Adirondack adventure

The thermometer read 5 degrees on this blistery winter day as we hiked to the summit of Mt Jo in the Adirondack High Peaks region. Beautiful, serene, freshly fallen, powdery, and white. 1/28/07

Bottle feeding

I bottle-fed a newborn child yesterday. he was unaware of my holding him, but already had the rooting reflex to direct his tiny lips and mouth toward anything that was soft or protruding conveniently at mouth level. he began sucking the bottle forcefully, taking in every last ounce and drop of neonatal formula, reaping whatever he could from life, being only but a day old. it was quite an amazing and intimate thing to observe up close, and i would like to say that we shared a moment, a bond. but in truth, his behavior and actions were driven purely by newborn instincts, and anyone who had the gentleness and patience to nurture him could have served as an able surrogate. still, the child found calm and safety in my arms, and i too, must admit, that i found the experience to be quite soothing, albeit sprinkled with some apprehension that i was either cradling him too tightly or not tightly enough to prevent him from slipping through my arms.

Venting anger

While i consider myself a rather mild tempered guy, nothing frustrates me more or brings out impatience in me more quickly, than having to sort things out over the telephone. i am generally pretty good about keeping my cool. it is seldom that i yell or direct my anger outwardly towards anyone. but theres something about having to resolve things over the phone, like for instance, correcting an overcharged bill, or trying to plead with the receptionist to squeeze me into a fully booked apointment schedule, that gets me agitated and often irrate. i become vulnerable to utilizing verbal abuse, and become too overtaken by passionate to proceed with reason.

She says let me transfer you to customer relations. he puts me on hold. he says let me transfer you to my supervisor. fine, defer your duties. share your responsibilities. make life easier for yourself and a bitch for me. make me explain to them my concerns again. and again. then reexplain for the third time, and if i'm lucky, i'm not thinking and swearing aloud by now, wtf, did i just get disconnected? so i redial, frustrated. gotta listen to that annoying fake female robotic voice drone on slowly again about transfer options like when to press one and rehear that para espanol, pressiones dos nonsense. and god forbid i have to verbally voice my selection into the recorder only to have to repeat myself again and again. i admit it, my tone of voice is low and deep. thats ok. i just have to try hard and hold the phone closely. apparently closer. and speak louder and more clearly, goddam it! enunciate. overly enunciate, if thats even possible to do. alas, thank god they finally understood me correctly that time, but now i have to verbally confirm that yes indeed, i did speak correctly. and all of that was just so i could get through, and speak with a real human, competent or helpful still no guarantee. so tell me, how does having to speak, respeak, and confirm that i spoke correctly. then reconfirm that i did confirm correctly, speed things up any? it fuckin doesn't. and it gets me mad before i even get the chance to talk.

A Beautiful mystery of life

I helped deliver a baby last week. Brought new life into
the world. I was so pumped up for the next few days
afterwards. It was probably one of the coolest things
I've ever done. But to say it wasnt also one of the most
weird and out of the ordinary experiences of my life would
be a lie. I'm not sure anyone can ever be prepared for
such a moment, until you've taken part in one. Its definitely
one joyous tear filled occasion. But its bloodier than you
think. And yes, they'll poop, the mothers that is, amidst
all the hard work and glory.

Since returning from break, I have found myself plunged
deeply in the crevasses of Obstetrics and gynecology.
Admittedly, it has always been a mysterious world to
me/men, and while it may not be something we would like
to concede, this much is true. Coming into this rotation,
I knew next to nothing about pap smears, child birthing,
hysterectomies, and c-sections. Talk about feeling out
of place when patients see you wearing a white coat and
automatically confer upon you a wealth of knowledge and
trust, in a field I know next to nothing about. And while
I could probably tell you all the stages of the menstral
cycle in gory detail, like when the hormones should peak
and ebb, and when the endometrium will slough off and the
bleeding begins, how is that understanding supposed to
help me identify with the wrenching pain of menstral
cramps, the labor of delivery, and the anxiety of
expectant mothers? I'm not sure it can, but I'm gonna
try and find out and inch myself one step closer to
understanding this one mystery of life.

Winter's a Beach in Florida

80 degrees on this gorgeous winter day in Tampa Bay, as the sun makes her westward descent into the Gulf of Mexico. 12/29/06

Rekindle

As i sat there by the firepit chatting up an old high-
school crush (a mutual one back then) while tending to
the hot coals with the poker, gingerly coaxing a flame
back to life, i couldnt help but wonder at the time
whether or not she also picked up on the subtlety of
the metaphor.

Psyched Out

Observations from within E2/E3, the acute Psychiatric Unit

We could all use a litle more common sense. We had this
one patient who shuffled around listlessly, his eyes half
shut, appearance dishelved, and hair unkempt. We asked him
daily why he appeared so somnolent and presented with so
much lethargy, as if it were too big a mystery to figure
out. This guy was juiced up on near-maximal doses of
Depakote, Haldol, Zyprexa, Lithium, Ativan, and Ambien,
each one, when taken individually at the therapeutic dose,
could likely do that to either you or me.

Our patients are disgruntled. We place them on mood
stabilizers and antipsychotics. We ask them daily why they
are feeling so irritable and vexed to be here, as if there
would be nothing incongruent with appearing content and
happy to be held against your will inside a locked acute
psychiatry unit. How do you react when you see someone
smiling in their mugshot? Does that not strike you as being
inconsistent?

Can a cocktail of the most clinically effective
antidepressants possibly ameliorate a depression caused
by the sores of troubled relaionships, exhausted financial
recources, and a life mired deeply in substance abuse? Do
pills really have the power to reforge troubled bonds,
replenish a lifetime of frivolous spending, and exhume a
life buried by drugs and alcohol?

So why do we continue to keep pushing meds? I am starting
to wonder whether all those free catered lunches have a part
to play in all of this? Are the pharm companines having it
their way unjustly?

Tough decisions

a lot of medicine is about making tough decisions with hard consequences in the face of uncertainty. the true art of medicine, i've observed is being able to navigate forward firmly in spite of these uncertainies. medicine, in the end is a practicing science, and science is all about making informed decisions given supportive evidence, keeping in mind that these things will constantly change.

how do you convince a patient that taking medicines is essential for his health and well-being while simultaneously respecting his right of autonomy to refuse? when the duty to act and protect begins to blur with the boundaries of respecting a patient's right to choose, how does one find a reasonable resolution? beneficence, one of the defining principles of medical ethics implores healthcare providers to "do good." Implicit in this guiding principle is the duty to act in the best interest of the patient.

No Free Lunch

Is it wrong to acccept free lunch and fancy dinners from drug reps? Will this somehow influence what medicines i am more likely to prescribe in the coming future? i would like to think not, but many in the profession, including members of the nofreelunch campaign, backed up by strong consumer data demonstrating the simple magic of modern advertising, seem to think otherwise. but when a student is expected to cough up 200 grand for a medical education these days, how can one pass up daily catered meals at a noontime conference sponsored by Merck or Astra Zaneca? I havent been able to yet. And the placard of pens emboldened with drug names, including Lipitor and Levitra in the mixed company of Zocor and Viagra, each dangling and dueling colorfully from the multi-overstuffed pockets of my lab coat, seem to confirm that. http://www.nofreelunch.org/index.htm