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