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it's time to move on

i will be starting to write somewhere else. i'm not sure where yet. but the time has come. much has changed.

If at first you don't succeed, try, try, and try again. Then give up. There's no use being a damned fool about it.

I've tried for some months now to write, but it's just not any good. Things may crystallize eventually, and maybe with some clarity I will be able to cut them into stones for display. But for now it still seems murky.

I'm getting back to myself. Internship can be miserable, and I did my best to maximize the misery outside the hospital. I needed to fall apart altogether and that's why I went to Africa. To fall apart, and be reborn. Think phoenix.

I didn't come completely undone, and maybe I still need to. I didn't reach a center of clarity, or break away from the trivialities of life. But I made some progress. I remembered some of the things I value about myself. And I made plans to foster those things. Plus I got to see the bright night sky from a dark land. If that's not inspiring, maybe nothing in nature is.

Two more weeks. I can do two weeks of anything. At least that's what I'll tell myself. It's true as long as I believe it.

cowboy funk

i'm in one of those moods, ya know? i can't stick with anything for more than about 3 minutes. which is not enough time to make a proper dinner, or read any part of a book, or do the dishes, or the laundry, or the ironing, or write a letter.

it doesn't even have to be a letter, just something. but i wouldn't even have anything to say. i perpetually feel that way these days. if you don't have cancer, i don't know how to interact with you.

the nausea is coming in waves now. or is it sorrow? to myself, i make sick jokes, just to stay sane. sometimes, when i have a spare moment, i sneak over to the room on 1 East that has a keyboard, and play a song of remembrance.

some evenings i feel like playing taps. but it's been so long since i've touched my horn that i feel like i've never played trumpet.

well there's a sad thought. that used to be one of my defining characteristics. if you'd have told me, "tell me 5 important things about yourself" that would have been up there. if i wasn't lying. i'd probably lie. just to mix it up. you learn something about a person when you see how they respond to a lie.

that sounds pretty twisted. but it's amazing how many people dont want to know the truth. these people flat out tell me that they dont want to know their prognosis. but they're the only ones, cuz the family sure wants to know. they don't always say it in those words. they just "want to know what to expect." what to expect. expect expect expect.

expectations are a funny thing. a %$#@ing thing. but you know that. nothing causes trouble like expectations. i guess they're necessary. or else you're just unsettled all the time. maybe that's what this feeling is.

yup. i wanna vomit again. i just figured it out; over the last month, on any given day, i'm more likely to pronounce someone dead than i am to talk to a friend. no wonder i'm all screwed up.

each paragraph is a new sit-down. in case you hadn't figured it out.

i'm kind of losing my mind too. this happens periodically routinely.

the rest was just gibberish. i told you i was going crazy, but i'd prefer not to leave actual evidence.

Vanity of vanities, saith the Preacher, vanity of vanities

Lift not the painted veil which those who live
Call Life: though unreal shapes be pictured there,
And it but mimic all we would believe
With colours idly spread, — behind, lurk Fear
And Hope, twin Destinies; who ever weave
Their shadows, o'er the chasm, sightless and drear.
I knew one who had lifted it — he sought,
For his lost heart was tender, things to love,
But found them not, alas! nor was there aught
The world contains, the which he could approve.
Through the unheeding many he did move,
A splendour among shadows, a bright blot
Upon this gloomy scene, a Spirit that strove
For truth, and like the Preacher found it not.
~P. Shelley~

Gandalf

Yet it is not our part to master all the tides of the world, but to do what is in us for the succour of those years wherein we are set, uprooting the evil in the fields that we know, so that those who live after may have clean earth to till. What weather they shall have is not ours to rule.

The abandonments

I don't remember it being there so much as I remember it being gone, and now it's one of those childhood memories that I can't be sure really happened, or if I've just tried to think about it enough that it seems real.  John G in Memento.

In my last year of high school, I distinctly losing the Nearness of God. There was no singular event that heralded His departure, but instead a feeling of overwhelming dread overtook me as I discovered I could no longer feel His presence. Have you read Ellen White's Early Writings? There's a passage I think of whenever I try to sort this stuff out in my head.


"Dear Reader: A sense of duty to my brethren and sisters and a desire that the blood of souls might not be found on my garments have governed me in writing this little work. I am aware of the unbelief that exists in the minds of the multitude relative to visions, also that many who profess to be looking for Christ and teach that we are in the "last days" call them all of Satan. I expect much opposition from such, and had I not felt that the Lord required it of me, I should not have made my views thus public, as they will probably call forth the hatred and derision of some. But I fear God more than man.

When the Lord first gave me messages to deliver to His people, it was hard for me to declare them, and I often softened them down and made them as mild as possible for fear of grieving some. It was a great trial to declare the messages as the Lord gave them to me. I did not realize that I was so unfaithful and did not see the sin and danger of such a course until in vision I was taken into the presence of Jesus. He looked upon me with a frown and turned His face from me. It is not possible to describe the terror and agony I then felt. I fell upon my face before Him, but had no power to utter a word. Oh, how I longed to be covered and hid from that dreadful frown! Then could I realize, in some degree, what the feeling of the lost will be when they cry, 'Mountains and rocks, fall on us, and hide us from the face of Him that sitteth on the throne, and from the wrath of the Lamb.' "

The dreadful frown of God. That's the closest thing I can compare it to. But it wasn't a frown, it was an absence. Alarmed, I checked myself. I had not fallen into sinful ways (please forgive my use of this antiquated terminology, but such was the way I saw the world at that time). I thought to myself "Perhaps I have strayed," and so I went back to the places where I had known God before. I went to Bible study, participated in church, volunteered  outreach activities, increased my own reading of scripture, and spent time in prayer and meditation. And still, the Halls of Heaven were vacant.

My God, my God, why hast Thou forsaken me?

He trusted in God that He would deliver him; let Him deliver him, if He delight in him.

I am not given to trust feelings very often, but occasionally I experience profound, wholly overpowering moments of insight and clarity. The logician in me scoffs at these instances, but ultimately his objections fall on deaf ears. It makes me sound like a crazy person (this {along with many other things} does in fact make me a crazy person), but it's true. I don't argue with it, I don't advertise it, I just go with it. The results are rarely disappointing. So when I say I trust my instincts, this is what I mean. I'm a beep-ing lunatic.


I was a little lost at this point in time. Not to outward appearances. I did well in class, had plenty of musical commitments to keep me busy, taught lab, tutored, and wrote for the school paper. I didn't go completely to pieces (maybe I should have). I ran away to Hong Kong for a year. Maybe I'll talk about that some other time. But it doesn't factor prominently into this story arc.


I read in college. Not a lot, not prolifically. But enough to get my feet wet and my mind working. My senior year, I read The Sacred Canopy by Peter Berger. It's a fascinating book about the social construction of religion. It's rather convincing. Had I felt rebellious at that point in time, that would have been enough for me to get rid of religion entirely.


I maybe was an existentialist. It's kind of a dirty word, or at least old enough to be irrelevant, but I had that phase of Kierkegaard and Camus and Sartre and Kafka (oh even now, if asked, I'd say my favorite authors are Dostoevsky, Salinger, and Hemingway. and for all the Murakami I've read lately...), or I'd like to say it was just a phase. I'm sure some things remain from it.


Do you know who Kurt Gödel is? You can read all about him somewhere, but he's important to me because of his incompleteness theorems. Tom Thompson spent two days on this, starting with Cantor and his countable and uncountable infinities and power sets and somehow winding his way around to Gödel.


Any effectively generated theory capable of expressing elementary arithmetic cannot be both consistent and complete. In particular, for any consistent, effectively generated formal theory that proves certain basic arithmetic truths, there is an arithmetical statement that is true, but not provable in the theory.


I'm sure this has some mathematical relevance, but to me, the implications were metaphysical. It allowed me to free myself of Reason as a ruling body, just as Berger had allowed me to free myself of Faith. No. It wasn't a freedom. It was a betrayal. The systems I had in place to organize my life had abandoned me.


The most important thing that happened in college was the death of Brandon Moor. I admired Brandon wholeheartedly. We were precisely the same age (day, month, year), and maybe that's why I felt a connection. Though not just that; we were both in the same Honors classes, we both played brass instruments, and I think we both liked the same girl. But he was handsome and charming and personable and spiritual. I wanted my God back the way Brandon seemed to have Him. I often saw Brandon as a better version of myself. I wasn't so much jealous as inspired.


Brandon took a year off to be an assistant chaplain at Georgia Cumberland Academy, and while there was in a fatal car accident on January 31, 2005. I celebrate that as the day I died. I felt I should have. Brandon was capable of far more than I would ever be. Why would God (no, it was "god" then) allow such a thing, or if it has to happen, at least be smart about it. Take the loser, not the golden boy. Why ruin something so beautiful? Huh? Tell me. I'm listening. I'm all ears. You've got my full undivided attention. 


So Much Unfairness of Things. But in this story, Father and son have a complete falling out.


I didn't handle it very well. There was a memorial service for him at college. I couldn't go. I felt nauseated. I don't really know how I made it through that week, or the rest of the year. Probably because I was plenty busy with all my other activities. I should have fallen apart. That probably would have been the smart thing to do. I was the fool with a house on the sand, but I continued to live there, because there was no rock to be found.

boat built of moonbeams

awake and dreaming yet i trudge across
the forlorn night's unyielding dark demise
no mood light from my moon its bleached abyss
serenitatis drowns my sunken eyes

indifferent man, with constant turning face
what will betide my fortunes? rise or fall
on distant shores, the unobserved place
lit by the sun but dark to else's all

a sail unfurled launches lonely craft
the lonelier captain leaps into the void
a spangled sky approaches fore and aft
where star-crossed vessels hope to be destroyed

expanses of the heavens and the seas
match not the unhinged mind for vagrancies

lesson learned

a surgery resident stopped by yesterday to tell me that the surgery consult i ordered was inappropriate. he didn't really go on to explain what was inappropriate about it, but instead tried to make an analogy. failing miserably, i cut him off, telling him i was post-call and didn't have the patience to listen to him founder. what he must have heard was that it was because I was post-call that I had decided to consult him, and he proceeded to tell me that being post call was a poor excuse for making a poor decision.

we transferred that patient to surgery today.


This whole experience reminded me of something important. (Why yes, I am about to preach)

Never complain down. It does no good to whine to those beneath you. It makes you sound weak, lazy, and unprofessional. If you have a complaint to make, speak to your peers or voice your concerns to your superiors. But you have nothing to gain by grumbling to your juniors. Even if the consult had been a poor decision, I'm not about to pass on this surgeon's unhappiness to my resident or attending. If he really hoped to prevent bad consults in the future, he would have been better served by spending his time doing a little education.

Instead, I just think he's a crybaby with poor clinical judgement.

Where is the spirit in 1+1?

If he suspends the glass above the flame, the brew will sizzle until one chemical interacts with another. The concoction will sizzle every time. Molecules colliding with increased energy, their behavior ruled by the laws of physics. Ruled by the laws of physics. The future, present, and past of every material object is subject to the laws of physics. The orbit of every celestial body, the fall of every drop of rain. His own body a collection of molecules. His desire a cauldron of hormones whose chemistry has just been scientifically documented. His brain a case of matter, blood, and bone.

But he feels direct experience of his own soul, his spirit. He cannot accept that as an aggregate of flesh, a clump of matter, that his future, past, and present are already determined by the laws of physics. He cannot crush out the intuition that he makes choices, influences the world with his mind and spirit. He cannot crush out his belief in God.

mean? yes, but that's why i didn't say it aloud

little old lady (LOL): i'm old enough to be your grandmother
me: ... {no ma'am, you're too old to be my grandmother}

In the beginning...

"All beginnings are difficult"

It's hard to know where to start, because it's hard to know what exactly is pertinent. Where can I begin the story so that it makes sense? Well, but I'll try to keep things concise.

I grew up in the church. Truly, it can be a wonderful way to grow up. Went to church school, starting in elementary. Went to Sabbath school and church services every Saturday, and saw the same people there as I did the other days of the week. My parents were fair and reasonable, but firm when it came to their own values (which didn't necessarily coincide with the official church line). It's a very structured and secure environment, and I did quite well. I excelled in school; I remember how upset I was in 3rd grade when I got a B in handwriting. I played by the rules (by and large, and when I didn't, I didn't get caught); I was never sent to the principle's office, or even so much as reprimanded more than once or twice. I had friends enough, and a younger sister who would help me build forts and Lego bases. Ok, so I had a bit of a temper (I once kicked in a windshield), and some prominent isolationist/introverted/antisocial tendencies (though not enough to be considered on the autism spectrum), but all in all, I'd say my parents could give themselves a Win.

To be fair to environmental considerations, I've grown up with a remarkably well-adjusted and well-behaved group of friends, and they're to be credited for keeping me out of all sorts of trouble. We all were good students, and altogether we managed only minor mischief. As a group, we were active, with music, sports, church activities, student governments, etc. When I say this, I'm thinking mainly of high school days, but the roots go even further back, to Kumon, and computer and swimming lessons, and piano class.

So, those are the sorts of things you could learn from report cards and interviews with my parents. Really, that would give you a pretty good picture. There's not much else that went on under the surface. Well, some self-doubt, self-loathing, self-hatred, though not for any particular reason. I wasn't mean to people around me, I didn't lie, cheat, or steal. (Ok, a few lies sometimes to save me some trouble, and I sometimes looked at my neighbor's test, but mainly out of curiosity, as I always trusted my own answers more). I was never bullied or abused. I was very naive and innocent to the things that tend to get people into trouble (substances, feelings, hormones, power, vanity, etc.) Ok, I had a few early crushes (Cheri Wild, Tiffany Lo, Jacque Copenhaver, Katrina Gonzaga), but I didn't know why I liked them or what I wanted to do with them. I'm getting off track though. What I'm trying to say is, I hate myself sometimes, for no particular reason, and this tendency goes as far back as I can remember.

Let's summarize: Enter one bright and talented young boy, well-bred and with similarly gifted friends. He had some struggles with self-worth, and possible depression vs dysthymia, though this was ego-syntonic, and caused no great distress.

I didn't give much thought to life and love and why in the early years. I believed in the church doctrines, more or less, but I didn't bother to get baptized. Still, I participated in my church; I was religious vice president of my class for a couple years, and was a Teen Minister in the church youth group. I talked at school chapel once or twice. I never enjoyed Bible study though. To me, it seemed like a waste of time, since I wasn't even reading it in the original languages. I mean, I figured scripture was pretty much true, but I never considered it to be infallible; how could it be? It's just a translation of someone else's words. In my mind, if I saw the big picture, I didn't have to worry about the details. Anyway, I saw the impact that God could have in the lives of others (even if I got sick of hearing the drug addict conversion stories, I wasn't one to argue with results), and even felt His presence myself. This would change, toward the end of high school, but that will be the next chapter.


A few last words, things that are important on a very foundational level:

There can be no comprehensive understanding of my psyche without talking about love. In the end, or maybe in the beginning, or probably both, I'm a romantic, an idealist, an INFP; despite all my cynicism and skepticism, I ultimately have hope. Hope for myself, hope for others; love for myself, love for others. This probably deserves its own posting, maybe a chapter, and maybe I'll acquiesce, but at the least keep it in mind as you read.

And this might be the most important, and the key to all that will follow. There are a few things I've never had any reason to doubt, but if I had to pick one, it would be the love of my family. In this I consider myself to be immeasurably blessed.

Foreshadowing (+/- foreshortening)

My friend Dustin rather recently published the highlights of his philosophical journey, and I thought I might try something similar. It will not be a comprehensive understanding, but I hope to make some of my thoughts (which ultimately aren't really mine, but a mash-up of many others) better understood.

I will say up front that I don't see any reason for anyone else to believe as I do. If part of it resonates with you, fantastic. If not, then enjoy the glimpse under the hood(ie). This here is not a road map to happiness, or salvation, or success. It will not help you get through school, meet (or enable you to so much as talk to) the boy/girl of your dreams, or find a job; if anything, I'd predict the opposite. It will be an attempted summary. Mein Kampf, if you will. I feel no need to apologize, because this is likely to be intensely personal, and subject to all sorts of revisionist memory. I will be as honest as I can, though not at the expense of others. Furthermore, this journey is by no means complete. At least, I hope. You never know. Each new day is so wonderfully unpredictable.

It sounds a little bleak, I know, but trust me, I've tried to consider my options very carefully. Here's the short of it: it allows me not to want/have to kill myself.

galeanthropy is the proper term

i was thinking i'd diagnose "lycanthropy" in a patient, just to see if anyone took note. then i thought, no, that's too common. this person looks more like a cat. what would that be called? feline-anthropy? felanthropy? i googled felanthropy, and all i found were people who couldn't spell.

if i was a girl, i'd use "miss anthropy" as my gaming handle

mono no aware (alone and nescient)

break up - heart break

stunned silence, no mistake

cancelled plans, wasted wishes

blurry eyes, broken dishes

dont talk to me, for goodness' sake

let me dream, never to wake

break down - new low

chest heavy, mind slow

collapse defeat surrendering

memory re-rendering

resignation tendering

total shutdown, world of no

break in - what is lost?

papers strewn, drawers tossed

trust broken, lines crossed

self-loathing, unforgiven

recreated, changes striven

devil deal reeks of faust

break out - taking flight

desperate aimless through the night

hazards met couragelessly

unparalleled depravity

hidden from the garish light

longing still to have things right

break through - breaking dawn

yesterday now all but gone

tiny shards, remnant prayers

buried under new affairs

cracks oozing despite repairs

unseen beneath impressive brawn

break away - day all new

sky is shining, sun is blue

ear pressed close to far-off wind

search for whispers from a friend

secret heart murmurs true

(((i miss you, i miss you)))

+stealth

I'm strongly considering posting anonymously. At least for my poetry.

- It would allow me to elaborate and exaggerate with much less risk of repercussions. And while I'm thousands of miles away from these complications, I'm only about 5 seconds away from my phone.

- I just mean, not much comes to me "out of the blue." There's always some sort of connection. Oh mercy, this is just what I was complaining about the other day. These little threads that keep me tied to reality. Some days I feel that they vanish altogether, and that I'm drifting drifting drifting. It's no small wonder I always find my way back, eventually.

- It wouldn't decrease circulation, which is probably best characterized as "arrested," for all i know/care

But then, why "post" at all. Why not just journal if I wanna be all secretive about it? I have no good answer.

I wonder, if I became a musician, how I could write songs that were so personally revealing and part with them. I would hope very successfully...

books, my new old best friend

the top row of my bookshelf looks totally badass right now. that is to say, it's pleasing to my eye. here's how it's stacked up: the idiot, high fidelity, the house of god, a collection by auden, the stranger, kafka on the shore, the imitation of christ, paradise lost (bleh), my name is asher lev, the rivals sheridan, edith hamilton's mythology, for whom the bell tolls, wuthering heights, on liberty, haroun and the sea of stories, the notebook (oh dammit, that'll subtract a few manliness points), franny and zooey, and how to survive the end of the world as we know it. i also have a stack of books that i'm supposed to read (by when?) but i recently got a nook, and now the stack is slightly taller but will last me a lifetime.

so, currently i'm reading (i mean, i've started, with some general intention to finish in the next decade) on the road, the great book of amber, sputnik sweetheart, and persuasion. i probably will finish persuasion first, just because that's on the nook, and the novelty hasn't even begun to wear off.

stray thought

people would literally call it "having one's heart in the right place." but i say it's dextrocardia, and it can be associated with other abnormalities.

nosce te ipsum (failure at the cave)

I've had people tell me that I should go with my first impression. However, meta-analysis reveals that (in terms of medically related multiple choice questions) I'm more than twice as likely to change a wrong answer to a right one than a right answer to a wrong one. So when I can't make up my mind and someone advises me, "Don't over-think it," what I really hear is "I'm betting on the one-third, not the two-thirds." And that is not a statistically sound decision, my friend.

Enneagram

I'm split pretty much between 5 and 9, and 6 is the runner-up. i can't really argue. and if i really was upset about it, i wouldn't be telling you here. feed the birds.


take the test

more in-depth interpretation

Quotes from The Idiot that amused me

In an abstract love for humanity one almost always loves only oneself. - Nastassya Filippovna

But it does appear that a certain dullness of mind is almost an essential quality, if not for every public man, at least for everyone who is seriously interested in making money.

thoughts from saturday (not published then because i fell asleep in the middle of writing)

Everything secret degenerates, even the administration of justice; nothing is safe that does not show how it can bear discussion and publicity. - Lord Acton

I'm not sure if I believe it, and if I do, I don't know how to incorporate it (into a money making business). I'm all for keeping things on the up and up. But absolute transparency sacrifices an awful lot of efficiency. To say nothing about organizations or governments, I would find such an open policy to be cumbersome on a personal level. And so while the saying has a nice ring to it, it might only be as true as something like "Ultimate power corrupts ultimately." (A lengthy discussion on this topic is not suitable for my present level of wakefulness. But if pressed, my quick and easy cop out answer is that I haven't seen overwhelming evidence for either side)


The thing I like about allusion and metaphor is uncertainty of the boundaries. I've gotten myself into trouble before by saying "as you wish" to people who've watched The Princess Bride more than I have. And so that would be a misinterpretation. Similarly (but oppositely), I might say "Good night, good night," but the "parting is such sweet sorrow" might be lost on someone not looking for it, and therefore they might not recognize that in repeating my farewell I'm expressing just how much I appreciated our time together. Or, they might take the allusion to an unreasonable extreme and deduce that I plan, in the next few hours, to kill myself with a dagger. All I'm saying is that allusion leaves a lot of room for user error. But, I still like it. It does such a good job compressing a lot of meaning.

extraordinothing

my phone vibrates a little bit longer when a call is coming in than it does when i'm getting a text, and that extra buzzing always makes me think, 'dammit,' because usually i'd much rather respond to a text than pick up the phone. i mention this because it's ringing right now, and i'm very sure i wont be answering it.

i had something really neat and clever that i was gonna write. it wasn't mine at all, and i would have stolen it word for word (or at least thought for thought) from a book, but i'm 99% sure that you haven't read it (or, i'm sure 99% of you haven't read it), and the other 3% would just be impressed by my extensive interests (and mathematical calculations). but i've forgotten what it is/was.

my brain could use a little synchronized intermittent mandatory ventilation (SIMV). i know i'm learning about this stuff so that i can treat patients with ARDS, but i think there are real life lessons in here as well.

sometimes my mind is a balloon whose string has been let go. sometimes i pop the balloon just so it wont get away from me. probably i should just ask someone to fasten it to my wrist, at least until i perfect my one-handed ties.

one of the guys on my team asked me today if i was married or had kids. i said, 'not to my knowledge' and laughed. i always wonder how seriously people take answers like that. of course, i know myself well enough that the absurdity of such a suggestion makes a good joke.

it's kinda like when people ask me what i want to do. of course i know they're really asking what sort of residency i'm trying for, but it still amuses me to answer them 'to graduate.' as if that would be an accomplishment.

the funny thing is, i've actually stumbled upon something i think i could like. this isn't really good news. i've spent the last 5 or so years trying to rid myself of any strong personal desires. fortunately, this thing is well-aligned with the ideals i've tried to adopt. unfortunately, it seems impossible. and i still hate the idea of failure. or maybe it's being alone when i fail that i'm afraid of. failing isn't so bad. it's trying to pick myself up afterwards that is exhausting. i'm surprisingly heavy for my weight, and it can be tough to find point with good leverage.

well, not really. you just need to make me think that you have some insight into my situation, which is as easy as asking, 'don't you just hate clinic?'

il faut imaginer Sisyphe heureux

i just want to sleep

kthxbai

Life's a bitch and then you die {i should be so lucky}.

i must be feeling sorry for myself. i finished watching pride and prejudice, and now i'm watching moulin rouge. and the football game is on. the amount of self-loathing i will have for myself in the morning (or sooner) is absolutely indescribable. how am i not an alcoholic?

this is my own fault. that bit of information has not been lost on me, much though i'd like to conveniently forget about it. it's what i get for reading twilight, and watching full moon wo sagashite, and listening to l'arc~en~ciel's flower.

at the same time, give me a goddam break. it's not that i mind having things go the way they always do (ok, that's a lie, but i can live with it), but i hate feeling so inescapably alone. i just want a friend around that i can actually talk to (meaning, they actually have a chance of understanding me, and not just understanding the words i use), that i can trust, that will put some effort in him/herself so that it's not all up to me. am i asking for too much? probably. but like i said, i'm not asking for things to be fair, i'm asking for a break.

up to date

i was told today that i shouldn't be a surgeon. i wont get all into it, but essentially i'd be selling myself short, and thereby dishonoring myself and God. i guess there goes my dream of being an African missionary, unless i marry a surgeon (yet another criterion in an already impossibly rigorous marriage checklist. prospects remain poor, to put it mildly)

i'm doing alright on the new years resolutions. well, the renewed resolutions. by this point, none of them are new, just rehashed versions of things i've been telling myself i need to do more or less of for the past fifteen years.
things i'm doing well on: wasting less time, practicing music, studying, exercising, not playing video games
things i'm doing poorly on: being good company, being honest, being nicer

hospital story (NSFW)

quote of the rotation (why would he even tell me this?!):
me: do you have sex with men, women, or both?
42 yo M: oh, women only. only.
me: ok, wha...
42 yo M: [interrupting] but i let a guy go down on me once.

But who may abide the day of His coming?

it was passing, transient, ephemeral. it was fierce while it lasted, and i thought i there wouldn't be an end of it, but looking now, the swelling's gone, and if my memory was poorer i'd wonder if it was ever even inflamed.

it's called atopy, and it seems to be involved in eczema, allergic rhinitis, asthma, and anaphylactic shock. basically, anything allergic. it hereditary, so it's part of a family history, just like diabetes, hypertension, cancer, and autoimmune disorders.

it is a hypersensitivity reaction that affects parts of the body not directly exposed to the allergen. in this way, the body is quite retarded. it takes a small signal, something rather meaningless, and amplifies it completely out of proportion. and while you can use antihistamines and steroids, the best thing is to avoid the stimulus entirely.

palpitations, anxiety, insomnia, chest pain
i had pericarditis last year (no, not from atopy. i'm done with atopy, unless i talk about limerence or Flow, which happen to be things i know quite a lot about, strangely enough. ok, not strangely. i dont throw out big words or concepts like that unless i'm trying to make links. what, like i don't know what i'm doing here? please. if i may remind you, this is mostly a logbook for myself, an encrypted black box, so of course it will be, at times, impossibly obscure. the purpose of my writing is to remind myself of things. there you go, the organization's mission statement. wind tape).

i had pericarditis last year, which i suppose is much better than carditis, because the heart itself isn't infiltrated. not that it can't be complicated. the major problems that arise are pericardial effusion (which can lead to tamponade), fluid that accumulates between the heart and its soft shell that applies pressure to the heart externally, impairing it's ability to fill, and constrictive pericarditis, which also is restrictive, but by way of thickening of the casing, not fluids.
mine wasn't exciting in any of those ways, and the cause probably was viral, or post-viral, probably (non-infectious causes are much less likely in my case). no big deal. hit the NSAIDs hard for 2 weeks, and hope i don't end up with adhesions (fibrous attachments) though even those aren't very remarkable (no long-term sequelae).

Kal Hat'haloth Kashoth — all beginnings are difficult

Two funny things happened this week. Well, not funny. Wonderful. Things that seem like milestones in their own little way, even though I’ll be the only one marking them. But they’re kinds of things I think I was hoping for when I signed up for all this in the first place.

A patient asked for me by name. This wasn’t a medicine patient. It was actually one of the people I’d been taking care of while on pediatrics. A 20 year old boy with cystic fibrosis. One of my first patients ever; I think I picked him up on my first day as a real 3rd year, back in July. As a beginning 3rd year, I didn’t really know what to do for any of my patients. Even now it’s difficult, though I’m getting better and contributing more (today was particularly good; I pointed out to my intern that we should probably start p.m. CPAP on the woman with OSA that we just took off the vent, and that we should probably start ibuprofen on our pericarditis patient (but what if he has uremia from kidney failure?)). But this story was before I’d done so much studying. At this point, I was just a vitals-taker and a medication reconciler.
CF (I’ll refer to my patient by the initials of his disease) wasn’t a difficult patient. He was just in to treat pseudomonas pneumonia or something. Probably on pip/tazo and cipro. Contact precautions, so MRSA, tx w/ vanco. Some of it I learned 2nd year. Some of it I learned from him. What I’m trying to say is that the things I had to offer him were not medical. They were the same things any 25 year old could talk to a 20 year old about. I guess the one real difference was that I knew his disease, so I could somewhat understand what he was going through, and what he was up against. And communication was easy, and we got along well, and I enjoyed having him as a patient on my peds service.
My classmate paged me a day or two ago. CF wanted to know where I was, and if I’d stop by and see him. Sure I would. And I’m right back in there. Does he have a job? Yeah, he’s been working at the community center for a few months. Has he started college? Nah, never liked school. Figures he needs some education eventually, but for now he just wants to take it easy. How’s the girlfriend? She’s fine. Working, taking classes. She’ll be in to see him later today. Her grandparents probably come too. They’re really nice.
I haven’t asked him yet if he knows that he’s sterile. The vas deferens just don’t develop. Or rather, they do, but get clogged up just like the lungs, and involute (unlike the lungs, which dilate, which is why bacteria grows so nicely in there).
CF made a movie. I’m gonna go see it tomorrow. I’ll probably ask him how the paperwork for the lung transplant is coming along. I doubt he gets approved. He’s not an ‘ideal candidate,’ I’m guessing. But I hope he does, and I’ll push for him to. He’s my patient (even if it was for less than two weeks, and this all happened 5 months ago). I think I’ll always consider him my patient. I guess this is continuity of care. So that was the first thing.

A patient thanked me for saving his life. I didn’t personally save his life, but I was involved in the process. I know DKA when I see it. Nausea, vomiting, polyuria, polydypsia, ALOC. Anion gap acidosis, hyperkalemia, hyponatremia. Classic presentation. Fluids (we gave him 13 liters the first day), insulin drip (0.1 U/kg IV. blood sugars were initially 1670!), remember to add some D5 and potassium as things start to correct. Not too fast, don’t want him to herniate his brainstem. No problem. But wait. 52 year old, previously healthy individuals don’t get insulin dependent diabetes just like that. What else could be wrong? Maybe this guy has pancreatitis. Get a CT, amylase, lipase. Aha, so that’s it. Calculate Ranson’s. Amazingly, he’ll probably be fine. And today he was. We’re advancing his diet currently. No, I didn’t order any of this stuff. But I knew what to do. My senior asked what I would do, and I knew. Blow for blow, turn for turn. And it was right. My plan would have corrected this guy’s problem. And he’s getting better, and we’re just monitoring to see his pancreatitis doesn’t have further complications. And he thanked me. He said to me, “Thank you for saving my life.” And his brother said, “thank you for saving my brother’s life.” And I know I didn’t. I know it was the senior who ordered it, and the nurse who placed the bags, and the scientists who studied hormones like insulin, and the physicists who figured out how to make 3D images the human body with ionizing radiation, and the pharmaceutical companies who learned how to synthesize the stuff, and the clinicians with their placebo controlled randomized prospective trials. But still, a small part of me feels like I finally did something that mattered to someone else. And I try not to get all worked up over feelings, but this is kinda new and wonderful. So that was the second thing.

a new low [into the rift]

i am so completely disappointed in myself. (this, of course, being in addition to my general, smoldering malcontent)

and this after a pretty good spell. over the last few days, i started really picking up the pace in my BMS (best medical student) campaign, i found a present that i was supposed to get on my 17th birthday (from my grandfather who has been dead 23 years), i watched a reasonably good movie in The Diving Bell and the Butterfly, i studied more than is characteristic, i was practicing trumpet almost enough to start improving, i was exercising almost as much as i should, i was eating almost as well as can be expected. i was almost sleeping well. (those 'almosts' probably sound like a bad thing, but given that i'll always expect more from myself, they're as much as i can hope for)

and then this. this. this, after all my careful planning. this, after all my reconditioning. this, after all the rebar and bricks and sandbags and sutures. this, after all the brooms and rags and bleach and ammonia and acid. this, after all the knots and bolts and lids and locks and caps and corks. this, after the aspirin and motrin and amitryptiline and methadone and lidocaine and ketamine and liquor and cocaine.

/often go awry
/gang aft agley

all i wanted was an empty room.
all i wanted was a quiet space.
all i wanted was an all alone.
all i wanted was a time erased.

~ oh no, not back here
The woods are lovely, dark and deep,

~ you know where this ends
But I have promises to keep,

~ it's an interminable darkness
And miles to go before I sleep,

~ and we were just there...
And miles to go before I sleep.

i need an excuse. something, anything to make my contribution to this mess less categorical. a starting point for rationalization, justification, exoneration, vindication, whatever word might apply. i never want to be completely defenseless (even if my situation is indefensible, of which i'm like 99% sure. one who repeatedly makes the same mistakes = idiot)

goodbye, productivity. fare thee well, peace. au revoir, sanity. i barely knew ye.


my purest heart for vou / mon cœur pur pour toi
kimochi warui

yay science. yay protocol.

Request for application: whether parachutes are effective in preventing major trauma related to gravitational challenge

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence-based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence-based medicine organized and participated in a double blind, randomized, placebo-controlled, crossover trial of the parachute.


And while we're having fun, some useful definitions:

Clinical experience: making the same mistake with increasing confidence for an impressive number of years

Evidence-based medicine: perpetuating other people's mistakes instead of your own

Compliance: (1) change in volume per unit change in pressure; (2) a tendency to give in to others; (3) obedience to a dictate given by an authority; (4) doing what the doctor wants

Delivery system: something that connects "providers" with "consumers." Examples include vending machines, Federal Express, and managed-care companies. "Health care delivery" is to be distinguished from the practice of medicine by physicians.

Management: the process of directing a patient through an institutional protocol mandated for his condition without furthering one's understanding of his illness.

Specialty: a practice that is restricted in some way