Whelp, Xangas back.

Looks and feels a lot like wordpress, which is where most of us seemed to migrate. I guess it will depend on whether or not the team can hold on to the sense of community that made xanga great. And as xanga is reinventing itself, I decided it was about time for me to reinvent myself as well.

For nigh on umpteen years I have taken this blog through revision after revision as I grew and changed from college student, to medical student to intern, resident, and now attending.

Now It’s time for another self reinvention as I begin a new job, in a new city, with new responsibilities and a shiny new paycheck to go with them. Everything in casa de J is getting upgraded. A new computer and phone to replace the old ones. A new high rise apartment to contrast my former room after having moved back home. A new luxury car, which has been causing somewhat of a headache trying to decide whether to lease or buy, and what to get. First world problems I know, but as someone who rarely paid attention to mechanical goings on, this has involved a lot of research on my behalf.

I am also trying to get into researching the stock market and revisiting economic studies to figure out how best to save and/or distribute my disposable income not marked for loans and or living expenses.

And perhaps most importantly, it’s time to touch base with my hobbies again. The goals on my to do list are to be revisited, not intiated, but coming back to xanga and starting at least weekly updates is on there, as is to read the great books, get back to cooking, dancing, singing, playing piano, and all of those.

So, stories will come as I feel in the mood, but hey, Rome wasnt rebuilt in a day, right?

Welcome Back, All

-Dr J

That right there is my family Coat of Arms. Pretty sweet, right? But what is a coat of arms?

Well the introduction of armour in the twelfth century made it essential for knights to wear appropriate colors or markings by which he could be recognized on the field by friend or foe. Since the use of armour and heraldry became widespread in Europe, there was danger that two or more knights might choose the same identifiying symbols, and so to obviate the confusion, the sovereign appropriated the right to approve the particular distinguishing marks to be used by those entitled to display a coat of arms. Therefore the right to use specific and distintive devices became a mark of nobility or honor in the realm

While in Scotland, located at Edinburgh Castle, Brian and I came across a herald who had a large logbook of family crests and coats of arms, so on a whim we decided to see if our family was registered as I had been told often by my parents as a child that we come from Russian Nobility. As it turns out, we do! 

The shield is in red, representing fire and fortitude, depicting three scythe blades issuing from a rose in the center all done in silver which stands for peace and nobility. The scythe expresses the hope of a fruitful harvest of things longed for and the rose, reckoned the first among flowers is held to be typical of beauty, grace, and hope

The crest, shows a knights helmet representing wisdom in defence and is topped by a ducal coronet denoting royal or seigniorial authority in gold, the color of purity and valour. Rising out of it are a plume of five ostrich feathers signifying willing obedience and serenity, also done in silver

The heraldric supporters are two bulls (my zodiac sign is Taurus-score!) which represent valour and magnaminity

The family motto is Nichevo which roughly translates as “Let things take their course”

This discovery came at a perfect time and really touches some important notes with me. I have some blue blood, apparently associated with bravery and serenity, family values which are right in line with my history of risk taking and remaining calm under pressure, I can be magnanimous as noted by my very own zodiac sign who is my heraldric supporter. 

I am slightly less thrilled about my family motto although it is still very appropriate. I had hoped for a badass family motto, like never say die, or strength in all things. Instead, Nichevo is a uniquely russian word that translates as “let things take their course” or “it cant be helped” or basically “shit happens”

A family motto to me means something your family can draw on in times of hardship, reminding you from where you came, where you are going. Mine is basically a shrug. When the going gets tough, …eh, it is what it is. 

The more I thought about it though, the more I realized that like it or not, this is exactly what most of the men in our family have done. My grandfather, My father, Myself, we are not big complainers. When faced with challenges, we tend to carry on as usual and let the universe sort itself out. This doesnt mean we dont constantly work to better ourselves, but that we acknowledge we can only change ourselves, not our circumstances. 

Thinking back to my work drama, I have lived this motto wholeheartedly. The decision to hold me for probation and all the the chaos that ensued was never in my control. Not the length of time, not who I worked under or with, and not the terms. I was angry, and depressed, and the more I struggled and fought the situation, going to lawyers, counseling, bitching nonstop to friends or online, threatening to leave medicine, the less things changed. When I simply accepted that I couldnt change my circumstances but could work within them, I ended up rediscovering my love of teaching students and interns, becoming a more careful and meticulous physician, and getting some of the best evaluations I have had in the entire residency. I still dont care for my hospital, but when I just let things take their course, everything solved itself.

So although my family motto may not be as badass as I hoped, it taught me that since 1413 my ancestors have bred an impressive equanimity into ourselves, and if I tap into that family faith in the universe, things will be okay. Trouble may often come to call, but that doesnt mean it has to stay

SO the next time I have drama or problems, I will look at this over my desk, throw up my hands, and say “nichevo”

After all, it’s in my genes.

A minor interlude from your previously scheduled travel posting

—

I actually felt more like myself this weekend than I have in a long time. WHich is a strange thing if you think about it. I mean, I’m always myself, aren’t I? Who else would I be?

And yet, over the last several months I just havent felt like me. I wouldnt call it a depression per se, although I am sure that figured into it what with the whole workplace drama. But this weekend I went up to San Francisco (Aside: hate that city, still felt pretty happy overall) for a friends wedding, came back down and had a memorial day bbq with swimming and beers, and today even was in the mood to go run a half mile with the dog and play piano. 

I’m not sure what changed, but I’m glad it did. I find that every so often I wake up and have a wordless epiphany. It may relate to how I feel about myself, or in what direction my life is going, but I just get this driving impetus to look within myself and change something. Not because I dont like who I am, but because I could be better. 

Even sitting down here to put virtual pen to paper, it feels like I am slowly re-learning to articulate myself in a way I haven’t been able to in some time.

Perhaps this feeling comes at a time that I am questioning why I wanted to be a doctor. Not the same way that I did when all the hospital things first occurred, as that was more of a knee jerk reaction. But more in the sense that if I am really going to re-apply to fellowship, I should be certain that medicine is the best fit for me. To commit myself to three more years of education if I succeed the second time around means giving up higher immediate earning potential in favor of seeing only patients in an organ system in which I am interested. It means giving up California sun for Illinois winters. 

And while I enjoy my job, and dont mind going to it, I also feel as though I dont love enough. That it doesnt bring me the mind numbing bliss that my fellow physicians seem to enjoy just from being in the hospital. And though nobody coerced, cajoled, or convinved me to go into medicine against my will, I often wonder; If I had to go back and do it all again, would I?

In the past I said yes because without it, I would never have met the friends I now number among my closest. I would never have been privileged to see still beating heart, or the view of the inside of your digestive system or watch a complete stranger breath their last in front of me. I may or may not have lived out of state. I definetly would not have the power and authority to influence people as I do.

As I sit here with the few cards and gifts I have received from my patients over the last three years, I realize that yes, I would still do it to myself again. Somewhere along the way I lost myself in the process of medicine and let connecting with people (not necessarily helping them, just connecting) become secondary to the workflow. I could blame the hospital environment, I could chalk it up to burnout, but ultimately I let it happen to me. It’s as though I lost the forest for the trees.

And so I have set out to recapture that feeling. Even if it doesnt begin at the hospital. Perhaps I will volunteer reading to kids, or give a dollar to someone homeless, or just call up a friend for no reason other than to say hello. I aspire to be more than I am. Whether it is like Captain America, who sees the best in everybody (you know, except nazis ) Or Doctor Who, a man fascinated by creation itself and always thinking on his feet, I want to positively impact others around me.

My heroes may be fictional, but that doesnt make them any less real, or inspiring. And maybe, just maybe, that’s what I needed to realize to make a change.

Thank you for your time, we now return you to your regularly scheduled programming

-J

Okay, time for me to come clean about the tomato fight…pun intended.

Oh dont worry loyal readers, it actually happened. you have the pics to prove it. However the fallout from said tomato fight is that tomato juice got into and subsequently ruined and or otherwise rendered ineffective everything i was wearing. My shirt, sandals, shorts, cell phone, and car keys, or specifically the car alarm disarming key.

So to recount briefly…being covered in stinky tomato pulp with 2 friends, I had previously covered my car seats in towels, and now divested myself of my clothing down to my boxers. I sent Ward to unlock the car while I washed off what tomato I could. Remember when I said the car alarm disarming key was permanently disarmed? Yes, well that meant the moment i turned on my car the alarm began honking with no way to disarm it.

all. the. way. home.

So somewhere in between pomona and los angeles, with the car alarm blaring, i was pulled over by the police, who suspected the vehicle might be stolen. As the cop walked up to the window, he never had his hand off his gun. Why?

because as I rolled the window down, he was assaulted by the smell of something rotten, and confronted by three people covered in a mysterious dried red substance, sitting on towels, giggling like maniacs and in various states of undress.

Dr J: I was in a tomato fight officer! 

Officer: a what?

Dr J: A tomato fight! thats why we are all in red. also, the smell.

Officer: licence and registration sir.

Dr J: okay, but i have to get my wallet out of the trunk

Officer: why is your wallet in the trunk?

Dr J: thats where my pants are

Officer: why are your pants in the trunk?

Dr J: because thats where we dumped all our stuff after the fight

Officer what fight

Dr J: the tomato fight!

Officer: step out of the car sir

So clad in nothing but my batman boxers, i stepped out and around my car with the officer at a safe distance the whole time, popped the trunk obtained my wallet and license and handed it to him. Once he satisfied himself that everything was legit, he fired off a few just in case questions

Officer: you folks been drinking?

Dr J: surprisingly, no.

Officer: no drugs, no immigrants, no dead bodies (he was being humorous or very worried here)

Dr J: you saw the trunk officer, would you like a closer look in the garbage bag?

Officer (remembering the smell) um, carry on 

And off he went, with the winning bizarre story for his precint for that day

I have not taken a lot of time for myself lately. It seems like i have constantly been pushed or pulled in some direction at somebody’s behest, be it work, or my girlfriend, my mother, or a friend in need. I dont begrudge any of these obligations, though I do think they have contributed in some way to my current funk (quick! somebody bring in da noise!) mostly because everything I try to do for somebody seems to disappoint them.

I am a talker. This doesnt mean I dont or wont act, just that I find words to have a lot of power, and believe that ever situation has a right thing (and conversely, a wrong thing) that can be said. Words of comfort, words of care, words expressing intent or goals, but overall words. I like to hear somebody ask for help or advice, or have someone tell me they love me, or appreciate what I have done. I would go so far as to say that any blogger shares a similar attitude with me to a degree…after all, if we didnt believe in the power of words, why bother to set them down for others who come after us?

My girlfriend, much as I love her, places much more emphasis on the importance of actions. Words are just a fancy way of not doing anything to her. Should she have a bad day, she doesnt want someone to talk with her about it, she wants them to intuitively recognize that she is upset, then take her out to do something, regardless of moping until she cheers up. Similarly, there is never a expressed desire for me to come over or spend time with her…just the assumption that if I want to, I will. This has caused me no small degree of difficulty in our actions. Neither way is right or wrong, but the viewpoints and philosophies on life that accompany the two have led to many misunderstandings and upsets.

At work, I remain under the microscope, held to a different standard than my coresidents, every mistake magnified, every good or appropriate action minimized, ignored or taken for granted. Because of preconceived attitudes from earlier interactions with the hospitalists, this unpleasant existence will be my de facto reality for the remaining 6 months of my residency until such time as I can pack up and return to Chicago. 

At home, I recently observed the 7th anniversary of my fathers death, which took place while I was away in med school during finals week…I have previously commented on it here, here, and here for those of you were not following me at the time.

Becuase of all these various things going on in my life, I have given up, or at least let fall by the wayside all the things I used to do…rock climbing, model building, crosswords, reading, performing comedy, even blogging, and how much time does it really take to sit down in front of a computer and write a few sentences? I have grown, I have matured, but I am not sure that I like who I have become…there are days I miss just being me, and I need to find some way to recapture that before all this outside world crap overwhelms me.

Those of you who have been commenting along, thanks. Though we may be virtual strangers, I do see your comments and it is nice to know that real people exist out there with invisible ears for me to bend. We all have our own dramas, I am just hoping that I can return to being a sitcom sooner rather than later, and maybe these words can help ground me until I can do just that.

Dr J out.

*Hello* *hello* *hello* *hello*

Anyone still out there? If you are consider me impressed. I am clearly going through a “meh” writing phase, mostly because I am out doing things. But every now and again it’s nice to come back to see how everyone is doing and write myself these little reminders of what it is like going through residency.

So what is it like? I am now a second year resident. I have been keeping this particular iteration of the blog going since my third year of college and for the last 5 years it has been primarily related to my experiences as a burgeoning medical professional. 

As I have mentioned before, being a resident is a LOT better than being an intern. The general hospital staff have a lot more confidence in you, you have a lot more confidence in yourself and it’s when you finally start to feel just a little like the doctor everyone you know assumed you were from the day you got your acceptance letter to med school. I make decisions about patient care. Yes I have an attending to oversee and discuss those decisions with, but ultimately, the attending is there as my safety net. I am the one seeing the patient every day, writing orders, calling consultants and in general dictating the plan of care. As an intern I was doing a lot of these things as well, but there was almost the feeling at times that I was mostly there to write notes and follow orders. If I didnt know something, I could ask my senior, or my attending, or just assume someone higher than me would have the answer.

Now, I cant afford to take the luxury of hoping someone else will fix it, when it comes to my patients. In the last year alone, I have diagnosed several people with cancer, others with AIDS, and convinced more families than I care to think about changing their code status. Some of these things would have happened regardless of whether or not I took a leading role. Others only happened because I decided to follow up on something that just didnt feel right. A couple were just dumb luck. But each of those decisions rested solely with me.

It’s not something you think about at the hospital. You are too busy with writing notes, or catching up with coworkers at lunch, or attending conferences, or working on research. Every moment, even the idle ones are filled with something. It’s not even something you think about that often at home. You are too exhausted and have to do the chores, socialize, make dinner, take care of family if you have them. But every now and again it still hits me how much total strangers place unquestioning faith in my decisions

And those few quiet moments are the reason that you stay past the work hour restrictions, writing notes 2 hours after you finish. why you come in with pneumonia even though everyone in clinic seems to have taken several days off their jobs for a case of the sniffles. why even in your downtime, you end up discussing journal articles or patients. Because no matter how I claim to be more than just my job, it will still be a large part of my past, and what has shaped my ways of thinking and behavior. 

In the end, no matter what specialty you have chosen to go into, the truth is that we are always learning, always thinking, always on call, even if it is only to ourselves for the sake of patients we may not even have met yet. Regardless of when the shift ends, we are all still 24-hour people.

On several occasions I have written about making a patient DNR (do not resuscitate); about the difficulty, the responsibility, the power of convincing someone to just let their loved one go, to not force them past their allotted time on earth. I have written about how I have helped others deal with this all too common modern medical situation. I have written about why I think it’s a good idea that everyone have an advance directive. 

And yet, I realized I have never written about how I actually go about it myself. You know my basic formula based off Dr Folkmans advice, but how does one go about convincing a patient or family to change from “do everything humanly possible to keep my loved one alive” to “I dont want them to suffer anymore, if anything happens let them go.”

Well the first thing I always do is introduce myself. Nobody wants to be having life and death discussions with a stranger. So my goal from the get go is to build trust and rapport, to convince the family I am on their side, that I am using my education and experience to do what is best for everyone. Next I ask what the family understands of their loved one’s condition thus far. Oftentime people may be unaware of just how sick their loved ones are. They see someone come in with a minor infection or some mild chest pain, and not understanding the disease process, become frustrated or surprised when people appear to get worse in the hospital, a place they brought them too for healing. When the family explains how much they know, it gives me a better idea of how much further I have to take them.

I repeat myself. Often. I use a lot of stock phrases such as “his condition is very serious” or “she hasnt been doing well” peppered liberally throughout my talk. If anything I sometimes use my authority to overestimate slightly how close a person may be to death, so the family has no choice but to confront the issue now rather than a last minute phone call in the middle of a code by a covering doctor or someone from the crash team.

And after I have explained what is going on, after I have told them what critical interventions we have been doing to simply maintain the current level of awareness/health however dubious it may be, I start rolling out the big guns, and just like on Jeopardy I do so in the form of a question.

“Now have you and the patient ever discussed what treatments they would like if they were in this condition?” 

Unfortunately, in many people the answer is no. So I take two steps forward and one step back. I try first to personalize the issue for them, reminding the family that they know the patient better than I do, and ask them about their quality of life before hospitalization compared to know with whatever hospital needs they may require. I ask them if the person was standing there with them able to see themselves lying in a hospital bed, what would they want done. Would they want to continue in this way.

This may all sound very manipulative, and I cant deny that on some levels it certainly is. But I am not just running willy-nilly through the hospital trying to off people left and right. The people I take this approach with often have been unable to confront this on their own, have been in a state of denial and even if they decide they still want everything done, futile care though it may be, even the discussion gets them started with the process of preparedness, of acceptance, of realistic expectations.

That said, I dont leave people all open ended with a simple here are your options, full code, dnr, or cmo. That would be failing both myself and them. Most people are rarely confronted with the complexities of death on a daily basis and may not know when treatment is futile. For a doctor to tell them all this and then walk away saying what would you like is as useless as not discussing the subject at all. After the discussion noted above, I offer my recommendations. I tell them, if it were my family member, I would make them DNR, or cmo if the case warrants it.

And then I emphasize that do not resuscitate does not mean do not treat. Just because I dont think someone should undergo the suffering of rib fractures from compression, or electrical burns from defibrillation, should not be subjected to weeks on end of mechanical assisted breathing, should not lie in a bed full of tubes pouring out of every orifice does not mean I instantly leap to withdrawing care and starting the morphine drip. I start back at square one reminding the family how serious the condition of their loved one is, and ask them to consider allowing a natural death, or a death with dignity to occur if the body simply cant take anymore rather than forcing them back into life repeatedly.

I carefully avoid any reference to my own religious beliefs unless directly questioned. They have no place in this discussion, although respect for the families beliefs does. I repeat these conversational tidbits until the family gives me a clear reasoned response. Either they agree with my recommendations and change the order, or they tell me they still want everything done. And regardless of my own feelings, I accept that clear answer when given. If I disagree, I wait until another day and bring the issue up again. Sometimes it takes a few days for the veil to lift from someones eyes.

After having just one of these discussions this morning, one of the fellows relayed back to me that the nurses had spoken with him and told him I had done a great job of handling the family and discussing one of the harder topics in medicine. While nice to hear that I am deemed by my peers to be performing so well, I wish I hadnt become so proficient at this talk so quickly.

-Dr J

While on my way to noon conference today one of the med students stopped me and asked me how I liked the program. I told him truthfully, I was very happy with it. Then he asked if there was anything I didnt like about my residency program.

And I had to stop and think about it. I remember not so long ago when I was in the exact same position on the interview trail, questioning every resident I could find about hidden flaws, what the program directors werent telling you. It was almost cute to be so interrogated.

So I wanted to give him an honest answer. I thought long and hard, and at the end of it, I honestly couldnt come up with anything. There are certainly things I dont think are perfect, but they are the same things I would be complaining about in any program. As things go I have it pretty good. No overnight call, a q6-7 call schedule on wards, great coworkers, attendings who are enthusiastic about teaching, a prompt and efficient ancillary staff, the list goes on. Nothing overtly bad or unpleasant really came to mind.

I told him so, and then I smiled to myself. It was nice to rrealize that I picked the right program for me.

After all, the man who is truly happy is the one who smiles when there is no one else around to see

It is very difficult for me to go to bed unless it is on the hour or half hour. I can not in good conscience turn in when the clock reads 12:36, 1:05, or 2:47…I always end up rounding up. So instead here are some random thoughts I had or links I came across today

Fed up Texans want to secede
“‘Texas is a unique place,’ he said. ‘When we came into the union in 1845, one of the issues was that we would be able to leave if we decided to do that.’”
Yes, Texas, go ahead and secede. Mexico has been waiting for you… and undressing you with his eyes.

I am really happy to know that being an actual Pirate is still a viable career choice…do I need to go to Pirate college, or just sign up for a parrot and peg leg?

Somewhere out there is a company that has actually figured out how to enlarge penises, and its helpless to reach potential customers

“Here’s to the Gents and Ladies
And the foolish times we spent
They cost me Afterlife in Paradise
And they were worth every single cent””
-Straight To Hell, by Great Big Sea

Easter preparations finally settled down, and will be celebrating this weekend. Dyed all the eggs blood red earlier today, since it was Holy Thursday and that is what you are supposed to do.

Hope everyone else is having an interesting life at the moment.

I feel sorry for kids today. The internet has ruined porn.

Now hear me out hear for a moment.

Those of us of the male persuasion used to have to work a lot harder for our naughty pictures. Remember the days when you first found your dads stash of dirty magazines hidden in the toolshed/garage/bathroom? Or maybe it was those late nights you stayed up watching the scrambled channels, trying to figure out if you were seeing boob or elbow? Or the really determined younguns who saved up their money and then sauntered over to the nearest homeless man or college kid and convinced them to buy you the latest issue of playboy or if you were truly perverted, hustler?

Yeah you do. And the difficulty in obtaining your smut made reading it all the more worthwhile. (You just looked at the pictures, honest!) There was always that one kid in the neighborhood who would always have the stack of dirty magazines in the treehouse, and you would all go over just to flip through them and ogle the naked ladies.

If you were a girl, you were probably having slumber parties, the goings on at which dirty old men can only dream about.

And then the internet came and ruined it for everyone.

Oh sure at first it was just an extension of the print medium. Dial up provided a world of selection to the carnal conosseiur. A randy redhead, exotic asian, or the brand new world of fake celebrity photos! But, given the time involved waiting for the computer screen to load, we would always return to the trust treehouse of whore-or.

But the decline continued. Soon, dial up was replaced by cable, and then t-1 connections. Private video sites, and then myspace, and finally redtube, youporn and their misbegotten ilk. Gone was the social bond formed in obtaining porn, replaced by legions of individuals sitting alone in front of their computer screen. Gone were the classy pinup girls of the calendars, replaced instead by celebrity sluts like paris hilton. Gone was the element of imagination from fantasy, as rule 34 took firm hold of the internet.

Last to fall was the simple joy so many men used to be able to express at merely simply seeing a woman naked. With mere naked women available at the click of a button, smut peddlers had to work harder to compete with each other to lure the average consumer with their succubi. The fantasies of yesteryear (threesomes, lesbians “convinced” to give men one more try) became replaced with acts of bondage, rape, bestiality, and tentacle porn (oh you wacky japanese)

With anything you could imagine already made into porn (damn you rule 34) brand new perversions had to be created to keep up with the demand. Things like 2girlsone cup or lemonparty, goatse and you know the rest. Yes you do, dont try and pretend you dont.

Now dont get me wrong, I love porn as much as the next guy. I just weep for the lost innocence of the future generations, who will never know the simple joys of seeing sideboob on a scrambled channel.

Boy, nostalgia catches you at the weirdest times.