Month: May 2005

  • Dear Hearts and Gentle People

    When I interviewed for residency in Norfolk, Virginia, the residents I had dinner with tried to school me in local populations. “The Virginians who live close to D.C. are very different from those who live near North Carolina,” they tried to tell me. They went on to name the different cities they were from, around the state, almost all of which were on the coast.

    “What about Roanoke?” I said.

    And everyone stared at me. One guy said, “Oh, they’re all backward. We don’t consider them Virginians.”

    Someone told me recently that Roanoke is full of gangs now, and it’s not how I once knew it. Even so, it’s funny how, even before that snooty guy’s comment, I was already considering not putting Norfolk on my Rank List. One of their foreign medical graduates basically spent the entire evening apologizing to me that she wasn’t an American citizen. I felt sorry for her, because someone must have been pretty cruel to her to give her such a complex!

    She was already a physician back in her own country, and she had nothing to apologize for.

    I remember those “backward” people in western Virginia very fondly. When I think of good people, my neighbors and friends from that part of the country come to mind. I feel sorry for people who never know that feeling of a place where they feel they belonged. Out of all the places I’ve been, and all the people I have met, I have never encountered as kind of people as lived in those parts.



    Dear Hearts and Gentle People

    I love those dear hearts and gentle people
    Who live in my home town,
    Because those dear hearts and gentle people
    Will never ever let you down.

    They read the Good Book
    From Friday ’til Monday.
    That’s how the weekend goes.
    I’ve got a dream house
    I’ll build there one day,
    With picket fence and ramblin’ rose.

    I feel so welcome each time I return
    That my happy heart keeps laughin’ like a clown.
    I love the dear hearts and gentle people
    Who live and love in my home town.

    There is a Buccaneer for sale in my area, and I’m agitated that I am not in a financial situation to purchase it. It would be nice to have a boat with a spinnaker, but paying the electric bills is nice too.

  • Open Range

    I love Texas, but I’m oh so glad I don’t live in Dallas.

    When you’re lost in Dallas, you might as well take a picture.


    Downtown Dallas

    When I drive, I get lost a lot. Sometimes I end up in rattlesnake country.


    Mesquite

    West Texas is very windy (and dusty), and it was inevitable that windmills were used for centuries to help irrigate crops. Newer windmills, however, line the edge of the Caprock and help to generate electricity.


    Windmills West of Abilene

    There was a time when I wanted to live in New York City in a penthouse. That time is long gone. I want to live in NYC like I want a sterling silver toothbrush and a bidet in my bathroom.


    Home on the range

  • Wingman

    I have to give a little thank you to my mentor in anesthesiology for explaining to me what a wingman is and how it relates to anesthesia in the operating room.

    When I started my anesthesiology rotation, one of the CRNA’s, whom I’ll call Marco, gave me an introduction to the surgery floor, even though it was his day off. Very nice of him. I wish that they’d been nice enough to do that when I started Ob-Gyne.

    When he explained to me what a “wingman” is, he referred to “Top Gun” which I haven’t seen in ages, but may have to peek at sometime again.

    A wingman is someone’s partner, when they fly a fighter plane together. The man in the front may be busy honing in on shooting at a target. But as most planes never even see the plane that shoots them down, this fighter needs a wingman who is just a little behind him and can see the big picture. If the pilot is doing something wrong, he can make suggestions, because he is just a little farther back and can see everything as a whole, while the front-guy is concentrating on a really hard task, to the exclusion of all else.

    Marco mentioned that it was great that I was able to find that loose EKG module plug in the trauma room, but could I do it when there was a bleeding, dying trauma patient in the room, and everyone was telling me to do things, all at once?

    He said anesthetists (CRNA) work as a team with the anesthesiologists (MDA). The MDA is the “wingman” who focuses on the patients vitals and other things, while the CRNA focuses on the intubation or other tasks that he is doing.

    I think that’s a wonderful analogy.

    He says that sometimes, when two people have been working together for so long, the CRNA doesn’t even need to look at the monitor behind him in order to know that the patient is okay. He needs only to look at the MDA’s face, as he checks the patient while the CRNA is intubating him.

    He gave me another analogy.

    He mentioned the movie “Stripes” (which I don’t think I’ve seen) which was about a group of black soldiers in the Army. They were doing target practice, and bragging about how well they can shoot. And the sergeant comes up and says, “Yeah, you’re really good now but CAN YOU DO IT AFTER THIS!!!!” And he yells really loudly in each guy’s ear.

    Marco mentioned that it was different shooting at targets when you’re in combat, and bullets are whizzing past your head, and your buddy is dying next to you, and bombs are going off.

    You have to be able to focus on a really fine task, to the exclusion of all hell breaking loose around you.

    “And that is when you fall back on your training. You should not let your education interfere with your training.”

    I asked him what was the difference between the two.

    “Good question,” he said. He went on to explain that in the Air Force, a Captain once told him that he should always make sure that he got his degree, whereever he went. “That is your education, because everything is moving towards ‘having your degree.’”

    But a sergeant, who is the grunt man, who trains soldiers, and has to be fit because he usually has to show them how to do something in order to train them, told Marco that his didactic learning is necessary. That is his “education.” But in the Army, you receive your training.

    Training is what you fall back on, in times of stress. The almost instinctive ability to perform a task, even though all hell is breaking loose, because you’ve run through the scenario many times in your head, and you’ve practiced it over and over.

    He said, that both education and training work together, so that when you are ready, you will find out that your hands cannot move fast enough for what you are thinking.

    I hope that I can achieve that some day.

    He says I will need both for my residency.

    And that I will need to learn to multitask. And that is what the training is for. ACLS and PALS algorithms. . . is all training, so that when the shit hits the fan in an emergency, we all can “fall back on our training” to do our job and do it well.

    Matt is my wingman.



  • Sail On, Silver Girl




    Playboy: When you wrote “Bridge Over Troubled Water,” did you know immediately that you had written a hit?

    Simon: No, I did say, “This is very special.” I didn’t think it was a hit, because I didn’t think they’d play a five minute song on the radio. . . . Funny, I’m reminded of the last verse. It was about Peggy, whom I was living with at the time: “Sail on, silver girl … / Your time has come to shine” was half a joke, because she was upset one day when she had found two or three gray hairs on her head.

    from http://www.defectiveyeti.com/archives/000817.html
    and http://www.ckk.chalmers.se/guitar/simon.interview6.html

  • It’s Not You

    When I was in medical school, there was one attending who, for some reason, took some insane pleasure in insulting my abilities as a physician. There were only certain students who were *eir “golden boy” and could do no wrong, and they were usually the kinds that sucked up a lot to *eir face, and badmouthed *em behind their backs.

    I hated this attending with a passion and tried my best to avoid *em, because every altercation usually ended in my feeling like I was going to cry right there on the hospital floor.

    Later on, when I was doing my psychiatry rotation, a patient came in who was suicidal, bipolar, and a drug addict. I recognized the patient’s last name, and gasped. It was my hated-attending’s kid!

    Suddenly it became clear to me, that I may be an inept medical student, but my attending’s behavior was enough to drive *eir own kid batty. From that point on, I didn’t give a hootinanny what *ey said to me.

    A good mom is hard to find these days. The other day, I was examining a patient and a kid bit his aunt while I was in the room. I honestly don’t know that any of my relatives have ever bitten their relatives. And I don’t think it’s because they got their rabies vaccinations.

    I love my mom. She’s always been my biggest fan and supporter. When I was struggling in college and graduate school, she always let me know that I could do it all if I wanted to.

    Happy Mother’s Day to my dad too, because my mom couldn’t have been a mom without him.

  • Lessons Learned

    The other night, Matt asked me to list things that I regret. I really couldn’t list much. I sometimes “regret” things before their resolution, but when things turn out just fine, I stop pre-”regret”-ing.

    There are always things that I could have done differently, but often times, without the consequences of a poor choice, I would not have learned something very important about myself.

    Every day at work, I meet folks who regret things. I can only hope that I am helping them stop pre-”regret”-ing somewhat. There is a little girl who comes to our hospital occasionally. She nearly drowned 3 years ago. She cannot eat. She cannot talk. She cannot blink. Touch her, and she goes into spasms of clonus. I cannot imagine how much money goes into her care. It’s certainly more than it would cost to increase the number of newborn screening tests in Texas. The results of a child’s injury is catastrophic in terms of the amount of money required to keep them alive, which is why lawsuits of pediatric malpractice can rival those of other specialities.

    In addition to the economic cost to the country (because many disabled children are on Medicaid), couples who have a disabled child have high divorce rates.


    I Am the Disabled Child

    I am the child who cannot talk. You often pity me. I see it in your eyes. You wonder how much I am aware of…I see that as well. I am aware of much…whether you are happy or sad or fearful, patient or impatient, full of love and desire, or if you are just doing your duty by me. I marvel at your frustration, knowing mine to be far greater, for I cannot express myself nor my needs as you do. You cannot conceive my isolation, so complete it is at times. I do not gift you with clever conversation, cute remarks to be laughed over and repeated. I do not give you answers to your everyday questions, responses over my well-being, sharing my needs, or comments about the world around me. I do not give you rewards as defined by the world’s stardards…great strides in development that you can credit yourself. I do not give you understanding as you know it.
    What I give you is so much more valuable…I give you instead opportunities. Opportunities to discover the depth of your character, not mine; the depth of your love, your commitment, your patience, your abilities; the opportunity to explore your spirit more deeply than you imagined possible. I drive you further than you ever go on your own, working harder, seeking answers to your many questions, creating questions with no answers. I am the child who cannot talk.

    I am the child who cannot walk. The world sometimes seems to pass me by. You see the longing in my eyes to get out of this chair, to run and play like other children. There is much you take for granted. I want the toys on the top shelf. I need to go to the bathroom… oh…I’ve dropped my spoon again. I am dependent on you in these ways. My gift to you is to make you aware of your great fortune, your healthy back and legs, your ability to do for yourself. Sometimes people appear not to notice me; I always notice them. I feel not so much envy as desire, desire to stand upright, to put one foot in front of the other, to be independent. I give you awareness. I am the child who cannot walk.

    I am the child who is mentally impaired. I don’t learn easily, if you judge me by the world’s measuring stick. What I do know is infinite joy in the simple things. I am not burdened as you are with the strifes and conflicts of a more complicated life. My gift to you is to grant you the freedom to enjoy things as a child, to teach you how much your arms around me mean, to give you love. I give you the gift of simplicity. I am the child who is mentally impaired.

    I am the disabled child. I am your teacher. If you allow me, I will teach you what is really important in life. I will give you and teach you unconditional love. I gift you with my innocent trust, my dependency upon you. I teach you of respect for others and their uniqueness. I teach you about the sanctity of life. I teach you about how very precious this life is and about not taking things for granted. I teach you about forgetting your own needs and desires and dreams. I teach you giving. Most of all, I teach you hope and faith. I am the disabled child.

    From the Ohio Coalition for the Education of Handicapped Children;
    “Education Update,” Vol.14, No. 2.

    from http://www.ga1.freeservers.com/#Allison

  • Flags

    A lot of people these days seem to think a flag is a statement of something. Right-side up, upside down, flying high, or burning in a trash can.

    Mostly, if I see someone flying a flag upside down, it just makes me think that someone doesn’t know how to fly a flag, despite that they are presumed intelligent enough to attend an institute of higher learning.

    And if it’s burning, mostly likely it’s an old flag that needed disposal.

    I think Russia’s new flag needs. . . something. It’s so. . . plain.

    Maybe. . . a sailboat.

    In Thailand, you can’t tell if someone’s hanging the flag upside down.



    Good Thai Citizen


    A Rebel


    Flags traditionally were used for sailing vessels, because it’s easier to see a flag on a mast than it is to hear a little guy at the top of the mast yelling at the top of his lungs.


    http://library.thinkquest.org/5391/flag_messages.html


    For diving there are two types of flags:


    DIVER FLAG RULE CLARIFICATION

    (as per U.S Coast Guard 1st District Special Notice to Mariners 1999)

    International Code Alpha Flag: There has been some confusion over the status of the traditional sports divers’flag because of a change to the U. S. Inland Navigation Rules concerning the use of one meter high rigid replica of the International Code Flag Alpha (a blue and white flag).

    The Alpha flag is to be flown on small vessels engaged in diving operations whenever these vessels are restricted in their ability to maneuver if divers are attached to the vessel. But in sports diving, where divers are usually free swimming, the alpha flag does not have to be shown and the Coast Guard encourages the continued use of the traditional sports diver flag.

    Diver Down sport diver flag: The sport diver flag is an unofficial signal that, through custom, has come to be used to protect the diver in the water. It is the responsibility of the operator of a diving vessel to determine if his crafts movements are restricted. To be most effective, the sport diver flag should be exhibited on a float in the water to mark the approximate location of the diver.

    Information on this page courtesy of the New Jersey Council of Diving Clubs.