The first few weeks of fellowship I saw a fair amount of Lyme disease which, being from Texas, was like a cool, exotic infection I'd only previously read about. Neat. The last few weeks of fellowship, however, I've been seeing a lot of chronic Lyme disease which, being a made up condition, has made me accordingly increasingly sad.
There are a lot of unfortunate, difficult to treat diseases that exist in the world: dementia, sciatica, fibromyalgia, the crazies; but for the most part there's little debate whether these are true disorders or not. Whether you believe the primary problem in management is organic or more pyschosocial isn't so important as in either case you can at the very least categorize it, label it, and provide a foundation upon which you can work with your patient. Fibromyalgia, the wackiest of them all, even has research proven therapies which can help, sort of, if anyone would ever cooperate with a physician's recommendations. Chronic lyme disease, on the other hand, is a disease that in all reality doesn't even exist. There is in fact no such thing as chronic Lyme. The patient may as well just tell me a woodland fairy placed a curse on them so I could at the very least reply with, "that's impossible. Woodland fairies don't know any curses. Only marsh fairies cast spells. Jeez." Instead I am left with either "get out of my office," or "interesting, tell me what's been going on."
The clinic appointments for these unfortunate souls inevitably becomes an endless list of various, mostly subjective complaints followed by a review of systems I wish I didn't have to go through. Everyone's abdomen will be tender. Everyone's joints sore. Everyone's blood work and imaging are completely normal. Sometimes they are at the very least a little creative with their complaints -- something I do appreciate -- but even if you can get a patient to admit that a particular symptom is getting better it is often quickly pointed out that it's only because it's about to get much, much worse. "Blue tongue you say? It doesn't look blue now." "Yes well it's not blue today." "So it's getting better?" "No! Why would you say such a thing?!" The worst part inevitably comes at the end when I must decide how I want to tell them they're full of it. Despite various approaches I have yet to find the reply that yields a grateful smile and gratitude for the visit. I am finding it is often enough easiest just to defer the conversation to my staff -- who I have to discuss the case with regardless -- who with his years of experience can tell patients there's nothing we can do for them in a very polite, scholarly, and time efficient manner.
If it weren't for the fact that most these people are otherwise good folks who are eagerly trying to figure out why they feel like crap literally all the time it would just be perversely funny. Because of their various personality disorders and tendency to believe whatever lunatic site they found on the internet over a trained specialist who can explain to them why chronic Lyme is nothing more than heavy metal induced insanity, however, I can often only extend so much sympathy. In the end the best solution may just be to give them what they typically want: an endless supply of medicine. That's why I am actively working on a cure with the Willy Wonka Pharmaceutical Company. We hope to have a twelve month supply of prescription strength Sweet Tarts Lyme Zapper! ready to go by winter. Due to the unforeseen tastiness of the cherry and green apple formulations leading to production shortfalls, however, it'll initially only be available in grape. Thankfully that's the strongest flavor. Unfortunately it's also the most expensive. And the kind that gives them cancer; I read it on the internet.
Sunday, November 13, 2011
Sunday, November 6, 2011
I'll Save You!
About a year ago I partook in the military's Combat Casualty Care Course also known as "C4." A week long academic and field training course designed to prepare us for combat medical care as it is provided in the first and lowest echelons of care from the battlefield itself to the first triage and staging areas such as the Forward Operating Base (FOB). In summary: it was cold. The rest of the details I may or may not eventually get to later, but first a story.
Much of our practical field training consisted of forming up in our platoons (see below) and undergoing marches which would take us into various situations where invariably someone's legs would be blown off. Each platoon was broken down into four security teams (X1-4) which provided security and two litter teams (L1 and L2) which provided the actual medical care, collected blown off limbs, and carried the stretchers. All teams had individual leaders (marked by *.) The entire platoon itself was additionally headed by a platoon leader (P). A march would begin in two columns with two security teams in the back and two in the front, the litter teams dispersed somewhere in the middle. It would inevitably end with the litter teams running about in varying degrees of order or chaos while the security teams provided some degree of perimeter cover -- or, as in this last case, just watched the mayhem with an amused curiosity. The missions always changed in detail, but they always consisted of a march to an objective, an attack by our various training instructors (TIs) on the platoon, and people getting their legs blown off.
Much of our practical field training consisted of forming up in our platoons (see below) and undergoing marches which would take us into various situations where invariably someone's legs would be blown off. Each platoon was broken down into four security teams (X1-4) which provided security and two litter teams (L1 and L2) which provided the actual medical care, collected blown off limbs, and carried the stretchers. All teams had individual leaders (marked by *.) The entire platoon itself was additionally headed by a platoon leader (P). A march would begin in two columns with two security teams in the back and two in the front, the litter teams dispersed somewhere in the middle. It would inevitably end with the litter teams running about in varying degrees of order or chaos while the security teams provided some degree of perimeter cover -- or, as in this last case, just watched the mayhem with an amused curiosity. The missions always changed in detail, but they always consisted of a march to an objective, an attack by our various training instructors (TIs) on the platoon, and people getting their legs blown off.
X1 X1 X1 X1* L1 L1 L1 L1* X2 X2 X2 X2*
P
X3 X3 X3 X3* L2 L2 L2 L2* X4 X4 X4 X4*
Two columns of two security teams and a litter team each form a platoon. Or a bunch of random letters.
P
X3 X3 X3 X3* L2 L2 L2 L2* X4 X4 X4 X4*
Two columns of two security teams and a litter team each form a platoon. Or a bunch of random letters.
After the initial orientation and a few dry runs where we mostly just stared at each other in confusion, the majority of our exercises went off relatively well. The first where I was leader of litter team one was uncomplicated thanks to my impeccable leadership skills and, more likely, simple luck and good fortune. The latter exercises also went off without too many casualties save one surgical intern who had a helmet dropped on her head after stepping on a land mine. The helmet was real, the mine just covered her entire left side in red dust which would never come off. Our second mission, however, was a colossal failure, but for those who were there watching it all unfold as part of the perimeter security teams -- of which I was one of them -- it was like staring at a slow moving, never ending train wreck of comedic folly.
The mission as described was to find a downed C130, locate casualties, secure the scene, and evacuate the wounded. Pretty straightforward it sounds, but not so much in action. At least for us. After a short march we reached our designated stop point where our reconnaissance team was sent to evaluate the scene. After returning with the information of what they saw the team leaders and platoon leader collectively deliberated for a number of minutes before coming up with the simple plan of sending the two front security teams to secure the perimeter alone while everyone else just sat back and waited. That was it. No more plan than that. Not surprisingly it all started to fall apart when 5-10 minutes later we began to hear gunfire and explosions about a half mile down the trail where our forward security teams had so nobly previously wandered off to.
Not having any contingency plan for what to do in case of explosion we briefly fell back to the tried and true action of staring at each other in confusion for a few seconds before we all made the collective decision to simply get up and run as fast as we could towards the scene of the action. So off we ran, all sixteen of us in two rear security teams and two litter teams and all in various states of disarray, not entirely sure where exactly we were going or what we were to do when we got there.
We arrived to find a half erected security perimeter set up around a lightly smoking C130 and a few ramshackle cement houses all surrounded by the scrubby trees and dust which make up the majority of south Texas. Carrying only our plastic rifles, canteens, and the same Kevlar helmets and flack jackets that everyone else had, my rear security team passed by the column's litter team in an attempt to complete the half ass parameter that was already in place before they got there. This placed me immediately adjacent to the C130 and privy to all the action which was about to unfold.
The litter teams arrived shortly after we did to what was still a relatively unexciting scene of smoke, sound effects, and people lying around with rifles staring off into the trees pretending to provide cover. One litter team diverted off into a gully on the left to assist some wounded there while my column's litter team headed directly to the right to the downed C130 where, presumably, the bulk of the wounded would be waiting. This latter team, litter team 1, was composed of a motley crew of four: one young, fit, and tall male Army nurse; one young, fit, and tiny female Navy nurse; one older, overweight, and enthusiastic Army physician assistant (PA); and one very old, very huge, and very Colombian Army nurse. Together they approached the smoking aircraft in a disorganized run, but whereas most the team slowed on approach, the PA ran full steam ahead into the back of the craft GI Joe style yelling a heroic, "I'll save you!" This was followed by a loud bang from deep inside the dark aircraft and all went silent.
"I've been shot!"
"Who is it? Where are you?"
"It's me! I've been shot in the chest!"
"How do we know it's you? .... Who won the 2007 Super Bowl?"
"How the fuck would I know! Come get me out of here!"
So went the back and forth between the faceless voice in the front of the blackened plane and the skeptical litter team waiting reluctantly outside the ramp doors of the back of the craft. Finally, either sufficiently persuaded or for lack of anything they could think of better to do, they decided to go in after him.
*BOOM!*
Immediately after their collective decision to enter the C130 the two hundred pound Colombian Army nurse stepped on a land mind placed right outside the plane and was out of action. Within just a few minutes litter team one was down from four medics to two.
"Ahhh! My leg! I lost my leg!" screamed the Colombian clearly enjoying the opportunity to pretend to be wounded as he rolled around the loading ramp of the airplane. His comrades attended to him and began applying tourniquets as taught while he continued to thrash about as imaginary blood loss led to imaginary hysteria. Their task was not made any easier by an impressive size differential as the remaining medics had over a one foot and hundred pound size differential between them. The platoon leader who had been supervising attempted to instruct them towards cover while simultaneously seeking assistance from litter team two who had just recently secured their wounded in the gully. He had mixed results.
Treated but still lying exposed outside the airplane, the bulging Colombian Army nurse was left to wait while the two man litter team one went back into the smoking darkness to retrieve the rest of the injured. The explosions around the landing zone had mostly tapered off by this point, but the sporadic gunfire and incessant yelling from the TIs who offered mostly unproductive or entirely terrible advice continued. The platoon leader continued to shout instructions most of which were either unheard or unheaded. Around this time litter team two came to assist. Not sure of what was going on exactly and hesistant to act they loitered outside the plane.
*Crack!* *Crack!* *Crack!*
Fed up with the chaos and clear lack of command and control, the TIs decided to add to the situation by having one of the newly arrived litter team's legs shot out. Counting the PA still in the front of the plane, the Army nurse bandaged and bleeding outside the plane, and three more disfigured mannequins in the plane itself there were now more wounded than medics. What order there had been completely fell apart as the medics attempted to carry, drag, and pull whatever wounded they could to any semblance of cover available. This was made all the more difficult by the fact that the inside of the cargo jet had been heavily coated with fake blood for the fake bodies. When the medics emerged they would as often as not be covered in as much or more blood than the mannequins themselves, and frequent stops were necessary to reposition and regrip the slippery wounded. The inability to effectively move the heavily lubricated mannequins eventually earned them the term of endearment, "greasy Ken dolls." One more land mine went off, and the mission was over.
The post-mission debriefing was an unhappy and frustrated attempt to explain what exactly went wrong -- essentially everything it turned out -- and what could have been done better -- maybe not step on so many land mines? It was an excellent example of how not to execute a rescue mission which was not too much of a surprise considering none of us had ever done anything at all like it before. I'm not entirely sure if I was supposed to leave my post on security to assist with the moving of bodies, but it likely would have just led to my legs getting blown off. In either case it was an amusing story since in the end we all kept all of our limbs. "I'll save you!" became the catch phrase for our platoon and the battle cry for all further field training during the course.Thankfully no further mannequins had to lose their lives in rest of training.
The mission as described was to find a downed C130, locate casualties, secure the scene, and evacuate the wounded. Pretty straightforward it sounds, but not so much in action. At least for us. After a short march we reached our designated stop point where our reconnaissance team was sent to evaluate the scene. After returning with the information of what they saw the team leaders and platoon leader collectively deliberated for a number of minutes before coming up with the simple plan of sending the two front security teams to secure the perimeter alone while everyone else just sat back and waited. That was it. No more plan than that. Not surprisingly it all started to fall apart when 5-10 minutes later we began to hear gunfire and explosions about a half mile down the trail where our forward security teams had so nobly previously wandered off to.
Not having any contingency plan for what to do in case of explosion we briefly fell back to the tried and true action of staring at each other in confusion for a few seconds before we all made the collective decision to simply get up and run as fast as we could towards the scene of the action. So off we ran, all sixteen of us in two rear security teams and two litter teams and all in various states of disarray, not entirely sure where exactly we were going or what we were to do when we got there.
We arrived to find a half erected security perimeter set up around a lightly smoking C130 and a few ramshackle cement houses all surrounded by the scrubby trees and dust which make up the majority of south Texas. Carrying only our plastic rifles, canteens, and the same Kevlar helmets and flack jackets that everyone else had, my rear security team passed by the column's litter team in an attempt to complete the half ass parameter that was already in place before they got there. This placed me immediately adjacent to the C130 and privy to all the action which was about to unfold.
The litter teams arrived shortly after we did to what was still a relatively unexciting scene of smoke, sound effects, and people lying around with rifles staring off into the trees pretending to provide cover. One litter team diverted off into a gully on the left to assist some wounded there while my column's litter team headed directly to the right to the downed C130 where, presumably, the bulk of the wounded would be waiting. This latter team, litter team 1, was composed of a motley crew of four: one young, fit, and tall male Army nurse; one young, fit, and tiny female Navy nurse; one older, overweight, and enthusiastic Army physician assistant (PA); and one very old, very huge, and very Colombian Army nurse. Together they approached the smoking aircraft in a disorganized run, but whereas most the team slowed on approach, the PA ran full steam ahead into the back of the craft GI Joe style yelling a heroic, "I'll save you!" This was followed by a loud bang from deep inside the dark aircraft and all went silent.
"I've been shot!"
"Who is it? Where are you?"
"It's me! I've been shot in the chest!"
"How do we know it's you? .... Who won the 2007 Super Bowl?"
"How the fuck would I know! Come get me out of here!"
So went the back and forth between the faceless voice in the front of the blackened plane and the skeptical litter team waiting reluctantly outside the ramp doors of the back of the craft. Finally, either sufficiently persuaded or for lack of anything they could think of better to do, they decided to go in after him.
*BOOM!*
Immediately after their collective decision to enter the C130 the two hundred pound Colombian Army nurse stepped on a land mind placed right outside the plane and was out of action. Within just a few minutes litter team one was down from four medics to two.
"Ahhh! My leg! I lost my leg!" screamed the Colombian clearly enjoying the opportunity to pretend to be wounded as he rolled around the loading ramp of the airplane. His comrades attended to him and began applying tourniquets as taught while he continued to thrash about as imaginary blood loss led to imaginary hysteria. Their task was not made any easier by an impressive size differential as the remaining medics had over a one foot and hundred pound size differential between them. The platoon leader who had been supervising attempted to instruct them towards cover while simultaneously seeking assistance from litter team two who had just recently secured their wounded in the gully. He had mixed results.
Treated but still lying exposed outside the airplane, the bulging Colombian Army nurse was left to wait while the two man litter team one went back into the smoking darkness to retrieve the rest of the injured. The explosions around the landing zone had mostly tapered off by this point, but the sporadic gunfire and incessant yelling from the TIs who offered mostly unproductive or entirely terrible advice continued. The platoon leader continued to shout instructions most of which were either unheard or unheaded. Around this time litter team two came to assist. Not sure of what was going on exactly and hesistant to act they loitered outside the plane.
*Crack!* *Crack!* *Crack!*
Fed up with the chaos and clear lack of command and control, the TIs decided to add to the situation by having one of the newly arrived litter team's legs shot out. Counting the PA still in the front of the plane, the Army nurse bandaged and bleeding outside the plane, and three more disfigured mannequins in the plane itself there were now more wounded than medics. What order there had been completely fell apart as the medics attempted to carry, drag, and pull whatever wounded they could to any semblance of cover available. This was made all the more difficult by the fact that the inside of the cargo jet had been heavily coated with fake blood for the fake bodies. When the medics emerged they would as often as not be covered in as much or more blood than the mannequins themselves, and frequent stops were necessary to reposition and regrip the slippery wounded. The inability to effectively move the heavily lubricated mannequins eventually earned them the term of endearment, "greasy Ken dolls." One more land mine went off, and the mission was over.
The post-mission debriefing was an unhappy and frustrated attempt to explain what exactly went wrong -- essentially everything it turned out -- and what could have been done better -- maybe not step on so many land mines? It was an excellent example of how not to execute a rescue mission which was not too much of a surprise considering none of us had ever done anything at all like it before. I'm not entirely sure if I was supposed to leave my post on security to assist with the moving of bodies, but it likely would have just led to my legs getting blown off. In either case it was an amusing story since in the end we all kept all of our limbs. "I'll save you!" became the catch phrase for our platoon and the battle cry for all further field training during the course.Thankfully no further mannequins had to lose their lives in rest of training.
Saturday, November 5, 2011
Uhoh!
Two weeks ago my parents came for a visit. Just a few days ago they left. I'm still finding random objects left behind. Whether to call them gifts or not varies depending on the object. Today's gift: two umbrellas in my closet! Awesome, I've been needing an umbrella for oh... about four months now? The black and white checkered dress shirt distinctly suggestive of a picnic table cloth on the other hand I thought I had disposed of before they left.
Their visit though somewhat lengthy by the standard of most visits to small town, middle of nowhere, went surprisingly well. There was the requisite major family argument about whether or not the October Nor'easter was going to end life as we knew it on the Eastern seaboard or not, but that aside it was a remarkably pleasant two weeks. Much of it was spent watching a great if not eventually disappointing World Series or making trips back and forth from Price Chopper with various things to stick in my fridge. Such as a six pack of Romaine lettuce heads which I will hold onto until the gigantic-salad-composed-of-nothing-but-lettuce craving kicks in. And when it does I will have two different flavors of salad dressing to chose from. Or A1 steak sauce. Or Worcestershire sauce.Or an industrial sized bottle of ketchup.
The rest of the trip was divided amongst road trips to Woodstock, VT; Burlington, VT; and Seacoast, NH. The only one of these worthy of note was the last as it was both scenic and complete with a trip to Markey's Lobster Pound where my parents reminisced about their prior visit some twenty years before by eating the largest lobsters they could find. My dad even somehow managed to come away with some vintage postcards from the time of their visit and a coastal New England restaurant guide all complements of Mr Markey who they chatted up as they are want to do. Woodstock and Burlington on the other hand, are worthy places to visit only if you have no other places worthy to visit.
Other highlights of the trip include my mom cleaning my apartment to a level of cleanliness it will likely never see again; my dad bumping, kicking, and karate chopping my coffee table sufficiently till one of the wooden rails broke off; and an early Christmas present consisting of a huge, new, flat screen television complete with swanky new stand which I am still not entirely sure what to make of. I think overall they had a pretty good time; I know for the most part I did. And I hope to eventually one day stop finding new bath towels in my cupboards, closets, and washing machine. Until then I gotta find a way to dispose of a dozen bagels and a half dozen apples before they go bad. Someone may be getting a pretty unique gift basket in the next few days here.
Their visit though somewhat lengthy by the standard of most visits to small town, middle of nowhere, went surprisingly well. There was the requisite major family argument about whether or not the October Nor'easter was going to end life as we knew it on the Eastern seaboard or not, but that aside it was a remarkably pleasant two weeks. Much of it was spent watching a great if not eventually disappointing World Series or making trips back and forth from Price Chopper with various things to stick in my fridge. Such as a six pack of Romaine lettuce heads which I will hold onto until the gigantic-salad-composed-of-nothing-but-lettuce craving kicks in. And when it does I will have two different flavors of salad dressing to chose from. Or A1 steak sauce. Or Worcestershire sauce.Or an industrial sized bottle of ketchup.
The rest of the trip was divided amongst road trips to Woodstock, VT; Burlington, VT; and Seacoast, NH. The only one of these worthy of note was the last as it was both scenic and complete with a trip to Markey's Lobster Pound where my parents reminisced about their prior visit some twenty years before by eating the largest lobsters they could find. My dad even somehow managed to come away with some vintage postcards from the time of their visit and a coastal New England restaurant guide all complements of Mr Markey who they chatted up as they are want to do. Woodstock and Burlington on the other hand, are worthy places to visit only if you have no other places worthy to visit.
Other highlights of the trip include my mom cleaning my apartment to a level of cleanliness it will likely never see again; my dad bumping, kicking, and karate chopping my coffee table sufficiently till one of the wooden rails broke off; and an early Christmas present consisting of a huge, new, flat screen television complete with swanky new stand which I am still not entirely sure what to make of. I think overall they had a pretty good time; I know for the most part I did. And I hope to eventually one day stop finding new bath towels in my cupboards, closets, and washing machine. Until then I gotta find a way to dispose of a dozen bagels and a half dozen apples before they go bad. Someone may be getting a pretty unique gift basket in the next few days here.
Monday, October 31, 2011
Everyday is Beautiful
Just about every day in New Hampshire is beautiful. Surprisingly, physically beautiful. Rarely does a day go by that I am not in some small way amazed by the natural appeal of the state. For the first couple of months I felt like I was at summer camp minus the frito pie. Now that the snow has come it's starting to feel more like the Mongolian Steppe, but I hear the Mongolian Steppe is lovely this time of year. In either case I still take great joy in daily looking at the San Antonio weather forecast, and smiling that it ain't super sweaty outside.
Here are some pictures of some colorful trees.
Here are some pictures of some colorful trees.
Monday, October 24, 2011
A Few Random Photos
A random assortment of pictures.
This is my apartment. As you can see it looks like every other apartment that has ever been mass produced in the standardized manner. You can tell my generic apartment apart from the others because it of all the dirt outside and the paneling which is a creamy beige, not the usual creamy toap. If you are wondering what the inside looks like, just think of your standard apartment and then put my stuff in it. It's really pretty boring.
A storm is a brewing! Long before Irene there were regular rain storms. They sometimes looked like this.
Here's the road and bike path leading up to the hospital which is, as so many things are up here, obscured by trees. Although I do not take this road to the hospital myself, it is the best looking of all commuting road options. Plus one day while biking it I saw a woodchuck running along the path. A gigantic woodchuck.
This is my apartment. As you can see it looks like every other apartment that has ever been mass produced in the standardized manner. You can tell my generic apartment apart from the others because it of all the dirt outside and the paneling which is a creamy beige, not the usual creamy toap. If you are wondering what the inside looks like, just think of your standard apartment and then put my stuff in it. It's really pretty boring.
A storm is a brewing! Long before Irene there were regular rain storms. They sometimes looked like this.
Here's the road and bike path leading up to the hospital which is, as so many things are up here, obscured by trees. Although I do not take this road to the hospital myself, it is the best looking of all commuting road options. Plus one day while biking it I saw a woodchuck running along the path. A gigantic woodchuck.
This is where I imagine the giant woodchuck lived. On a giant rock in one of the scenic clearings you can find mountain biking the wilderness.
This is just a picture of Megan running with sparklers on the Fourth of July. What could be better than two sparklers at once? Truly she is a lucky girl.
The road to my apartment. Old, cracked, and a major black bear thoroughfare.
The parking lot outside my apartment. Usually there're a lot more turkeys.
Here's comes the wintertime! And a frozen solid automobile.
And in conclusion here's a link!
When Casual Goes Amok
Boots and brown uniform or shiny shoes and blue uniform. Simple. Back when I was an Air Force resident I never had to decide what to wear, just had to make sure it was clean to wear it. Considering dress clothes are little more than expensive, uncomfortable ways of letting other people know how much money you make, I did not mind this situation. Now, however, I am a civilian and being a civilian physician I am also a professional. Time to don a wider variety of shiny shoes and an endless combination of pressed shirts, ironed slacks, and variably colored ties in order to instill confidence in my patients and trust in my medical decision making. A few hundred dollars later, I do not care for it.
Thankfully due to the inherent infection risks involved with ties doubling as improvised germ swabs, ties are optional and I have opted out. My wardrobe is thus about as comfortable as the uniforms I used to wear. The thought of paying $2 a shirt for a wash and ironing to maintain this wardrobe remains ridiculous to me, but I have accepted this reality and in reality it is better than the equally ridiculous alternative of wasting time doing it myself. The problem lies not directly in the wearing and caring for the clothes themselves, but in deciding which clothes to wear.
Being an infectious disease fellow I am compelled to do other things than just take care of patients and trend their blood sugars. I've got to research in order to maintain my infectious disease street cred. Traditionally this involves absolutely no patient contact, and considering our fellows' office is windowless it currently doesn't even involve human contact. I just sit in my room, in front of my computer, and make research magic. Occasionally if I'm feeling adventurous, or losing my mind from sitting all day in a windowless room, I will take my computer to a study area on the eight floor, but even there I don't interact with any human beings in any official capacity. One would think, therefore, that I could perhaps dress casually for such a job. Maybe try to make myself comfortable for something that is inherently tedious and uncomfortable. And one would be wrong.
Not entirely sure what the reaction would be I tried to slowly ease into a more casual form of dress. First I ditched the pressed shirts for generic collared shirts. Then the slacks for run-of-the-mill khakis. And, finally, khakis for jeans and tennis shoes. That's apparently when I got greedy. Based on the numbered of bewildered responses and frequency of exasperated double takes I had gone too far. Research casual, it turns out, ends somewhere between a casual pair of Dockers and a dress shirt with its sleeves torn off. Maybe corduroy pants and a bolo tie would be ok, I don't know. In either case after about the seventh startled, "oh, jeans!" I decided to return to the khakis and collared shirt look just to stay in good standing. Perhaps when I get enough publications under my name I can dust off the ball cap and sport coat look. Just in case I'm feeling a little douchey.
Thankfully due to the inherent infection risks involved with ties doubling as improvised germ swabs, ties are optional and I have opted out. My wardrobe is thus about as comfortable as the uniforms I used to wear. The thought of paying $2 a shirt for a wash and ironing to maintain this wardrobe remains ridiculous to me, but I have accepted this reality and in reality it is better than the equally ridiculous alternative of wasting time doing it myself. The problem lies not directly in the wearing and caring for the clothes themselves, but in deciding which clothes to wear.
Being an infectious disease fellow I am compelled to do other things than just take care of patients and trend their blood sugars. I've got to research in order to maintain my infectious disease street cred. Traditionally this involves absolutely no patient contact, and considering our fellows' office is windowless it currently doesn't even involve human contact. I just sit in my room, in front of my computer, and make research magic. Occasionally if I'm feeling adventurous, or losing my mind from sitting all day in a windowless room, I will take my computer to a study area on the eight floor, but even there I don't interact with any human beings in any official capacity. One would think, therefore, that I could perhaps dress casually for such a job. Maybe try to make myself comfortable for something that is inherently tedious and uncomfortable. And one would be wrong.
Not entirely sure what the reaction would be I tried to slowly ease into a more casual form of dress. First I ditched the pressed shirts for generic collared shirts. Then the slacks for run-of-the-mill khakis. And, finally, khakis for jeans and tennis shoes. That's apparently when I got greedy. Based on the numbered of bewildered responses and frequency of exasperated double takes I had gone too far. Research casual, it turns out, ends somewhere between a casual pair of Dockers and a dress shirt with its sleeves torn off. Maybe corduroy pants and a bolo tie would be ok, I don't know. In either case after about the seventh startled, "oh, jeans!" I decided to return to the khakis and collared shirt look just to stay in good standing. Perhaps when I get enough publications under my name I can dust off the ball cap and sport coat look. Just in case I'm feeling a little douchey.
Thursday, October 13, 2011
The Amazing Race for the Amazing Race
This week the Amazing Race started, one of the few television programs I've ever cared to remember to watch. Although never truly as good as the one, single season of Amazing Race: Family Edition, the Amazing Race: Vanilla is still a pretty good time. Especially if you enjoy strangers yelling at each other in taxi cabs. This series' first episode was relatively unremarkable, but I imagine it achieved what it meant to -- that being to identify the snowboarding dudes as dudes, the cocktail waitresses as bimbos, the grandparents as slightly senile grandparents, the Survivor couple as scheming soon to be scoundrels, the male flight attendants as the token gay couple, and the twins, apparently, as not having memories that can last longer than thirty seconds. I imagine the climax of the season will be when either of the brother-sister duo runs the other over in their brand new, special edition 2012 Ford Focus.
The episode reminded me, however, of a friend and I's amazing race last spring in an attempt to have the most amazing movie marathon ever: an Amazing Race amazing movie marathon. What could be better than spending a whole day watching a whole season of Amazing Race? The answer is a whole lot of things, but in San Antonio not much. Being the master planner of this party I was assigned the task of obtaining the videos, and so I devised a plan.
Plan A: Go to Blockbuster and rent it.
Genius in its simplicity. Unfortunately no Blockbuster admitted on their website to owning any Amazing Race DVDs in the entire San Antonio area, and sure enough none of them actually owned them when I visited their stores and demand they show me where they kept them. Blockbuster does own a surprisingly large number of Firefly copies, however, which is why I imagine they went into bankruptcy.
Plan B: Go to another movie rental chain and rent it.
Very similar to Plan A, Plan B was different in that it involved going to other movie rental chains. Not surprisingly it too failed. People do not want to watch Amazing Race in South Texas. Not when there's sweet Tejano music weekly at El Mercado at least! Seriously, what can compete with an accordion?
Plan C: Go to any other store I can think of and buy it.
This plan was admittedly devised on the fly while driving about in my fruitless pursuits of Plans A and B. I visited two separate Best Buys, a Walmart, a Target, and even a used booked store which for whatever reason also sold movies. The end result was no Amazing Race, but a decent book on the Soviet Union's war in Afghanistan and, somehow, a 2000 piece puzzle of a castle in Germany.
Plan D: Use NetFlix to rent the series.
Brilliant idea in that NetFlix has multiple seasons of Amazing Race for rental. Terrible idea in that you can only rent one of 3 or 4 DVDs in a season at a time. Not ideal for a one day marathon. Aborted.
Plan E: Use NetFlix streaming video via Laura's giant television.
Laura has a gigantic television. Its size is measured in yards and the weight of it has ruined the foundation on that side of her house. Assuredly inside of all that plastic and hardware there would be a means of connecting directly to the Internet. There was not.
Plan F: Use NetFlix streaming video via Paul and Rachel's Nintendo Wii.
Easy to obtain. Easy to hook up. Already wasted a whole heck of a lot of time previously setting up a NetFlix account for Plans D and E. It seemed pretty flawless to me. It was at this time that we noticed NetFlix does not stream any of the Amazing Race series over its streaming video.
Plan G: Screw it. Let's watch The Pacific instead.
Around back up plans five or six is generally when I consider giving up, and so way gave up after Plan F. Clearly someone, divine or otherwise, did not want us to have an Amazing Race marathon. It likely would have been too amazing. There probably wouldn't have been anywhere to go after that and the rest of our lives would have been lived in listless boredom and indifference knowing our best day was already in our past. In either case we watched The Pacific instead and it was confusing. Too many guys with dark brown hair and average height. Thankfully most of the difficult to tell apart characters got killed off early in the series so by the end I had some idea what was going on. It turns out the war with Japan was rather wet. Or at least that's what I believe the take home message was.
Our amazing race ended in failure, but in the process I learned a lot about Laura and together we learned a lot about ourselves. We didn't win the grand prize, but what we lost we more than made up for in friendship. I wouldn't have run the race with anyone else. Mostly because no one else has a love for the show and a gigantic TV. But also because of the friendship. It is its own reward, especially when you don't have a real reward. Or a television movie marathon to watch.
The episode reminded me, however, of a friend and I's amazing race last spring in an attempt to have the most amazing movie marathon ever: an Amazing Race amazing movie marathon. What could be better than spending a whole day watching a whole season of Amazing Race? The answer is a whole lot of things, but in San Antonio not much. Being the master planner of this party I was assigned the task of obtaining the videos, and so I devised a plan.
Plan A: Go to Blockbuster and rent it.
Genius in its simplicity. Unfortunately no Blockbuster admitted on their website to owning any Amazing Race DVDs in the entire San Antonio area, and sure enough none of them actually owned them when I visited their stores and demand they show me where they kept them. Blockbuster does own a surprisingly large number of Firefly copies, however, which is why I imagine they went into bankruptcy.
Plan B: Go to another movie rental chain and rent it.
Very similar to Plan A, Plan B was different in that it involved going to other movie rental chains. Not surprisingly it too failed. People do not want to watch Amazing Race in South Texas. Not when there's sweet Tejano music weekly at El Mercado at least! Seriously, what can compete with an accordion?
Plan C: Go to any other store I can think of and buy it.
This plan was admittedly devised on the fly while driving about in my fruitless pursuits of Plans A and B. I visited two separate Best Buys, a Walmart, a Target, and even a used booked store which for whatever reason also sold movies. The end result was no Amazing Race, but a decent book on the Soviet Union's war in Afghanistan and, somehow, a 2000 piece puzzle of a castle in Germany.
Plan D: Use NetFlix to rent the series.
Brilliant idea in that NetFlix has multiple seasons of Amazing Race for rental. Terrible idea in that you can only rent one of 3 or 4 DVDs in a season at a time. Not ideal for a one day marathon. Aborted.
Plan E: Use NetFlix streaming video via Laura's giant television.
Laura has a gigantic television. Its size is measured in yards and the weight of it has ruined the foundation on that side of her house. Assuredly inside of all that plastic and hardware there would be a means of connecting directly to the Internet. There was not.
Plan F: Use NetFlix streaming video via Paul and Rachel's Nintendo Wii.
Easy to obtain. Easy to hook up. Already wasted a whole heck of a lot of time previously setting up a NetFlix account for Plans D and E. It seemed pretty flawless to me. It was at this time that we noticed NetFlix does not stream any of the Amazing Race series over its streaming video.
Plan G: Screw it. Let's watch The Pacific instead.
Around back up plans five or six is generally when I consider giving up, and so way gave up after Plan F. Clearly someone, divine or otherwise, did not want us to have an Amazing Race marathon. It likely would have been too amazing. There probably wouldn't have been anywhere to go after that and the rest of our lives would have been lived in listless boredom and indifference knowing our best day was already in our past. In either case we watched The Pacific instead and it was confusing. Too many guys with dark brown hair and average height. Thankfully most of the difficult to tell apart characters got killed off early in the series so by the end I had some idea what was going on. It turns out the war with Japan was rather wet. Or at least that's what I believe the take home message was.
Our amazing race ended in failure, but in the process I learned a lot about Laura and together we learned a lot about ourselves. We didn't win the grand prize, but what we lost we more than made up for in friendship. I wouldn't have run the race with anyone else. Mostly because no one else has a love for the show and a gigantic TV. But also because of the friendship. It is its own reward, especially when you don't have a real reward. Or a television movie marathon to watch.
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