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| Saturday, September 1st, 2007 | | 5:22 pm |
End of Medicine month
It's a wierd feeling to ponder the trepidation with which I approached call before Medicine month. Now I feel like I could handle any problem on the floors. In the beginning I called my seniors to check everything; now my seniors call me to see if I'm still alive because they haven't heard from me in hours. It's been intense. I've cried many times. Sometimes from frustration, but more often tears were shed with patients, knowing that I had helped them or that I could, even if it was only making their death comfortable and with dignity. Medicine isn't just a lot of hours, it's a lot of heart, for to be a good doctor you must emotionally invest in your patients at least enough to care about their lives, for they are in your hands. I'm glad though for the repreve of going home and forgetting about work. I try, and am mostly successful I think, to leave work behind when I leave. I've never cried about work at home. I mostly just try not to think about it too much. Fortunately there are plenty of distractions, with Anna and her hyper-active dog, Montana, always ready for a run or a hug or a dog pile. | | Monday, July 30th, 2007 | | 8:51 am |
One Twelf
Almost one 12th of the way done with my intern year! Yay! My next month is internal medicine which will carry more responsibility and time pressure. This month ended up realively easy since it was all outpatient clinics unless I was on-call in the hospital. So far it's been pretty much like Gray's Anatomy. j/k, more like scrubs. I would characterize my residents as "giggly" and also quite intelligent. I have learned a lot and look forward to sponging more. Wish me sleep! | | 8:49 am |
Fewer Americans are smoking, poll reveals
Finally, something to celebrate about in our current public health climate. WebMD (7/28, Hitti) reported that a new "Gallup poll on smoking shows that 21 percent of U.S. adults currently smoke cigarettes." Gallup first started "asking people in the U.S. about their smoking habits in 1944. Back then, 41 percent of poll participants reported smoking." This year's Gallup smoking statistic "is very low, but it's not quite an all-time low. 'From a statistical perspective, a 22-percent reading in 2004 and a pair of 23-percent measurements in 1999 and 2006 would be considered equivalent to the current reading,' states Gallup." The new Gallup poll also reveals that "most current smokers -- 55 percent -- report smoking less than a pack of cigarettes daily." And, "81 percent of current smokers say they would like to give up smoking and 79 percent say they're addicted to smoking." Additionally, the Gallup report indicates that "one in four current smokers report starting to smoke before age 16. That percentage hasn't been lower since 1991, according to Gallup." | | Tuesday, July 10th, 2007 | | 6:21 pm |
First Week as Dr. Nuwer
Being a doctor is scary! Mostly because I feel like I don't know anything and I don't want to kill anyone because I'm an idiot. Hopefully this feeling will go away soon because it turns me into a bumbling idiot. For example, the code pager went off indicating someone was dying somewhere, so I run to the room get there and the lady is stiff and shaking - not a seizure, but a drug reaction to this chemo drug she's on. I'm panting, the nurses ask if I'm a doctor and I meekly say "Yes", because I have NO idea what to do. Fortunately, my senior resident came strolling in and took care of it. What did I learn in the last 4 years? Not much practical stuff! Any way, I'm getting my feet under me and learning to introduce myself as Dr. Nuwer. It's really weird. I have my first patients already: a mom and baby that I delivered, or rather, assisted with her C-section. Exciting! | | Wednesday, March 7th, 2007 | | 12:22 pm |
Happiness is BLU
This weekend I had the opportunity to watch my favorite sports team win a prestigious tournament, the Stanford Invite. My UCLA Ultimate team, BLU, beat the Pie Queens of UC Berkeley in finals. I got to see them whip University of Washington in Semis too. I couldn't help but feel proud every time a player made a sweet play. My favorite part, however, was seeing the change that has happened since our first year together. The players have developed so much since our first season. It still surprises me sometimes to see someone make an unexpected play. A formerly tentative player gets a diving blocks or a player that used to have weak throws steps around to throw a difficult pass. A player that struggled with long throws for years, finally consistently throwing beautiful long throws. A zone offense that I toiled to get them to use and understand, shredding the zone defense of another team. This work has not been done by me, it's been done by them and their coaches since then. I love seeing something that I helped create flourish without me even needing to be there. I helped set the pieces in motion. I helped set original strategies. I helped shaped their game by providing a strong example and through coaching. And now I can sit back and enjoy the beautiful artwork that they create for all of us to watch and admire with happiness. | | 12:11 pm |
Survey
I'm working on a research project right now about the effects of long-distance running on children. I mostly enter data, but there are some things I can't help but feel. One of the questions is rate your daily mood on a scale of 1-10 with 1 being always sad and 10 being always happy. The kids involved are middle school age. Everyone knows middle school is a rough time. Still it makes me fundamentally sad when the children answer any number less than 6. Kids are supposed to be happy and having fun! The other thing that I've been noticing is how many children have checked the box indicating that their family income is less than $20,000/year. I have a hard time imagining living on that as one person. I think about the sacrifices that these family must make to make ends meet. I wonder how these kids pay for good running shoes...maybe they can't afford them. I can't help but feel privileged and at the same time called to help these poor families in whatever way I can. The good news is that neither of these 2 data points seem correlated. The kids from poorer families seem to have the same distribution of happiness as the privileged kids. Maybe money can't buy happiness after all. | | Tuesday, December 5th, 2006 | | 11:28 pm |
Worlds
If you didn't think I could take Ultimate to the extreme - I just did (and you should know me better!). I just played in the World Flying Disc Federation's World Club Ultimate Championships. It happens every 4 years in different locations around the world. This year's was in Perth, Australia. Yeah, I had to look it up too. Perth is a large modern city on the West coast of Australia. It's big draw are loads of beautiful beaches - crocodile and shark free. We stayed in some beach condos just north of the city, but spent most of our time at the incredible field complex. There was Ultimate as far as the eye could see. I played on a team from San Francisco. We were in the co-ed or mixed division which had 41 teams from around the world. Our team Red Fish Blue Fish was seeded 15th,and we finished an astonishing 4th in the WORLD. How cool is that? We lost in Semi-Finals to a long-time rival from San Fransisco Brass Monkey. Then we just ran out of energy in the 3/4 game. Japan swept the Men's, Women's, and Master's brackets. They are so fast and flexible and make up for their short stature with incredible jumping ability. In the Mixed division, Team Fisher Price from Vancouver beat Brass Monkey. I had a great time meeting people and hanging out with my team. Although I only knew one other player before the tournament, we quickly bonded and had a lot of fun together. In total we played 267 points of Ultimate in 11 games. I played 160 points, the second most to Gretchen who played 164. We were short on women so all 6 of us played a lot. If you care, here were our games: Pool Play: Red Fish Blue Fish 17 7 Pula (Philippines) * Red Fish Blue Fish 17 10 Bootius Maximus (Australia #1) Red Fish Blue Fish 17 13 Drunk Dogs (Japan #3) Power Pool: Red Fish Blue Fish 17 7 Dis'Chords (Canada #5) Red Fish Blue Fish 17 12 Woodies (Germany #1) Red Fish Blue Fish 17 12 Camelot (Canada #2) Red Fish Blue Fish 8 17 Slow White (USA #2) Prequarters: 16 10 Bootius Maximus (Australia #1) Quarters: 17 14 Bad Larry (USA #6) Semis: 8 14 Brass Monkey (USA #4) Bronze Medal Match: 15 17 Slow White (USA #2) ** | | Wednesday, November 22nd, 2006 | | 8:15 pm |
| | Friday, October 13th, 2006 | | 6:34 pm |
cardiovascular health strikes again...and again
This is a direct quote from the book that I'm studying for my liscensing exam: "A 50-year-old marathon runner who eats well and has a high HDL without other risk factors for coronary heart disease (diabetes, high blood pressure, smoking, family members with early heart attacks) is unlikely to have had a heart attack. A long-term smoker with a positive family history and chronic high blood pressure, diabetes, and high cholesterol has had a heart attack until proven otherwise!" Here's another one for the young people: "Smoking is the single most significant source of preventable morbidity [illnesses that don't kill you] and premature death in the United States." | | 5:20 pm |
Oh the places you'll go
I have my first residency interview on Oct 30th. Should I go in costume? Maybe as a doctor... I think I want to stay in California. I applied to 5 programs in Northern California and 3 in Southern Cali. I'm also going to see a program in Albuquerque that looked interesting to get some variety. I want to choose a program with an associated Sports Medicine fellowship because you get better training in that area. However, only 3 of the programs I applied to meet that criteria (San Jose, UC Davis in Sacramento, and Santa Monica). So we'll have to wait and see which ones I like the best. The way the residency applications work is weird. We submit our top choices in order (Rank List) and all the residencies submit their top applicants in the order they would like them. Then a computer matches us. It's called the Match. I'll get the results on March 15, 2007. And then on to Graduation on June 1, 2007, but who's counting ;) | | Thursday, October 5th, 2006 | | 12:55 pm |
Age is an attitude
My mother has always told me and continues to show me that age is an attitude. A few years ago she started eating right and working out after 20 years of child raising. At age 50 she climbed Alta Peak in Sequoia national park, just over 11,000 feet, requiring a gain of 4000 feet over 7 miles of hiking. It turns out that she's probably right, age is an attitude. At least partially. Check this article out: http://www.nytimes.com/2006/10/05/health/05age.html?_r=1&oref=slogin | | Thursday, September 28th, 2006 | | 3:23 pm |
Accident Waiting to Happen
I've decided that this is an excellent phrase to describe Los Angeles. On the drive back from San Jose to LA you have to get over 4 lanes as 3 freeways merge within a few miles. Immediately sweat started dripping down my back and my hands. That cold sweat right before you do something dangerous. Pump-fake, swerve, honk, blinker, blow-by. Finally I made it across the lanes of heavy traffic at 10pm on a Sunday night. Yesterday I almost got hit by a car speeding down one of the cross streets near my house [not the same cross street where I DID get hit last year]. As both of us screeched to a halt, she looked at me as if it were my fault that she was speeding, talking on the cell phone, and not using lights near twilight. I just drove on. Because that's LA. Today I witnessed an absolutely atrocious traffic maneuver. For those of you who don't believe that road rage exists, try this true story. I was stopped next to a large SUV at Wilshire and Westwood, a gargantuan intersection extending 8 x 6 lanes. In front of the SUV was a small sedan from Colorado. We were in heavy traffic and the light turned green. Instead of accelerating quickly, slamming to a halt in 50 yards, and blocking the intersection, the usual LA move, the sedan pause to wait for traffic to clear. The SUV went insane, started yelling, and honked on his horn until the sedan slowly crossed the intersection when it was clear. I had my windows down and took the brunt of his horn. When the next light changed, the SUV swerved around the sedan into oncoming traffic, swerved back in front of the sedan and slammed on his brakes in an attempt to "punish" the sedan for being slow. When I pulled in front of the SUV later, I was surprised to find a middle aged couple with a handicap sticker in my rear view mirror. Isn't LA a lovely place? | | Wednesday, August 23rd, 2006 | | 3:05 pm |
It's been a while
I miss summer vacation. I tell all of you who are still in school. Prolong it as long as possible! During the 2nd two years of medical school you get excited about a so-called "Golden Weekend". You know what that is? Saturday AND Sunday off. It's just so distorted. I wish I was in Canada with my family on their family vacation or with Anna and her family at their cabin in Colorado or playing frisbee in some remote part of the world. | | Saturday, April 15th, 2006 | | 12:10 pm |
Coexistence
Happiness and safety constantly seem to be at odds. Can you ever have both? Remember when you were growing up and your parents told you not to jump off the roof and ruined all your fun? Much later you realize they were just trying to protect you and might even appreciate their efforts especially when you have your own little rebels to watch over. But can you have a safe happiness? Experience has led me to believe that both happiness and safety are transient features of our life here. While they can coexist, they are often found independently. Take dating for example. The plight of men (mostly) in our culture is having to ask someone out. Without abandoning safety and taking a risk, you have no chance of finding happiness in romantic love. It has occurred to me that choosing safety and resisting chances and change to stick with a safe status quo cannot guarantee happiness. What I mean is that it is a fact of life that change happens to people and to situations. If you don’t actively jump out of the safety net occasionally to adapt to the change, you risk waking up years down the line to realize that everything has changed and you never even recognized it happening. I have had so many older adults tell me this in various ways. It seems that the only way to experience happiness over time is to celebrate it every chance that you get. There is no safety in preserving happiness as it is because happiness is ephemeral. I find that with taking risks the thrill of living and the rewards of happiness increase. You have to work up the courage to jump out of your safety net sometimes. You must convince yourself that the risks are worth the potential rewards. If you work really hard for something, many times you can find the happiness you were looking for. Like Emily Dickenson said: “Success is counted sweetest By those who ne’er succeed. To comprehend a nectar Requires sorest need”. Often what you are looking for is found in the process. The feeling after the goal has been achieved is often less happy and exciting than experience of putting in the work and the moment of achieving your goal. The poem goes on “Not one of all the purple host Who took the flag today Can tell the definition, So clear, of victory, As he, defeated, dying, On whose forbidden ear The distant strains of triumph Break, agonized and clear”. I believe these concepts can be applied to any aspect of life: jobs, family, friends, dating, beliefs, travel, events, sports, growing up, etc. I have been fortunate enough to have experienced a lot of happiness in my life. I used to think that happiness could be safely preserved behind a white picket fence in a loving home, but I have realized that this is an American dream. Perhaps a dream worth striving for, but nonetheless unrealistic by its very nature. While change is uncontrollable I find that the challenges and risks I have taken have prepared me to step out of the safety zone and face whatever it is that lies ahead. My parents were right; I don’t need to jump off roofs to find happiness. I just need to summon the courage to open the door and discover what was knocking. | | 10:03 am |
Spring
Spring is here and with it we are showered with religious holidays celebrating a new life after hardship. You can see it in the seasons (if you don’t live in LA) when the first spring flower peaks its head through the snow; it’s a good cause for celebration! Whether it has been Lent or Passover or a hard winter, sacrifice has been rewarded in the end with the greatest gift: a new life. Were you chosen to witness it? Perhaps through religion, perhaps through nature, perhaps through time. Were you saved? For a moment, for a lifetime, for an afterlife. Whatever your beliefs may be, the coming of new life with spring deserves celebration and giving thanks. Take a walk and admire the new flowers peaking out of the earth after the rain and you’ll know what I mean. | | Sunday, March 26th, 2006 | | 8:28 pm |
Death and dying
We recently had a teaching session on end-of-life care. They asked us to write about a patient and personal experience with death. Patient: I had a patient on neuro consult that was dying of vascular disease. We were consulted because the patient woke up the morning on hospital day 87 and couldn’t move her lower limbs. I went alone to the ICU to examine the patient. She was barely able to answer my questions, intermittently squirming with pain and being knocked out by her opiates. Every few minutes this cycled. She had no sensation to any modality and was flaccid. It appeared that she’d had a massive spinal stroke. I was on my Psychiatry rotation a couple of weeks later and we were consulted for competence on a Do Not Resuccitate/Do Not Intubate request on the same patient. The patient was in much the same state. I spoke with the doctor who had witnessed the DNR/DNI and he said she went in and out of lucid states. She had done the paperwork with full understanding according to the physician. The husband was upset and was trying to get the paperwork invalidated. Our team endorsed the physician’s competence judgment. Personal: One of my friends from my Ultimate team at UCLA committed suicide about a year ago. It was a crushing blow to everyone on the team, especially those close to her. I had been an informal mentor to this girl; she was like a little sister to me. She’d told me about her struggle with depression and her struggle with coming out early on. Although she sometimes talked about suicide, no one knew how seriously to take it. After all, she was seeing doctors and therapists and taking medication. One evening, I remember getting the frantic phone calls from my captain: 15 missed calls while I was at a party. We gathered to mourn and stayed up all night together in her dorm lounge. I missed school for a week. Our team went to the scheduled tournament that weekend and did a lot of talking and hugging and crying. Several of us got some counseling. We had memorial services on her birthday and on the anniversary of her death. We created a student group to raise campus awareness about depression and suicide so that maybe one day we could help prevent this from happening to other people. Sometimes I think I see her walking across campus; I still miss her greatly. | | 8:12 pm |
You jerk
Over the course of this year I've had repeated conversations with various residents about being a jerk. The sports medicine (non-surgeons) doctors that I have been working with both told me that they thought about going into Orthopedics. Both of them decided not to because they didn't like the person they were becoming on their surgery rotation. They said that the lack of sleep combined with pressure and the culture of surgery made them irritable and bitter. I spoke with a surgery resident who basically admitted that she had to give up being nice for the sake of time. There was just no way she could accomplish her daily tasks if she spent time "going the extra mile" with patients. At this hospital "going the extra mile" could be defined as helping an elderly patient find the bathroom or staying 2 extra minutes to talk to the parents of a sick child. I saw this sort of thing happening all the time and one day I realized I had started doing it too. I would race down the halls doing tasks barely noticing the human beings around me. I stopped holding the door and the elevator for slower folks. I inhaled my food alone in the locker room rather than finding people to enjoy the meal with. These are just a few of the reasons I am NOT going into surgery. I found the surgeries on orthopedics to be very interesting, but I just couldn't go thru the long years of residency like that. I have no desire to be the nameless whitecoated jerk rushing down the hallway in search of whatever in the endless cycle of scutwork. | | 8:02 pm |
The grossest thing I've seen in medical school
You've already heard about the time I almost passed out (Spinal Tap), but you haven't heard about the times I've almost puked. I thought it would be blood that got me on both counts, but it wasn't. The grossest things I've seen in medical school all involved pus. Pus is disgusting to the highest degree. I will relate two disgusting pus stories here. These stories are not advised for the weak stomach... The absolute most disgusting thing I have seen was on head and neck surgery. This old fellow comes in with yet another hearing aid related ear infection. He takes out the hearing aid and there's just pus dripping everywhere. Gross! The resident took him to the procedure room and started removing the pus. Then she got out the microscope and started cleaning. She made me "take a peek" at the magnified puddle of nastiness before she finished. Double gross! It sometimes amazes me that the above experience topped this next one, but the magnification was just unbelievably nasty. The other grossest patient I saw in "Butt clinic". Every tuesday on General Surgery we have "Titties and ass" day which consists of Breast Clinic followed by Rectal Clinic. The patient had connections between his bowels and the skin around his butt. Some of them had gotten infected and drained gobs of pus onto the dressings. When you dress deep wounds you have to stick 1/2 inch wide strips of ribbon like dressings deep down into the hole. When you pull them back out after a day they can be utterly teaming with nastiness or just the normal blood and guts. Ugggg. The pleasures of medical school... | | Monday, February 13th, 2006 | | 10:23 pm |
Burnout
Sometimes I ask myself "Why am I so tired all the time?" Which inevitably progresses to "Why am I doing this craziness?" I oscillate between feeling like what I am learning is so cool and such a privilege to feeling that I've been imprisoned in my third year of medical school. July seems so far away and it doesn't even end there! You go straight into 4th year. Hopefully spring break in April will be a refreshing two weeks... | | Saturday, January 7th, 2006 | | 10:49 am |
White Christmas
My family actually left LA during Christmas for the first time ever. We went to Taos, NM to be with my brother Stephen who is at school out there. I didn't know how it would go to be stuck in a 3-room cabin all together for 5 days. We had a great time. We watched movies and played games and went out to do stuff in the area. It was really nice to see Steve who is doing GREAT. Yeah for family! Merry Christmas too all. |
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