Wednesday, April 11, 2018

Pictures of Celebrities That Cannot Be Autographed AND How Many Fingers and Toes Do YOU Have?



Several exciting or at least mildly interesting things happened near me in the past ten days or so, and I really can't share any of them, which truly sucks. This is the first week in well over two years that anything in my life has been bona fide interesting enough be mentioned in a blog. Obviously a whole hell of a lot of things have been mentioned in this blog in the past two years or so, but even I don't pretend that any of them were honest-to-goodness interesting enough to have merited space in even a forum so obscure as this blog. 

In one instance, I read an X-ray of a  grandson of someone famous.  The radiologist was at home asleep when I first viewed the CT scan. I knew instantly what it was.  I called and woke up the radiologist of record because the surgeon would want a more precise reading of the images before cutting into the child. I then hand-carried the copies down to the first floor, alerting the E.R. physicians. 
When the lead surgeon arrived about fifteen minutes later, I managed to be strategically in his direct line of sight. he remembered me from my sub-internship and invited me to scrub in for the surgery. I called my supervising radiologist, who  graciously allowed me to vacate my shift about half and hour early in order to observe the procedure. The diagnosis was a volvulus or twist of the ileum, which is the final section of the small intestine, just before the reversal of direction of the intestines, where the ileocecal valve separates the ileum from the cecum, which is the very first portion of the colon,  near the appendix. 

What was interesting about the particular patient, in addition to her age of nineteen months, and her grandfather, who is famous and who shall remain nameless here because I do not wish to lose my license to practice medicine before I even have it, was that her internal organs were not in the customary places. She had (and still has; it's not a condition a surgeon is going to attempt to repair) situs inversus. In layman's terms, her internal organs are reversed. With situs inversus, it can be  a total mirror image, with all organs reversed, or just some of the organs can be out of the usual arrangement.  With modern medical technology being what it now is, a child in a first-world country doesn't typically reach the age of nineteen months without medical professionals bringing him or her into the world being aware that the orientation of his or her internal organs is reversed laterally.  The vast majority of the small number of babies  (one in ten thousand is the current rate of prevalence reported for the condition) who are born with reverse internal organs are now diagnosed as such prior to birth. Images obtained via ultrasound examination from mid-pregnancy on will usually allow the condition to be detected if the radiologist is alert depending also upon the quality of the ultrasound equipment or the number of organs involved. 

The nineteen-month-old child is an identical twin. If identical twins divide relatively late (Day 5 or later following conception; for reference, dividing at Day 10 or later results in conjoined twins), they have a greater-than-average chance of being mirro-image twins. This happens in roughly one-fourth of monozygotic, or identical, twins. in other instances, situs inversus can be associated with genetic syndromes or abnormalities. Sometimes it happens with no other abnormalities. Donny Osmond has lateral situs inversus; his reversal was discovered when he underwent surgery for pain on his left side, with turned out to be appendicitis. (Appendicitis more typically presents with pain in the lower right quadrant. Osmond's appendix ruptured before it was removed, most likely due to the situs inversus causing his pain to be on the "wrong" side for appendicitis.)

If an ultrasound exam takes place either at a physician's office or at a business that provides ultrasound exams for essentially novelty or recreational purposes, it may be that no radiologist ever reviews the footage.  A competent obstetrician -- even one who spent the bare minimum of time in radiology rotations during med school, should be able to spot fetal organs that aren't in their usual places from the mid-second trimester of pregnancy. The people running what are essentially portrait studios for the not-yet-born offspring of those among us who have more money than brains  and fall for all sorts of schemes designed to part the fools of whom I write from their money, should not be expected to contribute medical information based on the ultrasound exams they perform.  The training of these photographers, ultrasound technicians, or whatever one would care to call them, varies from place to place, but in no instance of which I'm aware are the people working these spa-like ultrasound studios actually medical doctors, much less either OBGYNs or radiologists. I would take even gender identification from them with the contents of a large scoop of salt and not merely the proverbial pinch.

I'm veering off-topic here, and I'm doing so without the blessings of any of my lecturing or supervising professors (I technically write this entire blog without the blessings of any of these people, but such is especially the case with regard to what I will say next).  It is my opinion -- and I'm very much a voice in the wilderness in this regard -- that both medical professionals and  expectant parents should approach the use of ultrasounds with more caution than is the current norm.   Ultrasound technology for prenatal purposes has been around since the 1950's, but didn't attain much popularity here in the U.s. until the 1970's.  Since that time, the medical community has studied potential cause-effect of fetal/maternal ultrasound exams against just about everything under the sun, and have yet to find correlation or causation between ultrasound examination and anything. That does not mean that some link won't be found in the future. It would be very sad, for example,  if a link were eventually found between ultrasound exams and autism.  I really doubt that such a link will ever be found; for one thing,  I suspect it would already have been found by now if there were anything linking the procedure with the condition.  Still,  if I ever become pregnant, I will have ultrasound exams only when medically indicated or maybe one extra exam to determine the baby's sex. As cool as it is to know who or what a baby looks like months before it is born, which is possible in 3-D and 4-D sonogram procedures, I'm personally not going to shoot for an entire album of prenatal photographs of the baby. I can wait until the child is born for that.

In another instance of prenatal ultrasound examination, I was able to point out syndactyly (third and fourth finger of the left hand were conjoined by skin) before my supervising radiologist mentioned called attention to the condition in a  twenty-nine-week fetus.  The radiologist and I  were, of course, not in the presence of the family when I made this discovery. (If we had been in the presence of a family member, I would of course have needed to have kept my moth shut and would have let a person more skilled in patient- or parent- communication broach the topic. The time for me to make brilliant and unexpected dianoses from the various images I see is not in the presence of patients or family members.)  This was interesting to me because I had, on several occasion in recent months, discussed the condition of polydactyly with a friend of mine. My friend has a physician friend who invented a device to sever a child's extra digit if there is no bone in the extra digit. (Sometimes the extra digit found in cases of polydactyly is essentially a full-formed digit with osseous and ligamentous tissue [bones and associated connective tissues], but in other cases the digit is little more than a skin tag.) It's obviously easiest to remove the digit if no osseous or ligamentous tissue is present.  The condition of polydactyly can exist by itself or can be one symptom of many in several syndromes. 

After stumbling across cases both of volvulus and syndactyly, I assumed that my excitement for the immediate future was over. Then I had a case that was not medically all that exciting, but small-town girl that I am, I could not help being at least a little bit excited to review the CT scan of an extremely well-known person. I cannot disclose the person's identity because in a civilized society,  hospital personnel do not exploit the sick and injured who come to us for relief. We can boast that we treated someone who is really famous.  We just cannot identify the famous person. I don't even break it down by category (politician, athlete, actress, singer, and so forth) because it would be too easy to give it away if the person on the other end of the conversation happened to guess correctly.  Perhaps when I reach the age of sixty, I'll be less scrupulous about this sort of thing, but for now I play by the rules. Trust me (or don't). She is really famous.





If it never occurred to you to express gratitude for something as simple as having been born with the usual number of fingers and toes . . .


.  .  . It's not too late to begin doing so now.


Saturday, March 31, 2018

Practicing To Be a Practicing Physician, and Watching Vintage Judge Alex Cases on YouTube



For anyone who doesn't know and actually cares, I'm technically in school -- medical school, to be more precise -- but I'm beyond the classroom phase of my education other than the occasional seminar, which even licensed physicians are required to sit through on occasion.  My education now consists of on-the-job training with close supervision and a liberal amount of critiquing.  I actually perform some patient procedures, but I don't have the power to determine any treatment or course of action for a patient. I have to go through all the motions as though I'm qualified to make those life-or-death decisions, but in the end, someone smarter and more powerful than I is there to confirm or to overrule any decision I make.  Even though I'm mere months away from graduation, I have no more power than I had a year ago because each clerkship rotation is in a different area of medicine, and each one is new to me. 

The nice thing about my current rotation -- radiology --  is that much of the work is done behind the scenes. If I make an incredibly stupid error, I'm corrected in relative privacy rather than right in front of a patient and his or her relatives. I don't make tons of incredibly stupid errors, but the possibility of my doing so does exist. It's much less stressful to know that, should my diagnosis be laughably off the mark, the audience of witnesses will be very small.  It is a consolation, however minuscule. This year, for the most part I have only to worry about making a fool of myself, though there are exceptions.  The stakes, however,  will be higher next year, and even more so the following year, when I'll be  in the actual position of potentially killing someone with my screw-ups.  Even this year there's the possibility of doing considerable damage if I bungle a procedure, but the program does everything it possibly can to provide a safety net. They do this for the good of the patients and not for the preservation of my honor and peace of mind. Where my fellow med students and I are concerned, if the system could give us more responsibility with less support, they would do so, as we would learn more quickly (and the hospitals would get more free labor), but patient well-being has to come first.

Teaching hospitals face a difficult balancing act. Prospective physicians have to learn to perform the procedures they will need to perform once they are licensed. A medical school or hospital cannot simply wait until a physician is licensed, then expect him or her to know how do do all the things he or she will need to be able to do without any actual hands-on experience. They do what they can to give us simulated practice. We performed our first incisions on cadavers. We do computer simulations. We also have access to remarkably life-like dummies that give us the opportunity to perform many invasive procedures on them before we get our hands on their genuine living and breathing counterparts. 

At some point, however, all of us have to take the plunge and perform procedures of all sorts on live humans. It's frightening for us, and it would really be frightening for them if they knew it was our first time at the procedure, but of course they never know that. Sometimes they don't even know it's the student who is performing the procedure. I certainly wouldn't want to know if I were they. 

The first time I did a lumbar puncture, I very nearly passed out. I had to stop right after the initial puncture. A nurse held the needle in place; the supervising physician would have taken over if necessary for patient safety, but she chose to treat the situation as if it would have been treated had I been the actual physician and not merely a student, so she allowed the nurse to hold the needle for the fifteen seconds or so that it to me to stabilize myself. I sat and put my head down until the light-headedness left me, then continued without a hitch. 

I don't think anyone would argue with the idea that it is at patient expense that medical students master the procedures that comprise their jobs, but if we didn't learn them, everyone would suffer. We at least have the benefit of the dummies for practice. A couple of generations ago, once everything that could be done on a cadaver had been done, it was on to real live patients with no in- between. One couldn't have paid me enough to be a patient in a teaching hospital back in the day. It's treacherous enough now.

After a long week (I was officially on duty for eighty-two hours in the hospital this week; I was physically present for considerably more hours), I needed a diversion. For that diversion, I went to YouTube and found a few vintage Judge Alex cases. Those old classic episodes were the perfect venue for unwinding after a difficult work week. One case in particular -- Bidwell versus Hale -- was quite a hoot. Megan Bidwell, a lesbian (not that there is anything wrong with being a lesbian; it's merely worth noting that an avowed lesbian would unintentionally conceive a love child after the personal and public confirmation of coming out. Her reason for it was that she was drunk; it would take a whole lot more than mere alcohol to compel me to do anything that could possibly lead to the conception of a baby with Mr. Hale, and I'm heterosexual), was suing the father of her child, David Hale, over charges made on a joint credit card. The case would have been mundane to the point of boredom were it not for the litigants and their companions (with the exception of the plaintiff's companion, Kathryn Moore, who appeared normal as far as I could tell and was smart enough to say essentially nothing), who looked to me like haphazardly constructed puppets. When they spoke, they gave me the strong impression (which I really hope was a false impression) that they were the products of consanguineous relationships. I'm speaking of serious dueling banjos here. Again, because I do not wish to be sued, I must clarify that this is nothing more than an impression I had. I have no evidence whatsoever to support the proposition that any of the people featured in this case were the products of brother-sister or even aunt-nephew relationships. They merely appeared to be such.

Ms. Bidwell described for the audience and for all of us in TV Land how she made it to her child's gestational age of twenty-three weeks without knowing she was pregnant. This is far from any sort of record; you may have caught an episode or two of TLC's I Didn't Know I Was Pregnant, where women show up in emergency rooms with acute abdominal distress, only to be told that they're in labor.  Perhaps I should be less judgmental, but I don't quite understand how any sound-of-mind woman with cognitive function approaching the normal range could make it much past the first trimester of pregnancy without harboring at least a suspicion that she might possibly be, as the French would put it,  enceinte.  Ms. Bidwell next complained that, upon discerning an "awkward feeling in [her] belly" that he (it's not entirely clear, but I assumed the male pronoun was in reference to Mr. Hale) wouldn't "take me to any doctor or anything to find out if I was pregnant." Why would she have needed someone else to take her to a doctor to find out if she was pregnant? Did she lack the capability to seek medical care for herself? And while I'm the one of the last people who would disesteem the importance of medical care by professionals, home pregnancy tests are available at almost every pharmacy or supermarket. The bottom line for me is that if I were incapable of acquiring medical care without the assistance of such a a numbskull as David Hale, I would give up and consider myself as good as dead at the first sign of a medical emergency.


Megan Bidwell and her comparatively normal-appearing significant other, Kathryn Moore

Defendant David Hale spoke with an impediment I have no idea how to describe. Judge Alex made reference early in the episode to dental work Hale had done recently as being the alleged cause of his speech anomaly. I obviously have no idea what was done to the defendant's mouth or what he sounded like before the dental procedure.  Dental work notwithstanding, he's an odd duck, though not nearly so odd as was and presumably still is his wife/witness.  She was easily the most bizarre character featured on that particular day, and would quite possibly find a place in Judge Alex's Top Ten Most Idiosyncratic Litigants if such a list were to be compiled. She reminded me very much -- in speech and mannerisms --  of some of my cousins' cousins' cousins in Oklahoma, minus the heavy Oklahoma drawl.

David Hale and his bride and would-be P.I., Angela Brown

At some point during the case, when David Hale's bride of one month, Angela Brown (whose boobs appeared to droop at least three-quarters of the way to Antarctica; I'm not meaning to be catty in saying this, because she at least has boobs, but in all sincerity, I don't know if she went bra-less in attempt to seduce Judge Alex, or if she was wearing a bra, yet gravity still had such a potent impact on her anatomy), was telling a rather convoluted story of how she had attempted to conduct her own investigation of her then-future husband by contacting Ms. Bidwell through Facebook, bailiff Mason Burroughs failed to contain his laughter. He turned his back to the litigants and to the gallery of the courtroom as he wiped his eyes and at one point snorted. Judge Alex eventually lost composure as well. The audience laughed throughout the entire fiasco. Then the litigants and witnesses began to laugh. I had the strongest of urges to walk through my television screen to tell the litigants and witnesses, "They're not laughing WITH you, morons [and morons may very well have been a literal if not euphemistic term of address for the individuals featured in this case]. They're laughing AT you. There IS a difference." 

I suspect one of the reasons Mason laughed so boisterously was because white people on the program made more thorough fools of themselves than had any of the black litigants. I wouldn't accuse black people in general of behaving any more outlandishly than white people do. In real life, uncivilized behavior is something on which no single ethnic group holds anything resembling a monopoly. On TV court shows, however, the producers somehow find more people of African-American ethnicity that they are able to persuade [with money or with whatever it is that producers of court TV shows use to entice people to appear on their programs] to air their grievances in ways more emotive and flamboyant than are typical of the Caucasian litigants. This case, however, belied that entire premise.

In attempting to check these people out,  I googled their names. Ms. Bidwell was charged with assault and battery in May of 2017. Her mugshot was reprinted in a Virginia publication entitled Gotcha!. Gotcha! is a weekly periodical from Richmond, Virginia, which is comprised solely  [except for the obligatory advertisements; God alone knows who or what would choose to advertise in such a rag] of mugshots. How does such a publication have a large enough circulation to be sufficiently profitable to remain in print? Seriously, who buys this shit? I might possibly purchase a single issue if someone I knew was included in it, though I certainly wouldn't subscribe. Maybe that's the point. Perhaps many of the residents of western Virginia know so very many people who are arrested that to them, reading Gotcha! is like thumbing through a high school yearbook or family photo album. Perhaps it's the closest thing to a high school yearbook or family photo album that some of the readers will ever own.


Megan Bidwell's mugshot (photo credit - Gotcha!)

Here is a link to the episode for your viewing pleasure.




Saturday, March 10, 2018

Thank God I'm Not Married to Medicine



One side effect of having in excess of an entire month off is that I have had the opportunity to watch at least one TV program that I previously didn't know existed. Married to Medicine is a reality program on the Bravo network featuring  women who are MDs and women who are married to MDs or who are MDs married to MDs. A slight twist on the premise of the show is that all of the regulars on the show are African-American. 

I've been supervised by and have worked with African -American women who are doctors and nurses, and none of them conduct themselves as do the women on this program, at least at work. I'd be willing to bet a month's mortgage payment on the condo in which I reside (my parents, not I, make the payment) that they don't act that way when they're off the job, either.  The women on this program are only half a millimeter more civilized than the Real Wives of the various upscale communities, and most of these women have earned doctorates in medicine. Call me prejudiced (not racially in this case) but I expect more of medical doctors than what I have seen of these women. A few of them are merely married to doctors as opposed to being physicians themselves, but I would assume that even they have attained some post-high-school formal education. Maybe some of the women are osteopathic physicians. That's another of my prejudices; I hold osteopathic physicians to a lower standard than I hold MDs.

Doctors are not inherently perfect people. If the producers of a reality show came to me and asked me to help them locate  a given number of doctors who are unrefined, classless, and generally jerks, I wouldn't have any trouble accommodating the producers. I would be hard-pressed, however, even if I had access to my entire medical school community including all its students and professors, as well as every intern, resident, and attending physician working at any hospital affiliated with the medical school, to come up with six women of any race or creed who were as lacking in decorum as are the women featured on Married to Medicine. I would assume such is also the case with the spouses of those with  whom and under whom I work, though I don't know most of them well enough to state definitively that such is the case.

My guess is that participation in reality programs such as Married to Medicine is a highly lucrative second career. Money will persuade some people -- even ones whose level of education and presumed level of intelligence should exclude them from possession of the lack of judgment usually associated with agreeing to air one's shortcomings on TV.  Physicians are typically well-compensated enough that they wouldn't ordinarily be tempted by the lures offered by the production staffs of reality TV programs. Nonetheless, there are those among us for whom no salary is sufficient to support the lifestyle they have adopted.  Professional athletes are prime examples of this phenomenon. At least once a week I come across a hyper-linked story on present or past professional athletes who earned seven-figure salaries yet who are now either broke or bankrupt. 

While the incomes earned by most physicians are, at least in the short term, dwarfed by the incomes of professional athletes, the IQs of most professional athletes are, for the most part,  dwarfed by those who have successfully completed medical school. (Obviously not all professional athletes are of sub-average or even of average  intelligence. David Robinson of the U.S. Naval Academy and later of the NBA is often the first name to come to mind in any discussion of intelligent athletes. His son Corey is said to be similarly athletically and intellectually gifted.) While obviously not all professional athletes are dullards, and while there are obvious exceptions to this rule, the average college or professional athlete would not gain acceptance into an MD medical school program (perhaps many of them would be admitted to  osteopathic medical schools;I really don't know) if he or she were measured by the same standards as are other candidates for admission. 

It's conceivable that some or even most of those who agreed to participate in Married to Medicine did so because of financial difficulties and the need to moonlight for extra income.  I possess still another prejudice -- this one in terms of the intelligence, common sense, or self-control of anyone who cannot live comfortable on the salary typically  earned by a physician.  We all need to learn to live within our means. While I feel genuine  sympathy for those trying to remain financially solvent while working at minimum wage jobs, I don't feel all that sorry for doctors who cannot make ends meet. While sometimes divorce with its resulting family support/child support payments could cause a physician to have to scale back his or her lifestyle, a reasonable person can support a family on a physician's salary. In some cases with the Married to Medicine cast, they're living on not merely one but two physicians' salaries.  Even if  circumstances have caused a reduction in earnings of a doctor, the salary of a physician in the U.S. is still a living wage. Perhaps the physician's family can no longer afford a full-time house-keeper. Perhaps the number of and the expense of family vacations needs to be drastically cut, or maybe the number of restaurant meals a family eats needs to be reduced, and possibly an expensive home needs to be sold in favor of a more modest home in a more affordable area. Still, unless a physician's circumstances are highly unusual (perhaps a man fathered twenty children by eighteen different women and is required to provide financial support for all of them, or perhaps a woman married such a man; stupidity in regard to how one lives his or her life is not without consequences), adjustments can be made so that one can live with his or her spouse and/or family within one's means. It's feasible to make necessary adjustments to one's lifestyle in order to subsist on the fruits of one's labors rather than selling one's dignity in order to remain financially solvent.

Then again, perhaps it's not just money as a motivating factor where some of those featured in such reality programming are concerned. Among us are those who relish the prospect of celebrity for themselves even if the end result more closely resembles infamy than actual fame.  I don't understand it, and, for the most part, many of the people who have signed on for the lack of privacy that accompanies  participation in reality television probably don't fully comprehend just what it is that they're signing on for when they agree to allow their lives to be broadcast into living rooms across the nation.  I've yet to see anyone who has agreed to long-term participation in reality TV emerge unscathed. A very few families with large numbers of multiples allowed themselves and their offspring to be filmed for just a few segments, then took the money for whatever they needed it and went almost immediately back into obscurity. Those families appear to have beaten the system.  For the most part, however, if there's not something bizarre or at least highly quirky about at least one member of a family, the networks producing reality shows have no use for a family. Airing a person's or family's weirdness on national television isn't much more beneficial to the person's or family's overall well-being than airing the person's or family's soiled underwear would be.

With regard to  Married to Medicine, I take exception to the use of African-American physicians and their spouses in the program.  I should make it perfectly clear that I am in no way jealous or covetous of those who were selected to appear in this program, and no amount of money could persuade me to trade places with them. While presumably no one was compelled by any sort of force or extortion to participate in this project, I don't think it's a coincidence that African-American couples were chosen to participate in this program or these programs (there may have been a spin-off in a different location than the original; my schedule doesn't allow for me to follow any TV series, so I really don't know). Those of African-American heritage are often a bit more flamboyant or colorful (seriously, no pun was intended here) and perhaps more interesting than are their non-African-American counterparts. A reality show featuring my parents and their white and Asian physician acquaintances wouldn't hold the attention of many viewers for long. It seems almost as though Bravo scoured medical communities all over the nation for the loudest and most ostentatious physician families they could find.  It's probably not a coincidence that the couples chosen for this project have been African-American.  Those who participated are adults and as such legally entitled to make their own decisions regarding participation in such a project, but still, to me it reeks of exploitation.  

As a future physician, this program is an embarrassment to me. If I were an African-American prospective physician, it would be an even greater embarrassment to me.



Wednesday, February 28, 2018

Vacations, Jobs That Make Work Seem Like a Vacation, and How to Obtain One of Such Jobs




This vacation is running the risk of ruining me as a future doctor and is causing me to look forward to the vacations I will be able to afford later in my career more than I am looking forward to the actual career itself.  C'est la vie. It's a secret to which I would have been privy eventually, anyway.  The opportunity to take high-end vacations is a reason you should remain in school, study hard, and choose your course of study and future career wisely, kids.  If you can find the perfect but often elusive career that allows you to feel as though you are on vacation much of the time when you are at work and also compensates you well enough that you can take dream vacations at least once every two or three years, don't let the opportunity pass without grabbing it.

The problem for many among us is that we make decisions when we are relatively young which impact our options for the future. While the algebra course you're taking in eighth  or ninth grade (while Common Core pushed algebra up to ninth grade in many places, I think they're still offering it for eighth graders in some places) may not seem to be of tremendous importance, flunking it and having to repeat it next year reduces the number of math courses you'll be able to complete before college. This, in turn, may impact your admission to the university or program of your choice or the quantity and quality of your scholarship or grant offers, which, ultimately, will impact your post-graduate options. 

While tonight's homework may seem almost optional, if you skip one assignment, you probably will not skip just one assignment. It's incredibly easy for blowing off school work and homework to become a habit.  And while a person may think he or she can slide through middle school and high school without meeting basic expectations but will get his or her academic act together later, all too often it doesn't work out that way. Choices young people make will begin to impact the quality of one's vocational  and/or professional future  sooner than one would like to think.

I'm not suggesting that if someone blows a science test in fourth grade, he or she may as well give up on a dream of becoming an engineer.  Such would be ludicrous.  We're all sufficiently resilient to withstand a few failures in both school and in life, and failure can, if managed well, provide  tremendous opportunity for growth.  Furthermore, we all know people who were academic screw-ups until sometime early in high school, and who, for various reasons, chose to change courses and to succeed in school.   If a person hasn't found what works for him or her in terms of navigating the system of school by eleventh grade, however, the odds will have begun to work against that person in terms of future academic and likely professional-status career success. 

If a person is fortunate enough to have greater-than-average mechanical skills, those skills can often be parlayed into decent-paying jobs.  In future years, with the growth of technology, an increasing number of jobs previously performed by humans are going to be done for us by machines, but for now, auto mechanics, welders, and plumbers are still in demand.  Likewise, many students who attended my high school's rival school were the offspring of California State Department of Corrections employees.  Some of their parents earned six-figure salaries with having completed no education past high school. Most of these people loathed their jobs, but they were paid well enough and had enough time off that they enjoyed a decent lifestyle while not at work. They lived in relatively luxurious homes, drove expensive cars, and took  nice vacations. Most of them dreaded going to work every day that they had to work, but they had the resources to thoroughly enjoy their time off.  Such a job is, in my opinion,  far superior to flipping burgers for minimum wage, but still comes with a heavy price to pay in return.

The idea of being able to support oneself at a job  one actually enjoys doing is a relatively modern idea. There may have been some element of choice involved, but I don't think many people in my grandparents' generation had the luxury of choosing work based on personal fulfillment.  A person's job back then, for the most part, was based on skills a person had, what sort of farm or business the family might have owned, possible family connections to training for a particular vocation, or if a family had the means to fund the education of offspring.  I'm not sure if its onset followed  WWII or maybe even the Korean War, but the GI Bill afforded many people to obtain college educations who previously would not have had the means to seek higher education. With an increase in education came and continues to come an increase in options.  

More education is usually better than less education unless a person goes into heavy debt  to obtain a degree that doesn't typically lead to a decent-paying job.   If there's  little to no debt incurred, any degree is better than no degree. 
If a person is going to wind up with in excess of forty-thousand dollars of debt,  it might behoove the person to study something a little more practical than, say, art history.   Unless the holder of the art history degree is unusually lucky,  he or she has little chance of finding a job related to an art history degree that pays much more than minimum wage.  My cousin's other grandfather  got a degree in art history, but he waited until he retired after practicing for more than thirty years as an orthopedic surgeon.  By then it didn't matter that he couldn't find a job related to his degree. He was too old to work, anyway.  One of my uncles who is a banker has a degree in musicology. He got very lucky and found an employer who wanted to hire a college graduate, but the employer didn't particularly care in what field the degree was earned as long as it was a bachelor's degree from at least a moderately reputable institution.  

I had originally planned to remain in this vacation destination for only about ten days. My ten days have come and gone, yet I have no intention of leaving this place anytime soon. The people who manage this hotel say I can extend my stay as long as I want throughout the first three weeks of March.  I need to be back home by the day before the Match Day ceremony on March 16. I can afford the daily rate here for another two weeks. My bodyguard  has left, but I only kept him around because he had already been paid. I don't need that sort of around-the-clock protection.  

If you're in school and doing very well, that's great.  If you're not doing quite so well, you might want to consider increasing your effort. School isn't the only thing in life even when you're young, but if you give it too little priority in your life now,  later in your life you may lose out on the opportunity to take really cool vacations like this one I'm presently enjoying.





Thursday, February 22, 2018

I hope you enjoyed the Thin Mints, Bugger!

They're tasty, but are they really worth bashing in someone's windshield to get for free? C'est la vie. Better my windshield than an innocent Girl Scout.


Someone smashed my front windshield. My rental car was one of four cars in the hotel's coveted parking area that had its windshield bashed.The officer who came when I called said it looked like the tool of choice was probably a baseball bat, though I don't suppose it matters much. The thief opened the glove compartment, but found nothing there except the operator's manual, which he threw or carried and dropped about twenty feet away into the snow. The registration and proof of insurance are stored separately, so he didn't get to those. He took the two boxes of Girl Scouts Thin Mints that I had purchased just to be nice. He then opened my trunk, where I assume he hoped to find tons of valuables. Unfortunately for him, it was totally empty. His net gain from this act of vandalism and theft was two boxes of Thin Mints. 

I called the rental company. I paid for the extra insurance so that I wouldn't have to pay any deductible. Their representative told me the simplest thing would be for me to put the repair on my credit card and to give them the receipt when I returned the car, at which time I would be reimbursed. I would have preferred that they bring me a new rental car and take care of the smashed-up one themselves, but that's apparently not how things work around here. They called a local company, who dispatched someone to fix the windshield. 

The repairman spoke even less English than I speak French, which is a considerable accomplishment, as I can sing a few songs, say the basic greetings, and ask where the bathroom is in French. I don't know what this guy does if he ever needs to use the bathroom in a public place in an English-speaking  nation. We're not THAT close to the border. Not everyone where I am speaks French. The majority of the residents here probably don't speak French.

The guy wanted me to give him my credit card so that I could pay the full price before he even touched my car, and then he wasn't going to fix it until tomorrow, anyway. With our language barrier, we could not reach a meeting of the minds. I tried calling my dad first, as French is his native language. He wasn't answering. I then called my mom, who speaks good non-native French. I told her of the problem, then gave my phone to him so she could explain that if a deposit was needed in order to obtain a part, that would be reasonable, and that she would call another company to determine what would be a reasonable cost for the part alone and deposit before I handed over my credit card, but that I was not paying the total cost until the work was done. The conversation on both ends got louder and louder. She told me when I finally got mt phone back that she had to tell him she would call the police on him if he did not give my phone back to me. I could hear her screaming about the police. It's "la police" in French, so not hard to translate even for an idiot in French, which I am.

I called the rental car company, and was not calm or polite about the crook they had sent to fix my rental car. They called someone else to fix it and told me they would pay the guy so I didn't have to use my own credit card, which is really how it should have been in the first place.

My dad's ability to insult a person  in French is far superior to my mom's. In a few hours --  once the business opens -- he will call and tell them in words they'll understand that they are jackasses with anuses where their foreheads should be.

Update: One of the other three cars that was bashed into had a trunk opener that was difficult to maneuver. He had to take off his gloves in order to get that particular trunk open, and left a clean thumb print in the process The police dusted for fingerprints all over our cars, but got a match with those particular prints. Also, they found the same prints on my car's operator's manual.  The prints matched up to a local thug. I won't get my thin mints back, but he'll at least have to go through the hassle of the court system.

Friday, February 16, 2018

A Vacation to Make All Other Vacations Envious (except that I'm doing almost nothing; some people get bored doing nothing)

The sport of curling, win or lose, male or female, whatever the conditions or circumstances, seems less intriguing than watching ants while they're slogging their way through that Terro substance that they supposedly take back to their headquarters and share with their fellow ants until it kills all of them. I've seen no evidence that it works unless a person uses the heavy-grade version that you can't buy at Home Depot but have to get from your pest control company.

I'm having an awe-inspiring break from the usual grind of medical school.  An esteemed concert pianist had to cancel a concert and a series of master classes all geographically accessible each night to a particular hotel. They guy was a bit of a prima donna if his demands for lodging are any indication. He canceled too late for the hotel to find anyone else to rent it for anywhere near what the pianist was going to pay. I'm paying roughly a quarter of what he would have been charged (the hotel will presumably bill him for the difference between what he would have paid and what I'm paying), which is still an entirely ridiculous amount of money for me to be paying for a hotel suite, but I have only one life, and it may as well be an enjoyable life. Money isn't something any of us can take with us when we make our final departures. While I plan to live to a reasonably old age, I don't plan to leave an excessive sum of money sitting in banks or various other investment funds. I do not wish merely to live, but to live!!!, and doing so is going to cost me a few dollars on occasion.

The hotel suite has, of all things, a Steinway baby grand which, due to the thickness of the walls and the placement of the piano within the suite, may be played at any hour of the day or night without complaints from neighbors or management.  I woke up a couple of hours ago with a mild attack of insomnia, and chose to deal with it by playing the piano. I've seldom if ever had the luxury of playing the piano at 4:00 a.m. without having a Nerf football thrown at my head as a result.

A few friends are flying in for the weekend. I had originally said that no one could sleep in my hotel suite if they visited, but I'm waffling and allowing six friends to scramble for couches, recliners, or the one extra bed in the suite. My stay is here going to be longer than originally planned, so solitude during this break is of less importance than i originally thought it would be. besides, part of the fun of this vacation is having my peers be envious of me.

I even have a bodyguard who comes as part of the package, I'll need to tip him, but otherwise he is included in the flat rate I'm paying for almost everything.  I have no real use for him for the most part during the daytime. I have him hang around at night just because there are predators in the world, some of whom seek young and single women whom they consider to be vulnerable. Once the guy leaves, there is still reasonably tight security at the hotel itself, so it's not like I'm fair game for every sick puppy who might desire to make a leather coat from my hide.

I chose the study of medicine because I find it interesting, so even when I'm on break, I can't leave my field of study alone entirely. Yesterday, with an invitation, I went to  a hospital affiliated with a medical school near the hotel at which I'm staying. I scrubbed in for one pediatric abdominal surgery, talked to a few other specialists, then left. That's the nice thing about this being a vacation. There's no such thing as a shift. I can come and go as I please at any nearby hospital that will have me on its premises.

Breakfast will arrive soon. I'm having pancakes and fruit. I would probably gain weight on this trip were it not for one small issue: I cannot gain weight. My mom has issues with that as well, so it's presumably genetic. If she eats an amount that is roughly equal to what the average  sumo wrestler probably consumes, she can look good.  If I didn't wish to get myself killed, I could show you all a picture that proves my mom can beef up enough to be sexy.  I'm probably years away from that, though, plus I have a colon condition that makes it impossible for me to retain food long enough to absorb enough nutrients to look the way my mom looked in the particular picture in question. It's getting better, though, in the sense that fewer people accuse me of having an eating disorder. I'm less skinny and am starting to look my age, I consider it a very good thing.

I have no solid plans for today. After breakfast, I'll probably go back to sleep. when or if i wake up, I'll call and ask for a snowmobile to ride. I will need my bodyguard for that activity if no students are on break with whom I can tag along. Snowmobiling anywhere  interesting isn't particularly safe as a solo activity.

I watched a bit of the Olympic sport curling on TV. I don't get anything about it, as in exactly how it works or exactly why anyone would choose to do it. To me, as either a participation sport or a spectator sport, it seems roughly as compelling as is playing marbles. I haven't seen many televised marble competitions lately. they're probably around, though. Chances are that I'm simply not looking at the right channels. 




Friday, February 9, 2018

Completion of Medical School, Match Day, Marriage, Medical Specialty, Life!!!




I'm reaching the age where it's not unthinkable to consider marriage, although i personally think I'd be getting WAY ahead of myself to proceed too far into planning it or even thinking about it when I have no likely candidate in mind. A little over a month ago, I at least had a candidate. I wasn't taking his candidacy too seriously, nor was he, apparently, since he broke it off by phone over Christmas vacation. (The two of us were not yet engaged to be married.) My brother continues to remind me that the guy was at least classy enough not to have ended the relationship via text. I would have preferred an in-person break-off, however inconvenient it might have been. However, as much as I hate this statement when anyone else says it, I shall use it myself this once: it is what it is. The guy broke it off by phone. He could have hired an airplane to fly past my ski resort when he knew I would be outside, with a banner trailing the plane, spelling out the words: "We're finished, Alexis. Get over it!" almost in the style someone (his ex Stephanie March insists she had nothing to do with it) repeatedly flew above Bobby Flay at the podium as he attempted to give his speech prior to his star on the Hollywood Walk of Fame being dedicated. The banner trailing the plane disturbing Bobby Flay's ceremony read simply, "Cheater!" Sometimes the laconic approach is best. I couldn't have expressed it better myself.




In any event, I checked out the statistics for medical school students and interns/residents. It seems that, even with statistics for marriage overall showing a decline for individuals in their twenties as opposed to in previous decades) nearly half of medical students at my stage of medical education have already tied the knot. That surprised me, but I found my roster of students in my own cohort and counted. Out of the one-hundred-three students remaining in our cohort (As late in the game as it is, our number may soon drop by one. It seems that one of our members has found herself in warm if not downright hot water. Regardless of any connection the situation may or may no have with me, I'm staying out of it on both sides. I won't plead for mercy on her behalf, nor will I offer any evidence against her unless I am compelled by my superiors to do so, and such seems highly unlikely at this point.) forty-nine of the one-hundred-three are presently married. Two are on their second marriages (Where in hell do these people find the time for this level of activity?) and five of the presently single cohort member have been divorced. As far as who is currently contemplating divorce or even has filed for such, I haven't the foggiest notion. i'm doing well to know who is even married. I wouldn't know who had been divorced were Celinda not sitting here with me and cluing me in as to the marital status of the respective members of our cohort.  She somehow has time to keep up with such minutiae.  Numerous members of the cohort (even Celinda doesn't know the exact number but she estimates it to between ten and twenty) plan to get hitched during the break between graduation and the start of internship/residency. Interestingly enough, none of our cohort members are married to one another, nor, as far as Celinda knows, are the scheduled upcoming nuptials between any of our cohort members. While I'm the last person who should be providing marital or premarital advice, it would seem to be a wise act for a variety of reasons not to marry a person in one's own graduating medical school class at the same school of medicine, at least while the two are both enrolled in medical school. There's plenty of time later to develop the relationship and to make it legal if doing so seems like a good idea later. 



I find it highly dubious that anyone still reading this actually gives a flying squirrel's rectum about the percentages regarding relationships, though I'll share the numbers anyway because I've always been a math geek. It rounds up very slightly to forty-eight of my cohort mates presently being married. Fifty-two per cent of my cohort mates have been married. Counting all marriages, divorces, and remarriages, fifty-six marriages have taken place among members of my cohort. If we allow the divorced members to skew the statistics -- and it is a clear skew of the statistics -- fifty-four per cent of the members of our cohort have been married. 



One statistic I found interesting though not terribly significant is that -- depending upon whose statistics one chooses to believe, students enrolled in programs leading to degrees in osteopathic medicine have a significantly higher chance of marrying before their final year of formal schooling has been competed. One source I checked had sixty-eight per cent of the  D.O. candidates married by their final semester (or penultimate quarter depending upon the system) while another listed their rate of marriage in the same time period at seventy per cent.



I won't use this time to go into the differences between traditional (sometimes referred to as "allopathic" medicine and osteopathic medicine). Historically, the two evolved from the study of extremely different  forms of medical treatment, with osteopathic medicine focusing heavily upon musculoskeletal adjustment of the body. While  osteopathic medical students continue to receive more treatment in the study of musculoskeletal adjustment than do traditional medical school students, osteopathic medical students now receive considerably more training in areas considered "traditional medicine."  I don't wish to burden anyone with my own prejudices concerning osteopathic medical training, nor do I wish to engage in arguments with anyone concerning the same. I will say (and some will disagree)  that students in osteopathic programs were frequently rejected from traditional medical schools, and I will also say that students enrolled in traditional medical school programs post an average MCAT (Medical Schools Admission Test)score of 31.4, as opposed to the mean score of those enrolled in schools of osteopathic medicine , which is 25.31. Some sources have suggested that acceptance rates as schools of osteopathic medicine are lower than at traditional medical schools. if such is indeed the case -- and I'm not 100% convinced it is -- it would be, in my estimation, in part because students apply to osteopathic medical programs who know they haven't a ghost of a chance at admission to traditional medical programs and that osteopathic medical programs also deal with applicants who have been rejected from traditional medical school programs.



Prospective doctors of osteopathy take different board exams (COMLEX) than do doctors of medicine (USMLE). There may be very legitimate reasons for the different exams. Were i the god of Medical Exams, and particularly if I were in charge of prospective osteopathic physicians and the exams they were given, I would insist upon doctors in both programs taking the same exams. Osteopathic physicians frequently face attitudes of superiority from doctors of traditional medicine. Were i an osteopathic physician, I would welcome the opportunity to demonstrate that my knowledge, at least as measured by  single test, was equal to or superior to a doctor of traditional or allopathic medicine.  Alleging that one's test is actually more difficult than the test taken by doctors of traditional medicine, even if it happened to be true, which I highly doubt, doesn't cut it as an explanation in the real world. It's similar to most of the private schools in my area (typically the Catholic Schools), which insist on giving the equivalent to Form B, or the test that is offered in the fall, instead of giving its students Form A, or the identical test public school students take in the spring each year.  Private school administrators give all sorts of bogus explanations, sometimes even going so far as to outrightly lie and to say that their students took in the fall the identical test that the public students will take in the spring. Such is blatantly untrue. The test the private school students typically take in the fall is a slightly modified version of one the public school students took the previous spring, usually amended to make it slightly easier because it is given so early in the school year that students haven't had adequate time to recover what they may have forgotten over the summer.  (I use Catholic schools as an example here because it would be an unfair comparison to pit preparatory schools with annual tuition of an absolute minimum of twenty-two thousand dollars against public schools. The two groups of student populations have nothing in common. With Catholic schools, while they have a slight socioeconomic edge over public when considering both mean and median income and the fact that Catholic schools can and do reject anyone they would prefer not to have among their student bodies, it's still close enough to be an almost level playing field. Catholic schools should relish the opportunity to kick the public schools' butts on standardized tests each year. Instead, they give different forms of the test, yet still try to boast of their superior performance despite it being an "apples to oranges" comparison.



I use the two rather unlikely comparisons because in both cases, in my opinion, one group is opting not to take an identical test as the other when it would be a perfect chance, if the claims made by the smaller group in each case have merit, to demonstrate superiority or at least equality. If the osteopathic programs consider that they must test, in addition to the standard medical curricula, the musculoskeletal content covered in their program, they could include an additional test covering those areas, and could require their candidates to pass both exams in order to be eligible to practice medicine. While I will likely work with many doctors of osteopathy during the course of my career, Ido not wish to carry a chip around on my shoulder in relation to the supposed superiority of my training as compared to theirs. On the other hand, if I am brought to an emergency room with severe cardiac symptoms, I desire to be treated by a physician who has passed the respective required versions of the USMLE as opposed to the COMLEX with its extra two-hundred questions about musculoskeletal manipulation. I'll now climb off my soap box and return to my discussion of marriage as it relates to medical school and the practice of medicine.



I wouldn't really consider medical school to be exactly a microcosm of society for various reasons. What I would consider it to be is a multicultural, multi-societal, multi-geographical, multi-communal mixing bowl. The percentages of the racial breakdown of our cohort and of the medical school as a whole almost certainly exist on someone's computer and in a file cabinet somewhere, and they're probably being used as I type to attempt to gain additional funding due to a higher-than-average percentage of females, Asians, Africans, members who identify as LGBTQ or whatever is the current acceptable term, individuals with physical disabilities, individuals from backgrounds that would qualifying them as being economically disadvantaged, and individuals who have suffered what someone reading through stacks of applications would consider to have been significant trauma at some point in their lives. 



We, with our widely varying backgrounds, were thrown together into a lecture hall or two or three, and, perhaps most significantly, a human cadaver lab. Before ever being granted access to any actual hospital corridors abutting rooms containing live patients, we bonded over difficult content, demanding professors, and the dissection of cadavers.  It's truly a bonding experience. In some cases it's more of an un-bonding experience. Just as you grow close to some over shared trials, you learn through adversity that there are other individuals in the company of whom you will never spend more than five seconds if you are not required to do so.  A great deal of dating happens between cohort mates, as your dating pool consists largely of those with whom you spend time. A considerable amount of sex also happens. Most of us are at an age at which our hormones are running amok. The sex that happened in closets on Grey's Anatomy wasn't entirely a case of Hollywood's attempt at making things more titillating for viewers. It happens, though usually at someone's apartment and not in a hospital supply closet.  Some positions are more comfortable than others, not all hospital supply closets have locking doors, and there's a reason God or at least someone invented beds.  



Dating practices notwithstanding, practicality ended up leading most of us in different directions when it came to more serious relationships. On Friday, March 16, most of us will learn where we will serve our residencies. Either we can opt out of the program after our initial year our internship, or the program itself can opt out and invite us to continue our training elsewhere. Regardless, we're contractually committed to any institution with which "the computer" (I'm sure there is more than one computer involved, but it's always referred to simply as "the computer") matches us. We dash all over the nation having interviews while also trying to get views of hospitals and communities. We then submit lists of our preferences of programs in order. The teaching programs at hospitals also rank us in order of preference. We're assured that the system is fair and that it does not place preference of the institutions' preferences above preferences of the students, and that a fair and equal balance exists. I'm convinced that we're not far from knowing exactly how it happens, and the disclosure of how it works will, within a very short number of years, force the system to be "fair and balanced" (another term I've grown to detest but will use it here anyway), but for now, we as students  have no choice but to take the computer's word for it and to take the match that we're given.



For most of us, Match Day is perhaps the most exciting yet simultaneously the most stressful day of each of our respective lives. While we can opt out 9or be kicked out) after a year, that's not what most of us anticipate. we assume that our match will be for the duration of our training. That if we aspire to be general surgeons, the next five years of our lives will be spent at that institution. For a few specialties, it's a three-year commitment, but for others it can be six years.
We're stressed about being accepted into a program of our choice. We're anxious about the location. Imagine adding to that the apprehension of where a spouse or prospective spouse might end up in relation to where one's own residency might be. I can't imagine it, which is a reason I've chosen not to become too closely attached to anyone who faces as little control as I do over my immediate future. 



Some of my peers have girlfriends and boyfriends within the cohort. They'll choose whether to break things off cleanly, try to make a long distance relationship work, or somewhere in between. In some cases they may even get lucky and end up at the same institution, or very near. They'll find that they have very little time off, and what time they do have off may not coincide with the time the other has off. Their relationship may soon be history. Or maybe it won't Some relationships succeed against seemingly insurmountable odds.




My brother is in a relationship. His sweetheart is a registered nurse who will soon complete her certification as a nurse practitioner.. If it's what they decide to do, she will be able to travel to wherever he goes. Registered nurses and nurse practitioners can work almost anywhere. My brother and the woman in his life face the same hurdles anyone faces who is either a physician in training or who marries or attempts to maintain a relationship with one. The odds are probably technically against the success of their relationship. Technical odds are beaten every day of the year, though. It's all up to them The world is their oyster, whatever that means.



As for me, as much as the recent breakup hurt, I'm very relieved to be entering this new phase of my life with virtually no encumbrances.  I have a better-than-average chance of ending up where I think I will be matched, and it is my first choice. My plan, assuming I end up where I think I will be, is to spend the full five years there and walk away with the multiple certifications I hope to earn. If the ulcerative colitis situation doesn't improve, which I don't believe will be the case: for once in my life I shall dispense with my usual pessimism and will think positively; while colitis may always be a part of my life to some degree, it will improve, and I will function as a normal person to the degree that the specialty in which I ultimately practice will be a matter of choice and not a matter of default due to health concerns. 



I don't need to place any sort of time limit on a relationship. As it is, I'm barely the age most people are when they begin medical school. and I will have finished up all of my coursework in ten weeks (four of which will be spent on vacation!!!!), and will be graduating in roughly four months. If somewhere in the next few years, I find a person I'd care to share my life with, it will be sublime. If not, I have an astonishing career to which to look forward, I'll earn enough money to travel to exotic locations, and I can date or not as I see fit. Three members of my cohort have made proposals of varying sorts, but all are along the lines of "If neither of us is in a relationship in X number of years, we should meet up and see whether it would work out between us." I haven't said yes or no  to any of them, but if the time is right, I'll explore the options.



There are people who are my age of twenty-three who are working at Burger King while they try to pay off student loans as they try to find some way to use their relatively useless degrees.  And those are the ones who are relatively fortunate. Others have changed their majors four times and haven't yet completed their bachelor's degrees. They, too, are among the lucky ones. Still others are divorced (or never married) with a child or two to support with or without financial help from the child's or children's father(s). (I've vowed to stop using the term "sperm donor" to refer to baby daddies. It's an insult to legitimate sperm donors, who perform a valuable service to society. Thanks, Knotty, for opening my eyes and changing my perspective on that.)



I will very soon have not only my M.D., but a bachelor of science degree in biochemistry that I earned four years ago, in addition to Bachelors of Fine Arts degrees in piano performance, violin performance, and musicology. I didn't originally have the musicology degree, but my music faculty adviser looked over my transcript and noticed that I was a mere two courses short in that degree. I completed the courses online just for the hell of it.  If I really don't like being a doctor, I can probably find something to do with my music degrees. It probably won't pay tremendously well, but there's always busking as a way of supplementing one's income.



Marriage is something that I hope is in the cards for me. I will be cautious. While I don't necessarily wish to be married to another doctor, neither do I wish to be tied to someone who loves my salary more than he loves me. That's not to say I wouldn't consider having a stay-at-home husband for a few years while children were very young if he happened to be really good at it.  However I view it, though, barring some unforeseen tragedy, the possibility of which is so remote that it's pointless to waste time worrying about it, I have lots of time before needing to decide much of anything of consequence, and I have the potential, even without relying on my medical degree,  to earn enough money to live as well as anyone reasonably needs to live. Gold toilets or other features of the Trump Tower or other equally opulent places aren't things I need or even want -- ever.  Marriage to the right person sounds like a wonderful prospect, and I hope it happens for me eventually, but if it doesn't. I'm prepared to create a happy life for myself.



i don't own this video. Thanks to the rightful owner for allowing me to borrow it.