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

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?

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.

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.

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.

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.

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.

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...

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...

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.