Harlingen vacillates, between mid-December flip-flop weather - sunshine so bright it makes the asphalt look white and perfect strolling temperatures, and this dreary grayness that spits rain like a leaky faucet and is just cold enough to be uncomfortable. I think it's because of where we're situated geographically; the winds change frequently, and it seems like we get a different cold front coming down from the north every other week, punctuated by the regular south-Texas warmth. Today is dreary, but at least we had a nice Christmas yesterday - it was warm and sunny, and after opening present i spent the rest of the day in the kitchen, cooking up rice with pimientos, sweet potato soufle with marshmallows, green beans and broccoli (not in the same dish), roasted pheasants, white-tail deer tenderloin, honeyed ham, and wasail punch.

Now, I've got little to do but await contact from the administration. I've submitted my preliminary requests for third-year clerkships, and have been assured that all of my placements will meet Texas requirements. I suppose I should start gathering information and figuring out exactly what will be required of me, and exactly how I can go above and beyond that - I could be wrong, but based on what I've heard about some of the students, and what I've seen in my own colleagues, it will not be difficult for me to out-work the people sharing rotations with me. Perhaps the greatest advantage I have other them, though, is that I've lived with a doctor for 18 years - my father and I bonded over reviewing his procedures. That being the case, I know that it really pisses doctors off when they feel like they have something to teach you, and it's obvious you want to be somewhere else. I have done well in the basic sciences, but I am going to shine on the wards.

Running. Rumming.

Ross had this thing called "UMBR", their University Medical Board Review Course. It was conducted several evenings a week and one weekday morning throughout the 5th semester in Miami by the clinical faculty, and, in my opinion, was nearly useless - except for the fact that it was the gateway: 90% attendance was mandatory in order to be allowed to attend the final 10 days - a fantastic review of pharm and physio by Dr. Wazir Kudrath, who teaches for Kaplan. Thus, I actually sat through some of that information twice, which was a positive thing. I bring it up because, during those final few days, Nicole and I started working out in the mornings (the courses were 8 hours a day, starting at 1pm or something like that). That generally isn't my thing; my body takes a while to wake up, regardless of whether I'm doing weights, running, or something else. However, working out early gets it out of the way and frees up the day - so that's what I did today. During my year off, I had this enjoyable running route that took me down highways and over fields - around 5 to 5.5 miles. It was exciting to get back to it, but working out after a 12 hour fast is tough work, especially with unpleasantly vicious winds going against you half-way.

Nicole makes this rum cake that I absolutely love. Love. She sent two for me (one for the family - I ate that one first) a few weeks ago, and the last piece disappeared yesterday. That tragedy impelled me - emboldened me - to try my hand at my own rum cake! I googled a recipe, and actually came up with the same one she uses. So, after my run today (and before the arrival of my favorite Jamaican grandmother, who always comes down for Christmas), Caleb and I went out to pick up the ingredients. I started right after we got home - Nicole said that she'd consult for me, but that this was an incredibly easy recipe, which it was. I had the kid brother crisco the bundt pan while I took care of everything else. While it cooked, we went off to enjoy his birthday present - Halo 3:ODST. After an hour, I made the glaze and brushed it all over. I'd forgotten to poke holes so that it could permeate, but that was soon remedied. Now - I'm not an awesome cook, but I can survive; I can make a few things, and I've lived on my own and cooked for myself. I can cook, but I'm not a gourmet chef; the things I make are tasty, but few of them are as beautiful as this:

Apparently, one of my mother's friends uses the same recipe, but with coconut rum. I was only half-joking when I said I'd try it out tomorrow.

10 Point Buck

I've been back in South Texas for a few weeks now, and after a few hunting trips of watching the wildlife walk by (lots of doe, a bobcat, some rabbits, and two trespassing teenagers), I got my first shot at a buck in about 9 years. Dad and I were sitting out in a blind on his lease about 45 minutes away from Harlingen at the end of a rainy, gray week. Luckily, we didn't get stuck in the mud this time, and the weather had warmed up to the mid 60's by about 4:00pm, when we got to the blind. We were only sitting there for about 45 minutes when we saw a small doe walk out from the right side of the shooting lane just under the feeder, about 100 yards away. She moved back and forth, and was finally joined by another doe. At this point, Dad turned to me and whispered "We have meat in the freezer - you don't have to shoot a doe....unless you just really want to." On another lease last week, I'd chosen just to let the doe walk by, enjoying nature and waiting for something better. Fortunately, I made the same choice yesterday - the two doe had not even been gone for a minute, when a 10 point buck stepped out onto the lane! He wasn't out for the sparsely scattered corn; he was following the girls - and he'd have disappeared after them if there hadn't been some quick action. Dad grabbed his deer call as I set my rifle on the rest, my heart thumping a hundred miles an hour. I don't remember him blowing the call; all I remember is looking through the scope to see this buck stop, turn broad side, and look up at us - and then cross-hairs on his shoulder, and the shot. I looked up to see that he'd dropped right where he stood.

Bellerophon

I had a post a while back called "I, Dragonslayer", that dealt with the removal of a large gecko from Nicole's room in Dominica. Perhaps I should have waited until I truly killed a dragon - we received our step 1 scores today. I got a 239/99.

Ambergris Horizon

I got up to run today - getting the workouts out of the way opens up the whole day. It was chilly, though; the sky was the color of ash and a fine, ice-needle mist blew in from the north. Once that was out of the way, I stretched and watched CSI before searching for the car keys for 45 minutes. Finally, though, I got to Starbucks, and finished Carlos Ruiz Zafon's The Angel's Game - folks on Amazon didn't like this one as much as The Shadow of the Wind, partly because it was a more violent and dreary tragedy - but those were exactly the reasons I liked it more. I like my escapism - whether it's music, movies, or literature - to be slightly heavy (think Everlast's What it's Like, Will Smith in Seven Pounds, or Park Chan Wook's Oldboy), and this was exactly the right kind of heavy.

While I was sitting in Starbucks yesterday, I met my new girl - Beth Rowley. She was singing Nina Simone's "Nobody's Fault but Mine", which sounds like a little Joss Stone, a little Diana Krall, and maybe a little Winehouse (although, personally, I'd like to hear Nina's voice over Beth's instrumentals). I haven't discovered a whole lot of new music - time for searching was limited with this whole medical education and all. More than that, though, I think it's because I'm driving less - my daily commute used to provide exposure to new artists, and familiarity with the ones I already knew. I was driving yesterday, listening to Common's Finding Forever album (which is orders of magnitude better than Universal Mind Control), when I realized that, in addition to missing the music, I missed driving. It's so calming; it was like I'd snuck back into a little cocoon that I'd forgotten about. The enclosed space - empty but for myself - has been very relaxing these past few days.

Once I finished The Angel's Game, the sky darkened to marbled charcoal, the temperature continued to plummet, and the rain swelled from the ice pricks to fat dollops that hit my windshield like grapeshot. I walked through Waldenbooks in the mall, amazed at how many storefronts had closed up since I'd last been here. Some of them had simply moved to other locations, but some of them, I'm sure, disappeared forever - the whole thing felt hollow. So I left and went about collecting the things on my list, braving the gathering storm as I drove beneath powerlines covered in the big, black birds that always appear whenever the weather turns. I got most of what I needed, but after searching through three stores, I still couldn't find the tcb hair oil I usually use - it's like this town has forgotten that they have black people. I did, however, make an unexpected find - following Thanksgiving dinner, when I poured out an unfortunately tasteless Tempranillo, I'd promised my father that I'd get him a Malbec, since I'd never had one I didn't like. I was searching through the rows of HEB's wines, when I saw not just any Malbec, but Terrazas De los Andes! This was the wine Nicole and I had fallen in love with in Argentina, and hadn't seen anywhere in any of the stores in Miami.

By the time I was ready to come home, the sky was as black as the roads - it was like driving through a tunnel, along the slick floor of which spilled red and white neon glares, dragged by headlights and taillights. I opened the wine as soon as I was in the door, and it was almost as good as I remembered - almost, because the company just wasn't the same.

I'm still relishing the idleness - stuff'll have to be done soon.....but not yet.

The Bliss of Idleness

It only lasts for so long. When I came home during undergrad - home to bed I'd slept in since I was 16, home to an inescapable familial role - I could only stand about three weeks before I was bored out of my mind and ready to get back to my college town. Things were different when I moved back to Harlingen during my year off - I didn't hunger for the faster pace of a bigger city, rather I embraced my small town anonymity, eschewing the company of high-school friends, such that every single moment was mine and mine alone (it was perhaps the transitory nature of that stint that made it not only bearable, but so enjoyable). Now, I've been home for 4 days, and am relishing the lazy days - since Stef and Caleb are both home, I stay home too, playing Halo and watching TV with them instead of grabbing a book and fleeing to the nearest coffee shop (which I'll do next week once they're back in school). This idleness is blissful; this is the break I've been looking forward to since the beginning of med school. With those damned condensed semesters, we never got a summer vacation; it was two weeks at most. Looking back, I suppose that minimized time for forgetting, but it also shortchanged me of the academic decompression to which I'd grown accustomed. After 4th semester, that break went down to almost nothing - I had to pack up and move from the island, visit my family, move to Miami, and study for the Comp in little over two weeks (Nicole and I buckled down, studied like crazy and passed with no problems, unlike very many of our colleagues, who took the beast too lightly, and had to take it again). Then, after 5th, we took a tiny break to visit Nicole's family, and then jumped back into studying hardcore. And now...I'm enjoying the laziness of doing nothing.

Dad, Stef, Caleb and I went out to the deer blind on the lease today. We didn't see anything but a coyote, but it was restful and enjoyable. I'd forgotten how gigantic this Texas sky is.

There's paperwork to send into the administration and Christmas shopping to ponder. There are movies I want to see, stores I want to visit, a stack of books I want to read, gallons of coffee yet to drink, weights to lift, and miles to run. It'll all get done, but right now I'm enjoying ease of my down-time.

il Purgatorio

I'm fond of likening my sense of relief following a semester or school year to Dante's climb from Hell at the end of the Inferno. I suppose that metaphor is a bit more fitting now, because things weren't fine and dandy after Dante ascended the nine circles - there was still Purgatory, which is kind of where I am now. I really thought that there'd be a huge sense of relief following the Step, but there wasn't; it was almost as if I didn't (and still don't) know what to do with myself. For two years, my classes, my studying, my purchase of books and review books - my life, essentially, was aimed solely at this one test, this one chunk of 8 hours, a mere 336 questions. Now I'm sort of at a loss; I am relieved in a sense - though it was nothing short of a heinous beast, the questions themselves weren't that bad, and looking back I wouldn't have done anything differently; I felt that choices of USMLE World and Kaplan were the correct ones to make. However, this has been looming like a malevolent spectre at the periphery of my consciousness for so long, that its absence leaves me feeling a little aimless. I call it Purgatory because now, I must await my scores, and then complete paperwork, and then await my scheduling from Ross.

I am, however, already enjoying my time off. After the test, Nicole and I bummed around for a while, slowly packing and boxing and all the other unpleasantries tied to moving. I was fortunate enough to visit my grandparents before leaving Miami - once because it was scheduled and once, because Nicole didn't like the idea of the leaving the new vacuum cleaner I'd bought for the landlord, and felt that it should stay in the family. I got to begin Carlos Ruiz Zaffon's The Angle's Game, which is delicious so far, and we went to see An Education, which I hear is getting some Oscar nods. I got home two days ago, and Stefan got home yesterday - with Caleb, we've already burned through some serious Halo death matches. Today was spent doing more cooking (stirring and chopping, mostly - and being told what to do), and I might go sit in a deer blind tomorrow and stare at the landscape, waiting predatorially. This is something I've been looking forward to; I've come to realize that the waiting part of hunting, once you truly learn to enjoy it, can best be described as meditative.

I'm already starting to look at what will be required of me during my clerkships. Texas has strict accreditation requirements, and while I'm not set on coming back here to practice, I'd like to keep as many doors open as possible; and all of the properly accredited clerkships are available in NYC, so that's where I'm mentally preparing myself to go.

In the Mouth of the Bear

I used to have some pretty weird dreams - I'm not just talking "oh no, I'm falling and I'm naked" weird, I'm talking first rate weirdness that used to make me wonder if something was wrong with me. My dreams occasionally unfolded like interactive movies - the climaxes and resolutions were frequently surprising to me; I felt as if a few of my dreams were trying to teach me some moral. In high school, because of my fascination with lucid dreaming, I began keeping a dream journal - my dreams had always been very vivid, and I had no trouble remembering them. I'd wake up, and go to do the dishes, and while I stood at the sink, the tidbits would come back to me - then I'd write them all down before school. The point of recording one's dreams is supposed to be a signal to the subconscious that they're important - making them easy to remember. This is exactly what happened in my case - I'd have vivid dreams every night, and on the weekends, there'd be three or four a night. It actually got to the place where I was losing sleep, because I'd conditioned myself to wake up and write them down right away. That all sort of fell by the wayside during college - I tried to type out a few, but there was never anywhere near the same levels of the dreamstorm I'd had before.

I had a weird one last night, that recalls the previous levels of strangeness. I was hunting for something; I was at a little hunting camp. There were a few cabins, a main gathering house, etc. It was out in the wilderness, but where exactly I couldn't say; the weather was warm, perhaps in the 70s - I was wearing a light, button-up camo shirt, camo pants, and boots. Another family was there as well - a poor white family, whose children didn't seem too terribly interested in hunting. There was a girl of about 14, and two boys of about 10. Someone had to keep yelling at them to get ready, and to make sure to be on time. For some reason, I wasn't concerned about being on time, and I even had the feeling that I wanted to make the guides a little bit late. The inside of one of the cabins looked like something between a high-school hallway and the inside of a barn.

We went outside into the warm sun, and milled around for a bit. A small stream ran through the small patch of land, and off into the dark trees about 5o yards away, at the corner of the yard. I crossed the stream to the area in front of the main house, and there was the guide with one of his assistants. I'd figured that, since we were going a long way to hunt, we'd need a car, or horses - but there before me stood the most massive bears I'd ever seen. These creatures were larger by far then elephants; their heads were longer than I was tall. I figured we'd get a ride - no such luck. The guide looked at me and said "in you go" - and his meaning hit me. He tapped the enormous bear on its side, and it slowly, mechanically lowered its head, and opened its gaping maw. I thought to myself that I'd never seen a mouth so big on anything - that great white sharks didn't have mouths this large by half - and the guide gently pulled aside one of the bear's cheek flaps. I was seriously considering backing out -this frightened me immensely - but I figured it had to be alright; folks had done this before, hadn't they?So I placed my boot on the outside of an incisor the length of a butcher knife, and climbed up into the bear's cheek, trying to stay as far to the outside as possible. I shimmied my way up, and found a little nook in which I could lodge. Strangely, there was no terrible smell, and I kept on thinking to myself of all the food I'd kept in my cheek over the years - just because it was there didn't mean I had to eat it.

Then we were off, down a small dirt trail and on to a main street. I'd thought it a little odd that we were riding this way, when, if we were going to be on the road, we should have just hopped into a car - but those thoughts soon faded as I noticed things changing. A dim blue light seemed to emanate from the back of the bear's throat, but I wasn't going to sandwich myself between the tearing teeth to see what it was. Soon, though, the inside of the bear's mouth gradually turned into the back of an SUV, with blue tinted windows.

Then, we were making our way up some river that seemed to be running through an antique store.

Here, then, is the interpretation of my dream: the environs and the guide were very similar to the hunt my father and I enjoyed in Alaska after I graduated high school. The streets of Anchorage showed up, and it had a similar feel.

However, the deeper part, I believe is as follows: when I was on the island, my favorite pathology professor would respond to individual questions by sending his reply to the whole class - identifying information removed, of course. These questions would always multiply around exam time, and during that time, he would close his emails with the phrase that medical students in Rome - where he'd studied - would share with each other:

"In Bocca Al Lupo."

It means "In the mouth of the wolf " - how the students would wish each other well on their exams.

With the USMLE step 1 just ten days away, I feel like I'm in the mouth of a much more vicious beast than ever before. I mean...I must be if my own subconscious is wishing me luck.

It's getting better

There's something wrong when a significant increase in the quality of life comes with dogged study of stomach and colon cancer. However, that's the case - I was in a funk, plodding through pharm, and hoping fro some respite from the tedium. Finally, I started path - this is the fun stuff about the basic sciences. I've got about a month left in this run, and once I finish the path, there will only be behavioral science and review work.

I've decided that my new favorite show is ABC's Flash Forward. The show centers around this global blackout in which everyone glimpsed a few moments of their future in 6 months. It's been alright up to now - I need explosions and shooting to balance the drama of Gray's Anatomy and Brothers and Sisters - but the episode I watched yesterday (Gimme some Truth) may be one of my favorite episodes of any show ever. It was done so well, I might watch it again.

Kinda makes you wonder.

I'm doing path right now at the Kaplan center, and the guy is absolutely terrible. Nicole and I both agree - every single pathology professor we had on the island was better than this one, who, apparently, teaches at some top ten US med school. I sit and listen to him drone on and on, yammering endlessly about how the color of butter changes because cows eat grain in the winter and grass in the summer, and I can't help but feel like my time is being wasted. Kaplan's been pretty good to me thus far - but this is incredibly annoying. Pathology is supposed to be the most high-yield subject for this exam, and so far, it's the worst Kaplan has to offer. Thankfully, the BRS is awesome (although, I'm a little miffed that a new edition was released just after I purchased mine), and much of my review material is full of notes from when I was studying for the Comp.

Anyway, it's days like this that make me realize that I'm very lucky to have had some of the professors I had, even though I had to go to the ends of the earth to listen to their lectures.

A funny thing happened to me today - these kinds of things used to happen all the time, but something changed (I don't know what it was) in the past few years. Things in the distance have been blurrier than I like (it's just nearsightedness and not macular degeneration - I diagnosed it myself. I can do that. Sort of.), so I've been making sure to rest my eyes by going out onto the balcony and staring off into the distance. I was doing just that today, when two young women passed on the opposite sidewalk, and one of them shouted up to me "You look like a model!" I shouted back a thank you - maybe I should wear scrub pants and t-shirts more often. I'd say that they were attractive young women, but let's not forget what I was doing out there in the first place.

On another note, I think this country has got it all wrong - the Senate just voted to dump another $50 million annually into abstinence-education. It's just about the most asinine thing imaginable - you can't legislate away an evolutionary imperative, especially not when the target population has a mind-numbingly feeble grasp of outcomes and consequences. Instead of wasting all of that money, which really ought to be going towards something useful, they should let teenagers know how it really is - I've copied below an excerpt from a letter sent to Prudence at Slate.com.

"Annapolis, Md.: I have recently found out from a very good friend of mine that she has herpes. She's had it for many years. She is sexually active and very attractive. She has a history of many relationships.

The problem is that she does not tell her boyfriends that she has herpes. I sometimes get introduced to her partners and feel sorry for them. My friend does not tell them about her condition because, in the past, when she has told them (usually after they exhibited symptoms of herpes themselves), they no longer want to have anything to do with her. She wants very much to get married and feels that, after she is married, she will tell her new husband when the time is right.

Her excuse for this is that the "major" part of the population already has herpes and just doesn't know it. My respect for her as a friend has been weakened ever since she confided this to me.
Here is my question: The next time she introduces me to a new boyfriend, should I give him the news that his new girl is herpes positive ... or just stay out of it? "

Prudie's response isn't the important part here - it's that there are millions of people like this! I wouldn't tell kids not to have sex - sure, I'd share with them research about the emotional changes tied to certain ages, various cancer and pregnancy risks, et cetera - but what I'd focus on, is this:

"You can get diseases from sex."
My crowd would murmur in agreement - actually, if I'm talking to young folks, there'd be a lot of nervous giggling.

"A lot of those diseases will stay with you for the rest of your life."
Maybe more nervous laughter.

"You can't look at someone and know if they have a disease...there may not be any signs at all."
Things would quiet down a bit; I'd look out over the crowd and see the wheels turning.

"The person you have sex with might not even tell you that they might have a disease. You won't know anything's wrong until you wake up one day and your privates are covered in painful blisters and sores, and you're wondering what the hell happened. Then you'll remember that this will never go away. And that's just herpes....that's not one that can kill you."
Dead silence.

Now...how can I get in on that $50 million?

A Precarious Position

Today's step prep day 47 - it's our day off, so we ran some errands, squeezed in some gym time, and finally confirmed our official testing date (it all goes down 11/19/2009). I just finished the pharmacology review, and am all set to start pathology tomorrow. I still want to review the pharm, but I've hit a dangerous period in my studies - that place where I'm just tired of it. The last time this happened was somewhere around 4th semester, after an unrelenting onslaught of shelf exams, and - if I recall correctly - just before the microbiology shelf. I was trying to use every second to force myself to study, but something in my brain shut down and decided that I needed to spend the day watching free-running on Youtube. Luckily, when that hit me last night, I saw it coming. I'd wanted to review a bit today, but since I haven't, I won't beat myself up over it. A cold front blew in yesterday (it's down in the 60s now....I don't know what's going on), so we didn't go sit down and read by the pool. Partly to save my eyes the strain, I did, however, sit with Nicole and watch an episode of Brothers and Sisters and one of Private Practice. Then I watched Adaptation.

Hopefully the fire'll be back tomorrow. It's kind of not an option.

Macular Degeneration

I don't like how all of this time spent staring at a book or a computer screen is killing my vision. Not that I'm getting reading headaches - it's my far vision. I first noticed somewhere around my third semester that the distant crystal clarity I'd enjoyed for all of my life was just a touch out of focus - so, after studying for a while, I'd sit on my balcony and stare down the cow trail towards campus, forcing myself to pick out the most distant object my lenses could resolve. There's less time to do that now, but at least I can come home from the kaplan center and stare from the balcony into the downtown Miami.

All's Quiet On This Front

I enjoy thumbing my nose at unrest. While I was living at home (I can't remember when, exactly), working at some job or another, a hurricane brewed ominously on the coast, and people began to panic, and to prepare. I went to our local grocery store - H.E.B. - not because I wanted to pick up batteries and baby food, distilled water and duct tape like everyone else...no, I distinctly remember craving key-lime pie. That was it - nothing else; and so I stood in line with my trophy, while the anxious shoppers around me glared at my flippancy, giving me the dirty eye - or, what we call ojo. I enjoy thumbing my nose at unrest, but not because I am unsympathetic to the plight of others - I only thumb my nose at unrest that doesn't touch me. I'd been pleased that this economic nosedive hasn't affected me that much - sure, my bank was bailed out, but my money's fine (last I checked). Since I'm a student, I won't be looking for a job anytime soon. Thus, while this plague of decaying money rages around me, it's almost as if I sit calmly in the eye, eating my plum-filled Christmas pie.

That is....until now. Our landlord has been weaving through the process of refinancing this condo since before we moved in at the end of April. Florida, it seems, has some of the most atrocious sub-prime mortgage travesties, and the fallout continues to spiral. I'm not sure I've mentioned this before, but we're living in an area of considerable wealth, although the changing times have certainly taken a toll; when I last lived her, Lamborghinis and Ferraris were as commonplace as Fords and Chevvy's in most cities. Now, it's the lower-end BMWs, Mercedes, and Audis that seem to be the in thing, with a few Bentleys thrown in for good measure. Nevertheless, our landlord is apparently being foreclosed-upon. Now, this doesn't terribly upset me - I'm planning on being long-gone by the time anything is done about it, but I like our landlord; he's been very easy to work with, and I hope that things work out well for him.

I'm sure things are going to work out well for us. Nicole and I have decided to push the STEP back a few days, in order to better buttress our learning, and to leave time for last-minute tweaks. The pace of study has been moving along nicely, with subjects being completed in a timely manner - we've been doing questions in the morning, watching lectures in the afternoons, and hitting the books in the evening, and I've thankfully finished with the first year nonsense. Pharmacology, while it may be tedious, was actually fun for me, and it was the one subject in which I took meticulous notes - that was how I did so well, and, luckily, that's what I'm doing right now. Knowing myself, though, I'm in danger of resting on my laurels and not pushing myself, so I've got to make sure that, even though I think I've got it, and have done well on nearly everything pharm-related that I've ever done, I don't take it too lightly.

Today's our day off - that's the only reason you're hearing from me. These days of rest have fallen into a pleasant pattern - we'll get up, go to the gym, and then go shopping. Nicole likes the produce department at Publix despite the hideousness of their bananas, so that's where we go, with an obligatory stop by Target. Then, we'll go sit and read by the pool for a few hours, before fixing dinner for the week, and relaxing a bit. I like that things have fallen into a pattern, because it allows me to read and enjoy myself, without resenting the dogged determination with which I have to approach my studies ("CARPE" has become my new motto). I've managed to get through Malcolm Gladwell's ternion of The Tipping Point, Blink, and Outliers, and I'm pleased to say that each was better than the last. I also finally managed to finish Raymond Feist's Magician: Apprentice - I've been working through it a few pages at a time all semester, and it's done. I picked it up because it's supposed to be one of those classic fantasy books that I always felt I should have been exposed to. Speaking of fantasy, though, I've finally broken down and ordered George R.R. Martin's A Game of Thrones, which was the fantasy novel of its year. I tend to judge some books based on their amazon reviews, and this one has something like 1400 reviews, mostly positive - that's....well, that's Harry Potter, or Twilight level popularity.

The thing is, though, the rest of the Game of Thrones series has fallen into a trap that's plaguing epic fantasy right now - a new author will write a fantastic book, and then keep on writing, not knowing when to quit. The fervor whipped up by their novel nuances and characterizations proves too much of a money cow to pen final chapters, and so they keep going and going and going - the Wheel of Time series, the Sword of Truth series, the Malazan series - they all seem to fall into the same pattern. One author has even died before completing his works. Now, I'm all for epic-ness (thanks, Tolkienn), but some folks oughta know when enough's enough. That being said, I'm only committing myself to the first book in this series, since it's supposed to be all down-hill from here. However, I'm not going to start it just yet; in light of Fox's show "Lie to Me", which is based on the groundbreaking work of Dr. Paul Ekman - as well as Gladwell's references to Ekman in Blink, I've picked up Dr. Ekman's book Emotions Revealed - it seems like my kinda thing.

Despite all of this excitement over escapist literature (that's right...for me, even mainstream psych lit is escapist), many hours a day are still spent poring over Kaplan's green books. Such is life.

Step prep day 26

Still here. Still studying. Not doing a whole lot else.

You know, there's a drawback to getting more sleep than I'm accustomed to. There's a certain amount of deprivation that goes on during the general schedule of things, due to classes and having to be places on time and such. When it comes time to buckle down and study for an exam, I tend to regulate my sleep fairly religiously - the brain consolidates info better, and I just do better. An unintended consequence of this, though, is that my creativity seems to go into overdrive - sure, I can study, but I quickly find myself distracted by all the books I want to read and possibly write; I'm overwhelmed by all of the escapist pursuits I just didn't have the energy for previously.

Do you want to know how boring I am right now? I bought some starch for the first time the other day (anyone who knows me is wondering why I haven't done this sooner). The hi-light, though, is not the new crispness of my shirts, but it's how I picked out which brand. I was standing in front of the display at Winn-Dixie, looking back and forth between three or four different brands. Usually, I check the prices first; I assume most products to be fairly similar, in our economy of competitive capitalism. But then something caught my eye - I was reaching for the cheapest one (I figured starch was something to skimp on if ever there was such a thing), when I realized that there was one brand that was almost gone from the shelf. All the other brands were stacked out to the edge, but I had to reach way back in for this one. Thus, I decided that it was the one to get - clearly, folks who bought starch bought this starch. There are tons of possibilities to explain the relative scarcity of that brand compared to the others, but I'll just choose to believe that it's because it's been proven to work.

Physiology is almost done; I'm going to be getting into the interesting stuff soon.

USMLE Day 15

The studying's coming along - I've so far gotten through anatomy, histology, and neurology, and am painfully slogging through biochemistry. Damn cycles and enzymes....cycles of enzymes.... I do, however, take solace in the fact that these have been relatively low-yield topics; the Board just doesn't ask as many questions about them as, say pathology or pharmacology. I feel like once again I've sold my soul to something, or what's left of it; Sallie Mae already owns my soul. I guess I need to do well on this to get my soul back from Sallie.

I saw this post on the Yale Daily News, and I feel quite ambivalent. On the one hand, Yale has seen enough violence for a lifetime, with the terrible tragedy of Annie Le, and the court proceedings that I'm sure will drag on for months and months. On the other hand, however, I am elated - that someone can be absolutely frickin' nuts and still get a medical residency at Yale University. Seriously....what does a psych resident (that means that he's working on becoming a psychiatrist, not that he's a resident of a psychiatric facility, as it may seem) need with two shotguns, two assault rifles, and two sniper rifles? While I'm all for the Second Amendment (the original Homeland Security), one sniper rifle should be enough for anyone. This guy couldn't have been that bright, or he would have known to get a concealed carry permit - that's why they busted him. However, sometimes we just can't outrun our destiny, and, like poor Oedipus, our fate follows us relentlessly - wanna know this soon-to-be-ex-resident's name? Remington!

USMLE preparation: Day 11

Today's the first day that I'm really glad I'm doing this Kaplan thing. Over the past week, I've been making my way through anatomy, histology, and neurology (ick). I could have done this all on my own, but that would have meant slogging through old notes and review books - a significant portion of that time would have been dedicated solely to finding and organizing the material, much less reviewing. However, I'm particularly pleased with the post-chapter questions Kaplan supplies - the majority of them are straight recall, and not the third or fourth order questions like the USMLE will ask. After every one of their review books, though, they offer an assessment that is in the style of USMLE questions. This I like; I can find questions on my own (and I will, in fact, shell out for UsmleWorld - reputedly the best Q bank out there...sorry Kaplan), but having them correlate so closely with what I'm doing at the moment is a refreshing way of measuring performance. The assessments are going well, so I guess I can move on.

So I'm done with that - it wasn't that bad. I TA'd anatomy, so I was pretty familiar with a lot of the information. Now, though, I'm starting biochem - my arch-nemesis. It was by far my weakest subject, and while it's not supposed to be that "high yield", they're still valuable points I can mop up with a little effort. So that's this next week for me.

In other news, things aren't looking good for Annie Le, but I find it horrendous that Fox news jumped the gun and prematurely reported that they'd found a body. I tuned into the live feed of the press briefing at Yale, and could tell from the body language of the folks setting up cameras and microphones that there was no body; they were too business-as-usual, too calm - they were joking around too much for there to have been a body. The bloody clothes in the ceiling are the most ominous piece of evidence yet, however...so much was made of what she was wearing when she was last seen (brown skirt, green shirt), that the investigator's reticence to disclose whether or not they were actually connected to her further deepens the mystery; it almost seems as if the clothes found were not the clothes she was reported as wearing - hopefully they aren't. It's a stretch at this point, but I still hope for a happy ending.

Nose to the Grindstone

I've got a little over two months to review 2 years worth of information. A few weeks in, and I'm sick of it already - I've got to slog through all of the stuff I didn't pay enough attention to the first time around. It's going much more quickly this time, and I can't say I can complain too much; the Kaplan center's not a terrible place, the review materials are decent, and Miami's not that bad. I take it back; I'm not sick of it - I'm just sleep deprived. Already.

On another note, Annie Le's disappearance is exceedingly wierd. When a young woman disappears so close to impending nuptials, everyone thinks it's just cold feet. However, a few things make this case damn strange:
1. There is a 100-man task force looking for this girl. She's not a diplomat or a star - what gives?

2. No one from her family has said anything to the press. There has been no "please send our little girl/finace' back".

3. One doesn't just disappear if one is pursuing a doctorate at Yale.

4. The mysterious fire alarm?

5. The mysterious class cancellation

All of this leads me to believe that there is some very large, very significant piece of information that law enforcement is holding onto.

Holy Writ

Medical school is a cult. Everyone on the inside knows it, and I've referred to it in my own writing as such. The doctor/professor who lectured us during those last ten days of UMBR joked about the concept - we have our cult robes (the white coats), or own secret-language (Bigeminy, aorticopulmonary septa, subluxation, borborygmi, melena, etc); our own saints (Galen, Sir William Osler), specific rituals (abdominally speaking: inspect, auscultate, percuss, palpate), special commandments (Primum Non Nocere) and a dedication that rivals all major religions. We have tremendous faith - that this mountain of accruing debt will someday be whittled to nothing, that we can, infact, shift the balance of disease and health in favor of those upon whom we lay our hands. However, rigth now, I'm going to address our holy text. From these we diligently study our daily devotionals, "studying, to show ourselves approved". I only bring this up right now because my 17-pound box from Kaplan arrived today, and I am in my period of cleansing - for tomorrow I will begin my preparation for the tribulation of USMLE step 1. These will be the lamp unto my study, and the light unto my road to the score I want.

I don't have a definite schedule mapped out yet, but it's supposed to include at least a hundred questions per day. That's a lot of questions, given that this test is more than 70 days away.

Spokane River and Falls

These are from Clinkerdagger restaurant - it's nondescript from the outside, but offers some amazing views of the river and the falls, which we walked around afterwards.

Manito Park

These were taken at Manito Park's big garden.

These were taken inside the park's conservatory. I've always had it in my mind that I would someday own a little greenhouse, in which I'd grow succulent cacti and orchids...looks like they had the same idea.

Here's one of the many duck ponds that surruonds Manito Park.

These were taken from Manito Park's Koi pond - apparently, a few years ago, someone released their own diseased pet fish, which killed off all the koi, and what you see ther are just about all they have left.

Pictures from Spokane's Centennial Trail

I'm going to have to break this up, since Blogger's misbehaving. Here are some shots from the Centennial Trail that first day.

Checking in

So much has happened since I last blogged (all of it good), that I'm not quite sure where to start. Just after the last post, Nicole and I went to pick up my 13 year old brother, and spend some time with the family. My maternal grandmother had been visiting my family in Texas, and he rode the Greyhound back with her to Miami. He spent a few days with us - we walked around various malls, blasted our way through hordes of zombies at Gameworks, went to church with the grandparents, and went to south beach.

After dropping him back off with the grandparents, Nicole and I started the final section of UMBR (Ross' step 1 review class we've been attending through the semester). This section - pharm and phys - was run by the esteemed Dr. Kudrath. I say "esteemed" because his part of the course is the reason Ross imposed their mandatory attendance policy on UMBR - 90% attendance, or no dice. See, he's so good, that people would just skip the earlier stuff, and come for his part. I believe he also teaches at a lot of the Texas medical schools, and had some very specific, tested-and-proven advice to hand down to us. It was a grueling 8 hours per day, but I think we came away with an excellent review, and some fantastic advice.

We'd planned to take that advice, and hit the ground running, but we needed a serious break. Thus, Nicole and I spent a few days doing nothing but hitting the gym and reading by the pool.

(This blogger website is being unreasonable today, and so I may not be able to post all the picture I'd like. You've been forewarned).

After our poolside relaxation, we flew to Spokane to visit Nicole's family for a week. The last time I was in Washington was about two years ago in November - I managed to fly in on the same day as their first big winter snow. However, my bags chose to wait a day, and arrive at their leisure (I believe they stopped off in Milwaukee or somewhere like that). So there I was, wearing jeans, a button-up dress shirt, and the the little zip-sweater I'd layered on in Houston. This time was different - it hovered around 80 during the days, and only dipped down to about the 70's during the night. Nicole's parents wanted to make sure to show me the town at this time of year, and I've got to say - it's a beautiful city. Part of it remind me of Augusta, GA, and other parts of New Haven, CT. The river running through the middle of the whole town, though, adds in a certain something that couldn't have been done by engineers and city planners.

The first day (if I remember correctly -they all sort of run into each other), we walked around the park that hugs the river that runs through the city.

(Nope...blogger isn't letting me post pics the way I'd like to - I'll do it in a separate post).

So we walked around the park that first day, and had a nice lunch at Rock City Grill. After that, Nicole and her mom walked around Nordstrom, looking for baby clothes for a friend of Nicole's, while her father and I browsed ties we couldn't afford. We spent the rest of the day relaxing and hanging out.

The next day, we went to Manito park - Spokane's got a lot of parks, but this one is more like a botanical garden. they had their little plant conservatory. We spent a good amount of time walking around and smelling the roses, before heading to the Elk Pub in Brown's Edition. I'm not sure what I was thinking when I heard "Elk Pub", but I wasn't too far off - it felt like it catered to the hipster set and businessmen alike, with a whole lot of Northwest charm.

The next day, we did a bit of shopping - hitting up the Nordstrom Rack (their big bargain basement that, for Nicole, is always good for hundreds of dollars of savings on jeans and tops, and for me, is always good for at least one tie), and costco. We also went to see a friend of Nicole's mother, who has this fantastic projector set up in their living room. Forget flat-screens - I want one.

There was a lot of hanging out, a lot of eating good food - I went to mass with the family, and we had a huge family barbecue, during which time I got to meet the rest of the family. It was like a matching game - Nicole had been telling me stories about all of these people for years now, and I just had to put names to faces. It was a lot of fun - we also spent some time with their next door neighbors, who have turned their back yard into a beautiful little park. Their fire pit was an ingenious little deal crafted from a tractor wheel.

One night we went to the Gibliano Brother's Dueling Piano bar. The whole idea of a piano bar is very northwest (very Seattle - very Billy Joel and Elton John ), and, as such, is something with which I had no experience other than Nicole's stories. She and her mother were all revved up to go, so her dad and I tagged along. It's been explained to me this way - you have two pianos, and everyone sings along. Part of the way the pianists make their tips is that you pay them to play or to stop playing something. It's supposed to be a lot of fun - apparently, though, the crowd we mixed in with that night didn't know how things were supposed to go. There were some older folks singing their hearts out, but the rest of the folks were the college-aged crowd who, apparently, thought it was just some regular bar. Nevertheless, after a few drinks, Nicole and I belted out all the verses to Billy Joel's Piano Man (which, in my heyday, I could have gotten up on stage and tickled from the ivories), and Don McLean's American Pie. I hate to say it, because it probably isn't true - but I had more Bon Jovi in my soul than that crowd. (It's impossible to go clubbing in a college town and not hear Livin' on a Prayer).

Following that rousing start to the night, I made an interesting discovery - I love ginger; not the spice girl, not the castaway - but the actual plant. I mean, I'd always liked ginger-ale, but ginger's great, especially when added to martinis and mojitos.

We went out for Anniversary dinner (our 2 year, her parent's 29 year) at Clinkerdagger - the same place we'd visited on my last trip. Afterwards, we walked over bridges, taking pictures of the city.

This trip - this time off - has allowed my to finally get into some reading I've been meaning to do for quite a while. I've managed to get through the following:

Irving Stone's The Agony and the Ecstasy

Justin Evans' The Good and Happy Child

Carlos Ruiz Zaffon's The Shadow of the Wind (one of my new all-time favorites !),

and I'm reading Andrew Davidson's The Gargoyle.

Right now, I should be plowing madly through hundreds of questions in preparation for step 1, but my package from Kaplan hasn't arrived yet (it should today). So, I'll go through a few from a q-book I have, and hit it tomorrow.

Who's Louise?

We had our final this morning, and I've got to say I'm disappointed. I'm glad that's over. Not the final - I meant this whole semester. Jeez Louise.

Germy little kids

I must have caught something from one of them - I've been snuffling and snorking since Friday. Due to the reading I've been working on I can, however, tell you that since I don't have serious muscle aches, fever, or cough, I probably don't have the flu. I do have a theory to share with you, though. I remember when I was a kid and folks would say that if you get cold, you'll catch a cold - vividly do I remember learning about bacteria and viruses, and easily dismissing those old wives' tales. I've come to a realization, though - those bacteria and viruses that cause colds (most commonly rhinoviruses) are everywhere, all the time. You can't get away from them, but your body normally does a good job of fighting them off. Until, that is, something happens to slightly depress your normally hearty immune system - something like not getting enough sleep, or being cold and lowering your body's temperature, or, as we med students are familiar with, too much stress. (I could go into how cortisol inhibits the immune system and how steroids similar to cortisol are used to treat inflammation and other auto-immune disease, but I digress).

I'm trying to focus on the past few weeks' worth of lectures - we've got our final on Friday, and it feels like my head is too small for my sinuses.

All doors open...

Today in our large group session (the mandatory didactic cluster plopped into the middle of our week like a lemon on a highway - completely disrupting the flow of things), we had a lecture from an Obstetrician on the CPR (clerkships, profession, and residency) or obstetrics-gynecology. Now, when I speak of my future, I generally say that (1) I don't think family medicine is for me - I want to have a deep responsibility, (2) I don't think I want to limit my practice to children and (3) I don't have any interest in OB-GYN. Well, the doc today said that, back when he was med student, he'd basically said the same things. I guess that just goes to show that, especially from the standpoint of someone who hasn't done those clerkships yet, I can't really rule anything out.

I've always thought of male OB-GYN's as the teensiest bit odd, but apparently, there's a need for them.

We give our Spanish presentation tonight (I had to keep it short and sweet because of Nicole's newness to the language), and then I've got a paper to wrap up - that'll be it before the final next week.

Out of the Mouths of Babes

We began our little, week-long pediatrics rotation yesterday. This one was a little northwest of us, and wasn't too terribly difficult to find - as usual, Nicole and I drove out there the day before. The first kid we saw was a big ol' (not obese) 10 or 12 year old kid who screamed bloody murder when it came time for his PPD (tuberculin skin test). Those things do, hurt, but the only time I've seen that big of a reaction from a kid that old has been when there was some mental illness involved. The nurse had such a difficult time holding the kid down, that the doctor himself - an older gentleman who may very well play Santa Claus during the holiday - had to rush in and administer the shot himself. At this point, I silently glanced over at Nicole, as if to say "Nuh-uh. No way in hell. Not for me".

But the next little boy might have changed all that. He was about 3.5 years old - the middle of three kids. His older brother kind of hung around the room, while his little sister broke into whimpers every time the doc came near her. So this little boy had some adenoid cyst at the back of his skull that was of a great deal more concern to the parents - one of who had been this pediatrician's patient - than to the doctor himself. He'd come in because he'd been having a fever, but he was looking and feeling better. The doctor had us listen to his heart, and I was expecting some kind of atrial septal defect (the most common kind in kids). I listened to the four valves at the top of his little heart, and they were clear as a whistle - S1, S2, and silence, nothing else. I got down to his mitral and tricuspid valves, and could very clearly hear his first and second heart sounds - separated by a little early systolic murmur. The important thing is that this murmur went away when the pediatrician had the kid lay down - that meant that it was just an innocent murmur, and there was nothing more for the parents to worry about.

I think I was a little floored at how clear this little kid's heart was. See, we have the Harvey patient simulators, with tons of different problems and all the possible abnormal sounds a heart can make (just about). However, whenever I practice with Harvey, I find myself going in a little skeptical; I know that in real life, no one's heart is going to be that clear; real people don't have volume controls like that. But you know what? This little kid's heart was the clearest I've ever heard - so clear that I didn't have to think about it at all. I've never really considered pediatric cardiology, but there's something nice about most of your patients having bell-clear heart sounds.

The rest of the day was fairly uneventful; an osteopathic medical student from Nicole's neck-of-the-woods was scheduled with us, so we chatted about the injustices and hardships we all face as med students (not quite a pity-party...but close). We got to a little kid with asthma get put on a nebulizer that looked like a train, we talked with the doc about fevers and medications for kids, we saw a healthy-baby check on a one-month old - and actually got to see some of the reflexes we read about, but rarely ever get to see.

Finals are next week, and then 5th semester will have been but a dream.

On the Madness of Girls

After finishing my Physical exam, SOAP presentation, and DxR clinician case last week, I found myself with a pleasant little oasis of free time amid all of the other craziness. I've just gotten to the part in Irving Stone's autobiography of Michelangelo (The Agony and the Ecstasy) in which the artist, seeking to understand the human body from the inside, in order to completely comprehend the form for sculpting, has begun sneaking into a monastery's room for the unclaimed dead - to dissect. I'm thoroughly enjoying it - while his trepidation is not something with which I can readily sympathize (I'd been looking forward to dissection for years, but I guess I'm not facing excommunication or death, either), I do understand his wonder and awe. However, as much as I'm enjoying Michelangelo's uncharted journey down through skin and fat, muscle and fascia, there was something else I've been waiting to do for a while: I've been planning on watching Twilight.

My reasons for this are two-fold. First, Stephenie Meyer's series about psychic vegetarian vampires and the teenage girls who love them is absolute literary gold right now. I'm very interested in the economics of literature, and how current trends (like Amazon's Kindle) are changing things. It could be argued that Ms. Meyer is the literary heir to the hysteria whipped up by J.K. Rowling, merely stepping into place behind her, rather than creating her own hysteria, but Ms. Meyer used a tried-and-true formula. First, the paranormal romance series is doing better than ever (just check it out on Amazon). Second, women love vampires - ever since Anne Rice made them sexy instead of scary. Third, after watching the movie, I can say that it's quite honestly unapologetically high-school, and thus aimed at the perfect group. While I wanted to read the book to understand the inner workings of this latest literary juggernaut, I heard that the movie was better (a very rare occurrence), and so settled on that.

My second reason is my interest was sparked due to the ongoing romance between the lead stars Kristin Stewart and Robert Pattison. While chemistry onscreen is great and necessary, you just can't fake some things. I feel that part of the reason Mr. and Mrs. Smith was so much fun was the near tangible chemistry between Pitt and Jolie.

After watching the movie, I've got to say that it's nothing amazing or fantastic. I'm a little miffed that, instead of making vampire's shrivel in the sunlight or burst into dust and whatnot, Ms. Meyer instead makes them sparkle. It does, however, manage to capture the manic self-importance of high school - the belief that everything will be the end of the world. It seems like just another outing in a long line of ubiquitous vampiromances, adding nothing special to the canon (as far as movies go, Interview with the Vampire was much better. As was Blade 2). I think the reason for the earth-shattering success of the whole Twilight series can be attributed entirely to the unashamed mania of the 13 year old girl.

Who screams their hearts out and faints at concerts? 13 year old girls. Who went to see Titanic double-digit times, making it one of the highest-grossing movies ever? 13 year old girls. I think that pretty much sums it up - the 13 year old girl is a fantastic fan to have. Looking at the big money-makers in books and movies, they're not responsible for everything. Harry Potter seemed to open a door into the world of reading, and J.K ushered little boys and girls alike through like the Pied Piper of Hamelin. Movies don't do well unless they ticket money from the whole family, like the recent slew of superhero-action flicks. The top books and movies tend to be family oriented, but there's something to be said for the sheer power of their mania.

I wonder why little 13 year old boys don't act like this. My younger brother is reading Rick Riordan's Percy Jackson and the Olympians series which, for all intents and purposes, sounds a hell of a lot more interesting than romances with sparkly vampires. Rick employs familiar and lesser known Greek gods and monsters, spinning an engrossing yarn for the young adult group, and though I haven't read it, the series seems to be a capable mixture of years of scholarship and fantastic story-writing. So where's the hysteria? Where are the movie contracts? Where are the thousands upon thousands of Amazon review? I think the differences are, simply, due to the fact that the fan base is made up of boys.

You know, I'll be part of it is that girls are a whole lot more social. There are some fantasy series that are doing fantastically right now, but the guys who read them would rather do so in the comfort of their own homes, and then sit around blogging about them (errr...ahem...), instead of gathering into giggly gaggles to talk about the character's feelings. Perhaps I shouldn't say it's just a 13 year old girl thing - who are predominantly members of book clubs?

Still Standing

We just had our physical exam practical today - a 45-minute crucible created solely to determine whether or not anything we've learned thus far is theoretically useful, or actually useful. Remember the last 2? I didn't do so well on the first one, but I rocked the second one - and I think I did pretty well on this one. Nicole and I had put in hours and hours of practice over the past few days, making sure that we not only remembered everything we were supposed to test, but could do it correctly and in a logical sequence, all within that 45 minutes. Now, when I say "correctly", what I mean is not exactly as it's shown in Bates' Guide, but rather as the staff here have deemed correct. For instance, there were a few places where Bates said one thing, but the staff decided that they knew better. There was one tiny little nit-picky detail on which Nicole and I both lost points - instead of testing merely light touch over the trigeminal nerve sensory distribution (the nerve that picks up sensation from your face), we tested light touch and pinprick sensation. I sent an email to the faculty - some of the handouts we'd received said that this way was correct as well - but que sera' sera' I suppose.

We gave our SOAP (subjective, objective, assessment, plan) note presentations on Tuesday - not a whole lot to report there. I went in an explained all about why our patient - this little girl Nicole and I interviewed - might have an inherited disorder in how her body breaks down and uses fats (probably hypertriglyceridemia), and how to treat her.

We finished our GI rotation - I don't think I posted anything during then. GI was fun, but I don't know if it's for me.

I thought this news story was incredibly cool - they can grow entire mice from mice skin cells! The ramifications are stunning. I think it says something very odd about me, that, upon reading that they'd successfully developed hundreds of third and fourth generation mice from one batch of skin cells - I immediately thought of a planet full of a million me's - all born from the patch of skin on my arm.

In Hindsight....

I wasn't thinking clearly - I jumped on the "cardiac arrest" bandwagon. The layfolks out there don't really see a difference between cardiac arrest (when your heart stops beating), myocardial infarction (the death of cardiac muscle, most commonly due to coronary blockage), and sudden cardiac death (death due to cardiac problems without prior warning signs). I was thinking about it today after our test, and I realized something - everyone who dies has cardiac arrest. The fact that that was what was reported does not mean that the cessation of his heart's beating caused him to die, as it sounds like in the media.

When we think about cardiac related causes leading to death in a 50 year-old black man, several things come to mind. First, being black is a risk factor. Next come obesity, diabetes, smoking, atherosclerosis, drinking, etc - all things that contribute to general cardiovascular disease. However, the King of Pop wasn't fat, nor was he - as far as we know - diabetic or in possession of any serious genetic risk factors. His parents and siblings are still alive, and if there was any familial link there, we'd know.

When we think about death in celebrities, however, our differentials shift completely. They tend to either die when they are old, as most people should; they die violently, in accidents and such; or they overdose. If, in fact, his death was related to heart problems (that no one seems to know about), and drugs, cocaine is known to be a serious cause of myocardial infarction in young folks.


Know what I think happened? I think the King of Pop has always been a little eccentric; while being incredibly talented and arguably the best and most beloved entertainer this side of antiquity, he probably wasn't entirely in touch with reality. Perhaps he signed up for all of those shows, thinking it would be fun - you know, recapture some of his former glory (because the last few albums he released were nowhere near as hot as Thriller). However, perhaps he then became overwhelmed with this 50-show prospect, and decided that life wasn't worth living anymore. I think he had his doctor, whom no one can find, helped the King of Pop end his life - and that we'll have a very interesting tox screen reported over the next few days.

Perhaps, though, it was just an accident.

I also grieve that we aren't grieving more for Farrah Fawcett. She was kinda hot back in her day; she did a lot for cancer and....you know.....sex.

Stroke of Chance

I didn't' worry too much when the economy started crashing; I'm in school, and on student loans, and I'm not as affected as the rest of the world. Nor did I seriously worry when I heard about the monumentous bailout given to Bank of America, with whom I bank. Part of the reason I wasn't so worried is that they've always made my life much easier, so I figured they'd be OK. I've never had any hassles with them and their services were always easy to use - the tellers were always friendly and helpful. Their fraud prevention is top notch - when I first moved to Miami, I got several calls to confirm that I was, in fact, the person who had been using my card. Needless to say, they stay on top of things.

Here's where the strange string of coincidences starts. I just received my new bank card, and couldn't call in and activate it - like one is supposed to be able to do. So, sometime this past week (maybe Monday), Nicole and I went down to the bank to activate it and deposit some checks and such. That done, I didn't think much of it - until I tried to use my cards at Au Bon Pain yesterday on our lunch break from class. Both cards were declined. I figured it was no big deal - one card expired this month, and the new one hadn't been used yet.

When I got home, I called the bank, and in addition to their continuing to monitor my account for fraudulent usages, they'd received word that someplace I'd used my card had had a security breach - and that the integrity of my card information had been compromised. That being said, they'd put a hold on the card, effectively shutting it down completely. This was only a minor convenience; I realized that I'd much rather have them freeze everything than be nonchalant with my accounts. I was told that I could just head to the bank to pick up a temporary card, and that would be that. So once again, Nicole and I drove down to the bank, and I hopped out at about 4:50. Apparently, they were already closed, even though some folks were standing in the door talking. It still wasn't a huge deal.....but it was an uncomfortable, lost feeling; there was a disconnectedness, almost as if I was in a foreign country, didn't speak the language, and didn't know how long I was going to be there. I wasn't panicked, but I was uneasy.

Nicole and I were back at the clinic today, and I figured we'd just stop on our lunch break. I'd spent some time google-mapping out a route from the clinic to the Bank of America in Homestead (I'm sure I've talked about wonders and horrors of streetview). We actually got out of lunch a bit later than usual today; the patients were all very talkative, and just seemed happy to have someone to listen to them. Generally, if the patient only speak Spanish, I'll take the interview, and let Nicole do the physical exam. Today, we had chatty patients in all languages. Once lunch rolled around, we headed straight for the bank.

When we parked, Nicole was just going to sit in the car and study (which I probably oughta be doing right now - we have our first test tomorrow), but I told her that I had a feeling she should probably come in, and she did. I signed in and waited around for a few moments, until I was called back by a very amicable, very friendly middle-aged woman. She began asking me questions to verify my account, and then she opened up completely when it came out that I was a medical student - she loved doctors, and had the best of relationships with her personal physician. As she typed away, she started telling me about how she still had to lose 5 lbs from her mother's cooking in Colombia, etc. etc, that she thought lawyers were all arrogant, etc. We went to take my picture for the new card, and on the way back, I saw Nicole waving me over from the chairs in the corner of the room.

I'd seen her over there on the way to get my picture taken, and from what I could see now, I figured she'd just found some cute kid and was giving free reign to her pre-pediatric instincts. Such was not the case, though - there was a girl sitting in the chair beside her, shaking like a leaf (it almost looked like she was seizing) and looking absolutely terrible. The bank manager was holding her infant son, while Nicole talked to her. I quickly went over and tried to figure out what was going on. She was having some strange lower abdominal pain, had her arms folded in what looked like Trousseau's Sign, so the first thing I thought was hypocalcemic tetany - about which there was not a single thing I could have done. She wasn't breathing rapidly, but her pulse was rapid, and she said she felt nauseous, light-headed, and numb. Luckily, Nicole had seen her when she had - she'd been in line for the teller, and had started to lose her balance. The bank manager took her son from her arms and led her to the chair, where Nicole swooped in, announcing that she was a 3rd year medical student.

Once I got there, we continued gathering the history - it was fairly obvious that she was stable. They'd called her mother, they'd called 911, and now were were just trying to calm her down. The story that came out was that she was probably pregnant, but didn't want to be - she'd just broken up with the father ( same father as the other son), and was struggling to work enough hours to pay the bills - quite a bit for a 22 year old to deal with. What with the morning sickness and the anxiety over suddenly having 2 young kids with no father, she hadn't slept or eaten much for a week, about the length of time this had been bothering her. As we talked, she stopped shaking so much, but she almost swooned once or twice. Nicole and the bank manager comforted her when she burst into tears. The differentials included ectopic pregnancy and appendicitis, among other things, but finding out that she'd gone through the exact same thing with her first son was certainly nice to hear.

911 took their time getting there; several tellers remarked that they'd never taken this long before. When they came, they kind of brushed us aside - but Nicole and I managed to corner one of them. We didn't announce that we were medical students, but I'm sure that, 99 times out of a 100, they don't arrive on the scene and hear things like "bilateral tetany" and "afebrile without rapid respirations".

We grabbed a quick lunch at Chilli's after that, and all I could think was that, after this near-emergency, I was going to go back to a very calm, very bureaucratically burdened community clinic. I started thinking that maybe I'm supposed to do emergency medicine - granted, this was no huge catastrophe, but when faced with a person who was obviously not well, surrounded by a building full of people who are less qualified to deal with it than myself, I reacted right away and did what I could. My first thought, though, was "what can I do?" It's not like there's anything actually useful in my medical bag; it's just a student's bag. I've got a stethoscope and a blood-pressure cuff and a pen-light. I don't need any of them to tell that someone's not feeling well, or to see that they may need help. If someone loses consciousness, I don't need any of them either - there's really nothing in there that can help anyone, and I realized then, that the true and honest benefit of paramedics - their whole purpose, essentially - is to get sick people to a doctor.

The rest of the afternoon wasn't perhaps as boring as I'd feared; I saw a patient who'd had 3 heart attacks and a quadruple bypass - a hell of a lot of heart problems. Last week, Nicole attempted a cardiac exam on a fat woman, but really couldn't hear the heart sounds - with all that adipose flesh, it's understandable. This guy, though, was probably 150 pounds, 5'8 - not a large guy by any stretch of the imagination - and I couldn't tell what I was hearing when I listened to his heart. Part of it was that his pulse rate was 40 beats a minute - but it all made more sense when he returned the strangest EKG I'd ever seen. Seriously - he had PVCs and PACs, pathological Q waves, inverted T waves, wide QRS complexes - I'd never seen anything like it.

And now, with that exciting day done, I'm going to go back to studying about childhood rashes. Speaking of heart attacks, though, I'm very, very sad to report that The King of Pop is dead at age 50. Remember what I said about famous people dying in twos? Farrah Fawcett is gone, too. It's suddenly a somber day.