“He’s probably fine,” my colleagues counseled. “Those guys are tough.”

Intellectually, I already knew this. That did nothing to dampen my relief when I saw him standing in the lobby, waiting for me to escort him to the back offices.

He greeted me warmly, to which I playfully blurted, “Where have you been, young man?”

The winter chill had not affected the good humor of the homeless man who was old enough to be my father. A bit perplexed, he looked at me and an asymmetrical smile crossed his face.

“I’ve been fine—I just forgot to come in last week,” he said.

“I was worried about you, with the snow and everything,” I explained, realizing that my expression of concern probably sounded more like inconsiderate nagging. “It’s nice to see you.”

“Oh, the snow!” he said, his smile blooming into a wide grin. “I’m fine. I can take care of myself in this kind of weather; you don’t need to worry.”

He then began to pontificate on his sleeping arrangements and warmth retention. Clearly, he was well-versed in the arts of hypothermia prevention.

“Aren’t you moving to New York City?” he suddenly asked.

“Yes,” I replied.

“Oooh! You think this is cold? You just wait until you get to New York!” he said knowingly, his voice full of mirth.

He then began to laugh. Probably at me.

Don’t misunderstand: I support text capabilities in pagers. I like knowing what people want when they page me. With numeric pages, I’m never entirely sure of the urgency of the message or the impatience of the caller. Text pages facilitate efficiency:

• We’re meeting in the cafeteria at 10. See you there.
• I have no new recommendations for your patient, but please page 555-5555 if you have any questions.
• There’s another consult for you in the ER.

Furthermore, text pages permit fun (which helps decrease the anxiety associated with receiving pages):

• Got out of clinic early. Call me when you’re ready for dinner.
• Do you want Ethiopian or Thai food tonight?

Text pages, however, also permit spam pages:

• Buy a new leather couch 2day! Leather is the best! C U @ leather isgrate. co m

Spam pages during the day are tolerable. Spam pages at night—like at 1:15am, when most people are sleeping—are annoying as all get out. Spam e-mail at least allows the reader to receive the messages at his or her leisure. Pages, whether they be spam or not, demand attention immediately, whether one is asleep or awake.

And in the middle of the night, pages—like telephone calls—never bring good news.

Gabriel was the first left-handed person I knew. We were in the same second-grade class. Though a quiet kid, he was smart and had a fantastic sense of dry humor (though neither he nor I appreciated this until later grades). In addition to his handedness, his talent of flipping his eyelids “out” (so that the undersides of his eyelids were on display) distinguished him in our class. (The eyelid trick was pretty gross.)

I asked him a lot of questions about his handedness. Did he always know that he was left-handed? Was it difficult to write? Did he find doorknobs and ink pens annoying?

Certain medical conditions are disproportionately associated with left-handedness:

• mental retardation
• epilepsy
• schizophrenia
• autism

However, left-handedness is also disproportionately associated with talents in

• music (including the ability to discern perfect pitch)
• art
• mathematics
• athletics

Though theories abound, no one really knows why these traits are associated with left-handedness.

Additionally, many of our recent Presidents were/are left-handed:

• Gerald Ford
• George H. Bush
• Bill Clinton
• Ronald Reagan (who apparently could also write with his right hand)

Fascinating.

According to Mental Health America (an agency I had never heard of until today), many people are depressed in the US. They produced a report (which I have admittedly only skimmed) about depression in each state in America. They used data, which included

(1) the percentage of the adult population experiencing at least one major depressive episode in the past year, (2) the percentage of the adolescent population (ages 12 to 17) experiencing at least one major depressive episode in the past year, (3) the percentage of the adult population experiencing serious psychological distress, and (4) the average number of days in the past 30 days in which the population reported that their mental health was not good

to rank each state in its “depression status”. (They used DSM criteria to define “major depression”. They also used a scale (”K6″) that has six questions to assess “psychological distress” and a scale that the CDC apparently uses to measure “poor mental health days”.)

According to this report, South Dakota is apparently the least depressed state and Utah is the most depressed state.

They also assessed suicide rates within each state, extrapolating (fairly) that depression can result in completed suicides. They included an “age-adjusted” suicide rate (adjusted for the most recent suicide data they had, which was from 2004).

According to this report, New York has the lowest suicide rate and Alaska has the highest.

The paper goes on to argue that five factors—mental health resources, barriers to treatment, mental health treatment utilization, socioeconomic characteristics, and mental health parity laws—were associated with better depression status and lower suicide rates.

These factors makes sense, of course.

Of note, South Dakota, which is the “least depressed state”, is ranked #40 for suicides (where the higher the number, the higher the suicide rate). Utah, which is the “most depressed state”, is ranked #45.

If we cannot attribute the suicides in South Dakota to depression, then what are other underlying causes?

Alaska, which had the highest suicide rate in this report, ranked #21 for depression. Can alcohol abuse alone explain this disparity? (Washington sees a fair number of Alaskans, whether they be travelling to or from the state, and we often hear about the large volumes of alcohol Alaskans can consume.)

New York rated #19 for depression. That’s only two positions away from Alaska’s #21. Can we attribute New York’s low suicide rate to the availability of services, etc. alone?

Many, many confounders. Plus that whole thing about lies and statistics.

Hospital staff can easily tell when the medical center has hired new telephone/paging operators: They sound absolutely terrified when they announce codes.

To their credit, they try to speak calmly and clearly, but their voices invariably betray their fears:

“Code one-nine-nine, second floor, south wing, room twenty… code one-nine-nine, SECOND floor, SOUTH wing, room TWENTY… CODE ONE-NINE-NINE SECOND FLOOR SOUTH WING ROOM TWENTY—”

oh my GOD someone just told me that someone is dying will you PLEASE hurry up and DO SOMETHING

Within a few months, after announcing several codes, they sound like all the other seasoned operators. They announce codes like cynical junior high teachers who are performing roll call to a class of out of control kids. (Not that I was ever a part of that or anything.)

For all of us, it becomes business as usual.

She looked smart. The quiet intensity in her light eyes reflected her thoughtfulness; she was often considering the information she heard, turning it over, under, and around, as if playing with a Rubik’s cube. She revealed her intellect in both the questions that left her lips and the scores she received on exams. When interacting with patients, she expressed warmth and confidence; they all relaxed visibly when sitting with her. Her classmates held great fondness for her and the professors at the medical school predicted great academic and clinical success in her future.

“But that nose ring,” the attendings lamented, “it’s just so unprofessional. Maybe we should suggest that she remove it.”

A slender ring of silver, adorned with a tiny, pale pink gem, threaded out of her nose and into her nostril. It was not incongruent with her professional attire; the nose ring added style to the doctorly outfits she wore underneath her short white coat.

The attendings—all male, all in dark pants, light shirts, and conservative neckties with uneven knots, and all wrapped in their long white coats—sighed. Doctors aren’t supposed to have nose rings.

People noticed that the color was absent. The inquiries and suggestions began:

• “Where is the color?”
• “When are you going to dye it again?”
• “You should go for a bright red again. That red-winged blackbird look you had going looked cool.”
• “I really liked the gold color.”

It was the first time in two years that my hair was without a stripe of unnatural color. It wasn’t an oversight. After a break of a month, the color has returned.

I had waited until I had established myself as a competent resident before asking my hairdresser to apply a few stripes of blue into my hair. I had wanted that Superman blue-black color in my hair for over ten years, but simply hadn’t pursued it. Though there is no evidence that unconventional appearances result in adverse patient care, there are physicians who believe this must be true.

People liked it. Younger attending physicians, fellow colleagues, nurses, social workers, medical students, and patients—particularly patients!—all offered compliments to me about my brightly-colored locks of hair.

I watched the eyes of some attendings—all male, all older, and all in dark pants, light shirts, and conservative neckties with uneven (and loose) knots—take note of my hair as it rotated through a palette of at least five hues. They said nothing. Doctors aren’t supposed to have unnatural colors in their hair.

Scrub pants tend to run long. Usually, one never knows what socks lurk underneath the pant legs.

Hospital housestaff begin to look identical after a while: They’re all in blue scrubs, dark clogs, and white coats. The uniform clearly identifies who they are and may narrowly define their roles and personalities.

Doctors are supposed to look serious.

Next time, look at their socks. This is often the only place where housestaff can express individuality. Sometimes, they’re simply white athletic socks. Other times, they boast bright, solid colors, argyle patterns, broad or thin stripes, odd animal prints, amusing illustrations, or fun designs.

(Yes, even some male physicians wear wacky socks.)