>> Passage. Jason Kottke summed it up nicely: “… a tiny game that takes 5 minutes or an entire lifetime to play. It’s much better if you play it once and then read the creator’s statement. I didn’t know a game (and such a tiny one at that) could be so poignant.” Oh, and how poignant it is.
>> NKOTB Reunion! If you know what NKOTB stands for, then you and I are in the same age demographic. I honestly was never a fan, though “The Right Stuff” was kinda catchy. (Is that incriminating information?)
>> Natalie Dee. Her artwork is cute. I particularly like the pancakes shirt, though a co-worker of mine who received the shirt as a gift told me that the pancakes highlight the chest area a bit too much. “‘Look at my pancakes’ takes on a whole new meaning,” she commented.
>> Graph Paper. Many, many variants. Customizable. Free. It’s a little overwhelming.
>> Cognitive distortions. A reader and I were recently corresponding about these thinking patterns that can adversely affect mood. Being mindful and aware of what you are thinking helps evade these distortions. Thinking about thinking (metacognition?) has its utility, though one must also be mindful of not spending all of one’s time in one’s head. You can miss a lot of life that way.
31 Jan 2008 | 2 comments.
“Who is the President?”
Recently, I’ve asked many patients to name the President of the United States. How patients answer this question provides some information as to their orientation to the world. Some of these patients are delirious; some of them have dementia. Some of them are neither delirious nor demented, though their disorganized thoughts and behaviors suggest to their physicians that they may be cognitively impaired.
Here’s a sample of the answers I have heard. (Keep in mind that Seattle is a liberal city.)
The man with a recent traumatic brain injury.
“Ugh! I hate him.”
“What is his name?”
“I don’t know, but I hate him.”
The man with alcohol-related amnesia (Korsakoff’s amnesia).
“He’s an idiot.”
“What is his name?”
“It doesn’t matter. He’s an idiot.”
“Tell me the name of this idiot.”
“Tricky Dicky.”
The elderly woman with dementia and multiple medical problems.
“Oh, I like him.”
“Who is he?”
“Isn’t it Clinton?”
The older woman who is neither delirious nor demented, but is psychotic.
“George W. Bush! His father was President, too!”
The woman with dementia.
“Carter. He’s a good man.”
Another man with a recent traumatic brain injury.
“Isn’t his wife running for President now? Hillary?”
“Well, that man isn’t currently President….”
“It’s not still Bush, is it?!”
People with dementia vote. One study from 2003 reported that 60 people with dementia (out of 100—researchers asked both patients and caregivers) voted in the November 2000 Presidential election. Another study from 2002 from the same election described that 48 people with dementia (out of 75— researchers asked the caregivers only if the people voted) cast a ballot. A small handful of articles have inquired into the capacity of people with dementia to vote.
(Insert joke about Florida here.)
29 Jan 2008 | 7 comments.
Too Much Information.
The beige phone rings. The Resident cocks an eyebrow at the phone before picking up the receiver.
Resident: Hello?
Attending: Hi, this is The Attending.
Resident: Oh! Thanks for calling back. I had paged you about a patient because The Other Attending hadn’t called back when I paged him, but he eventually did… so I’ve already run the patient by him.
Attending: I’m sorry that I didn’t call back sooner.
Resident: It’s okay—it hasn’t been that long, anyway.
Attending: You see, I was in a dressing room when you paged and I didn’t want to call you back right then. I thought it might be weird if I was talking with you without any clothes on. (snickering)
Resident pauses. She raises both eyebrows, an expression of surprise on her face, before snickering herself.
Resident: (dryly) Thank you for your thoughtfulness.
Attending: (embarrassed laughter) No problem. Sorry I didn’t call back sooner.
Resident: It’s okay.
Attending: (serious) So you don’t need me right now?
Resident: No, not now. But I may call you later.
Attending: Okay. Call anytime.
Resident: Thanks.
The Resident hangs up the phone. She shakes her head and smirks.
28 Jan 2008 | 2 comments.
The Next Generation.
While working today, I saw many of my former medical students. Some of them are still medical students on different rotations, dashing about in their short white coats or standing idly in small semicircles while engaging in the Endless Rounds of Internal Medicine. (Though, to be fair, the rounding in internal medicine during my intern year was significantly shorter than the rounding in internal medicine during my time in medical school. Sometimes my rounds as a medical student would drag on for upwards of four hours. The surgeons would walk past, twirling their fingers in the air as if spinning basketballs to poke fun at our incessant discussions of differential diagnoses and random factoids related to pathophysiology.)
Some of them are now interns, clad in their long white coats as they co-sign orders for their own medical students. I spied a handsome intern—he did not see me scrutinizing his face—and murmured to my own intern and medical student, “He looks familiar to me… how do I know him?”
The Handsome Intern was hovering over his medical student, his expression brimming with concentration. As we walked past, I continued to examine his face. His Spidey Sense clearly did not inform him of my intrusive eyes.
My eyes caught a glimpse of the name embroidered on his coat. The spark of recognition flew through my mind.
“Ah!” I suddenly exclaimed. “He was my medical student a couple years ago… he’s cute!”
The intern and medical student both laughed at my candid remark. This young man was also cute when he was my medical student, though perhaps the haggardness that comes with call nights has added to his appeal. (Not really.)
Later on, I saw a recent medical student standing in a Small Circle of Rounding. She flashed a smile of recognition at me; I waved hello. My group proceeded down the hallway and, stopping in front of a patient’s room, squirted alcoholic sanitizer on our hands. (We support infection control.) The Recent Medical Student stepped away from the Circle of Rounding and caught my attention.
“I just wanted to let you know,” she said in a somewhat hushed voice, “that I often hear your voice in my head: ‘DON’T SNOW PATIENTS!’”
I laughed, amused with the double-entendre inherent in her remark. She was referring to the exhortation I deliver to medical students when teaching them about appropriate treatment of delirium.
“Good!” I said, pleased that I had perhaps prevented one future physician from oversedating her patients. “You see what I mean now, right?”
She nodded her head vigorously. “Yeah. I see it all the time. And then I see that they receive Sedating Medication at High Dose at Frequent Intervals and I’m like, ‘Duh!’ No wonder they’re snowed.”
I flashed the Winning Smile™ at her.
Suddenly realizing what she had said, she quickly corrected, “And I don’t mean that I hear your voice in my head in a psychotic sort of way; I mean I hear it as a reminder.”
“Yes, I know, I know,” I replied.
27 Jan 2008 | Comments?
Attachment.
I have two bookshelves. One is a large “Billy” bookshelf from Ikea that is both taller and wider than me. It is a plain pewter color and all the shelves are occupied. I acquired the other bookshelf from a tenant in the building when he moved out. It is a handsome, unpainted wood bookshelf that is tall and narrow. Most of the shelves are occupied.
To help assuage my own anxiety, I initiate projects early and work steadily. I do not like to rush, though I actually dislike the unpleasant emotions that accompany rushing more than the rushing itself. Hence, I have begun the process of determining how I shall release my books in preparation for my relocation.
I still have books that I used as a medical student, particularly texts that I read to study for my board exams. I literally haven’t opened some of these books in six years.
One of these books is Clinical Microbiology Made Ridiculously Simple. Medical students will know that the “Made Ridiculously Simple” series distills concepts of different aspects of medicine into mnemonics and goofy illustrations.
“I can’t get rid of this book,” I murmur to myself. “I studied microbiology in college. Bacteria are fascinating. I loved studying bacteria. This books reminds me of my discovery of the microscopic world.”
It remains wedged amongst a pharmacology text, a biochemistry book, and pathology volume.
Another book contains only recipes for cookies. Most of the cookies in there are a little too ornate for my tastes (either due to exotic ingredients or complicated preparation instructions). Furthermore, I obtain most of my recipes from the vault of the internet or from friends with exquisite baking touches.
“I can’t get rid of this book,” I murmur to myself. “A good friend from medical school gave me this book as a graduation gift due to my legendary fondness for cookies. Plus, there may come a time when I want to make ornate cookies for my friends. Sometimes, people just want a pretty cookie, even if it has coconut in it.”
It sits unused next to other cookbooks.
Then there are the few volumes of non-work, non-”how to” (e.g. how to juggle, how to perform magic tricks with coins, how to run properly) books I own—many of them were gifts. These books have provided hours of thoughtful, engaging entertainment and, sometimes, comfort.
“I can’t get rid of this Calvin and Hobbes collection,” I murmur to myself. “Calvin and Hobbes is a fantastic comic—this young boy and his stuffed tiger have reminded me of our human foibles… and, you know, inappropriate snowmen are hilarious.”
It remains stuffed amongst The Brothers Karamazov, The Amazing Adventures of Kavalier and Clay (hi Justin!), and American Psycho.
I could take all of these books with me to New York City, though this is not a practical option. I don’t own much as it is and am eager to shed many of my possessions. (I especially can’t wait to be rid of my car.)
I wish I could take all of my friends with me to New York City, though this is simply impossible. While I am deeply thankful that I can take my experiences from Seattle with me, I feel great sadness that I cannot bring along all the wonderful people who have created these experiences with me.
So, like these books, I shall enjoy my friends while I am still here. Parting with my friends will be more painful than parting with books, for certain, though I also know that, unlike the books, my friends will continue to be in my life even though I shall be 3,000 miles away. Books can’t call you up to say hello, fly out to visit you, or send letters to share news. People can.
Thankfully.
26 Jan 2008 | 7 comments.