The restaurant is a great place for a date.
I think we were eagerly plucking the fleshy morsels from the mussel shells when the topic of weight came up.
“I gained a lot of weight during my intern year,” she said, popping another mollusc into her mouth.
I cocked a skeptical eyebrow. Now finishing up her intern year, she was my medical student when I was an intern.
“You don’t look like you have,” I commented. The natural conclusion followed: “And, anyway, you don’t look fat.”
She laughed. “My clothes know,” she cheekily replied.
Her notes on patients in the hospital have floated across my eyes over the past year. Over two years ago, I taught her how to write concise assessments and plans on her patients. She still uses that template, down to the signature “FEN” (”Fluids, Electrolytes, Nutrition”) that precedes the patient’s code status.
“Maria was the reason why I wanted to go into internal medicine,” she recently explained to a fellow intern. Her confession is amusing, since I am not an internal medicine resident and yet, still became her mentor.
The topic of conversation drifted to The Enigma of Boys as we shared a piece of tiramisu.
“You’re a smart, beautiful, and accomplished woman,” I said. She was already rolling her eyes at me. “What? It’s true. Don’t settle for any guy—you want someone who is going to treat you right and not take you for granted. You want someone who is worthy of you.”
She nodded.
“And people are the most deceptive during courtship,” I continued. A smile of recognition crossed her face; she began to nod enthusiastically. “They want to make an endearing impression and will do just about anything to ensure that. After a while, they’ll let their underwear hang out—”
“—and soon, they’ll be farting in front of you,” she concluded.
“Yeah… and it takes work for that magic to continue. And that’s why it’s even more important that you don’t settle for just any guy—you want someone who is going to value you even beyond courtship. You’re worth a lot and you should be treated that way.”
“Yeah,” she said, mindlessly keeping the tines of her fork between her lips. “You’re right.”
She removed the fork from her mouth, smiled brightly (and what a smile it is!), and announced, “I can’t wait to fall in love! I hope it happens soon.”
“Yeah,” I said. “Me, too.”
(Part of the ongoing Relationship Series.)
11 Jun 2007 | 4 comments.
Sunday Morning Musings.
I think I was overly ambitious: I highly doubt that I’ll be able to produce 40 entries about relationships in 40 days. Day #40 is July 1st.
It’s not that I lack the source material for it. In my notebook I have scribbled down the following notes:
- hospitals as mazes
- Dr. B, the psychiatrist who mentored me and significantly influenced my career decisions
- arguably my favorite medical student who is now an intern
- music as “the soundtracks of our lives”
- the dancing Dane as an example of conditional (maybe?) relationships
Writing (online or off) is a notable commitment—the more I write, the less I read. It shouldn’t be a zero-sum game, but it often feels that way.
I am currently reading (in bits and pieces) “The Wanderer“, a piece that the New Yorker ran in September 2006 about former President Clinton. I first heard about this article from a friend of mine—a voracious reader who often pontificates on a variety of subjects, using phrases like “very lengthy hagiography” and “new constructs of language”—after he read it in the New Yorker in New York City (this is undoubtedly a point of pride for him). My friend had wistfully spoken about Mr. Clinton’s intellectual appetite and constant drive to learn. He contrasted this to himself and lamented that the constraints in our work—he is also in medicine—often stunts our abilities to think.
It’s not that we don’t learn a lot in medicine—we do—it’s just that so much of our training in medicine is memorization and regurgitation. He and I have often discussed that truly brilliant people do not go into medicine; they pursue careers in physics or philosophy. As a population, doctors aren’t the greatest thinkers—we don’t necessarily approach information (or our practices) critically. Maybe it’s the culture of medicine—we are indoctrinated to believe in and trust the instruction we receive from those who are more experienced. Maybe it’s the sheer volume of what we learn—we can’t think about everything we learn because there’s so much more to consume. Maybe it’s just laziness.
My friend and I, I think, wish we had the energy and time to learn about and understand everything (the world is an amazing place) and apply this bountiful knowledge to promote change (the world is an unjust place).
The written word not only teaches us content—how does photosynthesis happen? how do I program the VCR? what factors contributed to the final draft of the Magna Carta?—but also how people think. Because we are subjective creatures, all writers invariably introduce bias and arguments into their creations. Evaluating these arguments helps us understand what the writer is trying to communicate and can help us approach material with healthy skepticism. What is the writer’s agenda? What biases are present? What evidence is missing? What evidence would I want? Are the arguments logical? etc.
I recently received a book from my wishlist (my birthday still has yet to pass…) from a reader named Robert in Massachusetts. (Thank you much, Robert!) It is a book of “personal essays” and I am eager to read it, both to see how more accomplished writers approach this form and enjoy the prose for what it is. Surely their expositions have more coherent themes than this post.
I’m procrastinating on revising my personal statement for my fellowship application. I’m also frustrated with the ratio of what I know to what I don’t know. It seems incredibly small.
10 Jun 2007 | 2 comments.
#14: I Heart New York.
A good friend of mine is graduating tomorrow. He has earned his PhD and, to recognize his efforts, he shall don a purple robe accented with wide, black, velvet stripes and gold trim; a floppy purple cap with a gold tassel will adorn his head.
“It’s a Barney suit,” he dryly commented.
Later on this year, he will move to New York City to begin his post-doctoral duties.
“You’re going to join me there for your fellowship,” he has confidently remarked. “Maybe we can work on research together. Or teach more doctors about therapeutic interviewing. It’ll be great.”
My first visit to New York City happened when I was around eleven years of age. My father was required to travel to Manhattan for a business trip. He elected to take the rest of the family with him.
I don’t recall the long plane trip from Los Angeles to New York City. My mind cannot conjure up the details of our room at the Sheraton Hotel. There are only two things I do clearly remember: A taxi ride and souvlaki sandwiches.
We took a taxi from the airport to the hotel. My father sat next to the driver; my mother and I sat in the back seat. Night had settled upon the city and the cab was crossing a bridge. The windows of the taxi were rolled all the way down—it must have been late summer or early autumn—and the warm night air pushed my hair out of my face and felt alive and inviting against my skin. The cables of the bridge regularly sliced through the parade of white headlights from the cars on the other side of the divide, illuminating the interior of our taxi like a strobe light: Our shadows shifted stiffly and unnaturally against the dark vinyl of the car seats.
The taxi driver abruptly changed lanes at high speeds, swerving the car unpredictably to the left, then to the right. The cab weaved through traffic with the agility of an expert skier negotiating large moguls. My father was seated uncomfortably upright and said nothing. My mother held my hand tightly.
I stuck my head out the window and smiled broadly.
One afternoon, in the midst of touring Manhattan on foot, my father stopped in front of a metal cart on a street corner. There may have been a large, stiff umbrella over the cart. Maybe the aroma of grilled meat had captured my father’s attention and had lured him to the cart; maybe we were waiting to cross the street and he caught sight of the man preparing sandwiches.
My father briefly surveyed the contents of the cart before asking the man if he could purchase sandwiches. I don’t remember how the conversation proceeded, but I do remember my father asking the man to label the food.
“Souvlaki,” the man had said.
“Sool-vah-kee?” my dad guessed.
“No, soo-VLAH-kee,” the man repeated.
“Soo-vlah-kee. Souvlaki,” my dad said. He laughed—it was a laugh of mild anxiety. He thanked the man, paid him, and then distributed the sandwiches to all of us.
My dad loved it. He could not stop “mmm!”ing for the next half-hour. In fact, he purchased another souvlaki sandwich the following day (more “mmm!”ing followed) and, upon returning to Los Angeles, spoke fondly about the delicious souvlaki sandwiches in New York. This souvlaki commentary continued on an intermittent basis for the next four months or so. He purchased souvlakis (?) in Southern California, but they all disappointed him.
“The quality of the meat just isn’t as good,” he lamented. “The souvlaki in New York was the best.”
My parents purchased a “I (heart) NY” tee-shirt for me. It is the only souvenir I remember from the trip. That tee quickly became my favorite shirt; I wore it frequently and, when the seams eventually came apart, I felt sad. When would I be able to get another shirt like it? When would I ever return to New York City?
Hopefully soon…!
(Part of the ongoing Relationship Series.)
8 Jun 2007 | 3 comments.
#13: Donating Blood.
My first blood donation occurred when I was a college freshman. The experience included an air-conditioned trailer with tinted windows, a phlebotomist with blonde hair, and a free tee-shirt.
Although the warm and fuzzy feelings that came with knowing that I was “helping to save a life” were reinforcing, the free cookies were probably more motivating. (I’m not kidding.)
I donated blood on four or five occasions during my time in college; if I encountered the Bloodmobile near the dormitories or on campus, I readily let the phlebotomists access my veins. Donating blood wasn’t a habit; it was more like a surreptitious meeting between two acquaintances.
In medical school, I learned more about blood and its amazing properties. Prior to committing myself to a career in psychiatry, I had strongly considered becoming an hematologist-oncologist: The physiology and treatment of cancer was fascinating, but hematology was awe-inspiring. By far my favorite things to view under the microscope were blood smears; I couldn’t believe the various species of blood cells that occupied one drop of blood. And there is so much one can learn from looking at blood: Is there enough of it? Is the bone marrow generating more of it? Can the blood clot satisfactorily? Is a leukemia present? How is the individual’s nutritional status? To think that all of these things are travelling through the thoroughfares of our blood vessels is absolutely flabbergasting. One would never guess that so much life teems within the red solution.
Once I began my clinical rotations, I commonly saw bags of blood hanging from the IV poles of patients with ashen skin. The hospital always seemed to be on the brink of not having enough blood and, as a result, I started to donate more frequently. I wondered who was receiving my blood; maybe I had walked past my own bag without realizing it. More warm fuzzies. And cookies, of course.
As an intern, I continued to see the bags of blood hovering over patients and overheard the same message I heard in medical school: “The blood bank is running low again.” Was there ever a time when the blood bank wasn’t running low? Just how much blood does the blood bank need to avoid “running low”? Blood has a shelf-life; lore has it that as many as one-third of the red blood cells in an “older” (i.e. over a month old) bag of blood have burst by the time it flows into a patient. This, my attendings opined, was why hematocrits (red blood counts) commonly do not increase the anticipated 3% following a transfusion.
Thus, I started to donate blood even more frequently as a resident. It became a regularly-scheduled habit last year; I donated every eight to nine weeks as allowed. At the end of the year, I received a small note from the blood center informing me that I belonged to a small, single-digit percentage of people who donated more than five times in the past 365 days. The note stated that the vast majority of people donate blood only once or twice a year—surreptitious meetings, if you will.
Maybe it’s because I’ve actually ordered blood for patients that compels me to donate. (It’s not all about the cookies.) People do look different after they receive blood: They have more color in their skin and they report having more energy. For those individuals who require blood due to acute loss (car accident, bleeding stomach ulcer, etc.), their energy levels rapidly approach their baselines. For those people who have had low blood counts for a prolonged period of time (poor nutrition, very slow intestinal bleed, etc.), they report feeling better than they have in months, maybe even years. It’s remarkable how a little blood can change someone’s life. Then there are all the people who receive blood who don’t even realize it at the time: Maybe they’re on the operating room table; maybe they’re unconscious from a significant medical or surgical condition.
Some people can’t tolerate the sight of blood or of large needles. Don’t let anyone fool you: the needles used in blood donation are some of the largest (in length and, in particular, diameter) needles used in medicine. There was a time when I couldn’t watch the phlebotomist insert the needle; the thing is freaking huge and I was certain that if I watched the needle go in, it would hurt that much more. I think I also imagined the needle going straight through my arm or launching a geyser of blood.
In medical school, we learned how to insert IVs on each other (now that was a bloody and painful experience) and, thereafter, I felt less anxious watching the phlebotomist work. These days, I still feel a twinge of nervousness right as the (usually young, attractive, female) phlebotomist slides the needle under my skin; I still expect it to hurt a lot more than it ever does.
If you are healthy and can tolerate needles and blood, I encourage you to go to your local blood donation center to donate. The whole thing, from start to finish, lasts less than 45 minutes—if that—and you are truly offering an invaluable gift. You really are helping your fellow man, often in his time of greatest need.
If you are healthy and get squeamish at the thought of needles and blood, donating blood can be a great way to overcome your fears. The phlebotomists at blood donation centers are generally very adept at what they do (in contrast to the medical students who are often drawing blood from ill patients in the hospital!) and the support staff usually put forth great effort to make the experience comfortable for you. Not only will you have the knowledge that you gave a part of yourself to help someone else, but you can also get free food afterwards—and if you like cookies, they have plenty of those.
You can read more about donating blood here—but reading about it and actually doing it are two different things. Go do it.
(Part of the ongoing Relationship Series.)
7 Jun 2007 | 16 comments.
#12: Books.
When I was in my early teens, my father gave me a hard time about the books I read. I would invariably return from the public library with volumes of fiction: I solved mysteries with Nancy Drew, watched Hercules Poirot twirl his moustache on his egg-shaped head (for whatever reason, I just didn’t like Miss Marple), attended the lavish parties F. Scott Fitzgerald carefully constructed, sought the number 42 while hitchhiking across the galaxy, and relished the spookiness in the worlds of R.L. Stine. Choose Your Own Adventure books were worth their weights in gold and I wished Judy Blume was my friend.
(Tangent: The first time I ever read about a suicide was in J.D. Salinger’s short story, “A Perfect Day for Bananafish“. I remember feeling horrified upon reading Seymour’s suicide; I reread the page several times in disbelief. It was simultaneously compelling and horrifying.)
My father encouraged me to read Stilwell and the American Experience in China. Boooooooring.
“You should read non-fiction,” he opined. “The truth is more interesting than fiction. Reality is better.”
I disagreed. Fiction captured my attention and stimulated my imagination. I equated non-fiction with the history textbooks in school—the reason I wanted to read fiction was to get away from the list of bulleted facts I was required to read for class. Reality was not better; reality was dull.
(However, I shall readily confess that I read, re-read, and then re-read several more times the 1990 (?) edition of the Reader Digest’s Book of Facts. I particularly liked the sections on ancient civilizations—people really sacrificed other people to the Sun god?—and space—when would the Sun turn into a supernova star?)
As I progressed in my education, I devoted less and less time to pleasure reading. My courses demanded that I mentally digest (and then regurgitate) material related to biochemical pathways, the structure and sharing of genetic material, the interactions of antibodies with antigens, the capriciousness of HIV, the anatomy of the hand, the ion exchanges in the kidney, the criteria to differentiate alcohol abuse from dependence, the various blood vessels that feed the large intestine, the side effects of blood pressure medications, the different positions a fetus can adopt while in the womb, the various layers of skin, and how hemoglobin “captures” and “releases” oxygen.
My knowledge of biology and medicine grew while my ability to write and spell like a normal human being diminished.
(Then I started blogging.)
It was only about a year and a half ago that I impressed upon myself the need to read non-medical literature. There is more to life than randomized, double-blinded, placebo-controlled studies, handbooks detailing algorithms for various clinical scenarios, textbooks providing endless facts about health and pathology, and “how to” books about various interventions. Who was Harry Potter? What exactly was the Da Vinci Code?
These are the (non-medical) books I have completed thus far in 2007:
- Impro
- American Born Chinese (fiction)
- The Chinese in America
- Never Let Me Go (fiction)
- Affluenza
- The Tipping Point
Sadly, I think I’ve read more books in the past five months than I have in the previous two years.
What is also remarkable is that four of the above books are classified as non-fiction… and most of the recent additions to my wishlist (someone has a birthday coming up… cough cough) are also non-fiction texts. This does not indicate a dramatic change in character: When I daydream about the library I will have when I grow up, I see myself curled up on an overstuffed, oversized couch next to a large, picture-frame window that is dotted with raindrops, a cup of hot chocolate on a small table nearby, and a work of fiction in my lap.
I feel ambivalent when I walk into bookstores; on the one hand, I love perusing the aisles, skimming the myriad of titles, and sampling pages here and there. On the other hand, I hate that I don’t have the time to read all the books that interest me. Walking into a bookstore reminds me of the things I cannot have right now—including the priceless pleasure of reading many good books.
(Part of the ongoing Relationship Series.)
5 Jun 2007 | 11 comments.