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normal

Here’s a post I wrote earlier today on my phone:

   I’m not normal and my life clearly is not normal. I live in the hospital except for the few hours of sleep I get every night. I get my vitamin k (or lack there of) from fluorescent lights.  I’m wriing this entry as I stand in line in the hospital cafeteria for a grilled cheese sandwich. I wear pajamas all day long at work.  In my profession 80 hrs is the lower limit of acceptable time spent workig in a week. Actually, I don’t think the word “acceptable” is even accurate.

   But in any case I am of the opinion that sometimes it’s nice, even therapeutic, to feel normal. So I do two things everyday to feel normal: 1) I come to work in jeans and a tshirt (ie civilian clothing) everyday. There’s something really relaxing, almost cathartic after 15 hrs in the hospital to put on a pair of jeans and go home.  It only adds an extra 4 minutes to both ends of my day to change, but it’s worth it. 2) I try to take 5 or 10 minutes everyday to sit outisde either in a hospital courtyard or even out in front of the hospital. I’ll get an iced tea +/- a chocolate chip cookie and just take in some fresh air.  It’s nice and also very normal feeling. As a sidenote, I’m not sure yet how I’ll adapt this to Boston winters but I’m thinking about it now. 

   I know a lot of residents who deny themselves the chance to feel normal, either out of arrogance or feeling like they don’t have the time, but I thnk that’s a bad idea. My sense of normality is one of the ways through which I relate to my patients.  Everyone wants to be “normal” sometimes and everyone wants to relate to normal.  It’s why despite sleepiness and a list of boxes that need to get checked off pages long, I love sitting down to talk baseball with a patient.  It’s also why the same patient with untreatable cancer, for a even period of 5 minutes, will baseball with me.  Everyone wants to be normal sometimes.  Finally, occasional normalcy is also a reason why I haven’t and hopefully won’t turn into a complete asshole when the going gets tough (although some may disagree with my assessment that I’m ready not an asshole).  In any case, I should say when the going get tougher.  Plus, trying to be a little normal really doesn’t take that much time.  And as I like to say: even in medicine, 10 minutes never killled anyone, unless of course it was a code.

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whazzup whazzup?

Yeah I should probably be going to bed, but fuck it, it’s been a while so I’ll blog :-) 

One of the realizations I’ve had in the last two weeks is that internship isn’t too too bad if you don’t have much of a life to begin with.  Luckily for me, I didn’t.  I mean think about it, I spend close to 15 hrs a day in the hospital on average, which leaves me about an hour in the morning and an hour in the evening. 

I guess it’s all good though.  Someone once told me that the purpose of residency was to become a doctor not to have fun.  So be it ;-)

But I’m still lookin forward to this weekend.  I’ve worked everyday since since two fridays ago and I’m tired.  Just tired.  Last weekend I got destroyed.  It was the closest I’ve come to crying in public.  There was just so much stuff to do in each of my “12 hr” wink wink shifts that I didn’t think I’d get it all done even if I had 20 hr shifts.  It was brutal but I somehow pulled it off.  God knows how. 

But now I’m tired and I could really use a couple of days off.  My first day off of residency.  Good stuff.  I want to reward myself so I thought I’d buy some electronics or something but then the first paragraph of this post hit me–i.e. not having a life outside of the hospital–and I decided to do a spa day instead.  Yeah it’s a little soft but I think I’ll get a lot more out of a good back rub and maybe  a pedicure than an xbox, which will collect dust.  In fact I think the xbox would have the opposite effect and actually depress me each night when I came home to see it but not have time to use it.

Anyway, I better go and get some sleep now.  I hope everyone is doing well. 

More this weekend when I actually have some time.

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cure for the first week of internship: a reality check

Internship has started. Getting crushed. One week down, 51 to go in internship and 259 to go in all of residency. Plus I’m on call both days this weekend.  Time for a reality check…

Take it all in: it’s Final Countdown by Europe.

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past my bedtime

It’s after 9pm so I better keep this brief.  First week of internship is going… well it’s going.  Not too bad I guess.  I’m learning a lot and getting into the swing of things.  More on the specifics later, but it’s amazing how different life has quickly changed.  I feel like I’m in survival mode on most nights–just grab a something to eat and hit the hay.  Today I was shocked to get out at 5:30.  Just 12 hrs on the job!!!  Leaving me more time than I knew what to do with.  At least transiently.  I hit the gym for an old fashioned mudphudder workout and then ran across the street for some take bbq for dinner. 

Yum.

Yum.

I am adjusting to the fast pace of most everything–racing to get everything done at work, then racing to get home so I can have a few minutes of free time to unwind before going to sleep.  Yeah it’s crazy but it’s worth it.  I’m learning a lot everyday and it’s all practical knowledge–not random minutiae that I’ll never use.  Patient’s potassium is low, how much to replete with?  How long to bridge a patient starting on coumadin with lovenox?  It’s pretty useful. 

Anyway, I’ll write more in a bit when I have a few more hours consecutively off.  I hope you are all doing well. 

MP

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13 hours later…

And the first day of internship is done. Can’t complain–13 hours is not that bad even if I was hustling around the whole day. Picking up some thai food as a treat and then I’m going home. Thank you all again for the love that you have heaped on me in the last few days. I sincerely appreciate it.

Mudphudder out.

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5:45 am, june 22 2009

So it begins.

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the final countdown

So the regular readers of this blog probably thought this post was just going to be the video clip of “the Final Countdown” by Europe that I post every so often, but NO! it’s not!  :-)  So if you haven’t already flipped back to google, here we go.

my first page (non-official)

My other first page (non-official, from me to me)

Tomorrow I start internship.  Crazy.  I last wrote about my fear of totally messing up this thing and I appreciate your kind comments suggesting the contrary.  At this point, I just want to get in there and fire it up baby.  I’ve spent this weekend going in, rounding with the current team, writing orders, learning the system, etc.  I put in my first official order as a physician.  I called my first consult as a physician.  I did my first discharge summary as a physician.  I received my first page–well, my first official page from someone else–as a physician.  Even better, my first page was back to a number that wasn’t working.  That’s not a good sign.

But I’ll make one last comment on the craziness of this all.  As medical students we get to write orders occasionally–mostly in advanced rotations (e.g. sub-internships) but those orders are always cosigned.  So while you are always approaching the process as though you are the doctor, deep down inside you know that someone will (has to) be double checking you on any little thing that could affect the patient.  I suspect the next few weeks won’t be too much different as an intern but quite frankly, my senior residents won’t be able to double everything that will affect the patients’ well-being.  So it is with some (serious) thought and rethinking and re-rethinking and re-re-rethinking that I am putting orders in right now.  I hope and I suspect that I will build up my confidence with time and experience but for now, I’ll just have to be inefficiently careful to the extreme.  Patient wants tylenol?  Hmmmmmmmmmmmmmmmmmmmmm.  Hmmmmmmmmmmmmmmmmmm.  Is there any reason not to give this guy some tylenol?   Hmmmmmmmmmmmmmmmmmmmm.   Hmmmmmmmmmmmmmmmm.  You get the picture.  But I’m happy that this kind of thought process is not sustainable throughout residency so at some point, I’ll have to get faster. 

Anyway, the last couple of days has seemed cautiously do-able.  I’m always discovering some new, critical responsibility that the intern is responsible for on our service, so I hope that I don’t bring the service to a screeching halt tomorrow.  But we’ll see.  100% is all I can give.

Wish me luck (although most of you already have, so thanks again).

I’ll write to you from the other side.

Mudphudder out.

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my fear

Today I crossed the threshold of the hospital I will be doing intership in. I stopped at the front door, hung my head, took a deep breath and plunged myself in. My first reaction is some fear of the unknown. Not so much what to expect–I already know that I’m gonna get my ass kicked and then handed to me on a platter–but more along the lines of not messing up.  Too much. 

I just don’t want to be that bumble-fuck intern that’s in every residency program.  Some of you know what I’m talking about.  I recall one bumble-fuck intern I met during a rotation in medical school who started off presenting a patient on AM rounds with “Mrs. So-and-so is a … yr old female… who had no overnight issues and is doing well…”  At which point a few of us peered into the patient’s room and she honestly looked like she was dead.  I’m talking arm hanging off the side of the bed, mouth slightly open with eyes closed.  Long story short, she wasn’t dead but she had become septic overnight–while this intern was on call.  This was a recurring theme for this particular intern and very often to the dismay of the senior residents. 

I don’t want to be that guy.  I work hard.  Always have.  But then again, this guy must’ve too to get to where he was at.  Right? 

I don’t know–I guess what I am describing is a “fear of failure”.  This is a huge transition point in my infant career.  I actually have some responsibility for the lives of other people.  I’m a doctor and I don’t want to fuck it up.  I especially don’t want to fuck it up while putting in everything I’ve got.  I guess we’ll see how it goes.

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experiencing new things

Today I signed up for a gym membership.  The first time I’ve committed to working-out somewhere new in the last eight years.  It’s nice but small with not much weight-lifting equipment.  But this gym is close to home and I’ll have no excuses to not stop by for a 30 min workout occasionally.  And on the plus side it was the first time in about 3 or 4 years that I’ve felt comfortable leaving my wallet and keys in my gym locker rather than carrying them around the gym in a fanny pack. 

About 3 or 4 years ago, while I was working out at my other gym, a couple of guys went into the men’s locker room, cut the locks off of like 7 or 8 lockers and robbed everyone.  Some faculty members lost laptop computers, some people lost wallets, me–they took my raggedy jeans, with my wallet in them.  Even worse, my favorite belt went with my pants.  Motherfuckers.  There are few things as emasculating as getting your pants taken away.  Anyway, ever since then, I’ve carried everything of worth in a fanny pack while I lift weights, which was annoying.

Today, I felt emancipated.  I guess you can never be too sure but this seems like a nice place–and for what it costs, it better be nice. 

So I propose a toast: here’s to experiencing new things.  And not having my pants stolen.

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footwear for the wards

As of late I have made some fuss about my footwear to start off internship.  Yes, every young doctor secretly or not-so-secretly wants to be pimpin’ and for some, footwear is a big part of that.  I may have given that impression in the last post I made but for the sake of the youngins, I’ll clarify. 

First of all, you know me.  The mudphudder.   MP.  We already know that I’m the “why?” in “stYle”.  But make no mistake about it, when it comes to footwear and the wards, style is an afterthought.  Walking the wards for a sub-internship or any time consuming medical school rotation is no joke.  It kills your feet.  I suspect residency will be no different.  Going to the wards is like going to war.  And the preparation starts with your feet.  Without healthy feet, you can’t walk the wards or stand in the OR for 12 hours a day.  So when it comes to your feet, you gotta go with comfort and durability before the style factor even comes into play.  And I’m talking socks too: comfort and durability. 

You can always tell the newbie medical students on the wards: wearing pimped out shoes with dress socks.  I was one of them too once.  After a few weeks or months, spending evenings with your feet up on pillows wrapped in ice, it dawns on you that it may not be worth it.  True dat.  For the last few years, I’ve been wearing dansko clogs and sweat socks.  I love it.  It works–my feet don’t kill me when I go home (as much).  Plus, I can kick them off at anytime during conferences, lunch or even when I’m talking to patients to let my puppies breath a little.  Oh yeah.  Some of you know what I’m talking about.  Like when you’ve been on your feet for 15 hours straight and your feet hurt so bad that they’re numb and then you sit down, kick the shoes off and it feels so f’in good.  And to be quite frank, I don’t give a rat’s ass that some people may not like the white sock/black shoe look.  It’s comfortable and it’s professionally acceptable so all the haters out there can just eat it. 

Anyway, once the shoes have been narrowed down for comfort and durability (I once knew a crazy ass resident who actually used one of those podometers to calculate he walked an average of 5 miles per day in the hospital), then go for style.  I’m personally sticking with my trusty dansko clogs.  My bad-ass Johnston and Murphy shoes are strictly for walking Boston on my days off.  Yes, they’re comfortable but they’re not made for long hours.  My new Bruno Magli’s (I still love the fact that I have a pair) are strictly for *occasional* clinic use.  Yup–Even those bad boys I’m gonna be careful about taking out.  At the end of the day, despite my pimped out arsenal of footwear, I’ll mostly be relying on my clogs.

So to conclude, being pimped out is important but not at the cost of the feet.  Furthermore, being pimped-out is a state of mind so the “Superfly” should come across regardless of the footwear.  And if it doesn’t, then the fur on the collar of my white coat should give it away.

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continuing the pimpin’ out process

In an effort to be the most pimped out intern, I went out today and bought some new shoes and new shirts.  You already know that my tiny apartment is pimped–even more so since I posted that picture–more orchids out and a sweet printer/scanner/copier/fax hooked up to a wireless network so I can use it from anywhere.  Then again, my home is only 600 sq feet, so how far would I have to go?  I guess it’s the principle of it.  The state of “pimped-out-ness” is not about practicality. 

Mudphudder peacin out with his new Johnston and Murphys

Mudphudder peacin' out with his new Johnston and Murphy's

Anyway, I hooked myself with some sweet Johnston and Murphy walking shoes on sale (big sale in the store right now) and a pair of black Bruno Magli’s for clinic.  Yeah that’s probably over-doing it, but as I said the state of “pimped-out-ness” is not about practicality.  I unfortunately have not included a pic of my Magli’s because they are resting comfortably in their shoe bag and I don’t want to disturb them.  Now that is soft leather.  To round out my efforts for the day, I ended with some non-iron shirts from the Banana Republic.  Now, I just heard about these and I’m still not convinced that I won’t have to iron these shirts after washing them, but I just had to try them out.  You see, a pimped out intern doesn’t have time to be ironing shirts.

Finally, I turned on my landline today and I got such a wicked awesome phone number!!!  Let’s just put it this way, I memorized it after hearing it once.  DANG!

Well my peeps, it’s getting late and I gotta start getting used to going to bed early so I can wake up early.  I’ll take my leave for tonight, but more to come.

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a glimpse into my new life

FINALLY!!!! I’m back online.  Sah-weeeeeeeet!  Mudphudder is back baby.  So what to write about?

To date, I’ve been a little secretive about myself and for good reason–it let’s me speak my mind quite freely without fear of reprisal.  But for the readers who’ve stuck with me through the last few weeks, when posts have been few and far between, in effort to bring this little thing called the mudphudder blog a little closer to home, here’s a rare glimpse into my new life.

For one, I recently moved to Boston, Massachusetts for residency.  Boston is one of the few major cities in which I had spent almost no time before residency interviews but I am finding it to be a most awesome place to live.  The city where I attended medical and graduate school was, shall we say, not great.  Don’t get me wrong, I met a lot of really nice and wonderful people while I was there, but the city itself–not so great.

My superfly pad.

My superfly pad.

So here I am in Boston.  The pad is set up.  Actually, more than just “set up”.  I would call it pimped out, to be quite frank.  I just bought a big-ass 40 inch flat panel TV.  I just bought some nice furniture, including a couch deep enough to accomodate my shoulders (I hate lying on a couch with my arm hanging off the side).  Plus, I have all of my orchids here with me.  That was so key.  I had to give away a lot of my houseplants but managed to also bring a few with me.  I’ve had all of these plants for 6, 7 or 8 years.  And in during that time, they haven’t argued, whined or yelled at me.  That is even more key. 

Anyway, I’m just catching my breath now.  Since I was last blogging on a regular basis, I went through graduation, saying good bye to everyone, packing up and moving up here to Boston.  Doesn’t sound like much but it was.  Anyway, things are finally starting to settle down around here so hopefully I’ll have more time to write about the last few weeks and what’s going on now.

On the top of my list, I just want to comment on the Boston weather, which so far has been awesome.  Not too hot and in fact often pretty cool.  Where I was at before, it’s like 80-90 degrees right now.  Here, cool and in the 60s (although rainy today).  We’ll see how much I’m loving the Boston weather in a few months…

Anyway, it’s getting late so I should hit the sack (right after I finish watching “A Few Good Men” in HD; awesome!).  But MP is back and now you know a little more about me.  In particular, that I’m super-fly.

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back online tonight

I’m on my way to buy my new wireless router now so hopefully my Internet will be up and running tonight and I can get to blogging (from my computer rather than from my phone).

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i’m almost back

Hi everyone. No I’m not dead and no I haven’t quit blogging. As many of you know, I recently got residency on city far away from where I went to medical school and I have been in the painful process of packing and moving over the last few weeks. I apologize for my lack of blogging in that time but I have just been getting crushed. Between hosting family for graduation, finishing up 3 manuscripts (which mind you are not done yet) and of course the obviously painful process of packing up, I just have not had the time. Plus I haven’t had real Internet access in over a week. In fact, I am writing this entry on my new iPhone (which is Sah-weeeeeet by the way).

Anyway, please hang with me for another few days when I can set up my high speed Internet and I’ll fill you in ok the pain that has been the last two weeks.

With much love to my loyal readers,

MP

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my first porno spam

The bloggers out there know what I’m talking about when I refer to “spam commenting”.  These are people (or websites) who leave very generic but often flattering comments on other people’s posts in order to generate links back to their own websites, which usually are selling something.  In the last week, I’ve gotten my first two spam comments from what turned out to be porno sites.  Here’s one of my porno spam comments:

Do you do all your own writing? Or do you outsource some of it? I’m looking for some similar content for my blog! These are great posts!

Hells yeah porn-meister, in fact all that writing is mine.  You know, I get that question about outsourcing all of the time!  Something about my writing probably reminds readers of non-native english speakers in third world countries trying to write english.  And finally, damn right these are great posts.

Anyways, back to the story…  Of course I was as shocked as the certain someone, who found me looking at the porn sites, to find out that I was getting spammed by porno websites.  But I guess you know you’ve made it big when the porn sites start getting you.

In other news, most of my furniture is now gone.  I’ve come full circle.  I still remember the first night when I moved in here, eight years ago, when all I had was my bed and my TV.  Now it’s back to the same.  I can’t believe I’m talking about eight years ago like it was yesterday.  I can’t believe my frame of reference for time has gotten so long that eight years is not that much.  I’m getting old.

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sad

I said goodbye to my best friend’s two year old daughter today (I’ve known her since she was 8 hrs old).  Sure I’ll see my best a friend a few more times before I head out of town (he’ll be heading out of town not too long after I do) but soon enough I’ll have to say goodbye to him too.  I’ve been saying my goodbyes for the last couple of weeks, so that’s not new.  But for those of you who care to know, I tend to be the kind of person who has a lot of “acquaintances” but I maintain only a very small number of really really close friends that I know I can completely trust, etc.  After six years in the trenches together, it’s a bummer to say goodbye to my best bud, my big bro.

A real bummer.

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up to my head in…

Some of you may be wondering what the mudphudder is up to and some of you may not have even noticed no new posts in the last week.  I’ve now hit full-blown moving mode–packing stuff, selling stuff and storing stuff.  It’s brutal.  I’m hot, tired and sweaty.  And tonight, I’m being dragged to a party by a certain someone in about an hour.  No rest for the weary. 

As an update, I had one article that was published about a month finally show up on pubmed.  Instantly I received a number of questions and requests regarding the work.  So it is good to be indexed on pubmed.  Also, I had one manuscript rejected.  It was the kind of review, I’d call a “smackdown”.  Which is weird, considering we were invited to submit the manuscript to that journal.  Whatever.

Now, I’m stuck with two other manuscripts that I’m trying to finish before I move in a couple of weeks.  It’s gonna be tight.  And the last thing I need is a fucking party to go to right now.  But what are you gonna do?

Sorry about the lack of posts recently–I haven’t fallen off the face of the planet.  Please bear/bare (however the fuck you spell it) with me as I get through this. 

MP

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i’m awesome too

A good friend of mine is in town this weekend so I’ll keep it short and sweet. 

I recently came across a list of the 100 science articles that every graduate student should read on a scientist’s blog.  I curiously looked through the list and noticed very quickly that 9 of the about 76 (so far) posted articles were written by him!  HAHAHAHAHAHA!!!!!!  Watson and Crick’s Nature article on the double helix structure of DNA was not even on the list.  And the articles that were seemed to be mostly potentially useful to only a small subset of graduate students.  I won’t mention the scientist’s name because I don’t want to draw negative attention to this dude from my blog, but, COME ON!!!!  I pubmed-ed this scientist and noticed that, yes, he does good–no, great–science.  But to tell me that over 10% of the 100 articles every graduate student should read was written by this dude’s hand?  C’moooonnnnnnnnn…  A few of you might have seen this distributed over twitter and/or my response to it, so if you’ve taken a look at the list, am I wrong? 

This is what I look like on a bad hair day.  And I'm really smart.

This is what I look like on a bad hair day. Except that I'd never get caught dead in striped swim trunks.

Not that accolades mean much but even if this dude had won a Nobel prize, was a member of the National Academy of Sciences or HHMI (note though this person has accomplished none of those things), there’s been so much amazing science, which should be at foundation of every biomedical graduate student’s education, that no person could possibly take credit for such a large chunk of it.  That’s just my opinion though.  But hey, even I need my ego stroked sometimes–I just think it comes across better when it’s someone else doing it. 

So the final conclusion that I draw is that one’s blog must be the place for self-aggrandizement.  Therefore I just want to tell you that while this dude can take credit for roughly 10% of the 100 articles all graduate students should read, I can take credit for the other roughly 90%.  But then again, you already knew that.

Mudphudder out.

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what would scooby do?

As some of you may know, last week I started ACLS training last week (I’ve been twittering about it quite a bit and even posted some pictures from class).  For those of you who aren’t familiar with it, ACLS stands for “advanced cardiovascular life support” and I’m training so that I can participate in or even run codes in the hospital starting in July.  Part of the training consists of basic life support (CPR and using a defibrillator) and part of it–the “advanced” part–consists of recognizing when and in what order to use certain drugs or shock patients in order to bring them back from the light.  So when you’re watching Grey’s Anatomy and you see them yelling at each other, “EVERYBODY CLEAR”, “SHOCK”, “RESUME CHEST COMPRESSIONS”, “1 MG EPINEPHRINE IV”, and most importantly, “NOT ON MY WATCH–YOU’RE GONNA MAKE IT!!!”  That’s gonna be me in about a month and a half.   

Eew.  Keep your spittle--and herpes--to yourself.

Eew. Keep your spittle--and herpes--to yourself.

So the training has been rewarding so far but I was minorly disturbed by something one of the course directors said to me in response to a question I had.  As many of you know, a part of CPR is “rescue breathing”, which may have to be mouth-to-mouth resuscitation if you don’t have another way to push air into the patient’s lungs.  Rescue breathing is the only source of oxygen for a patient that has coded.  So in our class all of our mouth-to-mouth was done through a CPR mask that basically prevents direct mouth-to-mouth contact, for obvious “reasons”.  I put reasons in quotation marks because while it seems really “yucky” to do mouth-to-mouth on a stranger, it has repeatedly been shown to be safe–i.e. the risk of acquiring any kind of blood-borne infection (e.g. HIV) is incredibly low–on the order of 1:1,000,000 or less.  However, data also exist suggesting the rescue breathing may not be necessary in addition to chest compressions for a cardiac arrest.  The physiologic basis for reducing the number of rescue breaths is that stopping chest compressions to give the rescue breaths greatly reduces the blood flow to the heart and brain.  And a few studies suggest that chest compression-only CPR may be as effective as standard CPR for cardiac arrests.  The impact of these studies is that people who choose not to give rescue breaths to the dude they watched keel over at the Old Country Buffet, are off the hook.  The current recommendations by the American Heart Association are that rescue breaths be given at a ratio of 2:30 chest compressions, which is what you will see EMS/paramedics doing.  But, EMS always carry their handy-dandy masks plus they use a bag to ventilate people so they don’t have to worry about catching herpes or HIV from the arrested patient. 

So my question to one of our course instructors the other night was, how to do you feel about giving mouth-to-mouth given the strength of data suggesting that it’s pretty safe and probably worth the risk of saving somone’s life.  The response I got was that this instructor would never give mouth-to-mouth and the example I got was, ”you see a dude pass out at a bar in [popular part of town for bars]–would you want to give that dude mouth-to-mouth?  I don’t think so”.  To me it’s not so clear-cut and reminds me of a bumper sticker I saw recently: “What would Scooby do?” 

Scooby would probably say "I'm a dog, I don't know how to do CPR"

Scooby would probably say "I'm a dog, I don't know how to do CPR"

I’m not so sure how I feel about the thought of “yuck” coming into the decision making process of a healthcare professional performing life-saving measures.  I’m not saying it’s not practical but I’m just not at that point yet.  While some (and not rock-solid) data suggest no added benefit of rescue breaths for cardiac arrest, they don’t show any added harm either over the recommended guidelines.  Moreover, there are situations where using rescue breaths in CPR is superior to no rescue breathing, such as when the patient has a respiratory obstruction or arrest.  So while the two sides of the argument agree on little, I do think it can reliably be said that, for now at least, the data don’t show a harm from following the recommended 2:30 breaths:compression guidelines. 

I don’t carry my CPR mask/microshield around everywhere with me (and I never will) but then again the preponderance of data that I’m aware of suggests that mouth-to-mouth is safe.  So what to do?  What would you do and what would you want if you were the 350 pound dude with the lobster bib at the local Red Lobster who keels over?  If you’re giving different answers to those last two questions, you got a real dilemma on your hands, my friend.

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when the cat’s away…

Yeah, that s how I roll.

Yeah, that's how I roll.

…the mudphudder will play.  Today a certain someone went out of town for a five day trip to see the ‘rents, which means that I’m home alone.  Home alone.  Takes me back to a different time.  Except tonight I have two manuscripts that are in need of work and I have to move within the month.  I’m thinking this bottle of Bordeaux with a bag of Pepperidge Farm Milano Double Chocolate cookies will give me the power to plow through one of those manuscripts tonight.  Or put me to sleep and give me indigestion.  Probably the latter. 

So before I pass out or I start slurring my writing (already can feel the first half of that bottle taking effect), allow me to briefly wax nostalgic.  Today I picked up my graduation gown for the upcoming commencement.  Everyday I have more reminders of the fact that I’m jetting after spending eight years here.  Someone asked me recently if I was gonna miss the institution, and I said: “Hell no.  I’m gonna miss the people.”  I’ve met a lot of really nice people over the last eight years.  Today after I picked up my gown I ran into a security guard who I’ve said good morning to for the last seven years.  Today we talked at length.  I found out his life story.  And then I ran into a member of the cleaning staff who I’ve known for six years.  And so forth.  It’s pretty sad.  But isn’t that what life is all about?  Hear me out here–it’s not the wine talking–this thing we call life is all about experiences we have, the people we meet, the relationships we form.  Yeah, man.  That’s totally what it’s all about.  But it’s still sad.  It’s been fun, my peeps. 

I don’t know if it’s the, now 3/4, bottle of wine I’ve had but I have the urge to tell someone that I love them. 

I love you, reader. 

[Snoooooozzzzzzzzzzze]

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md/phd students are assholes

Or so some people must think.  I still owe you all a post on the MD/PhD student experience of going through residency interviews but one aspect of my interviews came to mind today and I wanted to write about it in a separate post.  (For the non-medical readers, if you didn’t catch my rants on the residency interview process, here’s a previous post I wrote as background).  One question that I was asked at a number of places was, “do you think you will be able to take orders from a more senior resident who is younger than you?” 

And my response was: “No.  If I am older, then I MUST know more than anyone younger regardless of how many years of residency the other individual has been through or that I have no experience in residency.”

What the fuck?  (yeah I’m writing it out).  Is it just me or was the interviewer essentially asking me if I’m an arrogant asshole?  It was even worse when I’d get the same question from different interviewers at the same place.  And it wasn’t just directed at me (although you may be thinking that), because I’ve heard other MD/PhD students getting the same question. 

The interviewer follows up: “Because some MD/PhD students have a hard time taking orders from younger residents.”

Here’s some breaking news: there are assholes in every field and every sub-group of people.  Sure there are jerks amongst MD/PhD students, but there are also jerks amongst regular medical students and residents as well. 

There are medical students and residents who walk into labs for their research rotations and having done some PCR several years ago, think that they are much better than graduate students or post-docs.  These people ultimately not only alienate everyone around them but also fuck up other people’s experiments through contamination, etc.  Yup, research people know exactly what I’m talking about.  And guess what–these fuck-ups are not MD/PhD students.  Yes, there are assholes everywhere. 

Now, my assumption is that these interviewers have had bad experiences in the past, which is why they ask.  And yes, I’ve even known MD/PhD students who have told me in the past that it’s bullshit to take orders from residents who are several years younger, but they were in the minority in my experience, and even before hearing that I would’ve classified them as arrogant.  

However, as I described above, I and others I know have had bad experiences with arrogant medical students and residents in the lab but that doesn’t stop me from giving them the benefit of the doubt to begin with.  In all fairness, though, I will acknowledge that the distrust does run both ways–yeah research people, I’m looking at you.  I remember in our lab the graduate students used to have a serious distrust and unjustified dislike of medical students, residents and fellows who rotated through the lab.  But that wasn’t cool either.  So let’s just try to get along people! 

Anyway, to end in a helpful and non-ranting manner, I’ll say how I always answer this question:

We all choose different paths.  That I may be older than many of the residents I’ll be working with isn’t because I was wasting my time–but rather because I was pursuing my own career goals through graduate school and getting a PhD.  In that time though, these residents have accumulated far more medical knowledge and experience than I have so there is absolutely no reason why I would have a problem learning and taking orders from them. 

That’s reasonable, I think.

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so i listen to phil collins

As a follow-up to my last post, I feel compelled come clean that I listen to Phil Collins’ music. Yes, I’ve been a fan since he rocked out on Invisible Touch with Genesis in the mid-80s. Much like Neil Diamond and Journey, Phil Collins rules–but in his own, semi-manly/wussy kind of way.  And what the fuck is this about Phil Collins being #5 on the list of “Top 10 Pop Artists for the Terminally Uncool“?!?!?!?  I’m outraged. Hello??!?!  These guys have obviously never heard about a ground-breaking band called Genesis.  When Peter Gabriel left Genesis, Phil Collins had the courage to step in and show us that having puppets in music videos is cool:

 

I won’t even get into his revolutionary solo work that includes the soundtrack of the Disney movie Tarzan

Moreover, what the fuck is up with that list in general?  I listen to at least half of those artists on a regular basis!  Bryan Adams?  What?!?!?!  C’mon!  (As a sidenote: I do the best Bryan Adams raspy voice the morning after I’ve had a couple of cigars and much too much to hard liquor on the night before).  I won’t even get into my outrage over seeing Neil Diamond on that list. 

Some people just have no taste in music…

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“eeeewwww, poor people!”

Score one for the bad guys.  I am seldom shocked anymore but even I was startled by this one.  A recent story published at gothamist.com reports on a recent slew of phone calls from the New York

I put this album cover here back Phil Collins sang a lot about poor people in this album.  How do I know?  Because I'm a proud fan.

Phil Collins sang a lot about poor people in this album so it seemed appropriate

University (NYU) to low-income families whose kids had gained acceptance for college to NYU just to remind them how expensive it is to attend NYU.  The story reports that officials at NYU, which will distribute $175 million in financial aid in the next school year, say the phone calls were simply intended to make sure families understood their often complex financial aid packages.  This was also confirmed and strongly condemned by the NYU school newspaper.

From what I’ve gathered now, NYU calls these poor low-income families and tells them, “it’s expensive here” and at best makes sure that they understand how much of a debt burden they will be taking on.  I can think of a few things that are not right (even for academia) with this picture.  First of all, everyone did not get this phone call, just low-income families.  It doesn’t take a genius to see why this would be offensive as the assumption seems to be that low-income families, perhaps by virtue of their low-income and socioeconomic class, are unable to even contemplate a number as big as $50,000 per year.  Oooooo–that’s so much money, I can’t even begin to understand what it means!  You know, this really does piss me off.  I’ve always felt that education should be accessible to anyone who was willing to work for it.  And as much as I used to bitch and moan about how much my university was giving me in financial aid and how much I had to borrow, the system did sort of work.  Yes, I was able to afford going to an expensive college but was I able to eat steak for dinner every night?  No.  I ate at the dining hall everyday (where rumor has it the food was laced with baking soda to make the students feel full on less food but that’s another story) and I had to cut out a lot of frills.  So what NYU appears to doing, in my opinion, is shear elitist intimidation and bullying.  These kids got into NYU and they clearly had loan packages to go there but instead of being recruited, their lack of money is being thrown in their faces.  As if these people didn’t know they come from a low-income family.  Unbelieveable.  As many have already pointed out these phone calls–while not directly pressuring these families–are just adding more pressure that these families must be feeling from their finances–a sentiment that has been echoed by some of the students whose families have received these phone calls from NYU. 

But as disgusting as I find NYU’s actual behavior, I find it even worse in light of the fact that they could be helping instead!  Rather than bullying low-income families and “reminding” them of how expensive it is for their child to go to NYU, they should be educating these families on the different ways of that education can be funded through grants and reasonable educational loans.  The “ins” and “outs” of financial aid are complicated–no question–and in my experience not really accessible to anyone who doesn’t work in a financial aid office.  As I am about to graduate from medical school, I now have to deal with all of those college loans I deferred for eight years.  Painful–not just the amount I owe but also all of the rules, forms, deadlines, etc.  I’ve been lucky that the financial aid office at our medical school has been really helpful in explaining things to me and hooking me up with the right people.  But this experience has also taught me that when financial aid is explained in the right way, all of the options and possibilities can be much clearer.  In the past, our financial aid office even alerted me when there were grants available that I was eligible for.  Over the last few years, I’ve come to realize that there’s a lot of free money out there that most people don’t know about.  Financial aid offices are gold mines.  These people are plugged in.  Talk to them–they can tell you about grants (free money) that you’ve never heard of.  That is, when the university isn’t busy trying to scare you into not going there.  I can’t say that I’ve talked personally to any of the kids or their low-income families that were contacted by NYU but in no story that I’ve read (including the responses from the NYU representatives) have I seen anything about the university also offering to provide guidance on how these families could afford to send their kids to NYU.  This is just disgusting.  I personally hope that I have misinterpreted what I have read or that I haven’t gotten a hold of the whole story but I’m skeptical that is the case.  But such a bold-faced and apparent attempt to weed out kids from low income families is appalling. 

NYU, help these families–don’t turn them away!  Shame on any college or university that turns away students who have been accepted with financial aid packages through the lowest forms of intimidation aimed at those who need help the most.

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what do you think?

Someone wound up on my blog by searching google for:

do thesis advisors have big egos

What do you think, Buddy?  HAHAHAHAHAHAHAHAHAHAHA!!!!!! ;-)

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on the need for more bone marrow donors: response to a reader

I was recently asked by one of my readers to call attention to the need for more people to register for bone marrow donation–a request inspired by the illness of one of his classmates at Yale School of Medicine, Natasha Collins, who is battling recurrent leukemia but is unable to find a matched bone marrow donor for a life-saving bone marrow transplant (BMT) due to her mixed ethnic background and despite a recent online marrow drive.  There will be, however, a second online bone marrow drive for Natasha at www.marrow.org (click here for more information).

Every year, more than 10,000 men, women and children get life-threatening diseases that can only be cured with a BMT. Some of these people find a matched bone marrow donor in their family, but 70 percent do not. These patients search the National Marrow Donor Program Registry for a genetically matched donor and most likely match to a donor of their same race and ethnicity.  However, over half of these patients–corresponding to roughly 35% of patients requiring a BMT– are ultimately unable to find a matched bone marrow donor.  Many of these patients are of minority or mixed racial/ethnic backgrounds–patient subgroups that are grossly underrepresented in (comprising just 24% and 3%, respectively, of) the 7 million bone marrow donors registered with NMDP (check out NMDP facts and figures, 2009).  Thus on the basis of shear numbers of donors available, patients of minority or mixed ethnic background stand much slimmer odds of finding a matched bone marrow donor.  And as a result, efforts are currently being made to increase the number of minority and mixed ethnicity bone marrow donors, for example through the NMDP and the MAVIN Foundation.

But this is about everyone.  Everyone who needs a BMT should be able to get one.  The fact that 35% of these patients cannot find a bone marrow donor is unfortunate and unacceptable.  My goal in writing this post is to raise awareness through which more people will hopefully get registered as potential bone marrow donors and those who need a BMT can get one. 

I sincerely hope that Natasha and every other patient else who needs a BMT are all able to find a matched donor.  

Time to do something about it.

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advances in cancer genomics webinar

From the Science/AAAS:

Watch Live on Thursday, April 30, 2009
12 noon Eastern, 9 a.m. Pacific, 4 p.m. GMT

Cancer is a complex family of diseases, characterized by the deregulation or dysregulation of the normal control pathways for cellular growth and/or apoptosis. Traditional research programs have focused on identifying and quantifying environmental and inherited factors associated with cancers found in particular tissues. Despite many advances, these approaches have historically been limited in scope due to technological limitations or excessive cost. With next generation genomic platforms, scientists are now able to cost-effectively assay individual cancer genomes and characterize them in terms of the global genetic, epigenetic, and transcriptional changes. In depth characterization of these events—and the relationships between them—will lead to better understanding of the mechanisms of tumorigenesis, metastasis, and therapeutic response. In this timely webinar, a panel of distinguished scientists will share their latest advances in cancer genomics and offer their views on the road ahead for this important area of research.

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career choice impacts your academic viability

What is the most consistent measure of academic viability?  Scientific accomplishment?  Enlightenment of fellow man?  Bettering mankind?  Not really.  In my experience the most consistent measure of the viability of ones academic career is funding/money.  When big-name scientists lose their funding, they get the boot.  When the dude who has never really accomplished much somehow gets his hands on several million dollars of funding, he becomes the star.  I’ve seen it happen.  It doesn’t quite seem right but I don’t think universities care, in general. 

I was listening to a story about a division head who is effectively being terminated because of the loss of major funding (and the inability to get more funding) and I couldn’t help but shake my head in sad acceptance.  “Sad” because the situation is obviously sad!  Moreover, I know this person’s work and it is good–like New England Journal of Medicine good.  And, “acceptance” because that’s academics for you.  Better to know the ground rules going in than be surprised.  Nothing surprises me anymore. 

Nonetheless, because this is a fact of academics, it is important to consider the fact that your career choice will impact the viability of your academic career.  As time goes on, our careers all become more differentiated but there is always opportunity for adapting our work strategy. 

So what am I talking about?  From the perspective of pure researchers, it is pretty straight forward I think (but correct me if I’m wrong).  Either get grant funding or get the fuck out of here.  My feeling is that the best way to maintain viability through constant grant support (besides the obvious: do quality work, do lots of it, and know the right people) is to be in a field that maximizes the ratio of funding opportunities to competitors seeking those funds.  And that’s a tough balance to strike because “hotter” fields, with many investigators, tend to suck up most of the funding dollars.  You think the NIDDK gives away most of it’s grant monies for research of irritable bowel syndrome?  Actually, I don’t know–that could be the case, but to illustrate my point, my guess would be most NIDDK research dollars go towards diabetes.  The field I did my PhD research in was really hot and also really competitive and cut throat.  As much as I’m always screaming that “I WAS ROBBED” when I get shitty reviews back on my manuscripts, a few of my reviews really did read like that reviewer just wanted to suppress our work.  But, then again there was tons of grant money for that area of research. 

What about clinicians in academics?  Here’s where it gets a little more complicated.  Academic physicians tend to fall into one of three categories: physicians, physician-scientists and physician-educators.  The one common denominator for job security to all three categories is the amount of revenue that the clinical practice brings into the department.  This is obviously applicable to the pure clinician who does not undertake much research or teach.  However, it is also applicable to physician-scientists and physician-educators because at the very least, if the money generated through research or teaching activities falls through, there is always the clinical practice to depend on until, for example, the next grant comes in.  Therefore, there will always be more academic job security for someone whose clinical field of practice generates more revenue than a clinician who doesn’t.  It’s a sad fact.  I’ve seen some junior faculty who are forced to near 100% clinical work in order to support their salaries (essentially guaranteeing the end of the research career) in comparison to some other physicians who can cover their whole salaries (even without grants!) by working 3 days per week.  That’s a big difference.  Moreover, for pure clinicians the clinical revenue from a full week’s work will significantly impact not only salary level but also promotions as well.  I’ve noticed this to be particularly hard on the general internist who practices in an academic center.  Deferring all discussions on the importance of the general internist for now, it has become a fact that these guys are some of the most underpaid physicians in this country.  Couple that with work in an academic setting and you have a recipe for failure waiting to happen.  Especially when these guys are compared side-by-side (in terms of revenue production) with colleagues in, for example, surgery.  The fact is that physicians practicing less lucrative fields in academics have to do something else (research, teach, etc) and that something else better generate some revenue or at least acclaim.  At the end of the day, it seems to me that we are essentially renting our faculty posts from the university (e.g. through grants, services or revenues generated).  And, in order to do what you want in academics, it is important to have some idea of how you can strike the balance between career, research, etc that will allow you to pay the rent.

I’ll end by saying I don’t think that tailoring your career or career path to one of high academic viability (lots of money) is how anyone should approach it.  I think first and foremost you have to do what you love and what you are passionate about.  But in my opinion, it is important to keep the reality of academics in mind too.  Academics is hardly the ivory tower that people imagine it as.  It should be approached strategically, with all aspects–the good and the bad–in mind, so that you can maximize the odds of being able to do what you love in the academic setting.

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vacation pictures

Well, back to real life.  When I woke up this morning, I was in pain.  And not just because I have a sunburn.  Anyway, below are pictures of the beautiful country I left behind for another year–not to be seen again until after internship.  Also, there’s a gator in one of the pictures, which I only just noticed now.  See if you can find it…

I just noticed that I didn’t get any pictures of the beach.  Maybe because I was too busy getting this nice sunburn.

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only in romania

Just kidding and no offense to my Romanian bretheren. 

I just read an article published in the Dec. 21, 2007 issue of Science Magazine entitled “Cognitive Recovery in Socially Deprived Young Children: The Bucharest Early Intervention Project” which reported the results of a randomized controlled trial looking at the cognitive outcomes of orphan children who were institutionalized versus those who were not.  Wow.  Didn’t know it was ethical to do a randomized controlled trial on that kind of a thing–randomizing orphans to either stay institutionalized or go to a foster family?  Sounds like someone’s IRB dropped the ball on this one…

Anyway, here’s the abstract from the article:

In a randomized controlled trial, we compared abandoned children reared in institutions to abandoned children placed in institutions but then moved to foster care. Young children living in institutions were randomly assigned to continued institutional care or to placement in foster care, and their cognitive development was tracked through 54 months of age. The cognitive outcome of children who remained in the institution was markedly below that of never-institutionalized children and children taken out of the institution and placed into foster care. The improved cognitive outcomes we observed at 42 and 54 months were most marked for the youngest children placed in foster care. These results point to the negative sequelae of early institutionalization, suggest a possible sensitive period in cognitive development, and underscore the advantages of family placements for young abandoned children.

And surprise surprise, the institutionalized orphans did not fare as well.  I guess, as my old friend and mentor who gave this article to me said, you never know the answer until you do the trial.

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status quo, baby. status quo.

Nothing to complain about today.  No outrage.  The soap opera that is living the academic life is on hold while I am on vacation.  I brought a digital camera with me but can’t find the adapter to upload the pics to my laptop, so I guess I’ll have to wait until I get home for some pictures of my last vacation before residency.  I cringe just looking at that last sentence.  Anyway, I just figured out how to use twitpic so you follow me on twitter, I’ll be posting pictures from my phone periodically. 

So that’s that.  Just living the dream for now.  Eating a lot.  A lot of seafood in particular.  Biking a lot.  Actually, I could complain about that.  Sore as heck after a 3 hour bike ride today.  Going to the beach.  Nothing to complain about there…

Anyway, going to have lunch tomorrow with an old friend who is now a professor at the university down here so I’m gonna hit the sack.

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