plastics

2009-03-21T13:14:00.000-07:00

Started a post about my stint on the plastic surgery service which is now over, but didn't get around to finishing up till today. Plastic surgeons truly are wizards. When most people think of plastic surgeons, they think of Dr. Rey, boob jobs, nose jobs, and Botox. They certainly do some of that, but the ones who do reconstructive surgery are truly amazing. Also of note, plastic surgery has little to do with plastic the material. It surprises how few people actually know where the name comes from. The suffix -plasia refers to cellular growth or multiplication. So the term hypoplasia means less-than-normal growth. Dysplasia means screwed up growth. So if some part of your body is dysplastic (screwed up) you get a plastic surgeon to fix it for you. Not really important, but possibly interesting.

A couple of weeks ago, I watched one plastic surgeon reconstruct a breast for a woman who’d had a mastectomy (breast removal) due to breast cancer. This gifted surgeon harvested a flap of skin and fat from this woman’s lower belly and attached it to her chest. It’s a boob job and a tummy tuck all in one surgery. It may not sound like much, but when you use someone’s own tissue, you have to give it blood supply. That means you save the blood vessels from the abdomen flap and then hook those vessels into the vessels of the chest. That involves a microscope, tiny surgical instruments, and suture that’s thinner than human hair. 10 hours later, this sixty year old woman had a new breast that looked and felt natural and a belly that was flatter and tighter than many 18 year olds’. It’s pretty cool to see how pleased these women are with their new bodies after surviving the horrors of cancer.

Another case I helped on was a facial reconstruction of an inmate who took a beat down in the prison yard. Of course, he told us that he was trying to do a back flip off of a bench in the yard. The inmates usually won’t fess up to getting beat up because they know that if they report an assault that will trigger an investigation and the next beat down they get will be worse. The only thing that inmates revile as much as a pedophile is a snitch.

Operating on an inmate is pretty bizarre. They bring him into the OR with his feet cuffed and a prison guard at his side until he’s asleep.

I wish everyone could see surgeries like this to really appreciate how gifted these surgeons are. To repair the first fracture, we put a plate in this guy’s right cheek by going through an incision in his mouth. The second fracture was a little higher on his cheek, so the surgeon made a small incision on the inside of the guy’s lower eye lid and dissected down to the bone to check out the second fracture. It was stable so he didn’t put a plate there. The third fracture was on the outside portion of the orbital surrounding his right eye. To check that one out, he made an incision from the corner of the guy’s eye toward the side of his head, sort of in the direction of his temple. That fracture was also stable and did not require a plate. He then sewed up the inside of the eyelid and the corner of the guy’s eye. Three pretty good sized fractures in his face and this guy will only have one visible scar that will be about half a centimeter long—not bad. The plastic surgeons are also pretty cool about letting medical students do stuff. That doc let me drill the screws into the guy's maxillae (his cheek bones) that we used to anchor the wires we used to wire his jaw shut. Drilling screws into someone's face for the first time is a pretty memorable experience.

But, the wildest part of the case is at the very end, when the guy’s all sewn up. The surgeon takes a small pair of forceps and actually grabs the guy’s eyeball with them and wiggles it all around. They do this to make sure that all the suturing they did around the eye didn’t entrap one of the muscles that controls the movement of the eye. It’s one of those things that just looks wrong. There’s a visceral reaction that you feel that you just shouldn’t be grabbing eyeballs with forceps. You have to do it though. My advice would be to avoid breaking your face. Plastics was awesome.

The Magellan Project

2009-03-12T11:28:00.000-07:00

I heard about an interesting idea at work the other day. I was talking about running with a Family Practice doctor that I’ve been working with lately. He’s a runner and has been reaching his goal for the past few years to run 1,000 miles per year. Intrigued, I asked what inspired the goal and he told me about another doctor that he knows that had what he called a Magellan Project. [By way of a quick reminder for those who may have forgotten, Ferdinand Magellan was a Portuguese sailor who led the first expedition around the world.] This other doctor had the goal to run around the world. (Not literally, of course, because Jesus is the only one I can think of who could actually do that what with the massive oceans and all.) But this doc wanted to run as many miles as the earth is around, which turns out to be 24,901.55 miles if you measure around the equator. (From pole to pole is actually about 43 km shorter than that, according to the sources I found on the Internet machine. The earth is apparently a little squatty). Anyway, sometime in the last couple of years, he reached his goal after several years of running by completing his 24,902nd mile. Pretty damn cool.

I’ve had thoughts bouncing around in my head about it for the last couple of days, and I’ve formulated my own, modified Magellan Project. I’m doing mine on my bike. I haven’t been very good about keeping track of my miles on my bike, which is a little surprising given the fact that I keep records of tons of things—but that’s neither here nor there. From now on, I’m going to keep meticulous records of my miles on the bike and I’m shooting for 24,902 miles. Fortunately, I have a nice cyclometer that keeps track of it for me. That leaves just the minor detail of actually riding the miles.

In addition to announcing my own Magellan Project, I wanted to issue a Magellan challenge to anyone who might be reading this. Start keeping track of the miles you run, walk, bike, swim, row, cross-country ski, whatever. Maybe combine the mileage from more than one activity if, for example, you’re a runner and a biker, etc. You get the idea. There are pretty easy ways to keep track of miles: cyclometers, pedometers, treadmills, even an iPhone with the MotionX app will probably work.

I haven’t put a time limit on this particular goal, because I honestly have no idea how long it’s going to take me—obviously several years. Not entirely sure why I’m so hot on this idea, but I think that doing anything for nearly 25,000 miles is an awesome feat of exercise and record keeping. It will be an awesome accomplishment. Maybe it's because I'm at an all-time high weight for me--I'm a bit fat right now. The world is getting fatter, and in the US we're leading the way. Time to get off of our collective duff. So, if you’ve got a pair (for the women, I obviously mean this figuratively), I think ’09 is the year you should also start your own Magellan Project. I’ll probably be posting updates on it periodically, and I’d love to hear about what anyone else is doing/has done or has heard about that is similar.

(For those of you that have speakers on your computer and the volume up, good luck getting that song out of your head)

Fond farewll to Peds

2009-02-21T07:31:00.000-08:00

I realized after my last two posts and the comments that were made, that I only talked about negative aspects of Peds, but there were some great moments too. Overall, I actually enjoyed it most of the time.

In the-world-is-so-damn-small department, during my week in the well baby nursery I was asked by one of the residents to help with some Spanish translation to explain to the mother of one of our patients when she would be going home and when she needed to bring her baby back for follow up.

As we were walking over to her room, the resident asked me where I learned to speak Spanish. I told him about serving a mission in Peru just as we were walking into this woman’s room. He says, “Peru? That’s where she’s from.” You can see where this is going. Turns out I lived in her brother’s house in my last area in the mission. She and her husband lived about 2 blocks away and we were all in the same ward for about 4 months. I didn’t know them nearly as well as I know her brother’s family, but I definitely recognized them right away. They’re now living in Salt Lake City. I was able to take care of their brand new baby girl for the next couple days before sending them home. We exchanged contact info and they've invited me over for dinner. Obviously a cool experience.

There were several other awesome experiences with the kids. One still makes me laugh every time I think about it. I was in clinic and a resident and I were going in to see a two month old Korean baby and his 3 year old brother. They were both in for well-child check ups. We opened the door and found the 3 year old standing on the exam table with his back to us, playing happily with his mother. His little brother was asleep in the car seat on the floor. When the 3 year old realized we were there, he turned around. His smile disappeared immediately, his eyebrows got angry and he started gesturing angrily at us and yelling at us—in Korean. I’ve never seen a kid go so quickly from happy and care free to pissed. He was really giving us a tongue-lashing. We’d never met him before. His mom explained that he was expressing his displeasure with the idea of getting a shot. I had to bite my lip to keep from laughing out loud. We told him that he didn’t need to get any shots that day and he went back to being sweet and happy as quickly as he had turned sour. It was fantastic.

I also wanted to mention that I appreciated the kind--albeit largely undeserved--complimentary words from several of you. As I've said before, writing about some of my experiences is helpful for me to wrap my head around the things I experience day to day. I'm glad that reading about them is a moderately enjoyable way for some of you to kill of few minutes at work.

More reasons why I won't be a Pediatrician

2009-02-07T14:10:00.000-08:00

I’m still on my Peds rotation and have had some additional unsavory experiences that have convinced me, beyond doubt, that Pediatrics is not for me.

I recently spent a week in what’s known as the well-baby nursery. This is where the healthy newborns go, usually for the first 48 hours of life, assuming all goes well. The majority of the time, the babies are with their moms in the maternity ward, but we go check them out every morning and periodically throughout the day to make sure all is well.

My first morning in the well-baby nursery, we had a baby who was born in the wee hours of the morning—certainly not uncommon. What was uncommon, was that he was born in the toilet of a gas station bathroom. Mom apparently thought she was going to lay a large dump and, we were told, was quite surprised when the baby came out. Mom would have to use both hands to count her pregnancies and has 5 living children, so a bit surprising that she didn’t recognize that she was in labor. As many of the mothers out there know, generally 2nd, 3rd, 4th babies tend to go quicker than the first. Perhaps she did know she was in labor and it was just too late to get to the hospital in time, who knows?

The more we learned about the situation, the more depressing the story got. The last few months she has been homeless. Prior to ending up on the street, she actually had fairly decent prenatal care. She got a fair amount of her lab work done, and had been seen by an OB multiple times during the pregnancy. Unfortunately for her and more unfortunately for her baby, she also has a history of heroin and meth use spanning several years—including while she’s been pregnant. We’re not really sure how she ended up on the street, but if you do drugs long enough, chances are that’s where you’ll eventually call home.

As the day went on, it became more obvious that the child was withdrawing from whatever Mom had been using just before he was born—our guess was heroin. Watching that brand new little boy twitching and flinching as his body tried to adjust to life without opiates was pretty awful. The worst part of the whole deal was that we couldn’t treat him for it. He was still in Mom’s custody and she was refusing a tox screen for either her or her baby. That means we couldn’t prove that it was withdrawal and we couldn’t treat him without either proof that he was withdrawing or permission from mom—we had neither. So for the rest of the day and throughout the night, everyone in the nursery could do nothing but hold him to try to comfort him. He was very stable, and was actually pretty calm as long as someone was holding him, but it was heartbreaking to watch a situation like that—born in a toilet, withdrawing from heroin. Rough start.

The nurses see this stuff all the time and are accustomed to seeing babies in this situation. Apparently this little guy wasn’t nearly as bad off as others they’ve seen. I really wasn’t much more than a concerned observer. I didn’t have much to do with his care, and it was still hard for me.

The Division of Child and Family Services (DCFS) eventually took custody of the child but that process takes time (Mom doesn’t have custody of any of her 5 living children). When he was finally turned over to State’s custody, we were able to treat him and he’s been doing well since then. Mom checked out of the hospital the day after losing custody and we have not seen or heard from her since. Fortunately for this little guy, his story looks like it may have a happy ending. Apparently his dad is currently in jail/prison, but some of his dad’s relatives have agreed to adopt him. They seem like a solid family and when they came to visit they were visibly excited to get the new addition. He will be going home with them soon.

We had another sad situation where Mom really wants her baby and wants desperately to take care of her. Unfortunately, Mom’s Psychiatrists have determined that her current mental state is such that she’s not fit to take care of the child—we agreed. Mom has enthusiasm and she spends a lot of time holding, kissing, and feeding her (supervised), but it doesn’t take more than a few moments with her to realize that something is off. She was devastated when she found out that the child would not be going home with her. She continued to come to the nursery to spend time with her daughter, every time she walked out the door she was wiping tears from her eyes—sad to see.

These types of things come up with some regularity in the Peds world (and in the Psych world as well). Pediatricians are sometimes forced to make tough decisions that could dramatically affect the trajectory of many lives. Many times it’s trying to choose the lesser of two (or more) evils. There are some tough decisions in almost any branch of medicine you end up in, but the decisions regarding kids are ones that I want no part of.

I won't be a Pediatrician

2009-01-08T17:26:00.000-08:00

Just started my pediatrics rotation this week—just in time for RSV and rotavirus season. That means tons of sick kids. Also means that I will likely get a nasty cough and fiarrhea at least once during the next six weeks.

Most of the time, I like kids—but usually at a distance. I prefer kids that I can give back when they poop or cry. In a medical setting, I find them terrifying. Nobody in medicine wants to make a mistake that causes harm to any patient, but this is especially true of kids. The margin for error is narrower and you really worry about messing up.

I'm on an inpatient team that treats us as interns. Interns, for those who don’t know, are 1st year residents. This particular team that I work on basically throws us into the mix with most of the responsibilities of an intern. For those of you who just shat their pants, fear not, we’re well supervised—orders have to be cosigned by MDs, etc.

One of our responsibilities is overnight call with cross-cover. That may not sound like much, but it’s the first time in my training that I’ve done cross-cover. Cross-cover simply means that when I’m on call overnight, I cover the patients that my fellow med students on the team (there are 3 others) are taking care of. That means that I’m not involved in the day-to-day care of these kids, and therefore don’t know a whole lot about them. Again, this may not sound like a big deal, but it can be pretty stressful. It’s kind of scary when you get a page at 3 a.m. from a nurse wanting to know what I want to do with the kid in room 34 that I’ve never seen before that is having trouble breathing and spiking a raging fever. You’re asking me?

But cross-cover isn’t the worst part—not even close. What is, you ask? Codes. I thought codes with adults were bad—codes with kids are horrific.

As luck would have it, my first night on call I’m working to get a little girl admitted for an infection in her hip. Sitting in the resident work room around midnight talking with a resident and an attending about the plan for this little girl we’re admitting when the code is called. The residents fly out of the room at full speed. The attending and I lag a little behind, but we’re still moving pretty good. We have to run down one flight of stairs and sprint through a couple different hallways. By the time we get there, there are about 20 people in the room with another 20-30 in the hall outside. I slow down when I see the crowd as I realize that there are already a ton of people there—I was a little surprised since it was nearly midnight. My experience from previous codes has taught me that the odds of me doing anything when I’m the 40th person on the scene are low. Not tonight. I’m standing outside the door (unable to see a thing) for no more than 15 seconds when I hear:

Some lady I can’t see: Do we have any more tall people?
Me (as I’m stepping into the room): $#*%. Right here.
Lady: okay, we need you to spell on compressions in just a second.

Not only had I not done compressions on an actual child before, I’d never seen it done. The old medical saying ‘see one, do one, teach one’ was in full effect. I watched the other guy doing compressions for about 20 seconds. I’m now bedside and it’s obvious why they wanted tall people. This little kid is about 2 years old and he’s in a bed/crib thing that is pretty tall. Shorter people simply couldn’t get enough leverage to do compressions properly (not that I knew exactly what ‘properly’ was at that point).

After 20 seconds or so, the lady running the code (I learned later that she’s an attending from the pediatric intensive care unit, or PICU, pronounced ‘pick-you’) tells the other guy to stop compressions. While she’s feeling in the boy’s groin for a femoral pulse, two nurses on either side are feeling for pulses in his arms. She sees that I’ve got a stethoscope around my neck and signals to me to have a listen. I grab my scope, put it on his chest—silence. $#*%.

Me: nothing.
Doc: no pulse.
Nurse 1: no pulse.
Nurse 2: no pulse.
Doc: resume CPR.

I quickly sling my scope around my neck and slide up to the side of the bed as the other guy slips past me to take a rest. For little kids, you don’t do compressions with the heel of your hand like you would an adult, you wrap your fingers around their rib cage like you would if you were going to pick the kid up. Your thumbs end up in the middle of the chest and you basically push your thumbs down on the sternum by squeezing the child’s chest between your fingers in back and your thumbs in front.

There’s no counting and very little talking at this point. In fact, it’s surprisingly quiet in the room considering all that was happening. I’m squeezing away.

Doc: okay, good depth, rate is about right. Good.

I’m surprised that I’m actually doing it right. Finding myself unexpectedly center-stage, I hadn’t really had time to size up the room completely. It sounds strange to write this, but I found myself stealing glances around the room as I’m doing compressions on a dying child. In retrospect, it made sense. I don’t know anyone who wants to look at the face of a lifeless 2-year old—no words for it.

I glance up and notice a young woman with a very intense look on her face. She wasn’t wearing scrubs and a nurse has her arm around her. Another second of watching and I realize she’s Mom—standing in the second row, bedside watching the whole thing unfold.

Doc: what was happening right before he stopped breathing?
Mom (concerned, but not panicked): he was fussing a little, then he just went limp.

I continue to do compressions for another minute or so (although it seemed like several minutes). Every 15 seconds or so, I can feel this kid fighting to take a breath on his own. Another nurse is giving him breaths with a bag mask. When you're bagging someone, it's not uncommon for some of the air to end up in the stomach. This kid's belly was inflating and his stomach was quite bloated. Another nurse passes a tube through his nose into his stomach to decompress it. His belly starts to deflate and there's green stuff coming out of the tube in his nose.

Doc: okay. I’ve got a femoral pulse.
Me: he’s trying to take some breaths
Doc: okay, stop compressions, keep bagging….still have a good pulse.

I’m a little relieved at this point. I’m thinking we got him back and we’ll transport him to the PICU where he can be intubated and kept alive—artificially if necessary. He takes a few more breaths on his own—heart stops again.

Doc: No pulse. Resume compressions.

I look up at Mom as I start compressions again—that’s a look I’ll never forget, she knew long before I got there that he was in big trouble and you can see it on her face. I go for another two minutes and the muscles in my hands are on fire so I call for someone to spell me. Someone else slides by me and I back away from the bed and steal another glance at his mom—hands covering her mouth, tears pouring out, but remarkably composed given the circumstances. I stand there, in shock, and watch for another minute or two of no blood pressure, no pulse, no efforts to breath. A nurse at the foot of the bed starts ushering people out of the room that aren’t doing anything directly to the boy. As I turn to go out of the room, I take one more look at the lifeless boy and his mom and wonder if she knows that we’re throwing in the towel—the bagging, the compressions, are all for her sake now, her son is already gone.

Out in the hall, there are 30+ people, long-faced, crying or close to it, shocked, defeated. It completely sucked. The last image I have of that experience is the remaining people filing out of the room. One nurse sliding a chair up close to the bed and helping Mom sit down. Another nurse disconnecting all the monitors, tubes, and tape from the little boy and wraps him in some blankets and hands him to his mom as someone else shuts the door. Her sobs are audible in the hall.

The crowd outside the room says very little and slowly breaks up. After a few minutes, I walk slowly back to the work room, take a drink of water, and we finish writing orders for the little girl with the infected hip. Very little is said about the little boy who just died.

I found out later that he had a very rare metabolic disease and he had actually lived longer than expected for someone with his disease. That’s why we didn’t do more aggressive interventions—like shock him or push drugs. I suppose it was a silver-lining of sorts to know that Mom knew that it was coming at some point. He had been fighting a losing battle since birth. Although not a surprise to Mom, undoubtedly still a shock.

Without question, the worst experience of my life thus far.

Hey, Goat

2008-12-28T12:57:00.000-08:00

My brother, inexplicably, purchased two pygmy goats for my parents’ Christmas present. He chose to deliver them during the climactic moment of the extended family Christmas party at my parents’ home. The whole family was gathered in the living room for the Christmas program, and my brother busts through the front door holding goats. My mom shat her pants and stared at him, hand over her mouth—confused, shocked. Shortly afterward she said, to no one in particular, "I always knew he was a strange child, but...."

As you might expect, the focus of the party immediately shifted to the goats. They were running around the kitchen, peeing, pooping, and giving the youngsters an education on procreation (both goats are male—my brother bought gay goats).

As you can see below, they’re pretty cute little guys. They actually seem to be pretty low maintenance pets so far. Give ‘em some hay, water, and a little shelter and they pretty much fend for themselves. They’ve taken up residence in the old dog house in the backyard. We’ve named them Doug and Gene. We figured that run-of-the-mill names were appropriate as goats are about as blue-collar as animals get. These two actually seem to prefer to eat the dead leaves under the back deck before the hay we put out for them.

My mom assures us that the goats are not welcome long-term. But, she’s quite an animal lover and we can see her warming to the goats already. We’re doing everything we can to delay their eviction.

This is a closeup of Doug. He and his half-brother, Gene, are about 3 months old, but apparently won't get much bigger than they are now.

This is Gene eating some hay. Notice his two front feet are in the bowl. They almost always eat with their feet in the bowl--no idea why.

This is Doug perching on a railroad tie. They love to perch on stuff.

Some of you probably know that my life's ambition is to build an energy-independent home on a small farm. I plan to have enough land to do some small-time farming and small-scale animal husbandry. Thanks to my brother's unusual gift, I'm getting some practice goat-herding--and I'm loving it.

Code Blue

2008-12-10T20:54:00.000-08:00

Some of you may have been in the hospital and heard the PA system start to ding followed by a monotonous female voice (it’s always a woman for some reason) saying things like “Code: Trauma, Alert 1” or “Acute Stroke Response Team” or “Met team” or any number of other codes that are called over the PA system. While none of them are good, some are worse than others. Code Pinks mean that a child is missing and presumed abducted until proven otherwise. Code Zulu means a helicopter has crashed at the hospital, but you almost never hear those ones (I’ve heard one Code Pink, no Zulus).

Anyway, as I’ve now been on a few codes, I thought I’d write a little bit about how it happens.

I’m currently on Internal Medicine and I was recently sitting in our little work room with the rest of the team (attending physician, residents, etc). We were busy talking over the plan we’d made for a patient we had just admitted to the hospital for pneumonia. As we were sitting there discussing what antibiotic we wanted to give this guy, the familiar dinging noise comes on the PA system and we waited to see if it was a code that we needed to go to.

“Code Blue. Patient Tower. Level 8. Room 24.” For those of you who don’t watch any of the medical dramas on TV, Code Blue means someone is essentially dead. They’ve had cardiac or respiratory arrest, or both. When you hear a Code Blue call, you immediately get a pit in your stomach and you drop what you’re doing and sprint to the room because the clock is ticking. It’s an adrenaline rush that is pretty hard to match.

We happened to be sitting just down the hall from this particular patient’s room. Even though we weren’t the team that was on call for codes that day, Code Blues are as serious as it gets and since we were the closest to the room we immediately booked it down the hall to the room. As we sprinted around the corner, we saw a woman in the hallway hysterically screaming at the top of her lungs, “You can’t let him die!” It turned out to be his wife and she continued screaming at us as we flew by her into her husband’s room—no pressure. He had gone to the bathroom to take a poo and his wife heard some noise in the bathroom. We obviously didn’t know it at the time, but it turned out that he’d had a heart attack on the can and fell to the floor. She screamed for help, two nurses ran in there, found him down and started CPR. When we got in there, we found the hospital bed empty…Shit, not good. We look in the bathroom and one of the nurses is wailing away on this guy’s chest doing compressions very aggressively—exactly as it should be (she actually broke his ribs, not uncommon).

The guy was on his back on the bathroom floor—face is purple, eyes open, pupils dilated, mouth open, the rest of his body stark white—not good. Within seconds the room fills up with medical people—docs, nurses, pharmacists, techs, you name it. Room’s full, lots of people in the hallway too. It’s pretty amazing how quickly people show up—and how many. It’s chaotic, but there is method to the madness.

My boss, was the first senior doc to make it to the scene so she was running the code. The person running the code, usually stays at the level of the patient’s waist and feels for a femoral pulse while asking questions about the patient to anyone who might know, and barking out orders to everyone else. The crash cart (little cart with all the life-saving equipment—defibrillator, bag mask, oxygen, medications, etc) was in the room at this point and people were furiously pulling stuff out of it as my boss called for things like the bag mask and the defibrillator. The nurse doing compressions is exhausted by this time so one of the residents on our team spells her and continues the compressions until the defibrillator is ready. I’m next in line to do compressions when we stopped CPR to check the electrical activity in his heart.

[Interesting side note, if any of you should find yourself in a situation where you need to administer CPR, if you do compressions to the beat of the Bee Gees song ‘Staying Alive’ you will do the compressions at the proper rate. I’m not making it up, people have actually published this in journal articles. So sing ‘uh uh uh uh stayin alive, stayin alive’ in your head as you pump.]

At this point, he starts trying to breathe again, although pretty unsuccessfully at first. Someone quickly slaps the pads on his chest and we see on the little monitor screen that he’s in V. Fib. Ventricular fibrillation is an arrhythmia that will kill you if not corrected, but a “shockable” rhythm, meaning the defibrillator can sometimes fix it.

My boss gives the order for the shock and yells the familiar “Clear!” and the guy gets zapped. Fortunately, he converts back to a normal heart rhythm after one shock, but his heart is still beating too slow, he’s not breathing well, and his face is still purple. As you might imagine, trying to resuscitate someone on the floor of a small bathroom is not ideal.

Since I was next in line for compressions, I was standing right at this guy’s side but since we’d gotten him back and stopped CPR, the extent of my involvement in the code was helping to drag him out of the bathroom, put him on a backboard, and lift him into his bed. It just so happened that I ended up right at his waist when we log rolled him onto the board so when I reached under his butt to position the backboard under him, I got a rather unsavory surprise. It’s a rookie mistake to fail to put on gloves as you come into the room on a code—you may have any number of bodily fluids all over the place on a code. I won’t make that mistake twice. I was sanitizing the hell out of my hands for the rest of the day.

Fortunately, this guy came around pretty quickly. Within a minute or so after the shock, we had him back in his bed and he was talking, asking us if it were all a dream and moaning about the pain in his chest (likely from the broken ribs). When someone codes like that, they go straight to the ICU ASAP.

The whole thing was over in two or three minutes. It obviously feels like much longer than that. As far as I know, the guy did okay. He had been admitted to the hospital for a problem unrelated to his heart. The heart attack was pretty unexpected and he’s pretty lucky that he happened to be in the hospital when it happened. Had he been somewhere else, it would have been curtains for him.

It’s high drama with the highest of stakes. You’ve got very little time to figure what to do with a patient that you usually don’t know anything about. Codes are pretty crazy, and I’m a long way from being able to run one, but it’s pretty cool to be a part (however small) of a Code Blue that ends well.

Despair, Inc.

2008-11-04T17:35:00.000-08:00

Many of you have probably seen these. I love them. Saw this one today and it seemed apropos to post here.

I've been thinking about what to post from my current rotation. After 6 weeks doing obstetrics/gynecology, I've seen/heard some blog-worthy material. I'm hoping to find time to write about a few things this weekend.

Playing Shrink

2008-10-04T10:22:00.000-07:00

For the last 6 weeks I’ve been working with patients on the inpatient Psychiatry ward. Inpatients are sick enough that they’re locked in—many against their will. You see patients with Post-Traumatic Stress Disorder who are homicidal, alcoholics with severe withdrawal and delirium tremens, depressed patients that have tried to kill themselves or are seriously considering it, patients with borderline personality disorder who cut themselves, and of course, patients with schizophrenia that hear voices and see things that the rest of us don't. I wish that folks like Tom Cruise, and anyone else who thinks that mental illness and Psychiatry are BS, could spend some time in a place like this. Floridly psychotic people are, at best, unsettling; at worst, downright terrifying. But, they can also be very sweet, very funny, and they’re always fascinating. The other amazing thing is how quickly really sick patients can improve with treatment, which usually entails pharmacotherapy--drugs.

Just a few anecdotes about some of the more interesting experiences I’ve had recently.

I had the opportunity to participate in electroconvulsive therapy. You’ve probably seen depictions of this treatment on TV—an old episode of the Simpson’s (Tracy Ullman days) comes to mind. The real thing is far less dramatic than what you see on TV. The patients who get this treatment are profoundly depressed and have not responded to other treatments.

Basically, you take the patient to the OR, hook them up to EEG (brain) and EKG (heart) monitors, and strap two silver dollar-sized electrodes to the patient’s temples. Those electrodes are hooked up to the ECT machine. Then you pump up a blood pressure cuff around the patient’s calf. The cuff acts as a tourniquet to prevent the IV medications from reaching the patient’s foot. Then you use anesthesia to sedate the patient and give them a short-acting paralytic drug (we use succinylcholine). Next, you hit the button on the ECT machine and the patient gets a little less than one amp of current delivered across their brain. This current induces a seizure in the patient, but due to the drug-induced paralysis, they don’t move much—except for their foot which didn’t get the paralytic drug because of the tourniquet. That one foot moves up and down rapidly much like a rabbit thumping the ground with its foot. You paralyze the patient so the seizure doesn’t hurt them (damage muscles, break teeth, etc). The un-paralyzed foot allows you to see when the seizure starts and stops. This is important because you want the seizure to last 15-45 seconds and you need a way to time it. Patients typically get up to 8 treatments over a 2 to 3 week period. It’s actually pretty underwhelming to watch—probably because you expect something really dramatic. The seizures are short and the patient doesn’t really do much other than move their foot and grimace a little. But it works. You can see noticeable improvements as the course of treatment goes on.

There’s an old saying that pharmacologists (the drug specialists) use all the time: everything is toxic, it’s just a question of dose. That’s pretty intuitive when you’re talking about drugs—less so when you’re talking about water. But it’s true. You can actually drink fatal amounts of water. It’s called water toxicity and you pretty much have to be psychotic to get it—like one of our patients.

This guy is in his 60s and has had schizophrenia and severe OCD for a long time. One of his compulsions is drinking. It’s called psychogenic polydipsia. This guy will happily drink several gallons of water per day. It’s dangerous because you can dilute your blood enough that you get electrolyte imbalances that can lead to potentially fatal seizures and cardiac arrhythmias. So, with patients like this you have to restrict how much they can drink—easier said than done. This guy has been known to sneak drinks while he’s in the shower, or drink water from the toilet, even drink his own urine. Like I said, you pretty much have to be psychotic to do it. Again, those who think mental illnesses are a crock or just “character flaws”, or a manifestation of weakness, need to see patients like this first hand. They’re not weak, or faking it, they’re undeniably crazy.

And every once in a while patients escape. The term for it in the psych world is eloping. Since the unit is locked, these patients sometimes get tired of being cooped up. So they’ll figure out how to get out. The first time it happened, it was a neurosyphilis patient. [If you let syphilis go untreated long enough, it will torch your nervous system and essentially make you crazy. Many people believe this is what killed Benjamin Franklin. Syphilis is now curable with antibiotics as long as you treat it early enough—not sure why our guy didn’t get any.] He waited until one of the smaller female staff members was heading out the door and then pushed her out of the way and made a run for it. He didn’t get far before guilt (or better judgment) got the best of him and he came back.

The second guy that eloped had no intention of coming back quietly. He’s a guy that is well-known, even famous in the psychiatric community in Utah. He’s in his 60s now and over the years, he’s been to many of the ER’s and psych facilities in the area. His family was killed in a car accident many years ago and he fell off the deep end shortly thereafter. He’s got a condition called schizoaffective disorder (which is schizophrenia plus a mood disorder like depression). Physically, he reminds me of the Michelin tire guy or the Marshmallow Man from Ghostbusters—pretty fat, white, and squatty. He does Tao Bo every morning with the recreation therapist. He’ll stand about 6 inches from the TV and shout things like “cardio” or “bonsai” as he sweats it out with Billy Banks—it’s impossible not to laugh. He enthusiastically greets me every morning with “good morning, student!” He’s currently writing a book about his run-ins with the police (there have been many). He also hates his Psychiatrist—who was my boss—because he’s convinced that the medications she put him on have made him fat. He threatens to sue her for it and insists that she owes him $2 million so he can buy health and life insurance. He’s called her a Fascist pig, a Nazi rat, and iron butt. We don’t really know where he gets this stuff. My favorite rant of his was when he yelled at us about how when he got out he was going to “buy a bicycle, go to BYU’s campus and run over some asses.” He refers to the psych ward as a “shitty shithole”. I nearly bite my finger off trying to suppress laughter every time we interview him.

His escape was a little more dramatic. He didn’t wait for a small female staff member, he pushed aside a good sized man and made a run for it. Word spreads quickly when someone elopes and everyone runs outside to track him down. This guy had made his way to a nearby street and was standing in the road cussing up a storm, trying to stop traffic and get a ride to who knows where. We were trying to signal the cars to keep going. Fortunately, it wasn’t a terribly busy road. About 10 of us finally surrounded him and basically hung out waiting for the police to show up. When these guys are on the outs you don’t mess around, you call the cops because they can be dangerous to themselves and others. Once we had this guy surrounded he knew he wasn’t getting anywhere and so he did the only thing he could think of—he squirted us with his water bottle. The police came, took him back to the unit, we gave him a shot of sedative medication, and then he was put in the seclusion room—the psych ward equivalent of time out (yes, the room is padded).

I’ll resist the urge to turn this into a diatribe about the social injustices that are rampant in our broken mental health system cause this post is long enough already. I’ll summarize by saying mental illness is a very real and complicated thing and it’s all around us. It’s much more common than most people realize. Every single one of you know someone who, by definition, has a mental illness. After spending 6 weeks in a psych ward I’m convinced that people who think psychiatry is a crock probably need to see a psychiatrist themselves. And the folks who think that modern medications really aren't necessary probably have no experience working with psychotic people for whom these medications are literally life-saving.

Handicapable

2008-09-11T22:52:00.000-07:00

I’m standing at a train station downtown the other day. As the train pulls up, I hear quite a ruckus behind me.

“A Sandy train!” I turn around to see three guys, probably all in their 20s, high-fiveing, clapping, and literally squealing with delight as the train pulls up. Mind you, this is not an unusual occurrence. Every other train is a Sandy train. It’s pretty clear that these guys aren’t accountable for their actions. I’ve been riding the train long enough to know that you want to sit by people like this when you’ve got a long train ride ahead of you because you’re bound to see some good stuff. These fellas didn’t disappoint.

I sit close enough to them to eavesdrop and watch them closely. Of the three, Steven looks the most normal (excluding the 50-something year old woman who is clearly supervising these guys—so there’s actually four of them). He’s wearing a U of U T-shirt and hat with some very old school LA Gear high tops ala Karl Malone. He’s sipping a Pepsi and eating M&Ms. In fact, all three of them are well supplied with snacks—they’ve obviously just come from Rite-Aid.

A few minutes into the ride, Steven starts needling Bryce. Bryce is the pudgy one: mild acne, glasses, T-shirt tucked into his Lee jeans that are hiked up well above his belly button, his ‘LDS food services’ baseball cap on backwards with a little tuft of hair sticking out onto his forehead, white sneakers, you’ve seen this look before. He reminds me a little of Piggy from The Lord of the Flies.

It starts when their caretaker asks Steven what he named the elephant (I assume they’d been to the zoo earlier) and Steven blurts out “It’s Bryce, gorgeous!” While not an ugly woman, this caretaker was hardly ‘gorgeous’ but that’s the only thing he called her.

Gorgeous: What is the Rhino’s name?
Steven: Bryce!
Gorgeous: What was the giraffe’s name?
Steven (louder, followed by giggling): Bryce!
Gorgeous (can’t even get the questions out in time):
Steven (shouting): Bryce! Bryce! Bryce! Bryce, Gorgeous, Bryce!

It’s the funniest damn thing he’s ever said/heard and he’s laughing so hard that he pulls his knees up to his chest and I wonder if he’s going to puke on the floor. His face is bright red and he has to cover his mouth.

Bryce doesn’t seem to care much. He’s much more interested in polishing off his Dew and his Snickers and doing what the beat from his iPod dictates. He’s rocking out, knows he’s pretty badass, and has no time for Steven’s BS.

The third guy is a dead ringer for Michael Phelps (his face anyway). He’s the quiet one with mild kyphosis (hunchback) and torticollis (involuntary contraction of the neck musculature on one side of the neck—it causes the head to turn to one side and up slightly). He’s got serious bedhead and, because of the way his head is cocked to one side, he has to look down out of the corner of his eye to see the action. Slap a white coat on this guy and he could easily be the mute side kick to some mad scientist who laughs but never audibly. I pictured him several times holding an Erlenmeyer flask with some bubbling green liquid and some tongs with a big panel of assorted switches and wires behind him. Anyway, Phelps is Hoovering his M&Ms and Gatorade and trying to suppress his laughter as Steven badgers Bryce. His laugh is totally inaudible, but it moves him up and down. Also of note, he’s got a pretty awesome fanny pack on.

During the 45 minutes on the train the only words I hear out of him are “M&Ms are sweet!” and he says it with such gusto and conviction that you’d think he was announcing that he’d found a cure for cancer. Had I never tasted an M&M in my life, I would have believed whole-heartedly that they were sweet.

Just before we reach Steven’s stop, Bryce drops something on the floor. Steven sees it, jumps up, crosses the aisle to Bryce’s seat, picks it up, hands it to Bryce, then sits back down without a word--an effort most of us "normal" people wouldn't have made. Then he stands up and gives Gorgeous a big hug.

Steven: See you tomorrow, Gorgeous!
Gorgeous: Bye, Steven.

The guys wave. With Steven gone, Bryce begins to loosen up even more. He’s shimmying in his seat and playing a few riffs on his air guitar. Then he starts belting out, “Ne ne na na saw her face, ne ne ena I’m a believer!” It’s “I’m a Believer” by the Monkees. He doesn’t quite have the words memorized verbatim and he’s singing it about two notes flat and two measures behind what’s playing in his ears—and he’s doing it loudly. Phelps sees that both of Bryce’s hands are busy shredding his air guitar so he takes the initiative to hold Bryce’s mic. He flips his empty Gatorade bottle over and holds it up to Bryce’s lips and the rest of us are treated to a couple more choruses of “I’m a Believer.” A memorable performance to be sure.

I looked around the train to see other people’s reactions. Although many people were amusedly watching them, amazingly, there were some people who seemed totally uninterested or unaware of the brilliance of that was unfolding. If two handi fellas rocking out to the Monkees doesn’t make you smile, you need a shrink. I decided then and there that when I have money I’m going to sponsor Special Olympics teams.

I’d love a chance to thank Steven, Bryce, and Phelps for making my day. Their rawness and enthusiasm was a much needed breath of fresh air in an otherwise stuffy train car. Maybe they’ll want to be part of my 4x100 relay team.

The Lonestar

2008-08-17T11:28:00.001-07:00

Just wrapped up my 6 week clerkship in surgery. I was working on a general surgery team so we did a lot of cases involving bowel surgery. For those of you who’ve never had the experience (which is likely most of you), having your hands inside someone’s belly is about as personal and invasive as it gets. It’s a weird experience and, in an odd way, a privilege.

I’ve come to better appreciate how physically and mentally taxing surgery is. Personally, I feel that surgeons (general surgeon’s in particular) are crazy (as the son of a retired general surgeon, I mean this as a compliment). They’re gluttons for punishment. I don't think they eat, sleep, or pee. I also think that many of them are sadists and the Lonestar proves it.

The Lonestar is a retractor that, as soon as you see how it’s used, will put fear in your heart.

Pretty innocuous-looking piece of plastic, right? Wrong.

Picture a patient lying on his back in the operating room, legs up in big leg supports such that he is positioned much like a woman getting a pelvic exam. Then picture his anus right in the middle of the larger of the two rings of plastic (a pleasant thought, I know). The smaller ring extends upward and basically frames his privates. As if having this guy’s junk staring you in the face for hours on end isn’t bad enough, he’s covered in the iodine we used to sterilize. So not just some guy’s junk staring you in the face, it’s rust-colored junk. An unpleasant sight for sure. Got it? Good. It gets worse.

Now your standing at the end of the operating table looking right between the patient’s legs (over the surgeon’s shoulders, who’s sitting on a stool right up in this guy’s business), and the scrub tech (the person who hands the instruments to the surgeon) hands him (or her, but in this case it was a male surgeon) what appear to be rubber bands with meat hooks on the end. Like these.

Without a moment’s hesitation, the surgeon unceremoniously buries the first meat hook in this poor soul’s inner butt crack (the patient is, of course, anesthetized, but still) and then stretches the rubber band and slides it into one of the little notches you can see on the Lonestar. Immediately after the hook goes into this guy, a rivulet of blood trickles down the patient’s bottom and drips on to the floor. My butt muscles immediately and involuntary flex as tight as they’ll go and my own anus is tighter than a snare drum. The pucker factor when you see something like this is off the charts.

The surgeon continues to sink these hooks in this guy’s butt in a circular pattern and stretch the bands out to the Lonestar. The net effect: it spreads open this guy’s deuce much wider than I ever imagined was possible (not that I imagine things like that very often). The surgeon looks back at me and can tell that I’m horrified. He chuckles and says, “Looks a lot like the worm that ate Jabba the Hut, huh?” Then he really lets out an awkwardly loud laugh as I stand there, eyes glued to this guy’s hole wondering what they hell he is talking about. Jabba the hut? What does that even mean? This shouldn’t be fun, for anyone. Sir, you’re not well.

Next, he asks for the Gelpi. When this instrument is used in the anus, it might be more horrifying than the Lonestar. Look at the damn thing. Sharp tips, a ratcheting mechanism—yikes.

It’s used to improve “exposure” (an important word to surgeons). Use your imagination. This sucker is basically the inverse of tongs you might use to pull some corn on the cob out of boiling water. When you squeeze the handle on tongs, the tips close around the corn. When you squeeze the handle on the Gelpi, the tips OPEN. Did I mention that the tips of the thing are like thumb tacks? I think the name for the Gelpi came from the noise patients would make if they were awake when you used it on them. Combine a gasp with a yelp and you’ve got a gelp, hence a Gelpi.

He puts the Gelpi in there and opens things up so wide that I’m convinced that if I squint I might be able to see out this guy’s mouth. I’m standing there wide-eyed, mouth open, when, mercifully, the surgeon asks me to go up to the other end of the table.

I’m now standing at the patient’s left hip. His left leg extends to my left, and his rust-colored junk is still staring me in the face, but his butt is no longer visible (except in the reflection off of the surgeon’s glasses). The surgeon grabs a Richardson retractor like this.

He puts it in the patient’s butt, pulls up toward the ceiling harder than I ever would have, and tells me to hold it there. For the next hour I stand there with my arm extended over the patient’s manhood trying desperately to provide even more exposure (apparently the Lonestar and the Gelpi weren’t sufficient). Maybe he just wanted me to feel like I was contributing. Buddy, I want no part of what we’re doing to this guy.

About ten minutes later, the surgeon nicks a small artery. The anus/rectum is a very vascular area and it bleeds like crazy when you do any surgery down there. Hitting a small vessel isn’t uncommon, but it’s still a strange sight every time. One minute I’m looking around the OR trying to stay awake, then all of a sudden the surgeon is taking squirts of arterial bleeding directly in the face. He gets hit in the glasses, the neck, the mask, the chest. The gowns you wear in surgery are Gore-tex so blood beads and then runs down them rather than soaking in. A little pool of blood forms in the surgeon’s lap (the gowns go down to about mid-shin). You want a strange sight, try watching arterial bleeding come out of somebody’s ass and hit someone else in the face. “Bizarre” doesn’t even begin to capture it. You can’t help but think What the hell are we doing?

A few minutes later I glance up at the anesthesiologist who is at the head of the table. He can tell that I’m bored and that I’m tired of holding the retractor. So, he decides to dance. He started rocking out up there. Because the surgeon is sitting down in the nether region, he can’t see this other doc who is busting a move at the other end of the table, neither can the scrub tech. I’m the only one in the room that can see what he’s doing. Of course, I’m caught completely off guard and I start laughing—hard. Holding a retractor in someone’s butthole and laughing isn’t a great idea.

Surgeon: Uh, what’s going on up there?
Me: Nothing, sorry.

This case lasted for about 10 hours. My feet hurt like crazy, as did all the muscles in my arms and back from holding various retractors in the most awkward places at the most awkward angles imaginable. Should give you some idea as to why I think general surgeons are sadistic crazies.

Pray that you never need surgery on your bowels.

Fire in Marijuana house

2008-08-15T19:04:00.001-07:00

Pretty good stuff.

Not My First Rodeo

2008-07-22T20:13:00.000-07:00

I’ve long felt that the best place to people-watch is a large international airport, but I may have been mistaken. What could rival the airport? Small town rodeo. I’ve been to two in the past month and seen things that are too brilliant to capture with words, but I’ll try.

Rodeo one: Oakley, UT. Certainly qualifies as a small town. I actually love it there—very pretty. The rodeo itself was pretty decent, although I was disappointed with the unfunny clowns. This rodeo also seems to draw more city slickers who only bust out the boots and hat once a year so the people-watching isn’t as good. I went the week of the 4th so they had fireworks at the end, but, shockingly, they didn’t play patriotic music. Instead of a God Bless America/Star Spangled Banner instrumental medley they were blaring crap like Happy Trails. Why not just announce over the PA that you hate America, the flag, the Constitution, and God?

Rodeo two was a gem if there ever was one. If any of you ever have the chance to attend the Plymouth, Utah rodeo DO NOT pass on it. The self-proclaimed “Best Amateur Rodeo in Utah” (not sure how many there are) does not disappoint.

We arrived a bit late so the bronc riding (bare back on a horse bucking wildly in an attempt to shed the rope that is compressing his balls) was well under way. Buck Ryan (a perfect bronc rider’s name) from Blackfoot, Idaho was on the mount when we walked into the arena (which consists of some rickety old bleachers about 15 rows high). Most of you wouldn’t know that Blackfoot is actually my hometown. Must have been karma or something, but as soon as I showed up the Blackfoot natives started winning. Buck took bronc riding. Mackenzie Barrington, also of Blackfoot, took barrel racing.

The raffle prizes were amazing. Oil changes, smoke alarms, 1st Aid kit from Crump’s. Comments from the PA like “Are you ready for more buckers” or "that calf was scootin’ and boogey’n”. Cowboys and cowgirls named Stetson, Rowdy, and my personal favorite, Lori Papageorge. I don’t know why that last one struck me as funny, but I laughed for about five minutes after she was announced.

The highlight of the night was an elderly gentlemen wearing a baby blue leisure suit. It was the kind of one piece suit made of thick polyester that you shouldn’t wear near an open flame. It also had one of those built in belts that starts in the seam on the sides of the suit and courses forward toward the sternum at about nipple level. We were able to get a photo from a distance which really doesn’t do it justice, but it will give you some idea of its brilliance.

This one is Ashley and I holding each other and loving each other and being cute together which is pretty much what we're about.

The Last Stand

2008-07-01T09:01:00.000-07:00

Tired? Nearing the end of your rope? Moments away from unleashing a murderous rampage on the next SOB who pisses you off even a little bit? May I suggest an unheralded place of refuge just a stone’s throw away? Comfortable beds and stunning vistas, it’s the ideal place for some sanity-reclaiming R & R. Gorgeous view of Geneva Steel’s old cooling pond and the I-15, crunchy yellow grass, RV parking, friendly staff speaking nearly Queen’s English, complimentary cookies and fruit 24/7, waffle makers at the free breakfast, mini fridge, microwave, ice with a hint of salt, excessively bleached towels, acoustics that rival Abravanel Hall, hot tub with water almost clear enough to see the bottom. Forget Jackson or Tahoe and consider North Orem’s La Quinta Inn and Suites (more like sweets!). A few days there makes the world right again.

What more could you ask for during the final stages of preparation for the most important test of your life (so far anyway)? Not much. For a variety of reasons that I won’t bore you with, I hunkered down there for the final few days of death-bed repentance before taking the USMLE Step 1 (United States Medical Licensing Exam). Became friends with three very nice couples enjoying their Golden Years by seeing the country. They were in town from Mississippi. Each morning when I went in to the little dining area for breakfast I found them watching Fox News and talking about NASCAR—nuff said.

Took the exam last Wednesday. ‘How was it?’ most people ask. Answer: more like a party than a test. Party hats, spirits, salty snacks, the whole nine. It was awesome. They told me that I’m the first person ever to get 100% and they’re waiving my final two years of school. They let me know on the way out that they’ll be using my exam as the key for the rest of the year.

Joking aside, it was about as craptastic as I was expecting (the test, the hotel actually wasn’t too bad). Nothing cool about it, but it’s over. I won’t know how I did for at least a few weeks. Praying for a pass at this point, forget 2 standard deviations above the mean—that’s just greedy.

After a couple of days of relaxing, I spent the weekend in Logan riding in the MS 150 (100 on Saturday, and 50 on Sunday--we didn't ride the Sunday leg) which is a fundraising bike ride for MS research. Everyone there hates MS and wants to see it cured. After 6+ hours on the bike and 101 miles we crossed the finish line—for the race. We made sure to remind everyone that we haven’t reached the finish line for curing the disease…yet. You can imagine a lot of the other unfunny and insensitive jokes that we were cracking along the way.

In all seriousness, that was probably the coolest finish line of any of the rides/races I’ve done. The last little stretch is a fairly emotional scene as you pass by the hoards of people cheering, many of whom obviously have MS.

I was riding with my good friend Zach and his family. His mom has MS. This was my first year in the ride, but they’ve been doing it for several years. They’ve talked about organizing a team called F.U.M.S. I think it’s a great idea. MS can F right off. It’s a stupid disease. So don’t be surprised if I hit you up for a donation around this time next year.

Big thanks to the Longson’s for letting me tag along.

Lessons in Vigilance

2008-06-13T18:10:00.000-07:00

Not long ago, I got online to make my car payment. When I logged in to my account, the balance seemed lower than I remembered it being the last time I checked it.

Naturally, I checked the history and sure enough, $28.51 had been withdrawn by Gold’s gym—odd as I’m not a member at Gold’s. In fact, at that point I’d never set foot in a Gold’s in my life (I’ve been there since to breathe hellfire at managers).

I scrutinize my account history and am embarrassed to discover that this has been happening the 20th of every month for the past 8 months. What an idiot! How did he not notice? Fair question. I only use that particular account to make payments on my car loan. Typically, I deposit a check for a few months’ worth of payments so I can make them online as opposed to dropping off a check every month. I get online statements. I don’t write checks on the account, nor do I have a debit card for it. I have absolutely no idea how anyone could get the account number. Since I only use it once a month, that’s about as often as I check the balance.

Anyway, when I realize what’s going on, I drive straight to my bank. I guess it’s a credit union, Mountain America, to be exact. I explain what I think is happening and they agree that something is awry. We begin investigating. The girl at the bank calls Gold’s. They deflect her to their billing company. We call the billing company, called Paramount something or other, who is staffed by complete imbeciles. They’re giving us the third degree and doubting my story.

I give the guy my account number, he looks it up.

"So you’re not Mohamed Allnur?"

"Uh, no I’m not."

"You don’t know Mr. Allnur?"

"No." (Mister? This a-hole is stealing my money).

Once the genius at Paramount realizes that they’ve screwed up, he stonewalls us and demands that we fax some sort of evidence. I let the girl at the bank follow up on that front. (Incidentally, Mountain America has been great through the whole thing).

I decide to pursue things from a different angle. I make some visits to a couple Gold’s locations to investigate. I pretend that I’m interested in signing up for a membership. How does one get a membership? What ID do you have to show? Payment options? You get the idea. Then I come clean and explain why I’m really there and I try to squeeze the sales guy for some info on this Allnur a-hole…no dice. I have to give the Gold’s corporate folks credit for effectively training all of their personnel to blame any and all problems on their billing company. That was the experience every time—deflected, stonewalled. Fun little game they’ve got going because Paramount blames everything on Gold’s. It’s delightful to deal with both parties.

The next day, I make a few phone calls to Paramount even though they were less than helpful the first time. Finally, I reach a girl who, God bless her, isn’t as smart as she is nice. She’s very helpful, but gave me information over the phone that could probably get her fired. Not only does she tell me which gym Mohamed visits (it’s the one on 53rd South and Van Winkle, if you see him, beat his face in for me), she also tells me how he paid (my bank account number without a bank statement, check, debit card, or any proof that the account was his--which of course it isn't--still have no idea how he got the number) and she actually gives me the Social Security number he used.

[Note to anyone who may find him/herself in a job where you deal with SSNs and the telephone. If you want to verify someone’s SSN over the phone, you ask them ‘What is your SSN?’. You probably shouldn’t say is your SSN 647-45-….]

Yes, I wrote it down. Not that it matters because A) I’m not a thief and have no plans to do anything with it other than give it to the police (assuming they ever call me back) and B) it’s probably not his anyway. In fact, I’d be shocked if Mohamed Allnur is his real name.

Anyway, I pay a little visit to that gym and give a pretty good tongue lashing to the smart ass at the desk who didn’t bother to verify this guy’s account information for the past 8 months. Mohamed never provided them with a debit card or blank check and Gold’s just let it slide—for 8 months. Rather than apologize profusely for being complicit in the theft, they too, question me why it took me so long to notice. I said some pretty harsh things to that guy and few of the other people they’ve got over at Gold’s—not the sharpest tools in the shed if you know what I mean (I’m sure they said the same thing about me when I left).

Long story short, I’ve since gotten all the money back and changed the account number. I’ve tried to file a police report with the Sandy PD and was told they would call me back. That was almost 3 weeks ago, haven’t heard from them yet. I also tried with the Murray PD because the gym he signed up at is in Murray. They wouldn’t even let me file a report with them. I was told that the gym would have to do it. I don’t really expect them to do anything with it. I’m sure old Mohamed is going to get away with it (in this life anyway). I’ve been pretty disappointed with the police. They never asked how much money was taken, for all they know it was thousands. And the follow-up, or lack thereof, has been very unimpressive.

Needless to say, I’m pissed about the whole thing. I hope karma catches up with ole Mohamed and that he loses a testicle to a fulminant case of gonococcal epididymitis.

I’ve been stewing about it for a few weeks now (that’s actually why I’ve waited to write about it because it would have been quite R-rated if I’d written before now). I’ve decided that once I’ve made my millions I’m going to start an organization that solves petty crimes free of charge. That’s right, I’m going to be a P.I. The police are swamped trying to fry bigger fish and all these petty crimes pretty much get ignored. No manpower to investigate them properly so the small-timers pretty much skate. I’m sure we’ve all heard variations of the quote ‘the only thing evil needs to triumph is for good people to do nothing’ or however it goes. Never more true than with small crimes like this one.

So I’ve added P.I. to my life’s goals. I think it would be an exciting and rewarding way to spend my golden years. Once I’ve made enough cash to take care of my family and build my ideal home off the grid, I’m going full-time private investigator. So to Mohamed and the others like him, be advised—I’m going to thoroughly enjoy putting the proverbial boot up your ass.

Jim White / Searching For The Wrong-Eyed Jesus

2008-05-29T10:26:00.001-07:00

Recently I rented a film called Searching for the Wrong-Eyed Jesus on a whim. I'd never heard of it, but for some reason the cover caught my eye in Blockbuster.

The film is a documentary of sorts that consists of little more than a camera crew following a musician named Jim White around the South. It's one of the most bizarre things I've ever seen, but I thought it was pretty fascinating. Jim White, as you'll be able to tell from this clip, is a weirdo that is hilariously philosophical.

There's good folky music, strangeness that can only be found in the deep South, and some scenes in Pentecostal churches that are bizarre to say the least.

Hey Bro

2008-05-14T17:44:00.000-07:00

I’m in a parking lot loading my bike into the trunk of my car yesterday morning after a quick repair at a bike shop on 33rd south and Highland Drive (the pedal and crank fell off suddenly the other day while I was on a pretty gnarly downhill…damn near killed me, but that’s a story for another day).

My car isn’t big enough to put the bike in without taking the front wheel off. Just as I’m setting the front wheel into the trunk on top of the rest of the bike, someone scares the hell out of me with a hearty, “Hey bro! Can I borrow a dollar for the bus?”

I didn’t see this person approaching me because the trunk door blocks my view and I’m focused on loading things in. It’s a husky voice so I assume it’s a man—wrong. With an opener like “Hey Bro” you can imagine she’s not exactly a pillar of femininity.

I only have a 20 dollar bill, which I’m not about to fork over, so I tell her I don’t have any cash. Without hesitating at all, she asks, “Can I get a ride to 7th east and 7th south?”

Quick side note: if any of you should ever find yourself in a jam and reliant on the mercy of strangers (like you end up living on the street, or you get into trouble while you’re out of town, etc.) it is much better to make very specific requests because for whatever reason it’s harder to find excuses to turn down a specific request when someone puts you on the spot. For example, don’t ask someone if they have any spare change, ask them if they have a quarter, or a dollar. I can only think of one occasion when I’ve rejected a very specific request like this. It was in San Francisco and a homeless guy walked up to me just as I was buying a hot dog from a street vendor and asked me if he could have $10. I laughed in his face. Really? Not going to start with 1 or 5, just jumping straight to 10, huh? Sure, would you like my ATM card and my PIN as well? This guy was clearly a professional pan handler and I eventually got him to admit it. Anyway, stick to specific, but reasonable requests.

Since this woman wants to get in my car, I take a closer look at her to size her up and determine if it’s safe. She’s about 5’6”, dark hair that’s starting to gray a little bit, pretty unremarkable wardrobe—T-shirt tucked into jeans, pretty clean. Based on the “Native Pride” hat she’s wearing I assume that she’s Native American (turned out she was Navajo). She’s probably 120-130 lbs, so I decide that unless she has a handgun in her backpack I’m probably fine.

“Uh, I’m not really headed that way, but I could take you to 7th east.”
“Thanks, bro. That’d be great.”

I close the trunk and then get in behind the wheel. She stands by the passenger’s door and just looks at me. Um, I said I’d take you, but if you’re waiting for me to come open your door, forget it. I reach over and open the door, she gets in. She puts her backpack on the floor and then puts on her seatbelt. That strikes me as odd. You’ve just asked a complete stranger—a man, no less—for a ride and then you buckle up? There are plenty of opportunistic crazies out there who would salivate at an opportunity like this, even if she does look like a dude. Lady, if you keep doing this, you’re eventually going to end up in some nut job’s freezer somewhere. Maybe she buckled up cause I did, but she’s clearly not afraid to engage in high-risk behaviors, just didn’t see it coming.

We’re not even out of the parking lot before it becomes apparent that she’s either completely crazy, or has been drinking copious amounts of the ole firewater. If you're that drunk before noon, you’ve got a drinking problem—period.

I would have paid a lot of money to have had a tape recorder for the next 10 minutes. She’s using English words, but the one-sided conversation that ensues is totally unintelligible. She tells me she’s Navajo and informs me that I’m lucky that I’m not Native American because if I was she would “totally be #%&$-ing with my mind right now.” She explains that she loves messing with other Natives’ heads. Dodged one there.

I think she tried to explain to me that her boyfriend is Ute and that he has a friend that’s Sioux, but I never did determine the relevance of that story. She’s giddy, laughing as people often do when they’re drunk, but she’s not really slurring words. She’s just not following any recognizable rules of grammar. She’s essentially spewing word salad, like someone with a head injury might—very bizarre. There’s about a 5 minute stretch where nothing she says make any sense, but she doesn’t stop talking except to take quick sips from her Burger King cup that I assume had Everclear in it.

33rd south is under construction right now, so it’s a slow go. As we’re getting close to where I agreed to make the drop, she informs me that several of her relatives went to school “with Harvard and Princeton.” I had to cover my mouth and choke back the laughter at that one. I didn’t bother to let her know that those are schools, not people. I’m not sure if it’s more funny or sad—probably a tie.

When we reach 7th, I announce that we’ve arrived there thinking she will thank me and hop out and be on her way. I’m pulled over and she just keeps blabbing. Due to the construction, 33rd is down to one lane. A line of traffic is building behind me. “We’re here.” More gibberish. The line of cars continues to grow, she’s not going anywhere. Someone honks, and I’m forced to make a quick right, north onto 7th. I decide I can get on the freeway at 21st instead of 33rd so I figure I’ll drop her there. She was late for something, so I decide getting her 12 blocks closer to her destination is a nice gesture.

She reveals that she’s missed a court date earlier that morning for no reason, which is absolutely hilarious to her. Probably just as well. My understanding is that judges don’t see humor in coming to court trashed. She apparently got a DUI two years ago (shocker) and it’s still not resolved. She feels that it was no big deal. More nonsensical talk about a lawyer, her dad, her boyfriend (who I would have loved to meet), and more crap that I couldn’t decipher.

We get to 21st and I start to pull over. “Wait can you just take me up to the car wash right up here.” Over the course of the ride she’s made it clear that she has no idea where we are, and in her current state, is quite incapable of orienting herself. Two blocks later, there’s no car wash in sight and I’m now taking her further away from her destination. I decide that it’s time to drop her off and pull into a 7-11 and put it in park. She has no idea where the hell she is so I take a minute and attempt to orient her and explain which direction she needs to walk. She says, “Thanks, bro” hops out and walks off.

Entertaining. Bizarre. Sad. Does this kind of stuff happen to anyone else?

Taking the House Back

2008-05-13T13:34:00.000-07:00

Some of you may recall the story about the little problem we’ve had w/ mice. If not, visit the archives and read the Mouse God post from February and you’ll be up to speed. Much has happened on that front since that time so I felt that an update was in order.

Until recently, I’ve pretty much left the mice alone since the first killings in February. But the mice are prolific procreators, and the problem had progressed to an embarrassing level given my bravado in the first post about the mice. So I refocused on retaking the house.

My sister and I started by cleaning out the food storage area of all the stuff they’ve been fattening themselves on. With their food source gone, they’ve been much more desperate and their forays out in the open have become more frequent and more daring.

So the hunt was back on, and I’ve successfully employed several methods. I started out hunting them by hand. I’d corner them somewhere and then snuff them out with whatever was close by: rolling pin, shoe, small piece of wood, can of fruit cocktail, etc.

I’ve also had some success using traps baited w/ peanut butter. The little guys can’t resist the stuff. I’ve found that putting the traps out of sight (under a shelf, etc) gives them a false sense of security and before they know it, BAM! Fractured skull. Lights out.

I think I accidentally starved one to death as well. The other day I was rooting around in some #10 food storage cans looking for him for a few minutes. I never could track him down. Found him dead a couple of days later. Apparently, I inadvertently boxed him in and he couldn’t escape. Yes, I wanted him dead, but slow deaths are unusually cruel. I feel bad that he either starved or died of dehydration.

As much as it pains me to admit it, I also have to credit our otherwise lazy cat with a couple of kills. He usually doesn’t show a lot of interest in it, but he has managed to off a couple of them recently.

Last week, I think I reached the pinnacle of my amateur career as an exterminator. I actually got one with a BB gun. I’ve had the idea for a while, but hadn’t gotten around to buying BBs until recently. I wasn’t sure I’d be able to hit one cause they’re small and pretty fast and BB guns aren’t the most accurate firearms out there. I also wasn’t sure if the gun would be powerful enough to kill one.

The BB gun we’ve got is an old one that turned out to be quite a bit more powerful than the ones they’re making these days. More than enough gun to do the job. I’ll spare everyone the gruesome details, but I will say that the little guy had both entrance and exit wounds courtesy of my marksmanship. I was about 10 feet away and was pretty shocked when I not only hit the little bugger, but killed him cold. I guess I shouldn’t have been that surprised. When I started thinking about his tiny body compared to the BB, I realized that a mouse taking a BB is about like a human taking a canon ball.

I’m feeling good about reclaiming the house. Allowing these little parasites to completely decimate the food storage, simply wasn’t an option. I did gain a new respect for them though. They learn quickly. At first, they would lazily make their way to cover when I flipped on the light and walked into the room. After a few of their comrades went down, they started showing a little more hustle as soon as the lights came on. They also changed up their escape routes to keep me off balance.

Recently, I saw an impressive display of grit out one of the smaller ones I’ve seen. I went in to check some of the traps I had set. One of them was not where I had left it. Puzzled, I began digging around the room looking for it. Sure enough, a little mouse had gotten his foot caught in it and then dragged it about 2 feet to cover. He was still struggling to get away. I reached down and picked up the trap and him and he immediately started biting the leather gloves I had on—he was not going to go quietly. Impressed by resourcefulness and fight, I considered letting him go. But with the broken leg he had, it wouldn’t have been long before the cat caught him and ate him alive. I decided to give him a quick and relatively painless dispatch instead.

I’m sure there are a few remaining survivors, but things have been pretty quiet on battle field lately. For such an insignificant accomplishment, I'm oddly proud of myself.

This Seems Fine

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

This is in India. I saw this the other day and nearly crapped my pants. It's a ritual that is several hundred years old and they claim it doesn't hurt the babies. I have my doubts.

I wonder how things like this get started.

"We should do something to help our baby be healthy and safe."

"I have an idea. Let's go drop him off the roof of the church."

Genius.

Ben Folds is a Wizard

2008-04-24T13:25:00.001-07:00

While watching him perform live last night, I concluded that this kind of talent can only be acquired by making a deal directly with Beelzebub himself. He is absolutely unbelievable.

I keep a running mental list of a select group of artists that can only be adequately described with one word: Badass. With his performance last night, Ben Folds secured a permanent spot on that list. Others on the list include Jack White, Beck, Tom Waits, Win Butler, Neil Diamond, but that's neither here nor there.

This is a clip of a song that he didn't play, but I really wanted to see/hear. It's dated (note the ridiculous light show and switching back and forth from black and white to color), but you get to see the wizardry I'm talking about. Particularly at about the 4 minute mark where it almost looks like he has 4-6 hands.

If you're not listening to him, you should probably start.

Elephant Paints Self Portrait

2008-04-21T08:31:00.001-07:00

I'm pretty busy studying with tests coming up so I don't have time to write about anything. In lieu of some meaningless anecdote, I give you an elephant painting a picture of himself.

Arcade Fire

2008-04-16T21:21:00.001-07:00

Some of you know that I'm a big Arcade Fire fan. This is them playing live in an elevator--not quite as spontaneous as the White Stripes' performance on a bus, but awesome nonetheless. If you're not listening to these guys, you need to start.

"Can I borrow your phone?"

2008-04-01T21:46:00.000-07:00

I’m not sure exactly what it is about me that makes me the guy that people ask to borrow a cell phone from, but it happens to me more often than chance alone can account for. I’d like to think that I look approachable and look like the type of guy who’d be willing to help someone out when they’re in a jam. But with the beard and the sour look that I have on my face more often than not, I doubt that’s the case. (People frequently tell me that when they first met me they thought I was pissed off.) I thought my aloofness was off-putting, but apparently not to people who need to make a call.

Several times on a crowded train I’ve been approached by someone and asked for my cell phone. It happened again today. With all of this lending I’ve been doing with my phone, I’ve noticed some things that I pass on so you can know what you might be in for should a total stranger ask you to use your phone.

First, when someone you don’t know asks to borrow your cell phone, they almost never use it to make the call you’re expecting them to.

Today’s episode is a good example of what I’m talking about. A guy walks the length of the train toward where I’m sitting, passing several people along the way and sits down directly across from me. He’s in a sweet pleather jacket holding an empty gas can. Mid-forties, cleanly shaven, buzzed head.

“Hey, do you have a cell phone I can borrow.”

I dig it out of my pocket and hand it to him, “Sure.”

He flips it open and dials a number, puts the phone to his ear. 30 seconds or so pass before this fella realizes that it’s not ringing because he didn’t hit ‘Send’. He finally figures it out.

No one answers on his first try so he flips the phone shut, reopens it and then tries again. He repeats this about 4 times. I didn’t have the heart to tell him that he didn’t have to fold the phone shut every time, that just hitting the old ‘End’ button would do the job. It’s not rocket surgery, my 3-year-old niece can do it, but phone borrowers frequently look like they’ve never used a cell phone before—maybe they haven’t.

I’m sitting there smiling at this guy who’s clearly frustrated by his struggles with the phone. I’m fully expecting that the empty gas can in hand means he is either calling someone for a ride or informing someone that he will be late or something like that. Nope.

When he finally gets through to someone he tells them not to mess with his desk and that he’ll be back later. He informs whoever it is that he’s probably going to the hospital because he believes he’s having a heart attack. Uh dude, if you think you’re having a heart attack, you should probably be dialing 9-1-1, not your secretary. I never did figure out the gas can.

After the call, he thanks me and then strikes up a conversation by saying, “Name’s Dave. Dave Wolf.” [I changed his name because I wouldn’t feel right slandering him if I was using his real name] He’s saying this as he reaches out to shake my hand.

Inexplicably, he begins describing his symptoms to me asking me if I think it sounds like a heart attack. He’s describing tightness in his chest, shortness of breath, pain in his neck and arm—all symptoms one might have during or before a heart attack. I thought he was exaggerating on the phone, but these are worrisome symptoms so I tell him that he should definitely get it checked out. Then he asks me if I’m in college. I tell him I’m a med student and he says, “I knew I was talking to the right person, I prayed about it.”

Something about the whole exchange didn’t feel quite right. He was either drunk, or not playing with a full deck, or rattled because he was about to have a heart attack, but something about him was just off a little. That too, is typical of the cell phone borrower, something will always be a little bit off.

Another thing you can expect is for them to violate what seem like common sense unwritten rules of 3rd party cell phone usage. Take Dave. In the few minutes that he had my phone in his possession, I watched him wipe his nose and his mouth with his dialing hand. ’Preciate it, Dave. Since he’s just wiped his nose and mouth on my phone, I take a closer look at both. He’s got what appears to be poo all over his lower lip. Maybe he was eating Tootsie rolls, or dipping some chaw. Either way, I don’t want that on my phone.

Another common violation of these unwritten rules: call length. As the lender, I don’t think it’s unreasonable to expect you to keep your call to a minute or two. Calling someone to pass on a quick message, or to tell them you’ll be at a certain stop in 10 minutes, that’s fine. What’s not fine is calling someone with my phone to socialize.

About a month ago, some dude sitting next to me asked to borrow my phone and then proceeded to shoot the breeze with his buddy for a few minutes. He also coughed on it repeatedly. Sorry pal, you’re done. I was forced to step in and cut him off. I’m sure he was planning on talking until I did.

Another no-no is talking on my phone in another language. Some guy (another tid-bit: phone borrowers are almost always men--no idea why) borrowed my phone a while ago, and starts speaking a language that I didn’t recognize. He kept looking at me and he was laughing a lot—definitely not an emergency call. Again, I have to step in and reclaim my phone.

I don’t know about you all, but cell phones have become affordable enough and so ubiquitous these days that I almost feel that people who don’t have them should explain themselves. I was in Ghana last summer and saw many people living in homes with no electricity or running water, but they had cell phones. Um, Ghana is in Africa—not exactly the front lines of technology. Few excuses hold water here in the US.

So if you’d rather not watch some A-hole shamelessly squander your minutes right in your face, be mocked in a foreign tongue, or see stranger germs slathered all over your phone, you may want to condition yourself to say “I don’t have one” so you’re ready when a stranger asks you, “Can I borrow your phone?”

There Were No Witnesses

2008-03-27T06:51:00.000-07:00

The past couple of weeks have been the most crash-ridden weeks of my life. As many of you may know, I’ve gotten into biking quite a bit the last couple of years. Last year I was mostly on my road bike. In January, I bought a mountain bike. With the warmer weather, I’ve been on it quite a bit the last couple of weeks, ergo the crashes. Five separate bike-related crashes. In all of them, I was the main participant and the only injured party (I should say the only human party injured—a little foreshadow for you). My biggest disappointment: no witnesses for any of them. No one to make fun of me later by bringing it up in social situations. No one to sympathize with my bruised ego and bruised body.

Crash #1: I’m cruising down to my buddies’ house for a garage sale. I’m rounding a tight corner (with some speed). I’m on a sidewalk that is lined with trees on either side. As soon as I round the corner, I see a group of kids playing on the sidewalk. With the low-hanging branches and minimal space between trees, there is no where for me to get off the sidewalk without getting clothes-lined by the trees. So, I slam on my brakes and aim for grass. My bike has the pedals that your shoes clip in to, and they’re brand new and very tight. Needless to say, I don’t get my feet out in time and I crash, right-knee first into the grass. I’m lying on my back, both feet still securely clipped in to the pedals for a couple of seconds while I admire the grass stain/bruise on my knee. Inexplicably, the kids do not turn around until I’m back up and pedaling away. They heard the crash, but didn’t see it.

Crash #2: Four of my friends from school, and I were going on a ride on the Bonneville Shoreline trail up by the U. 3 of my friends go up a rather steep part of the trailhead with apparent ease. I decide not to downshift because they made it look easy. I get about ¾ of the way up the little hill and realize that I’m not in a favorable gear for a hill that steep. I try to shift—an ill-advised move when you're on a steep hill and already straining your bike. The chain slips, I fall, again no one sees it. One of my buddies looks up and sees me on my back, but missed me tipping over. Unhurt, I climb back on the bike and keep going.

Crash #3: Definitely the most spectacular of the crashes and the one I really wish someone had seen. We’re on the same ride as Crash #2, a stretch of the trail called Dry Creek. However, at this time of year, Dry Creek isn’t exactly dry. I’m approaching a steep part of the trail that still has snow on it. The ground that is exposed, is thick mud that is a couple of inches deep—the kind of mud that loves to wrap itself around bike tires and not let go. At this point in the ride, I’m the caboose in our 5-man train. 3 of the 4 guys ahead of me have ridden up this steep stretch successfully. The fourth was wise enough to hop off his bike and walk it up. I decide to try to ride it.

This particular part of the trail is also quite narrow and has mountain on one side, steep drop-off on the other. As luck (or nature) would have it, the side that looks the most passable is the side closest to the drop-off. I think you can see where this one’s going.

I build up as much speed as I can going into the hill. Things seem to be going pretty well until I hit the deepest part of the muddy bog that is the “trail”. As my bike gets mired in the mud, my back wheel stops spinning, despite my best efforts to pedal through. I make one last-ditch effort to free my bike by cranking my front wheel to the side—away from the snow. Doesn’t work, bike stops, I lose my balance. This time I’m able to get my feet out of the clips, but not before I fall, head first, off the edge.

I don’t remember what I yelled as I went over, but it was surely something that would have made my mother feel like a failure had she heard it. Fortunately, my bike was so bogged down that it stayed put. I’m not sure how I managed to hang on to it, but seconds later I found myself on my back with my left hand above my head clinging to my handlebar that was hanging over the edge. It must have looked like a scene from a movie (Black Sheep comes to mind) where someone is desperately clinging the branch of some shrub praying that the roots will hold and prevent them from tumbling down into the ravine. After a few stunned seconds of silence, I realize that I’m uninjured. I do a pseudo pull-up using my handlebars and climb back onto the trail, do my best to wipe off all the mud, and pedal after my group, oddly proud that I’ve just front-flipped off of a cliff.

Crash #4: Not a crash in the traditional sense, but it was bike-related and quite a sight so I’m counting it. This week I’ve been riding my bike down to the train and taking it up to school with me. In order to get to class on time, I have to leave my house while it’s still quite dark (fear not mother, I have plenty of reflective clothing and a little signal light that blinks so cars can see me). Yesterday as I was leaving, I scared the crap out two deer that were foraging in our backyard. Totally unaccustomed to having company in the backyard at that hour, they were immediately panic-stricken when I pedaled out of the back door. They bounded away in opposite directions. One of them tried to jump the 6-foot chain-link fence. It looked really painful as she went full speed, face first into the fence…twice. Usually they can jump the thing without much trouble, but she didn’t have a lot of room to run and must not have had a full head of steam when she made the jumps. I stopped riding at that point to see if she’d stop ramming herself into the fence. She finally busted through a gate and into the neighbor’s yard.

The other deer had a little more luck. She booked it to the front gate and just lowered her head and plowed right into it. Fortunately, the gate popped right open and she was able to get out into the street where she felt safer.

Crash #5: On another trail-ride with a friend yesterday after school. He’s a much more experienced mountain biker than I am and he’s smaller than me and riding on a smaller bike. He’s barreling down the mountain and I’m trying to keep up but I can’t quite navigate the turns with the same ease. I come to a sharp turn that is covered in loose gravel. By the time I’m able to actually see the turn and the gravel, it’s too late to kill enough speed to make the corner safely, so my options are: ride into the trees, or do my best to make the turn. I don’t like my odds against the trees, so I stay on the trail.

As soon as my back wheel enters the gravel I know I’m done for. I fish-tail for a second and then come to the moment that anyone who’s ever wrecked on anything will probably recognize. It’s that split second when you come to the realization that 1) I’m going down, and 2) It’s going to hurt. That’s about all the time you have to think before you wreck. Somehow I manage to crash in such a way that one side of my handle bars jams into the ground while I impale the inner part of my thigh on the other side. I have a nice circular wound that is equal parts bruise and rubber burn (the grips on my bars are rubber). Fortunately, I was wearing gloves or I’d probably still be picking gravel out of my palms. Other than the near-puncture wound on my thigh, and the bruises on my hip and hands, I was okay and so was my bike. Again, no witnesses. There was a runner that heard me go down and turned around to see if I was okay but he didn't see it. He kept running the other way when he heard me laughing at myself.

As I’ve mentioned before, and as you can deduce from the account of my recent crashes, my athletic prowess is truly something to behold. Too bad no one has been around to behold it.

Analyze This

2008-03-22T19:09:00.000-07:00

I had a very vivid, very weird dream recently that I can’t make sense of. So for all you amateur Freud’s and Jung’s out there, I open it up to interpretation. If nothing else, you might laugh. I did.

I’m in an older building that is very dark. The room I’m in looks a lot like the locker room of my high school only much, much darker and older. I’m surrounded by many medical students (all fully dressed) that I recognize, but I don’t know any of them personally because none of them are in my class.

I’m sitting on a bench when a girl that I’ve known since elementary school, but with whom I was never really friends, just acquaintances, comes out of no where and she is singing a Faith Hill song to me, real sappy and romantic. I don’t recall talking to this girl for well over a decade. She proceeds to confess her undying love for me and ventures to prove that love to me by arranging the sausage and pepperoni on the pizza that has appeared next to me into the shape of a heart. I feel pretty embarrassed because everyone in the room—mostly upperclassmen—are staring at me. Then she leaves.

Moments later, a guy that I recognize because he and I were in the MTC at the same time emerges from the crowd and also confesses his love to me. I’m beyond mortified at this point because of the homoerotic spectacle (a phrase I stole from my brother) I’ve just been forced to be a part of. He’s sweating profusely and on the verge of tears. He pulls me in for a firm embrace as if he and I have just survived a near death experience together. Then he proceeds to drag me by the wrist through the throngs of people to another room in this building.

He introduces me to 3 people who, according to him, “made it all possible.” Person #1 is that strange Indian guy (dots not feathers) from the Bud Light commercials that says ‘Bood Light’ (See him in action here--he's at the very end). Person #2 is an Asian kid that I don’t recognize. Person #3 is a middle-aged Latino man that looks a lot like a guy that I once saw take a pee on the floor of the train one day.

We leave this room and go sit on some stairs nearby. I’m wondering what the hell has provoked all this, worrying that this kid is going to try to kiss me, when I realize what has happened. I somehow come to the conclusion that the Latino train-wetter is an acting coach who has given an assignment to his students to confess their love to someone as an exercise in acting. I’m trying to figure out why these two, near strangers, have chosen me to help sharpen their acting skills. Then I wake up—and laugh.

On Settling

2008-02-27T16:24:00.000-08:00

A good friend of mine emailed me a link to a very interesting article about settling. If you're married, it probably won't be of much interest to you. It's a bit long so I wouldn't try to tackle it unless you've got a few minutes.

The author of the article is a self-proclaimed feminist and she's straight so she's talking about settling for Mr. Good Enough and not holding out in vain for Mr. Right/Perfect. In my opinion, it's equally applicable to men. It's definitely thought provoking and insightful. I'd be interested to hear what people think of this. I think she makes some pretty compelling arguments. Click here to read it.

Public Transit: an endless source of blog-worthy material

2008-02-25T17:54:00.000-08:00

Experiences I've had on public transit (mostly TRAX) have probably been the subject of more blog posts (mostly on my other blog) than any other single topic. With the exception of emergency rooms, buses and trains are hands down the best places to see weird people doing/saying weird things. The train came through again today.

At the 21st South stop, a short, skinny guy gets on that I can smell immediately. Smells like he’s converted a septic tank into a sauna and has been holed up in there for weeks subsisting on a diet of cabbage, beans, and alcohol and when he finally emerged from his poo sauna, went and wallowed with some hogs for a spell—very pleasant. He’s unkempt, unshaven, filthy, and likely homeless. (They love the train.)

He immediately proceeds with his second egregious violation of unwritten social norms (the first violation, of course, was boarding public transit drunk, smelling like butt crack) by sitting next to yours truly when there are at least a couple rows of unoccupied seats where he could have sat next to no one. Much like the proverbial “that guy” who, in a nearly empty public restroom, pulls up to the urinal right next to you—when he could have easily created a 2-3 urinal buffer—then starts making small talk. Uhhhhh dude, if you insist on chatting at least wait till we’re washing our hands, I’m sort of doing something right now.

I try my best to keep a straight face while I fight to breathe through this guy’s unbearable funk—no small feat when he’s basically sitting on your lap. It becomes too much and I have to put my head down on my knees and pull my hood over my head to stave off asphyxiation.

As we approach downtown, the conductor chimes in on the PA system and announces that those passengers wishing to go downtown need to exit at the next stop and board a downtown train as the train we’re on is a University train. He probably announced that three times as we approached the stop—he even said which side of the platform to exit on. It is by far the most extensive and direct set of instructions I’ve ever heard during my year and a half riding the train. Crystal clear instructions in a perfectly audible voice.

We make the turn from Main street and head east towards the U. At this point, I doze off. 4 stops and about 20 minutes later, I awake to feel a hand rubbing the small of my back.

Homeless guy: Hey buddy, are you okay?

(egregious violations of unwritten social norms numbers 3 and 4: rousing strangers when they’ve fallen asleep on public transit by touching them; breathing in someone’s face when you’re piss drunk and have breath that smells like you’ve been eating poop sandwiches and chasing them with shots of anti-freeze)

Me: Uh, yep. Just taking a little nap.

Homeless guy: Oh, I thought maybe you were sick or something.

What on God’s green earth could have made me feel sick? Certainly not your stench. I really wasn’t annoyed. I thought it was pretty funny. I was actually a little touched that with the magnitude of the problems this guy is facing, he was actually feigning concern for me. He quickly makes clear his true motives for waking me up by asking me if the next stop is at the Gateway.

Me: Uh, nope, you’re on the wrong train. The next stop is University Hospital.

Homeless guy (long pause while he processes this): #$%!

He interrupts his stream of expletives with a very crass comment about a girl that’s getting off the train and happens to be wearing really tight jeans, then continues cussing randomly for about 30 more seconds.

Me: (soft chuckle)

Homeless guy: Do you know how I can get to the Gateway?

I explain to him that the very train we are on will be heading back toward the Gateway in a few minutes and if he just stays put, he’ll eventually get there.

Homeless guy: Oh wow! So the train’s just gonna flip a b---- (popular euphemism for a U turn)?

Me: Yep. Sit tight and you’ll get there. Good luck, man.

Homeless guy: Thanks, friend.

I’ve been laughing about it all day. For some reason the way he put his hand on my back and kind of rubbed it for a second is hilarious to me. I’m sure he won’t remember doing it, but I won’t soon forget it. As funny as it is to me, it’s also sad. Anyone who’s that drunk that early in the morning is leading a pretty hard life. You see a lot of sad cases on the train if you ride it often…and pay attention.

Back rubs from a drunk (and possibly gay) homeless guy—the train truly is amazing.

Now that shit's funny

2008-02-22T12:32:00.000-08:00

First, an apology to my mother (and any others who may be offended) for the title of this post. The double entendre was too irresistible—I had no choice but to go with it.

I’ve just come to the end of our Gastrointestinal Organ System block so I’ve been learning about poop and the like for 3 weeks. The test that I took this morning was much like I imagine an ice water enema might be.

But, in the spirit of GI I thought I’d pass on a few nuggets that I picked up during this block that are not only educational, but, in my mind, also very funny.

Number one, I give you the defecation posture. Some of you may already have perfect form, but I’d bet that many of you could use at least some improvement. That’s right, there is such a thing as proper pooping form when you’re on the can birthing one. The animated pooper is performing what’s known as the Valsava maneuver. With throat closed, the diaphragm pushes down, and the abdominal musculature contracts. This raises intra-abdominal pressure so as to send last night’s dinner south to swim, if you catch my drift. Incidentally, the Valsalva maneuver is the very same maneuver that males are performing when they dutifully ‘turn their heads and cough’ as the doc checks for a hernia. [Be sure to click on the images to enlarge them, the text is priceless]

My favorite part is that the diagram actually notes that the forearms should be used for support. Perhaps I’m just a natural, but that part seems pretty intuitive to me. I suppose it’s possible that there are some defecation neophytes out there that, without such instruction, would be liable to pitch too far forward and smash their chin on their knees or foolishly position their pelvis at an angle disadvantageous to delivery. Also, looks like this guy may have gynecomastia (man boobs), a mullet, and prefers to poo in the buff.

Number two (get it? dammit that’s funny), I give you the Bristol Stool Form chart. This chart was presented in several of our lectures, so yes, it is for real. You want to be in the 3-5 range most of the time. If you find yourself chronically in the 1-2 or 6-7 range, give me a call and we’ll talk over some things that can get you into the optimal range. [Click to enlarge. Spend a moment and absorb the brilliance of this chart]

Finally, I offer you a fact that I’m still trying to digest. During a lecture about laxatives, our pharmacology professor cited an article published in a 1905 edition of JAMA (if you’re not familiar with the acronym, the Journal of the American Medical Association is one of the most prestigious medical journals in the world and is generally a reliable source). The article was about a man than holds the record (which still stands) of the longest period of time without taking a poop. Take a second and try to remember the longest you’ve ever gone. My record, probably a about a week and it was after surgery so I wasn’t too concerned. Normally, I’m nervous after a couple of days. This dude apparently went 368 days between poops. One year plus! When he finally did go, he delivered 36 liters, no that’s not a typo, that’s thirty-six liters of poo. Next time you’re at the grocery store in the soda aisle count out 18 two liters and imagine them full of turd. Unbelievable.

So work on your form and shoot for somewhere between cracked sausage and soft blobs and if you've gone more than, say, a week, it's time to seek medical attention.

The Mouse god

2008-02-17T23:24:00.000-08:00

About a month ago I was laying in my bed reading, as I often do, and dozed off for a few minutes. I woke to a tickling that I felt on my arm. When I came to and opened my eyes, I was face to face with a very small, rather cute mouse sitting on his haunches looking up at me about 18 inches away, resting calmly on my chest.

I’m not afraid of mice so I held perfectly still, but I was certainly surprised. Surprise quickly turned to anger when my post-nap brain finally processed the fact that this little bastard actually had the audacity to climb on to my bed, then on to my chest and just sit there and stare at me. Sorry, no breathers on my chest pal, move it along or die.

In retrospect, I’m not sure why I was pissed about it, but I was—maybe because I’m not too keen on surprises in general, certainly not surprises that involve vermin in my face. So I made a valiant effort to catch the little guy but he wriggled out of my hands twice and vanished.

We’ve had several run-ins since then. One time I had him cornered in my bathroom. I sealed off the crack under the door with a towel and chased that little SOB around the bathroom with the plunger. I made contact with several blows that I thought would be fatal, but each time I raised the plunger, that little bugger would take off running again. He eventually managed to wriggle his way around (or possibly through) the towel and escaped into the hallway.

The other night I came down stairs late at night and flipped a light on in the basement and caught my little buddy out in the open, totally vulnerable. Curtains, pal. I thought I had him. The only thing I had in my hand was a toy doctor kit (part of a very clever/funny gift from my Valentine—touchdown!) I took a couple of good swings at that little fart with the doctor kit as I chased him around the basement (by “chased” I mean that I hobbled pathetically around…because of the broken toe of course). I made good contact a couple of times, but he got away again, seemingly unscathed.

Impressed by his Houdini-esque skills, I dubbed him the mouse god because he’s an unbelievable leaper, is very fast, seems to be able to go through doors, towels, plungers, boxes, or anything else I throw at him. I'd wager that the little punk can run on water like one of those freaky lizards. Every time he’s been able to escape unharmed…until last night.

Maybe it’s the fact that I’ve been sick for a few days and had some pent up frustration. Maybe it’s the book I’ve been reading about the war in Iraq (it’s called Chasing Ghosts—highly recommended). I honestly don’t know, but last night I had an insatiable blood-lust that I can’t really explain, or be proud of. As I walked by our storage room and heard that little SOB rooting around in there, I decided that enough was enough and that he had to die—immediately. The traps we set hadn’t worked so it was stake out time.

I waited patiently until I figured out where he was by listening intently to that annoying scratching noise his little claws make when he scurries around on a hard surface. Lest I entice some zealous PETA nut jobs into harassing me, I will spare you the details of his demise, but I will tell you that the mouse god is indeed mortal. I sent him to meet his Maker last night.

Other than his relatives that have also arrogantly taken up residence in our storage room, no one is mourning his death. I have since sent two of his relatives to join him in mouse hell and the few survivors that remain will be joining them shortly. I’ve damn near eradicated the entire family, and I’m strangely proud of myself for it. I feel a bit like the ripped out athletes in the Under Armor commercials that are always yelling "We must protect this house." I haven't yelled that yet, but I'm considering it...maybe after my next kill.

Toe-tally Lame

2008-02-09T15:26:00.000-08:00

The following is the fictional story that I’ve been using as an explanation for how I broke my toe. I’ve been surprised how often people—even people who know me well—have believed it. Evidently, I'm a pretty convincing liar.

I’ve changed a few of the details each time, but the crux of the story is that I was walking from the train stop to school when I saw a single mother carrying her handicapped child across the street. She was so preoccupied trying to carry one child and herd two others that she didn’t notice the snowplow bearing down on her little family. I see what is about to happen and, with complete disregard for life and limb, race into the street, snatch up the two loose children and tackle mom and the child in her arms into a snow bank, saving their lives. My heroics are good enough to get everyone to safety milliseconds before the plow strikes—everyone, that is, excluding me.

I was extremely fortunate that only my toe remained in the path of the plow. It’s been sort of a miracle that the knowledge that the whole family is safe has made it so I don’t feel any pain in my mangled toe.

My favorite part of the story is that I specify that she is single and her child is handicapped--details that I thought would be red flags.

Truth is I was running barefoot through a hallway in my basement and caught my pinkie toe on a bookshelf. The toe bent so it was nearly perpendicular to my foot, which felt really good. I spent a few minutes face down on the carpet using language I’m not proud of. I spent the next several hours sleeping. When I woke up, my toe was very sore and much of the top of my foot was blue and swollen.

Thanks to Mike who helped me with the fluoroscope and initial diagnosis. Thanks to Nate who lent me his walking cast to get me through the first couple of days. And big thanks to Crime Dog (Steve) and his dad (he’s a podiatrist) who did the X-ray that clinched the diagnosis (Mike and I were worried that I might have had a second fracture in my foot) and set me up with the supplies I needed to get better—very gracious and generous.

FORTUNATELY, my foot is fine and it was just the toe that was broken (it’s a pretty good break though, sort of looks like an inverted “T” with horizontal and vertical components to it). The toe should be as good as new in a few weeks.

UNFORTUNATELY, I broke it in one of the lamest ways imaginable and am forced to make up semi-impressive and wholly implausible stories about how I did it. This does, however, preserve my streak of breaking bones in unbelievably stupid, uncool ways. I’ve broken three bones in my life. Broke my hand swimming. Broke my nose catching a softball with my face. And now my toe jogging in my basement. I'm pretty athletic.

Pelvic exam, anyone?

2008-02-07T17:08:00.000-08:00

In talking with some people about an experience I had last week, I was surprised at the interest and the number of questions I’ve received. I thought some of you too, might be interested to know how future docs are trained to perform pelvic exams. If you’re not, stop reading now cause this is a bit long.

The short answer is that we learn from very professional and competent women currently in the employ of Gynecological Teaching Associates. The company was founded about 30 years ago by female OB/GYNs who undoubtedly had some horrific experiences at the hands of their own doctors and decided that there was a better way to teach pelvics (as we call them in the biz) than using cadavers and anesthetized patients who can’t say, “Um, that hurts.”

I wasn’t sure what to expect, other than near-crippling awkwardness, but I was surprised to find that it was several orders of magnitude LESS awkward than I had planned on.

Here’s how it works. 4 medical students are assigned to 2 instructors. The first person in the group is basically taken on a “guided tour” (that sounds awful, but it’s pretty accurate) of the first instructor’s body. Yes, you actually perform the exams on the instructors (who, by the way, are not our professors—we probably won’t see these women ever again—which is nice for all parties involved). I have no idea how much money these women make (I know they are fairly well-compensated) but it isn’t enough. The 2nd student then tries his/her best to mimic the first exam. The last two students perform the exams on the 2nd instructor, so you watch 3 exams, perform one.

So you come into the room and basically role-play as if it’s an office visit and the patient has never had a pelvic before. After the initial greeting and introduction, you explain the following:

Dr: The full pelvic exam consists of four parts. First, I’m going to examine your external genitalia (lymph nodes, mons pubis, both sets of labia, clitoris, urethra, pubic hair, etc). It’s important to say “I” as opposed to “we” during the exam or the patient wonders who the hell else is going to be examining them; it’s harder than you’d think not to say ‘we’ in situations like this.

Pt: (I imagine most patients don’t say much here).

Dr: Next, I’ll be using a speculum to examine your cervix. Have you ever seen a speculum before?

Pt: No. (Probably not true, but they want to see the damn thing before you use it on them, or so we were told).

You then ask them to make their hand into a loose ring as if to simulate a vagina and you show them what you’re going to do with speculum. They actually told us to use our other hand and make a fist with it to represent the cervix. You then have the patient look through the speculum, which is in her hand at this point, at your fist and say, “This is sort of what it will look like—-a little pink donut-looking structure.”

Dr: Any questions?

Pt: (In her head only) Lord in Heaven, get me the hell out of here.

Dr: The third part of the exam is a bimanual exam where I will place two of my fingers in your vagina (I thought this would be really awkward to say out loud and face-to-face, surprisingly, not so much) and one hand on your abdomen. I’ll be feeling for the margins of your uterus and for your ovaries.

Pt: (Again, probably not a lot of chit-chat at this point).

Dr: The fourth part of the exam is a recto-vaginal exam (important not to use the word anal because of the sexual connotations). Are there any questions?

Pt: I’m sorry, it sounded like you said ‘recto-vaginal’? You want to explain that one?

Unpleasant for everyone, but a recto-vaginal (one finger in each orifice) is the only way to check for fistulas (birth defect that is basically a hole that connects the rectum to the vagina, which is bad because you can get feces, if it’s a big fistula, or bacteria going from the rectum into the vagina which can cause recurrent infections like UTIs). This exam is also the only way to feel the back of the uterus and is a quick screen for endometriosis and polyps. My understanding is that this is not practiced widely, but it is the standard at University Hospital.

At that point, you hand the patient a mirror so they can follow along if they want to, and you move the drape and start the exam.

For the sake of decency, I won’t go into all the details about how this actually played out on my exam. But I will say that you sort of forget what to say and inevitably forget a step or two either with the exam itself or in the explanations you provide. Fortunately, these women were incredibly understanding, and were great at reducing the awkwardness and building our confidence that we can in fact perform the exam as it’s supposed to be done. Also fortunate that I didn't make any major mistakes or embarrass myself or anyone else.

There was one funny moment that my family will appreciate more than anyone else. Just prior to the recto-vaginal portion of the exam, you remove the outer of two gloves on your dominant hand. You’re supposed to de-glove below the level of the exam table (it’s not called a bed, and the sheet she’s using to cover her legs and abdomen is a drape, not a sheet—have to avoid anything even remotely sexual) so the patient can’t see your glove, or what might be on it (blood, other fluids, etc) from the previous portions of the exam. The two students before me had forgotten this step, so when I remembered (about the only thing that I did better than the others), they congratulated me and one of them mentioned my last name in the process.

Our instructor, still fully exposed, feet in the foot rests (they told us not to call them stirrups because no one will be riding a horse), with me still about 18” from her V-Jay Jay (as Oprah calls it) says, “I know a Dr. Thueson. Does he work at Alta View?”

Anyone in my immediate family knows that we can’t seem to go anywhere in the world without running into someone my dad knows either through medicine or some random connection. Just finishing up my first pelvic exam and sure enough, my instructor/patient knows Dad—priceless.

Who is Todd Shischler?

2008-02-06T12:11:00.000-08:00

Some of you may have asked yourself this very question. If so, you’ve done exactly what I hoped people would do when they read my screen name. Since it has caused a little confusion with at least a couple people, I thought an explanation of the origin of the name was in order.

It comes from a Bud Light commercial. In the first scene, we’re shown a typical scene backstage immediately following a concert. There are two attractive young groupies hanging around the after party. They cozy up to a guy who has a Bud Light in his hand and ask him to sign their bellies with a Sharpie. The guy obliges. They then ask him what instrument he plays in the band. The guy replies, “Oh, I’m not in the band, I’m just here for the Bud Light.” The girls walk off disappointed.

At this point the commercial cuts to a shot of the product, some Bud Light bottle with little bits of ice clinging to it, cut to a shot of the product being poured into a tall beer glass, as the voice over explains why Bud Light is superior to other light beers—you get it. Then it cuts to the final scene where the groupies have now cozied up to an actual band member. The real band member reads the name on the girls’ bellies and quizzically asks, “Who’s Todd Shischler?”

I thought it was a clever commercial, but more than anything, just a brilliant fictional name. I figured if I used it as a screen name, many would inevitably ask the same question the perturbed band member asks the groupies during the final scene. If you did, mission accomplished.

Hospital Hottie

2008-01-21T08:15:00.000-08:00

My winter school routine takes me through University Hospital every morning on my way to class. I’ve discovered a route that allows me to stay inside almost the whole way from the Trax station to my classroom—something that is important when it’s freeze-your-boys-off cold outside. The other morning I found myself about 20 feet behind someone in a full snow suit. Of course, I laughed out loud when I saw this. Yes, it is cold outside and it was snowing a little bit, but a full snow suit? With snow boots? Really? Seems a bit excessive.

This particular snow suit was immediately of interest to me. At first glance, it looked like a one piece. I decided to pick up my pace to get a closer look at this person. As I got closer I realized, much to my chagrin, that the jacket and pants were actually two separate pieces. They were, however, a perfect match and were obviously purchased as a set. A very soft pink color, nice. The full pink suit and this person’s unusual gait convinced me that I needed to move in for an even closer look, which I did. I ended up a couple of paces behind, but despite my proximity, I couldn’t really see much of this person’s head because of the fuzzy pink hat and the unruly blond pony tail in a pink scrunchie. Yeah, a scrunchie. Uh…2008?

With my interest piqued, I had to get a look at this person’s face so I picked up the pace even more to go for the pass—no small feat in a busy hospital hallway with people and linen bins from hell to breakfast. So I’m cruising at this point and Pinky is on my right. Initially, I’m just planning on a quick glance in the peripheral vision, but I’m floored as I discover that this little hospital ski bunny is actually a dude. No question, his nose and his masseters (muscles at the angle of the jaw that you can see when someone chews) are enormous. His face looked a lot like the dad in The Incredibles, although from the neck down this guy was quite thin and frail looking. But his face had that hard look that makes me think he could bite through a steel bar or eat rocks without any trouble. A dude? Never crossed my mind. The pink suit, that odd, feminine shuffle?

I nearly lost it and I undoubtedly gawked for longer than politeness would dictate, but I couldn’t help it. So at that point, I was in front of him/her and found myself fighting the urge to turn around to get another look. I came up with the brilliant plan of holding a door open for him/her. As a gentlemen that’s just what you do for a lady, even if she has a penis. I was more than rewarded for my courtesy with a soft “Thank you” in a voice that removes any doubt that, if not currently, at one point this person was a dude. Hard to tell what stage he/she was at with the transition. The snow suit made it tough to tell if he/she had boobs and the deep voice doesn’t go away even after the operation so no help there. The best they can hope for is a decent falsetto. This guy's/gal's needed work, still a baritone.

Needless to say, it made my day. Nothing like a morning stroll with a snow-suited transgender to loosen you up before an important exam. Unfortunately, I don’t think it helped. I took my Nephrology (kidney) final that morning—probably the hardest test I’ve ever taken. I’m nervously awaiting my score.

Gymtastic

2008-01-12T13:17:00.000-08:00

Last night, I went to my first ever gymnastics meet. The Lady Utes were taking on the #1 ranked Georgia Bulldogs at the Huntsman Center. We were a little late getting there so we missed the Utes on the vault, but we watched them do bars, beam, and floor. I went expecting it to not be that cool, but as the night progressed, I found myself really enjoying it.

Much of my enjoyment was due to the company I was in, but I found myself really getting invested in the event. First of all, those chicks are unbelievably athletic. We’re talking border line sold-their-souls-to-Satan athletic. I can’t believe some of the stuff they can do. Not to mention the brute strength. I’m pretty sure all of them would put me to shame in the weight room—including the ones that are legally handicapped because they’re shorter than 5 foot (there were a few).

One really amusing aspect of gymnastics is that while very athletic and unbelievable at tumbling, few of them are good dancers. There were several who, while attempting to be a little naughty and seduce the audience a bit, made most of us uncomfortable, feeling slightly embarrassed for their awkward “dancing.” Very funny.

There was a little more drama than I was expecting too. First, Georgia’s star had a bad night. She was the overall national champ last year so she’s the best collegiate gymnast in the country. She fell off the beam and stepped out of bounds on her floor routine. We cheered her every misfortune. I made plenty of personal attacks about the way the girls looked as they were competing. Things like “You look stupid when you run.” “Hey, you’re short.” “Were you trying to miss the bar and fall on your face?” “Your butt is really making a meal of that leotard, isn’t it?” “Why did you jump off the beam like that?” Or, “Nice step out on that landing.” Or when they would really screw up a landing, I might fire something like, “Whoa, you really stuck that one,” just dripping with sarcasm. You know, anything to get in their heads…apparently it worked.

Everyone stood and cheered wildly when the scores were announced and we learned that the U had knocked off the #1 team in the country by a few tenths of a point. My first meet ever and the U shocks the country by upsetting the mighty Bulldogs…not a coincidence if you ask me. An enthusiastic two thumbs up from me.

The Blog Gets a Soundtrack

2008-01-05T12:00:00.001-08:00

My good friend, Billie, introduced me to Project Playlist a long time ago. She put it on our class web page and I always thought it was pretty cool. Since then, I've seen it popping up on more and more people's blogs/websites which is great cause it's a great way to find new stuff to listen to. I tried to put it on the blog I have with my friends a long time ago, but couldn't figure it out (not the most tech savvy fellow you'll ever meet). Today, I thought I'd give it another go, and shockingly, I made it work...sort of. There are still a few glitches that you'll notice--working on those. But, at least you can hear the songs.

The songs range from mellow to hardcore, stuff I've liked forever to stuff I discovered in the last week or so. I'm always on the look out for new music, and Project Playlist is a great way to check out bands (by "check out" I mean you can listen to the whole song instead of just 30 seconds like iTunes) for free. I'd be interested in any feedback or hearing about bands you're listening to and liking.

FYI, if you click on the button that says "Launch Standa" (which should read "Launch Stand Alone Player", not sure why it's getting cut off) you can play the Playlist independently of my page. I often surf the web to other people's playlists...pretty cool.

On Gifts

2007-12-26T13:18:00.000-08:00

I would imagine that most of you would consider me a pretty laid back person. If you don’t, you don’t know me very well. There are, however, a few things that stress me out far more than I care to admit. One of those things is giving gifts to people.

You just never know if you’ve gifted at the appropriate level. Did I leave them thinking ‘Really? This is it?’ or ‘Wow, you really don’t know me very well if you thought I’d like this.’ Or you might be at the other end of the spectrum and leave the person wondering ‘What does he think we are? This was unnecessary and it’s way too much and I’m creeped out by it.’ Or you could be anywhere in between. Regardless of where you ultimately fall on that treacherous continuum of gift giving appropriateness, it is a stressful experience. For me, getting gifts for people is intensely personal and I don’t want to screw it up.

I’ve always had a hard time adequately explaining why I feel this way. Whenever I’ve tried to explain this gift-giving phobia to people, I always feel like the person I’m talking to is dutifully nodding their head as if to say, ‘Yeah, I understand that’ but really thinking that I’ve got issues and they’re just too nice to say so.

Today when I reread something that Ralph Waldo Emerson said, I immediately realized that he captured beautifully the sentiment that I have long struggled to express well. I had read it before, but it was a long time ago and I had forgotten it. Today it really resonated with me. He wrote the following in his masterful essay, The Poet:

Rings and jewels are not gifts, but apologies for gifts. The
only gift is a portion of thyself.

Well put, Ralph. Well put. This is the absolute truth and I guess that's why I worry that anything tangible that I give to someone will fall miserably short of conveying how I truly feel about the person I'm giving it to.

God Bless Old People

2007-12-19T08:49:00.000-08:00

I had a pretty funny day yesterday. I left the house in the morning to go to a dentist appointment. I didn’t get much further than the first traffic light before the hilarity began. I’m turning right at a green light just as an older gentlemen is turning left at the same intersection. We’re both turning north onto a two-lane road. He clearly doesn’t understand the laws governing right of way. When I see him go for the turn, I’m assuming he’ll turn into his lane, I’ll turn into mine, things will be fine. Grandpa clearly never sees me. He comes barreling into my lane, bypassing his lane altogether. I slam on my brakes, lay on my horn, swerve for the shoulder, utter some choice words, and brace for the impact. It was very, very close.

Then this fella does that little gesture where you lift up your right hand high enough for the car behind you to see—fingers together, thumb extended, wrist at a 45 degree angle—as if to say, “What? Why are you honking at me?” He follows that by flipping his palm over and swatting his hand quickly as if there is a bug flying around above the passenger's seat. Again, as if to say, “Why are you honking at me you stupid punk? Forget you.” My adrenaline is through the roof cause this guy just about drilled me. I pull up along side him to give him my best what-the-hell-was-that-BS-move face. I wasn’t going to yell or flash any obscene gestures, just wanted to give him a little glare so he’d be more careful next time. He pulls the one we’ve all pulled in that situation: stone face—just looks forward, doesn’t have it in him to turn and look at me. I suspect that if I had the chance to ask him who the president is, he would have replied, “Nixon.” I don’t know at what age we should begin this, but I’m a firm believer that at some point, old people should be required to take an annual driving test just to make sure they’re still coherent and competent enough to drive safely. Sounds heartless, but it’s a matter of public safety.

I get to the dentist a little early and settle in to read my book while I wait (still Omnivore’s Dilemma, a book that should be mandatory reading in the US). There is an older couple waiting near me. The man gets called back first leaving his wife to hang out in the waiting room. She starts cleaning out her purse. I glance over at her a few moments later and she has papers and miscellaneous crap all over the couch and end table—she’s definitely a saver. She’s sorting through these mountains of coupons, old receipts, and used tissue when I notice that she’s pulling out money from these huge piles of crap. A twenty here, a few ones there, a fifty, two tens, a five—all just mixed in with this huge paper salad she’s hauling around in her purse…ever heard of a wallet lady? Maybe take one of those twenties and go get ya a wallet.

I did feel some sympathy for her though. Just sitting there sorting through her stuff made her breathe heavily. You all know what I’m talking about. You’ve all seen a heavy person that’s a loud breather. She’s one of them. Her antics to this point were enough to make me smile a few times. About 3 minutes into this sorting routine she does something that makes my day, maybe my week—a classic leg lift. She leans on the arm rest to her left and gently lifts up her right leg at the hip—sort of pointing her butt down and to the right when one gets away from her. That’s right, she was doing the classic leg lift to sneak out a little toot and it got away from her. Fortunately for her, it was a quick little fart, nothing too dramatic, but definitely audible. I’m surprised to hear it so I look over as soon as it happens. She’s clearly mortified as we both come to the unspoken understanding that I've just heard her fart. I can’t quite contain it, so a little laugh escapes before I can convert it into a throat-clearing cough. I keep up the cough routine so I can head to the drinking fountain, which I do. I’m taking a long, slow drink trying to get it together and to think about what to do next. We were the only ones in the waiting room and I’m not anxious to get back there because I’m afraid I’ll lose it again. I take another long drink, some more throat clearing, another drink. With no other options, I return to my seat, pick up my book and pretend like the whole thing didn’t happen.

For me, it’s one of those things that I’ll laugh about whenever I think of it. I’ve laughed several times while writing this. Trying to contain the laughter got worse once I got back in to the dentist’s chair. I was having a chipped tooth repaired and my dentist always gives me the laughing gas anytime he’s going to drill. When I got that stuff flowing into my lungs and thought about grandma tearing crack out in the waiting room, it was over. I was uncontrollably giggly. Probably the best dentist visit I’ve ever had or will have.

Resurrecting the Molestache

2007-12-11T22:26:00.000-08:00

My buddy, Mike Cunningham, recently posted some pictures he took of me the day we both graduated from BYU. Since BYU has the curious rule of only allowing the most unacceptable facial hair imaginable—I’m referring, of course, to the mustache—I thought that I’d engage in one final “Eff you” to that particular rule by showing up to graduation with the most offensive mustache I could manage (If you’d like to see it, check it out at http://web.mac.com/thedigitalorange, go into the photo blog. Mike has a ton of rad pictures in there—as you’ll see, he’s quite good).

Mike’s post got me thinking about the various experiences I’ve had with mustaches over the years. I share one from a journal entry about an experience that happened after I started school up at the U. It is now about a year old, but the wounds are still fresh. I’m just now beginning to entertain the idea of shaving my beard and returning to just the stache. Anyway, here’s what I wrote about mustaches, I believe it now as much as I did the day I wrote it:

“There is nothing wrong w/ mustaches. Typically the mustache is a social faux pas for dudes under 40 (and unless it's a really thick push-broom ala Tom Selleck, it's a questionable choice for men over 40) but I think it's time for this to change. I decided yesterday to shave my beard and leave only the handlebar and already I've been mistreated for it. This morning as I was sprinting to catch the morning train, the conductor (if that's what you call the people that drive TRAX) waited for literally everyone in sight to board the train--except me. He took off as I was frantically pushing the button to open the door. I saw him looking in his rear-view mirror in disgust as I pounded on the button. His disapproving stare seemed to shout "F-you...and F your mustache" as he and his little train sped away. It is officially on!

I'm so outraged by this mustache mishap that I'm going to shave the handles and leave just the "molestache" portion. For those of you unfamiliar w/ the term, the molestache is the greasy upper lip sweater—the one that automatically disqualifies you from any babysitting gigs and sends people running to check the sex offender registry whenever they see you in their neighborhood. It's the mustache that doesn't extend much below the corner of your mouth--it's easily the most unattractive form of facial hair and hence the most awesome. Mine is particularly offensive because it's Larry Bird-blond and only visible in the right light. I'm thinking that on Monday morning I'll wait for that same conductor to pull into the station and walk right up to him, proudly stroke my molestache and then challenge him to a tickle-fight just to weird him out. I'll let you know how it goes."

Gentlemen, mark my words the day will soon come when men will again look to the mustache w/ fear and envy, and women w/ uncontrollable lust. I invite you to join the movement early. Buckle up ladies, they're on a comeback.

Don’t be surprised if you see me this holiday season with that same mustache made legendary by none other than Basketball Jesus a.k.a. Larry Bird (I didn’t make it up, but it’s one of the best nicknames in history). Check the picture, you'll probably have to squint to see the stache and you'll definitely struggle to peel your eyes away from the nutters he's wearing. Those are the most brilliant shorts I've ever seen and I've been looking for a pair for several years. If anyone knows where I can find some, please let me know.

Best Book Title I've Ever Seen

2007-12-07T09:46:00.000-08:00

I've added this to my Amazon wish list on the strength of the title alone. I'm sort of indifferent to the Donald, but I did go to Trump Tower when I was in NYC with my buddies this summer. We were hanging out in the lobby and in walks the Donald. His hair might look even worse in person, if that's possible.

If anyone has read this or heard anything about it, I'd love to hear about it--it's gotten great reviews on Amazon. As many of you may know, Zach Longson and I have two standing life goals. They are, in no particular order, to kick ass, and to be awesome so you can see why this title really grabbed me. Based on how cute Zach has been with his baby doll, Megan, lately we might have to add a third: be darling.

On a serious note, today marks the 66th anniversary of the 2nd deadliest attack on American soil, Pearl Harbor (it was surpassed by 9-11, you probably heard about it). Important to remember stuff like that. I went to Hawaii with my family when I was 7 and visiting Pearl Harbor is by far my most vivid memory of that trip.

An Amazing Dream

2007-12-06T10:07:00.001-08:00

I had a really funny (to me anyway) dream last night. I dreamt (or is it dreamed?) that the Church had commissioned me to make a large sculpture of a Temple (it had a base of about 6x6 feet and it was about 8 feet tall). I must have been asked to design the Temple because when the model was unveiled, it created some waves, and people seemed to be upset with me.

I chose to chisel my little Temple out of very dark granite, almost black, so right away I was on the wrong track. Probably should have been white marble or something. Secondly, in an egregious breach of Temple tradition, I opted to forgo the traditional Angel Moroni statue at the top in favor of a regular steeple like the ones most chapels have. Finally, the most offensive part. For whatever reason I decided it would be a good idea to include carvings of angels on the exterior walls of the Temple. Doctrinally inaccurate angels, I might add, because they had wings. The real backlash was created by the fact that in addition to making the angels winged, I made the female angels quite busty.

The unveiling took place in some sort of public courtyard, probably on Temple square somewhere (I vaguely remember seeing the Tabernacle at one point). The only people I can specifically remember being present where Chad Anderson, Nate Hurst, Gordon B. Hinckley, and Brigham Young (not sure if he was there as a spirit or a resurrected being, but I’m sure it was him). All of us were on the little stage where the unveiling was taking place. So, flanked by Chad, Nate, and two prophets I pull the sheet off my little sculpture in front of about 100 people or so. Some media, lot of dark suits, a few kids milling about. When that sheet came off, everything stopped. GBH looked disappointed with my work, but said nothing. Nate and Chad were doing their best to contain their laughter, and most of the crowd looked as though they had just been punched in the gut as they took in the busty angels I had carved into that black monstrosity. I would have loved to stick around for the awkward moments that certainly would have followed, but unfortunately, I woke up shortly after the sheet came off.

Reissuing the Fiber Challenge

2007-12-04T12:20:00.000-08:00

Today a good friend of mine mentioned to me how pleased he was with his fiber regimen. He and I are both fiber supplement converts. Here’s the story.

About a year and a half ago, a formerly close friend of mine suggested that I start using fiber. Initially, I balked at the idea and dismissed it as ridiculous. Thankfully, she persisted and eventually convinced me to try it. Life-changing. I was so excited by the changes I experienced, I immediately issued a fiber challenge to my classmates on our class blog. Some of you have heard this spiel from me before, but since it recently resurfaced, and since I suspect that many of you still haven’t tried this, I thought I’d take the opportunity to reissue the fiber challenge. The following is an excerpt from the aforementioned post:

“…I'd like to issue a fiber challenge. As future physicians, we're obligated to do all we can to promote the health and well-being of our patients, and the public in general. I'd like to invite anyone who has never tried it, to buy some bulk-forming fiber. Americans in general don't have enough fiber in their diet (because we usually don’t eat our 5 servings of fruits and veggies daily). Studies have shown that high fiber diets promote colorectal health and decrease the risk of cancers in this region of the GI tract. So pick any brand--Metamucil, Citrucil, or my personal favorite, Kirkland Signature (Costco brand--it's much cheaper)--and try it for a week. Mix up a little fiber cocktail after a large meal and choke it down. Yes, it tastes like a nasty glass of Tang-flavored sand, but it's worth it--trust me. I promise that if you persist, you’ll grow to first tolerate and then savor that flavor.

For anyone worried about cost, I promise that what you spend on the fiber you will make up by buying less Charmin. For those of you who can't quite conquer the social stigmas associated w/ this product, there are ways around it. Self-check out lines at the supermarket are a good place to start. Get a week under your belt, just one glass per day in the evening and I'm confident that you'll be converted. Once you are, the best way to combat the merciless teasings of nay-sayers (and they will come) is to issue them a similar fiber challenge to see if they have the intestinal fortitude to respond. Flip it on them and you'll see quickly how uncomfortable they become. Some people simply can't handle a little colon-blow and I don't think it's inappropriate to mock them for it. I hope none of you will be too narrow to try this.”

Since I originally posted that, I have learned that fiber, particularly supplemental fiber like Metamucil—as opposed to the natural fiber in foods—has been shown to bind LDLs. LDLs can be simplistically thought of as bad cholesterol (there’s a little more to it, but I’ll spare you the uninteresting details). So, downing a fiber cocktail after a large meal might actually decrease the amount of bad stuff (fat, cholesterol, etc.) your intestines absorb. Not to mention the consistent satisfaction, even liberation, that follows a good movement—smooth and clean.

To be fair, fiber supplementation is not all bliss. Some quick words of caution are in order. One, if you decide to accept the challenge (if you don’t, you’re a wuss), make sure you drink plenty of water. Most people think of fiber as something that will increase frequency and ease of bowel movements, which it will…if you’re drinking enough. What a lot of people don’t know is that fiber can be used to treat diarrhea. They do this with some cancer patients that get severe diarrhea from chemo. Fiber without water can lead to some fiber bricks that will make you feel more like you’re giving birth than going to the bathroom.

I consider this to be an issue of public health, not just flippant potty talk. I would hope that many of you will try this. And not just try it, but also have the courage to report your experiences in the comments section of this blog. I've got nearly two years under my belt, so feel free to ask questions and present concerns. I'm anxious to get you to join the movement of satisfying movements. Convert.

A Sobering Day in the City

2007-12-03T15:36:00.001-08:00

This is a very long excerpt from my journal, but it's my blog so I'll do what I want.

I was riding the train home today as I usually do. As we pull into the Midvale station (77th South), the lady comes on the PA system and tells us to get off the train, that a bus is going to take us the rest of the way. Within milliseconds the bitching and moaning begins. Are you f------ kidding me? Great, I’m never going to make my bus now. Et cetera. I’m in no particular hurry, so the whole thing is a little amusing to me. It doesn’t take much to get people’s panties in a bunch these days.

There are probably 75 of us standing on the curb awaiting our bus. A Trax supervisor in a bright orange vest tells us that there has been an accident that is blocking train traffic. At that point, I assumed that there had been a car accident somewhere that was blocking an intersection that the train has to pass through. There is some speculation about what the “accident” might have been, but no one really knows for sure. Since there’s not much to do but wait, I return to reading my book (currently The Omnivore’s Dilemma—highly recommended, but more on that in the future). After a few minutes, one of those massive sectional buses, with the giant accordion thing in the middle, shows up. We pile on to the already crowded bus and just as we all get situated, the guy who told us that this was our bus, boards the bus and announces that it’s not our bus. Several more F-bombs. One guy slams his folded newspaper down on the seat in disgust. Sighs and groans. You get the idea.

It was nice outside, we had what appeared to be a long wait, and I was tired of listening to people crying all over about the delay. I had a couple of Clif bars and my water bottle, so I decided I would walk to the next station (90th south). I start heading east toward State Street. The sidewalks are impassable at 78th South because of some construction on an overpass. So I keep walking east. 23 blocks and one hour later (5 east, 3 south, 4 west, 10 south, 1 east) I arrive at the 90th south station.

Along the way, a few things grab my attention. I pass an irrigation ditch that runs through a quiet neighborhood. There were about 30 ducks swimming around and hanging out on the banks. I probably sat there for five minutes watching them. The bank to the ditch was really steep, covered with snow, and slick. So the ducks didn’t bother inching their way down the bank, they just tucked in their feet at the top and slid on their bellies all the way down (about 8 feet) kamikaze style into the water. Not a very graceful entrance for most of them, but highly entertaining for me.

I’m firing off a few text messages to someone I care about as I pass a 7-11. An interesting guy comes out with an enormous Gulp of some sort (Triple Big, perhaps). He’s got purple dread locks, goth clothes—hoody with a skeleton screen-printed on it, tight black jeans with chains and buckles from hell to breakfast, boots made exclusively for kicking ass—and, he’s black. First time I can remember encountering a black dude who’s gothic. It's fresh and I like it. We’re both making our way along the sidewalk with those awkward measured steps that you do when the sidewalk is covered in slushy snow and the puddles look like bottomless rootbeer floats. He turns into the neighborhood, I keep going straight on State.

We eventually cross paths again right by the 90th south Trax station. He’s about 30 yards ahead of me walking along a yard with a four foot fence that has multiple ‘Beware of Dog’ signs posted. I see the two dogs lying on the ground. This guy walks the whole length of the fence and those dogs don’t move. When I approach the same yard, they go into a dead sprint straight at me. Plenty of those blood-chilling barks that start out as a low growl and progress to the very aggressive, very loud I’m-going-to-eat-your-face bark. German Shepherd and a Lab. Both looked fit and could have easily jumped the fence. So I’m expecting that, shortly, both of them will be sailing through the air and sinking their canines into my sternocleidomastoid (big muscle in your neck) and enjoying a blood meal from my jugular. Fortunately, it was all bark, no bite.

Black dude, purple dreads, a lot of metal, and enough caffeine to give an elephant the shakes—not a threat. Unassuming white guy with a backpack—attack the SOB. God bless dogs for being blind to color and stereotypes.

I get home and start my usual afternoon surfing session on the web, checking email, blogs, steepandcheap.com, and the news. I notice a story on KSL about an accident involving a Trax train. Turns out the “accident” was a pedestrian that jumped in front of the train somewhere between the Sandy and Midvale stations. Between stations the train gets up to 55 mph (I checked it once with my Garmin GPS). It threw the guy about 30 feet, and, no, he did not survive. I’m sure there would have been significantly less complaining had everyone known that someone’s father/husband/son/brother had decided to jump in front of a speeding train 3 weeks before Christmas. I was glad that I hadn’t complained about the delay—not today anyway. For me, it turned out to be a nice little stroll through the city and a sobering reminder about maintaining perspective. It will undoubtedly be a horrible holiday season for that guy’s family.

Snow

2007-12-01T11:16:00.001-08:00

This was the view from our front door this morning. We've probably had about 10" at our place over the last week (some of it melted of course) and I'm thrilled about it. I went out to shovel the walks this morning and my niece, Jaida (my sister Lindsay's oldest), insisted on helping. While I shoveled, she dusted off the cars, made snow angels, and cheered me on with comments like "You're a nice guy" and "You can be a great doctor." She definitely has a future in life coaching or authoring self-help books. When we were finished and taking our snow clothes off, she unashamedly announced "I have a snuggie and it hurts." To be three and without guile, you've got to love it.

Maiden Post

2007-11-30T12:01:00.000-08:00

Greetings to anyone who actually finds him/herself reading this. I have thought about starting a personal blog (I'm no blogging virgin) for a long time, but doubted that anyone would actually read it (I'm still skeptical, but what the hell). A few encouraging remarks from a couple of people that I respect a lot (you know who you are) were the final catalysts for creating this. As you've no doubt already noticed, I have a tendency to use a lot of parenthetical statements and I'm through apologizing for it.

For a long time, I've wanted to have a place where I can easily post things that I'm studying and thinking about, as well as the day-to-day things that are going on so people like my parents (currently on a mission in Ghana) will have an easier time keeping tabs on me. I hope it's at least entertaining if not informative.

The blog I started with my friends about 2 years ago is more for off-color humor and talking sports. Serious topics are often poorly received on that blog--and rightfully so. Seriousness sort of violates the spirit in which that blog was created. I also sometimes felt that I was dominating that blog so this one gives me another outlet, with a slightly different audience (probably no one).

A final reason for this blog is that I find it strangely cathartic to write things and post them to the world (or the 2 or 3 people in the world who actually read them). I also feel like it will be a quasi journal and I write much more carefully (and better, I hope) when there's a chance someone else might read it. Feel free to comment/criticize liberally. Heckling is not only encouraged, it's appreciated. I find myself reading others' blogs so if you have one, let me know and I'll bookmark it.