To Whom it May Concern

Ever since the dawn of time mankind has wondered, "Just how many calories am I burning?" While the first cavemen often decided this debate with blunt objects, modern man has turned to Science. Yes, Science!, the answer to all of man's problems not relational, emotional, or spiritual can show us the way! And with regards to this timeless question we can turn to "How Many Calories Are You Really Burning?" by Amby Burfoot in Runner's World magazine.

Through undoubtedly impeccable research Miss Bigfoot has determined that there are three main determining factors governing how many calories you burn from all that knee bent running about. And they are:

Weight: It's quite simple. The more you weigh the more you gotta carry from point A to point B and the more work you do. The more work you do the more energy you expend. Ta da!

Distance: Surprise, surprise, work and caloric expenditure are also dependent on the distance you travel. Amazing!

Means of Travel: Despite claims by some less informed there actually are significant differences in energy demands between walking and running. At low speeds running burns more calories per a mile as the body's motion and center of gravity changes to a larger degree than through a controlled, well mannered walk. All that hopping means that though you've travelled the same distance in space over land your body as a whole has moved through more space in getting there. At higher speeds, on the other hand, say of > 4 or 5 mph, things change. Your running pattern does not change significantly (though to be exact there are mild differences that can be appreciated), but your walking style becomes much more forced and unnatural requiring the use of considerably more energy. As such, a fast walk burns more calories per a mile than an equally paced run. Surprising? I guess!

All that breath-taking revelation aside, the important part is the numbers. According to a 2004 report by group of researchers at the University of Syracuse the following calculations apply:

Running - Total calories burned/mile = .75 * wt in lbs

Walking - Total calories burned/mile = .53 * wt in lbs

So in conclusion let me make this simple calculation.

A 170 lb man treks 5 miles in snowshoes. Assuming a brisk hike in snowshoes to be equatable to an otherwise normal run, he burns 637.5 calories. Booyah.

Reading Refinement: The Rest

In the spirit of getting this over with I will quickly summarize the remaining webcomics linked.

Dresden Codak: Greatly drawn, interesting, educational, funny, and rarely updated. Sometimes it's also hard to tell what exactly is going on, but, by the standards of the rest of the web it's pretty good. Brief plot summary is the main character, Kimiko, is some sort of introverted yet remarkably curved super genius who, with two friends who seem to have powers from who knows where, have stumbled upon time travelers from the future. That's really it so far. Not much else has happened. It's been kind of slow. So....

Pictures For Sad Children: Initially it seemed to be good, simple, and humorous; then as multiple story lines developed I began to have my reservations, and now finally it has become so confusing that I cannot honestly say what's what. Thankfully most the storylines don't seem to repeat so my inability to explain much of it can be overlooked, but the one plot that does seem to repeat is that the main character, Paul, is recently deceased and has since become a ghost only to wander about his life much as he did before. Like most the mediocre comics I've described so far it does have its moments and up until recently it uploaded daily. Now it's just Mon-Wed-Fri. Apparently it's hard work drawing stick figure based stories incomprehensibly.

Rob and Elliot: A blond-haired guy, Rob, and a brown-haired guy, Elliot, live in an apartment together and wacky hijinks ensue. That's really all you need to know.

Questionable Content: In many ways your stereotypical webcomic as described previously, but done surprisingly well. The story has become rather intricate with time, and so while you may be able to appreciate the joke in a random comic you most likely won't have any idea what's going on. In as short a synopsis as possible the main character, Marten, is an awkward wannabe Indie rocker. He is dating a nondescript girl named Dora who owns a coffee shop where Raven, a flighty girl of mostly little significance to the story, and Faye work. Marten initially wanted some Faye lovin' but Faye has issues related to her father committing suicide when she was a child. And wacky hijinks ensue. There's also an OCD neighbor named Hannelore who seems to be becoming a bigger character, and a couple what seem to be talking iPods to serve as the comic's talking animals, but I think I've said enough.

That's it. Makes you want to read them right? Nah, me neither.

The Story of a Pizza

Christmas is the season of giving. And the season of moralizing. In the spirit of one or the other I offer up this short tale.

I like myself some pizza. In fact I on average like myself some pizza about two times a week. It would seem that I also like regularity as I tend to alternate between two different pizza topping combos from the same Papa Johns every time I purchase (neither of which involves pineapple). Sometimes, though, things fall apart and the pizza people screw up my order -- but I don't mind because that usually means I get things for free. Just a week or two ago such an event took place and I arrived to find that they had for me a medium ham and green pepper instead of a medium pepperoni and green pepper. The obvious solution? Make a large pepperoni and green pepper and give them both to me for free. Yeah, it didn't make sense to me either, but who am I to repudiate their generosity?

The problem with sixteen slices of pizza was, however, that a typical medium two topping pizza lasts me two days, and although I do like pizza I don't like it for four or five days in a row. So my next task was to desperately try to find anyone I knew who was in town and happened to want a free medium ham and pepper pizza. It turned out that was absolutely no one. The few people I managed to contact quickly lost interest once ham was mentioned, but most people I didn't even get a hold of. So, worrying that I'd be forced to either throw the pizza away or eat it for five days in a row to avoid being especially wasteful, I turned to my neighbors. Thankfully for everyone involved I discovered my neighbors are not particularly picky people. Not only was a ham and green peppers pizza acceptable to them, but judging by their reactions no single act of kindness has ever compared with such a gift. Even a few days later they thanked me again for my charity. I'm pretty sure there's even now a framed picture of me hanging in their foyer. And it all didn't cost me a dime.

Which brings me to the moral of my story. Ask not what your country can do for you -- ask what you can do for your country. Okay so I plagiarized a bit and my plagiarism doesn't necessarily make much sense, but, truthfully, that's the point. My lovely neighbors -- despite my informing them otherwise -- thought I was sharing greatly out of the pure kindness of my heart. I was simply trying to get rid of stuff I felt too guilty to throw away. The pizza guys probably gave me my pizzas for free because it cost them nothing and doing so prevented complaints. I like to think they just appreciated my business. Our perceptions are inaccurate and so our perspectives become misguided. Keeping a ledger of all the rights and wrongs that we perceive are done to us then does not lead to an economical assessment of relationships but only to an excessive attention to self and a blindness to all the blessings already bestowed. As whether others are being selfless or selfish we will probably most of the time never know, it's frequently a whole lot easier and likely happier to not even worry about it. Free, mysterious pizza from family or friends is usually best enjoyed with just a little gratitude.

The end.

And now for a picture of Matt Bonner.



Ho! Ho! Ho! Merry Christmas!

Reading Refinement: Sluggy Freelance & Shortpacked

My two favorite webcomics are Dr. McNinja and Dinosaur Comics. The two that I sometimes question why I still read are Sluggy Freelance and Shortpacked. They used to be good at one time. I think.

Sluggy Freelance is interesting simply because it has been around for more than a decade now. It's really quite ridiculous. Despite this almost all the same characters remain, and almost completely unchanged. Even when they die they are usually somehow not really dead or in some convoluted fashion later reborn. So much so that much of the drama that the author tries to create -- as Sluggy's storylines are as detailed -- and unintelligible -- as you'll get in the webcomic world -- usually falls flat. Back before everything became one big muddled plot involving demons and aliens and evil corporations and talking animals and inept government and alternate dimensions and -- well that should suffice -- the jokes tended to be simple and amusing. Now they're mostly puns. Nevertheless, despite how dreadful the comic can at times now be the stories do have enough pull and an occasional joke is good enough to keep me coming back. That and the fact that this is one of the few webcomics that updates daily. Well actually I guess it doesn't even do that now anymore.... Hmm....

Shortpacked is the That 70's Show of the webcomic world in a "It's not terribly funny and most the characters annoy me, but sometimes it's on when nothing else is, and, seeing as I don't have anything else to do, I guess I'll watch it" sort of way. The plot and characters are pretty straightforward. Ethan, the main character, is a gay toy collector working at a toy shop. His coworkers who's names I generally cannot recall vary from a plain girl with father issues, a neurotic girl for whatever reason madly in love with Ethan, another dude who seems to do nothing but verbally and physically abuse people, and so on and so forth. The most recent addition is an asinine talking car whose only purpose seems to be to fulfill the talking animal requirement common to all webcomics. Much like Sluggy Freelance the jokes and story lines are ok but it updates regularly so, well, I don't have anything else to do; I guess I'll keep reading it.

Reading Refinement: Dr. McNinja & Dinosaur Comics

Alright. For those further wanting to indulge me on webcomics -- and I really wish you would -- a few brief comments and background on each respective one.

Dr. McNinja is, overall, easily the best of the webcomics that I have encountered. Unusual in that the illustrations are great, the stories are entertaining and the jokes generally pretty funny and original. Dr. McNinja himself comes from a family of ninja and so has natural ninja abilities even though he has chosen the life of a physician. His enemies vary from Ronald McDonald to other ninja to Mexicans on velociraptors to zombies, and he has two main companions: Gordito (a mustached young boy with two revolvers) and Benjamin Franklin (cloned or reborn or undead it's hard to say.) He also has a gorilla receptionist at the clinic.

Dinosaur Comics is my second favorite webcomic and involves absolutely no illustration whatsoever. The guy just reposts the same clip art in the same sequence every comic. What makes him a winner -- and he is a winner -- are the jokes. The comedy is, to me at least, sophisticated and yet surprisingly educational at the same time. Moreover as the dinosaurs and some of the off screen cast (a raccoon and a cephalopod) develop character the jokes get even better. There usually aren't much in the way of stories lines -- so you can usually pick any comic at random at fully enjoy it -- but despite this quite a back story seems to have built up over time. It has seemed recently that he's been resorting less to actual crafted jokes and more on absurd comments from the T-Rex or the inclusion of random one time characters off screen, but perhaps a thousand comics in the same daily setup has finally run its course.

A Webcomic Primer

Now that I've had a collection of links to various webcomics up for at least a few months I feel it's time I paused briefly to explain them. And myself for that matter as webcomics can be a bit... oh... peculiar.

I have always enjoyed comics. Not so much the Cathys and Family Circuses of the comic world -- I truly wish they were never shown in the printed press again -- but as a youngin' I loved to read Garfield and Peanuts, and, now that my tastes have become more refined -- or ridiculous depending on your vantage point -- I enjoy many printed comics like Doonesbury, Boondocks, and others. With the Internet has come access to a whole different world of illustrated joke and story telling with which to pass the time. Without the censorship and needs for broad appeal that comes with massive print subscriptions the humor can be much more creative -- and profane as the case may be. As it seems even many who are quite familiar with the Internet are not terribly familiar with its webcomics, however, I decided to share the ones I like with you all. And also so I could have a convenient set of bookmarks for whenever I am not on my own computer -- but hey let's focus on how considerate I am.

So to get a better appreciation of webcomics I feel certain general characteristics should be known. For example the authors of most webcomics tend to be young males in their mid to late twenties with a few in their early thirties. There are some older writers as well in addition to a few women here and there, but mostly it's young guys. The target audience for these comics is similarly also young males in their mid to late twenties probably because, perhaps obviously, young males tend to be the ones who waste the most time on the Internet. Many comics have significant appeal to women as well, and I imagine most aim for gender neutrality in their appeal, but by and large I would gamble the comedy of webcomics is much the comedy of male computer geeks. With these facts in mind it should probably not come as any great surprise then that the characters in many stories are doofy guys and well endowed ladies. Again these are generalizations and there are certainly many webcomics without an inept but lovable male protagonists or any conveniently large breasted women, but pick one at random and you'll see.

After reading a few you'll probably notice a few other common threads. The actual artistic capabilities of most webcomic artists, for example, tends to be lacking. The humor tends to be based largely on the random and ironic most the time though some puns unfortunately do frequently find their way in. And there for whatever reason tends to be a large volume of webcomics with talking animals or robots in them. Is this because nonhuman characters can voice opinions and provide views of ourselves that we would not easily accept if it were to come from another in our species? Probably not. They mostly seem to pull comic relief duties, but, hey, animals can be introspective too.

Before I close I'd like to share two more things. First is that the webcomics I have listed tend to buck much of the trend I've just gone over mainly because it got old reading the same comic with different names over and over again so the more unique ones had more lasting appeal. As such I feel the amount of comics centered around some sort of ridiculous fantasy, sci-fi, or "normal life" are not very well represented. Thank goodness.

And lastly, if you think these comics suck. Check out this guy. He's got issues. Mental issues.

I'll See You at the SICU

Ha ha ha. Oh me.

After four weeks in the surgical intensive care unit (SICU) I can honestly say I have learned one thing -- well two if you count the standard post-operative care for a middle aged man after a coronary artery bypass graft. I have learned that I would have made a terrible anesthesiologist. What was I thinking? Mesmerized by the glamor and allure? Hypnotized by a well put together and adequately managed clinical elective? I would have hated my life. I would have been filthy stinking rich, but, dang, anesthesiology is not my cup of tea. In as much as anesthesia is a cup of tea anyway. Fourth year has also made me very confident that I dislike surgery and radiology as well, and in that sense fourth year has served me well, but those are boring topics for another boring post. In summary, I love infectious disease. Hurray for bacteria and their organelle possessing brethren: fungi and parasites. You all delight me.

My deeply felt romantic feelings for such things aside, it turns out there aren't many interesting stories that result from 28 days of recording patient vitals onto sheets of individual sheets of paper every day. Not much that could or should be shared at least. What was interesting, however, had nothing to do with the SICU, but due to the fact that I was working with the anesthesiology team as at the VA the anesthesiology team is also the Code Blue team.

Code Blue for those of you not familiar with the secret world of hospital codes is basically "Code the Patient is Dead or Dying and You Have About Fifteen Minutes to Revive Him Starting from When I Stop Reading this Message." At the VA it seems most Code Blues, or simply "codes" as they're otherwise called, are run by three teams. The anesthesiology team, who arrive whenever they orient themselves and figure out where the patient is exactly, manages the airway with all their scopes and instruments; the internal medicine team, who usually arrive later because they actually have work to be doing in between codes, manages the code itself; and a team of spectators of unknown composition who generally mill around watching the two or three first responders work before the other two teams arrive. I'm not sure if this last team is composed of nurses or techs or just office workers, but considering we never know where anything is when we arrive and amongst our scrambling and calling for things one of them usually steps in from their gawking to to hand it to us a few seconds later I think it's safe to say they are at least from the area. All the teams aside, though, the general steps of a code are:

1) Find the patient.
2) Make sure the patient is in fact not breathing and pulseless
3) Control the airway, provide rescue breaths, and start chest compressions
4) Inject things
5) Shock 'em!
6) Repeat steps 2 - 5 a few times until someone eventually says enough is enough

How this all actually forms a story is when I step in one day -- or happen to be in the way as the case may be -- and shock the patient with the defibrillator pads. Although I needed a quick instruction on how to use them, I at least remembered to make sure everyone was clear from the body before zapping the guy -- unlike another student who almost got some collateral zapping. For those of you whose entire visual library of a code comes from ER or Gray's Anatomy the patients tend not to jump up that much or really much at all. Mostly just jiggle a bit. What they do tend to do, however, is smell like burnt people. The electricity running from the defibrillators into the body jumps the heart but also burns a little but of subcutaneous fat as well. It's interesting to say the least. And, although the patient died in my case in spite of our efforts, when patients do come back from the brink in real life they're usually pretty friggin' miserable if even responsive at all. Definitely no heart felt thanks or dramatic moments. Oh wells, someday I'll have a code like they do in the movies. And then a helicopter will land on me. What the hell.

A Compelling Work of Transcending Insight

In life's constant pursuit of more titles and honorifics I can finally add to my tally: Scott Crabtree, prize winning author. And the secret to my success? Entering contests with as few qualified competitors as possible. UTHSCSA's department of Humanities and Ethics and Other Such Things recently held such a competition throughout the entire health science center requesting essays covering medical ethics topics of our choice. In the end there were 13 maybe 14 submissions, and add to that the fact that it seems most health professionals tend not to be the best writers I figured I had a pretty good shot. A few hours and a few pages later and I was $250 richer. I didn't win the $1000 grand prize, but I did earn "honorable mention", and I did show my gratitude by not attending the awards dinner. (In my defense I didn't think I would win nor did I know that I had in fact had won until after the silly dinner took place.) My lack of proper thanks aside; since I so like reveling in my own glory I thought I'd share it for all to see. Enjoy Ro!

How Much for a Life: Triaging Friend and Foe

The act of triage is a straightforward, simple process. Quickly assess a patient’s injuries, obtain a rough prognosis, and decide whether they will be given emergent care, deferred care, or only the care which can be readily given to ease their suffering till they eventually, and likely quickly, pass. Despite its simplicity, however, it is readily obvious even to those who have not experienced such an affair that no step in the process is easy. In the rushed, chaotic environment of mass casualty events determining the extent of someone’s injury accurately and swiftly is not undemanding. Determining whether they can be saved is not simple. And making the decision whether to even try or not is profoundly psychologically and emotionally taxing even if the initial adrenalin rush means the full weight of the experience is not felt till some time later. Despite the gravity of the situation the ethics of the matter are also relatively straightforward. Simply put, with limited resources you must do the best with what you have. Few would disagree that those whose injuries make it so their chances for survival are minimal should receive the devoted attention of an emergency care team when there are two others also slowly dieing but whose chances are significantly better. It may be sad to abandon the one in greatest distress, but few would argue against the necessity of such action. Much of this changes, however, when triage comes to the war zone.

In just about every situation a doctor can find himself in he is surrounded by allies. His care is sought after and he is happy to give it. Even if the patient in question has obtained his injuries by engaging in activities the physician is less than supportive of or is a person the physician would not otherwise wish to associate with, the physician graciously extends his services because by default people are people and people deserve medical care. In armed conflicts this de facto starting position patients have is strained as many times the patients are less ordinary old people and more enemy combatants. Sometimes the physician will find he is saving the life of the same person who was only a minute ago trying to take his own. Sides are drawn and each side has sworn to neutralize if not outright kill the other. In settings where the physician can freely care for patients, whether friend or foe, completely and does not have to divide resources the inherent human worth of the individual carries the day and the physician can, should, and will completely devote his attentions to the injured person. In mass casualty events, however, the physician is once again forced to prioritize. He must decide if the life of a foreign gunman, the life of someone devoted to opposing the mission the physician as a military officer is avowed to, is equal to the life of a comrade, fellow allied soldier. In such situations some would question whether the rules of triage are the same. If, for example, when deployed to a relatively small field hospital a physician finds himself with a wounded enemy combatant rapidly losing blood from a large caliber gunshot wound to the abdomen, a thready pulse, significant pallor and the onset of shock fast approaching and also simultaneously a wounded friendly marine with a crush injury to his upper extremity, shrapnel in multiple locations, and moderate blood loss of his own, who should receive immediate care? Both would be classified as “emergent” under the United States Army’s Emergency War Surgery handbook – the former perhaps further subcategorized as “immediate” and the latter as “urgent” – but should the limited medical care be devoted regardless of who is who? Or, alternatively, in some circumstances is the character of the patient just as important as the gravity of his injuries?

Turning to conventional medical ethics would certainly be an appropriate start, but many of the basic principles such as autonomy and non-maleficence are not applicable in this problem as we will assume both patients are wanting the fullness of medical care and the physician intends to hurt neither. Even the concept of beneficence is of limited usefulness. The foreign combatant is at great risk of losing his life and hence it would be appropriate for the physician to devote most if not all of his immediate attention to saving it. Likewise, although the allied marine is at less risk of death the chances for serious long term injury and loss of limb are significant and it would be just as appropriate for a physician to devote most if not all of his immediate attention to stabilizing and repairing this injured soldier as well. Clearly both stand to be saved and both need the thorough attention of most the available medical staff. Beneficence would only suggest that we strive our best to help both, but in situations where we cannot it provides little further guidance. It would seem then that in order to obtain any clarity we must turn to the concept of justice.

Justice, the key concept behind the idea of triage, may be what will guide us here. Using this concept, from a purely medical perspective the standard rules of triage would apply as previously mentioned earlier. The foreign combatant needs immediate care, the allied soldier needs urgent care. Problem solved. Take it back a level to a more public perspective, however, and the costs of such a decision begin to add. A unit removed of one of its normal soldiers is a weaker unit, less effective unit, and a more dangerous unit for the other soldiers still active. Take it back another level to a more political perspective and the costs climb still more. How profitable is the life of a man who only briefly before was violently resisting the power of your nation in its most assertive form and how much more costly is the loss of a marine from duty to the overall success of the mission and safety of the nation as a whole? And take it into an immensely personal level and the cost is not merely an amputation but a life changed. Combat injuries and amputations are not entirely physical and the psychological wounds are often just as damaging – the effect creeping into the lives of family, friends, and forever altering the way the injured sees himself, the world, and his future. With the scales adjusting, a more nuanced perspective would ascertain that foreign combatants have family and friends too, many of which may be in no way involved with the conflict. Their sense of loss would be just as immense if he were to pass away. Likewise, wars are many times fought for minds as often as they are for neighborhoods and lives. The fair and generous treatment of POWs is key to getting insurgent gunmen to lay down their arms and the people to withdraw their support. With so many angles and so many perspectives to contemplate the consideration of justice has certainly opened up the problem of triage in a combat zone but in doing so it has laid it out in snarled disarray. The ethical equation has become an endless series of variables with largely debatable coefficients. With the issue becoming so gray where do we go from here?

The problem of such utilitarianism is that while it allows for a more discriminating approach it also has a tendency to deprive ethics of the moral strength it seeks to preserve. The fine measure of a thousand points of contention allows for rationalization as much as it allows for an exacting analysis of a complicated situation. The vast majority of medical oaths in existence whether they be the Oath of Asaph and Yohanan established for ancient Hebrew physicians, the Declaration of Geneva constructed after the abuses of World War II, the Seventeen Rules of Enjuin developed in Medieval Japan, or the Hippocratic oath created millennia ago are straightforward and fundamental. Although this is partly if not largely due to a need for concision and foundation, there is also strength and clarity in simplicity. When medicine gets mixed with a legion of other issues the central purpose of medicine, healing, quickly becomes diluted. As physicians become less healers and more business men, military officers, and judges the sanctity of life becomes less a commanding value and instead just another option to consider. At times these secondary roles and their duties may be inescapable, but they most always remain secondary. The first step towards gauging the value of a life is the first step away from the soul of medicine, and deciding how much an individual is worth requires a heavy spiritual cost in return. Tending to a seriously injured friendly marine over a sick and dieing insurgent gunman may well be the initial impulse of many a doctor in such a situation, but in doing so he would sacrifice much of what truly makes him a healer. His technical skills may remain, but his soul suffers. If we wish to continue on as doctors and not simply as learned technicians we must hold true to medicine’s foundational principles. In a world of competing priorities the defense of life must always remain priority one.

As interesting and debatable as all this may be the reality is significantly less than a thousand physicians enter military service any given year. Few will see any mass casualty events, and, as in the case of Iraq most Iraqis are treated in Iraqi hospitals, few will ever see a scenario such as this. Its practicality is not where its usefulness lies however. Often times ethical principles must be pushed to their extremes to appreciate their merit. One does not value autonomy until one is pressured to resist it and one does not appreciate honesty until one is tempted to ignore it. Likewise it is easy to accept the idea that the preservation of health and life is the underpinning of medicine, but until one is seriously enticed to believe otherwise they will likely never seriously consider it in their daily actions. It will be a nice idea quickly agreed to and quickly forgotten. Without thinking about at what point we would second someone’s survival for another purpose we will never think about the smaller ways we are already seconding our patient’s health for private incentives and personal biases. We may not be sacrificing insurgent gunmen for the arms and legs of allied marines but many physicians every day provide a little less care in order to get out of the office a little sooner, a little less consideration to personalities who irritate them, and a little less attention to those they think beneath them. One may question when gross discrimination is acceptable if ever, but until they do they will never see the hidden discriminations occurring every day. Most physicians will never triage in a war zone, but everyone balances a countless number of priorities every day and the more we think about them and the more honest we are concerning them, the more we will make the right priorities first in our lives and first in our practices.


Now what to do with all that money.... perhaps get myself a new grill?

Duck!

Or juvenile sharp-shinned falcon perhaps? It seems that in addition to an endless supply of deer, 'coons, and 'possums, Mexitexas also has its share of enormous birds of prey. This one buzzed overhead while I was taking out the trash leaving behind a window shattering sonic boom and distinct contrail over my right shoulder. Its target was not my own undoubtedly tasty giblets but a nearby bush full of small, cheerful finches. The falcon landed a few feet short, hopped over to the edge -- as such falcons are apparently want to do -- and then dove in to find himself a delicious finchy snack. The bush immediately erupted with the sounds of about 20 different little birds completely losing their minds, but after a few minutes of chirping, flapping, and what I guess was the falcon barking the falcon emerged barehanded. I felt bad for him, and then took some pictures.

Gorked Gourds

So Halloween passed without a single trick-or-treater and Paul and I were left with 5 lbs of some terrible tasting licorice mix he got from who knows where, but nevertheless this Halloween season was enjoyable and for one reason: Paul the Puking Pumpkin.* Too much substance abuse and perhaps a little developmental disorder have lead to this poor Jack-o-Lantern regularly releasing his insides to the outside world. We made it a few days before at Megan and Annie's place, and, though not the finest carving job of all, mine was certainly the only one barfing. What was best was that everyone credited me with such originality and imagination when in truth I had simply stolen the idea from a jack-o-lantern I'd see many, many years before. In reality I am not creative; I just have a surprisingly tenacious if not random long term memory. Our neighbors were probably not so excited about my contribution to the door step as their own pumpkin was a magnificently carved image of a pirate ship. Ours definitely brought down the beauty and class of the display. Unfortunately by the time Halloween came around their jack-o-lantern had been sitting outside so long that it was kind of shrunken and moldy so I didn't bother taking a picture of it. Just imagine a pirate ship on a pumpkin, though. Yeah... pretty awesome huh?

*By naming my pumpkin Paul I am in no way implying my condomate Paul has any substance abuse or development disorders. I just like alliteration is all.**

**Or do I?

Of Balloons and Blue Ducks

For whatever reason I decided to go to the annual "International Hot Air Balloon Fiesta" in Albuquerque, New Mexico in order to see hundreds and hundreds of balloons. I'm not sure what the official tally was, but they average 700+ hot air balloons each year which is about 698 more balloons than I have ever seen before in my life. The actual execution didn't go off terribly well due to poor planning on my part and dilly dallying on my brother and his fiance's part so we missed the morning session. Thankfully, however, we were still able to see the "balloon glow" which took place that night where all the balloons remained tethered to the ground and blasted their burners to light up the night. High winds killed that early too, but it lasted long enough for a frantic scurrying about trying to see all the hundreds of balloons inflating on the massive launch area. Essentially all an eight hour wait followed by thirty minutes of sensory overload.

So I still don't really know why I went; I guess I just really wanted to see a bunch of balloons, but for similarly unknown reasons I want to go back. We missed a lot and the little we did experience passed a bit too quickly. The photos also weren't too fantastic as the upper 40 degree temperatures that evening gave me the shivers making use of my camera's night scene setting even more disorienting, but here they are:

Balloons!

Those Damn Dirty Fish

Some people are incorrigible. Some fish, it seems, will respond only to violence. Despite two separate attempts at friendship, Paul's (my condomate) aquarium fish continue to insist on a tank to themselves. Shortly after moving in in February I purchased two platys who, for those not as involved in the tropical fish world as I seem to be, are essentially the Charlie Brown's of the fresh water fish world. Although they wished only to live peacefully and with friends, within 48 hours they were dead. Chased to death by their tankmates. One of the perpetrators, a skinny danio that Paul never even bothered to name, has since thankfully been smited and passed on, but the instigator of the killings, Charlie the Goldfish, lives on.

After my initial rage I moved into a general indifference to Charlie and his aquatic fiefdom. Recently, however, Paul purchased another smaller goldfish who was subsequently named Louie by another friend of ours, and, inspired by his successful integration to the tank, I decided to make another peace offering; this time with a third goldfish for the tank. It was only 24 hours before he was dead. I am not 100% sure that he was in fact murdered as well as he was stuck behind a rock and there is a distinct possibility that the idiot wedged himself there, but based on Charlie's track record I think I can make a pretty good case.

Now I am faced with the decision on what to do. Do I allow such war crimes to continue? Should I immediately flush Charlie down the sink to the filthy sewer from which he was obviously spawned? Maybe just chuck him into the dirt and debris outside for a slow painful death on land. I have considered pouring a quart of bleach into the tank and shrugging innocently when Paul awakes to find his fishes dead and half-dissolved, but I don't know. Right now the decision I'm leaning towards is simply buying a bigger, meaner fish in the beginning stages of a maritime arms race, but perhaps I just need to sleep it off.

Whatever I do there will not be justice on Earth till those fish are dead.

I Have Been Neutered!

Each year the University of Texas Health Science Center at San Antonio (UTHSCSA) solicits its new fourth year medical student class for words of advice for the beginning third year medical students as they start their first year of clinical rotations. The ensuing publication, appropriately titled Letters to a Third Year, is then shared with everyone who's willing to take one home with them. As I had a good deal of time and a message I felt that needed to be shared with the world I wrote my own letter. Attached below is how it reads in the book:

Dearest, Largely Unknown Third Years,

You have all probably heard now from various friends, family, and faculty about the joys and perils awaiting you in your third year of medicine: the stress, the excitement, the lack of sleep, the novelty, etc. etc. etc. You’ve probably also heard now about how third year will affect you as a person. How you’ll learn so much finally practical knowledge. How you’ll begin to develop confidence in yourself as a novice clinician. How you’ll develop a taste of the variety that medicine has to offer. How you’ll run faster and jump higher. All this is true, and I don’t mean to detract from any of it. What I felt was not conveyed to us – or to me at the very least – was something completely different.

Somewhere near the end of your first clinical year – or earlier if you’re particularly introspective – you’ll look at yourself and you’ll realize, “medical school has changed me.” Despite your best efforts to remain a caring and ethical medical student – volunteering a little bit here, resisting those accursedly friendly drug reps there – it’s a challenging battle. There’s just too much change, too much stress, too many demands, and, simply, too much to adjust to. Perhaps some may resist this inevitable decline, but even if you deal in a healthy and positive manner to what comes at you, not regressing, splitting, or repressing, you’ll change in many ways for the worse.

This is not to say that third year will totally change you. Hopefully the medical school application process successfully filtered all those types out, but you will certainly be a little bit more “short-tempered.” You’ll find yourself a little more inpatient in the car, a little less graceful with the errors of others, a little less generous with what you have, a little less inclined to call back a friend if its no big thing, and a little more likely to put yourself ahead of those you care about. Not only in stressful situations does this apply. Yes you’ll be irritable after a long night of scrubbing debris out of the wounds of an unconscious patient in the ER, but everyone knows that, accepts that, and it’s nothing particularly telling of one’s character.

All of this said, I do not mean to be a negative. Go out eat, drink, and be merry. Even during the worst of times – even during the controlled chaos of general surgery – you’ll still be able to find time to enjoy yourselves and still remain much the same charming person you always were. Instead I’d like only to issue a small advisory. Like all of life third year will have its ups and downs, and for some it may even means new highs and new lows. Some of you will do just fine, and some of you, despite my melodramatic introduction, will even likely with little effort become better human beings. The majority, however, I’d be willing to bet will be made just a little worse for wear. Use this then as an opportunity. The injury to character obviously need not be a lasting thing. Instead it can be the first uncomfortable stages of durable personal change – a forge, a crucible, a whetstone, whatever metaphor you want to use. Sometimes to become better we must first identify what is especially in need of improvement. The first step in this process often involves insight, however, and so I write you all briefly to encourage self-reflection. To those unobservant, such as myself, these changes can go unnoticed till you have to work to undo what’s been done, but with a little bit of honesty and vigilance a rough year can be made a stepping stone for greater personal development.

Go Spurs Go,
Scott Crabtree
MS3

Sucks doesn't it? Yep, pretty crappy. I think the word "change" occurs 20 different times there. They also apparently had enough time to switch out most my adjectives with the first synonym that came to mind but not enough time to edit my "MS3" which was obviously a mistake as all the letters were supposed to be written by fourth years. Some changes, as you'll shortly see, I truly didn't even understand. Seems the guy began to simply eliminate any words that didn't fit his fancy. Here's how it originally read:

Dearest, Largely Unknown Third Years,

You have all probably heard now from various friends, family, and faculty about the joys and perils awaiting you in your third year of medicine: the stress, the excitement, the lack of sleep, the novelty, etc. etc. etc. You’ve probably also heard now about how third year will affect you as a person. How you’ll learn so much finally practical knowledge. How you’ll begin to develop confidence in yourself as a novice clinician. How you’ll develop a taste of the variety that medicine has to offer. How you’ll run faster and jump higher. All this is true, and I don’t mean to detract from any of it. What I felt was not conveyed to us – or to me at the very least – was something completely different. It seems to me that while the third year of medicine changes you in a lot of ways, it also makes you more of a jerk.

Somewhere near the end of your first clinical year – or earlier if you’re particularly introspective – you’ll look at yourself and you’ll realize, “medical school has ruined me.” Despite your best efforts to remain a caring and ethical medical student drone – volunteering a little bit here, resisting those accursedly friendly drug reps there – it’s a losing battle. There’s just too much change, too much stress, too many demands, and, simply, too much to adjust to. Perhaps some may resist this inevitable decline, but even if you deal in a healthy and positive manner to what comes at you, not regressing, splitting, or repressing, you’ll change in many ways for the worse.

This is not to say that third year will make you into a jerk, hopefully the medical school application process successfully filtered all those types out, but you will certainly be a little bit more “jerkish.” You’ll find yourself a little more inpatient in the car, a little less graceful with the errors of others, a little less generous with what you have, a little less inclined to call back a friend if its no big thing, and a little more likely to put yourself ahead of those you care about. Not only in stressful situations does this apply, mind you. Yes you’ll be irritable after a long night of scrubbing debris out of the wounds of an unconscious patient in the ER, but everyone knows that, accepts that, and it’s nothing particularly telling of one’s character. This change is deeper as even fully rested after a short day reclining on the inpatient psych wards you’ll still not be quite the humanitarian you used to be.

All of this said, I do not mean to be a Debbie Downer. Go out eat, drink, and be merry. Even during the worst of times – even during the controlled chaos and narcissism of general surgery – you’ll still be able to find time to enjoy yourselves and still remain much the same charming person you always were. Instead I’d like only to issue a small advisory. Like all of life third year will have its ups and downs, and for some it may even means new highs and new lows, but it will also be very subtly abrasive. Some of you will do just fine nevertheless, and some of you, despite my melodramatic introduction, will even likely with little effort become better human beings. The majority, however, I’d be willing to bet will be made just a little worse for wear. Use this then as an opportunity. The injury to character obviously need not be a lasting thing. Instead it can be the first uncomfortable stages of durable personal change – a forge, a crucible, a whetstone, whatever metaphor you want to use. Sometimes to become better we must first identify what is especially in need of improvement. The first step in this process often involves insight, however, and so I write you all briefly to encourage self-reflection. To those unobservant, such as myself, these changes can go unnoticed till you have to work to undo what’s been done, but with a little bit of honesty and vigilance a perhaps unavoidably rough year can be made a stepping stone for greater personal development.

Go Spurs Go,
Scott Crabtree

Obviously not a stellar work of fiction in its original state either, but certainly a whole lot better than the piece of garbage currently with my name attached now in the hands of a few hundred people. Thankfully I'd gamble 90% don't bother to read more than an entry or two, but regardless, what the heck UTHSCSA? In the age of medical ethics and informed consent could you not even consent me to your terrible neutering of my entry? Argh. I emailed one of the many deans who headed this up to complain and advise they not follow the same algorithm for strangling the style and character in their letters next year so we shall see how it goes. I imagine, like so many things in school and life, that I am simply wasting my time.

Fight the Power!

Liberation's Lost its Fun

It's been a couple of years now since Iraq has been liberated, and the Iraqis themselves are everywhere enjoying the spoils of freedom. The collapse of the Hussein regime has been met with a brief round of applause followed now by a not so brief round of looting, violence, and sectarian politics. Currently, questions of troop levels and our future actions in the region are hot topics for discussion everywhere. Any yahoo with a 10th grade knowledge of the region and the ability to watch CNN or FOX news for 20 minutes a week can interject with their simple yet effective solutions for dealing with the situation. Being a self-respecting yahoo myself -- and the convenient owner of this here site -- I have felt compelled to enter the fray. And, heck, with all this EKG self study going on I'm running out of things to occupy my time with anyway. Now in as few words as possible, my answer to everything to do with Iraq:

Screw 'em. No I am neither a defeatist nor a Democrat. I do not think leaving the conflict will somehow solve it. In fact, I think abandoning the Iraqis to their own devises will likely lead to greater bloodshed then what we are seeing now. Moreover I feel there is even a small but real chance that such a deterioration in the situation could lead to the involvement of neighboring states like Iran and, especially, Turkey (our only real hope for a secular Islamic state in the region.) I also feel that by abandoning a war which we, at the very least, indirectly helped create we are committing a serious moral dereliction of duty. Most of all, however, I feel that we have little other choice.

The surge in Iraq, in as much as it was a surge*, has yielded few identifiable successes so far. Portions of the country are safer, but no region is truly peaceful. Fighting continues in Anbar and attacks still sporadically occur in Kirkuk and the Kurdistan north. Coalition forces continue to depart with the British leaving Basra only a short couple of weeks ago. The police force continues to remain infiltrated by militias and the politicians -- despite the fact that they can easily draft bills tackling immunity for our mercenary-lights in only a matter of weeks when they want to -- have been unable to decide on what to do with Iraq's oil wealth or any other essential topic. Even if we were to conclude that overall Iraq is safer and more stable than it was half a year ago there is little indication the Iraqi people or the Iraqi government have done anything with this change.

A bleak assessment does not a withdrawal make, however. Iraq may be in for tough times ahead, but this does not mean success is not possible. Indeed General Petraeus and many other high-ranking military officials seem to feel very strongly this way. With all due respect to them, however, the problems have always only been partially military-related. Beyond the political and security related issues mentioned previously (1) our military is taxed and consistently falling short of recruitment goals, (2) our other war is currently anything but a poster child for success**, and (3) the majority of American people care only enough to chitter chatter about it amongst themselves. In light of all this a decision to continue fighting in Iraq is not simply a question of keeping 100,000 combat troops or 60,000 combat troops, or 130,000 combats troops in the region. Rather it is a question of how to best divide the limited resources the American public has devoted to the cause of fighting its wars. There is good reason to believe another year in Iraq will only mean another couple thousand dead, wounded, and maimed American soldiers, another tens of thousands of dead, wounded, and maimed innocent Iraqis, and no more of a brighter future for a country that cannot properly conceive of its future than the the year previous. And, just as importantly, there is good reason to believe all we will have to show for it outside of Iraq is a dispirited and broken military, ever-deepening national debt, and a floundering Afghanistan.

In light of these realities a strategic retreat may be in order. Abandon Iraq to their own devises (figuratively speaking), secure Afghanistan, and, when our military has recovered, our reputation is on the mend, and the Iraqi partisans have had their fill of bloodshed we can reengage and properly, hopefully, fix the wound that is Iraq. A complete withdrawal is not necessary or even advisable. Intelligent planning on force reduction and the rescue of pro-Coalition Iraqi refugees can be achieved. This is certainly not a great idea, but, unfortunately, it very well may be the best. Unless the Iraqis begin to show they are willing to do anything but squabble and unless the American public is willing to invest any more to the cause than idle chatter our choices are few and poor. As we learned in the Pacific theatre in World War II and on the Korean Peninsula in the opening volleys of the Cold War sometimes the best strategy is the strategy of temporary retreat. In our current Global War on Terrorism if we are unwilling to fight harder than we must certainly fight smarter.

*Iraq is larger than California which is larger than Japan which, after world WWII, was occupied initially by some 350,000 US soldiers and marines; there have been roughly 170,000 military personnel in Iraq according to the more generous estimates and even including an additional 126,000 American and foreign contractors to the equation still yields only 296,000 in comparison.

** Attacks in Southern Afghanistan continue to increase while repair and reconstruction projects and funding continue to decrease. Although many NATO nations have responded to requests for further troops (Poland, the Netherlands, Denmark, the Anglo states) others can barely maintain public support for current levels (Germany, Spain, Norway, Turkey) and others have actually slightly reduced their contributions (France.) Moreover it should be noted that non-Anglo states provide only a fraction of the NATO force in Afghanistan and many have rules against active engagement except for in extraordinary circumstances. If the amount of drug production in a nation is any degree of its strength or stability, the country's record opium crop this year (the largest also in the world by far) should not be very encouraging.

There. I've talked about both Iraq and Paris Hilton now. My blogging obligations are over. Seacrest out.

Saving Lives, For Profit

Leaving the office last Friday after four weeks of outpatient medicine at a local private practice I felt as if I had been liberated. Not necessarily from the work as the work was not terribly difficult or demanding, but rather from the commitment. Although I was allowed to sleep in to a rather late 7:15 in the morning every day, I usually did not return home from work till about 7:00 at night. I may not have minded the job, but I minded the fact that all I did was my job. For almost 28 days I felt like I was less enjoying life and more listening to senior citizens tell me in as ambiguous terms as possible their various minor ailments. I am told once you hit your career days you are no longer supposed to enjoy life, and to an extent I acknowledge that that's true, but nevertheless I'd like to live in sweet denial for as long as possible.

Aside from the fact that 60% of my patients were 70 year old men and women telling me about their terrible shoulder pain which they hadn't even bothered to take any tylenol or aspirin for, I have other grievances. For one, my physician had me research a new topic every evening thereby limiting the little free time I had even less. For another, the man had not the worst handwriting ever, but easily the 5th or 6th. Since he still had paper charts that meant that I either had to try and tweeze out a coherent history from my half-senile elderly patients or desperately try and put together an idea of what happened from the studies he'd ordered and the correspondence of other physicians he'd sent the patient to. Of course those other physicians remembered to send copies of their notes only... oh... 40% of the time. The rapidity of the encounters at not only this clinic but many clinics I have been to either as a patient or a student have also convinced me the average American probably gets only mediocre care at best. There are certainly some great physicians there who actually devote enough time to a patient to provide great care as well, but I am pretty sure they are anything but the rule.

Though I like to complain there were some good sides too. My physician was, generally speaking, a fairly nice guy and easy man to work for. His nightly assignments, though painful, -- especially when they consisted of diseases that don't exist like "hand and foot fungus" -- were moderately educational. His office staff were also a friendly bunch. The patients were as a whole very grateful, and aside from a few Spanish speakers who mumbled their speech, I enjoyed most my visits. Though I have no desire to return, I do not consider it a bad rotation. Just a not very fun one.

One last thing I noticed was that with such rapidity of care the work up of patients becomes less well-thought out consideration of the applicable science and more the following of whatever whim or algorithmic pattern the particular physician seems to have acquired at some point through whatever means. I would imagine -- and so it seemed at this clinic -- that this makes such physicians ripe for the picking by anyone willing to provide a little bit of already digested, helpful medical advice. And of course since few things in life are truly free, this educational charity work is largely done by pharmaceutical representatives. Perhaps such industrial parasites are a necessary evil, but judging by the drugs prescribed the pharmaceutical industry does well by sending out their drones. All their blahbety blah blah aside, though, the drones did usually provide pretty delicious lunches. (Except for Crestor, I will never prescribed Crestor to my patients -- even if they need it. They're jerks.)

As a final note: a public service announcement. Beware the small tubes at Schlitterbahn. They may look like fun, but from first hand experience last weekend I can confidently say they only lead to bruised elbows and cervical spine injuries.

Oh and here's an unrelated photo from my previous stay at the Delevan homestead....

Gone Shootin'

If you'll remember, my loyal readers, my dear friend Tyler has a family house outside Austin on Lake Travis. It is awesome, and up until this year I was completely unaware of it. Likewise, it turns out, my dear friend Adam also has a family house. His, however, is outside Fredericksburg near Enchanted Rock. It too is awesome, and, likewise, I was once again completely unaware of its existence. Who else has a luxurious beach house or mountain home? I can't say, but I certainly hope to find out soon. All that aside, two weeks ago we went out to Fredericksburg for a weekend of relaxing, hiking, and shooting stuff.

Despite my illustrious military career which, my loyal readers, you'll recall has so far consisted of playing dress up, I have fired a firearm only once before -- and that guy deserved what was coming to him. Actually I only shot a rubber duck decoy, but if ever a duck decoy deserved it.... Regardless, that weekend I was given intense training in the loading and use of a twelve-gauge shotgun and 22 caliber pea shooter. The shotgun was cool because I could explode gently thrown clays with it while the glorified rifle was cool because it had a scope on it with which we tore up various soda cans. Though I probably fired a couple dozen rounds of both guns and only shot one legitimately thrown clay, I feel now that I am finally, officially an Army of One. Unfortunately the Army's changed its slogan to Go Team or Sea the World or something like that now, and the Air Force doesn't seem to use shotguns all too much, but at least when I do finally see a gun before deployment some years from now I will at least know what that I am in fact a terrible shot.

Of course all of our time wasn't spent shooting because no trip to Enchanted Rock is complete without a trip to the cave. Neither Adam nor Kate had been before and it was a joy and a privilege to take them there. Despite my outstanding record of being a generally great guy, my motivation in leading them through the caverns of E-Rock was not entirely benevolent, however, as when they exited through the birth canal at the end of the cave complex we were ready for them with cameras in hand. There are few sites more heart warming or completely hilarious than Moleman Adam struggling to exit to the light of day. We looked at the pictures and laughed. Later we thought about the pictures and laughed some more. Even two weeks later the thought of the pictures make me smile. Amazing that one moleman can bring so much joy into so many peoples lives.

Anyways, we also hung out at Adam's family's place which was beautiful despite being under the constant threat of scorpion attack, the jerky burgers we had Saturday night were fantastically salty as well, and affixing a headlamp to an akathisia burdened Bella (one of Adam and Kate's dogs) was worth at least 30 minutes of entertainment. What's important, though, are the photos. Those glorious molemen photos:

Pictures!

Ode to Ashlee

Few realize that in addition to my giant brain I am also in possession of an equally giant heart and the soul of a poet. I was saving this for their wedding day, but recent events have compelled me to share it earlier. My brother is marrying one Ashlee Hilliard and, after meeting her, let me say, in all sincerity, he is a lucky guy.

Ashlee, oh Ashlee

Forgive me if I act brashly,

But truly you are

A princess

A gem

A peach

A princess

A catch

A princess

A prize

A unicorn

Ashlee, oh Ashlee

Forgive me if I act brashly,

But truly you are the best sister-in-law I've ever had.

.

Rocky Mountain Majesty

It’s almost a week since I’ve returned from saving Mother Earth and I still feel that she wasn’t worth saving. In many ways I enjoyed the trip – the Sangre de Cristos are a beautiful mountain range and I loved being outside – but the overwhelming feeling is a feeling of futility. The majority of the time was spent working and the majority of the work seemed inefficient or ineffective. Whether it was laboring to slowly build up a trail so that, after some 200 cumulative man hours, it looked slightly more like a trail rather than a scrambled jumble of rocks or it was digging up parts of the hill side to fill in holes in other parts of the hillside it just seemed like we were fighting a losing battle. People were still hiking off trail. Many of the transplants likely died. I still don’t have any idea why we moved half of the rocks we did. The alpine environment was simply too fragile and mankind is simply too determined to enjoy it for our work to have any lasting significance I feel. Plus, especially in pertaining to our reconstruction efforts, it seems like we just despoiled one area of land in a desperate attempt to reclaim another previously despoiled area of land. Oh wells, let us not lament such things. They don’t make for very good stories. Marmots, on the other hand, make for great protagonists.

Marmots, for those not in the know, are essentially big, friendly mountain beavers that make sounds eerily similar to the sounds of an electronic pager. Their significantly smaller and more skittish friends the pica make noises exactly like electronic pagers. I am fairly confident they use this chorus of sound to coordinate their raids on our camp as they came to visit whenever they had the chance. Our leaders said it was because they’d eat anything and everything if given the opportunity, but I like to think they were just saying hello – saying hello by eating our stuff and licking up our urine that is. They never touched my gear, though, and for that I am grateful. I’d say I have a Planeteer like ability to bond with animals, but we all know no one liked Ma-Ti.

Marmots aside, the rest of the trip was for the most part enjoyable. Certainly met some interesting people and interesting personalities. From amicable old, nuclear plant workers who called me “doc;” to young, naïve Anglican-Tibetan Buddhists who could not stop talking; to extroverted, amateur snowboarding occupational therapists; and to a variety of people of all ages a little too in touch with nature and perhaps not in touch enough with the rest of the world it was an eclectic group. I am now also familiar with the term “cougar” as well so all the kids will respect my street kred once again. And I am now familiar with what congestive heart failure must feel like as physical exertion at 12,000 feet is essentially the shortest path to shortness of breath. There were mornings when I woke up and loathed getting out of bed, but, to be corny, I never regretted doing so.

I cannot let the account end here, however, as there was certainly much more to be experienced.

The Wag system, for example, was a unique treat. Although defecating in a glorified bucket was easy to get accustomed to, pooping out in the open with a frozen mountain wind blowing through your shorts was not. I never had to clean the Wag, but I can easily say I will not miss it.

The hike atop Crestone Peak was a joy and considerably easier than I was expecting. I may not be able to carry a pack worthy my salt, but I can certainly climb like a monkey when necessary. To be able to see the Great Sand Dunes National Park from atop a mountain was also an amazing opportunity.

And finally, jumping into an alpine lake was an experience I will never forget and hopefully never repeat. I had never felt uncontrolled reactive physiology before, but after jumping into that lake there was little I could do to stop myself from breathing 30 times a minute. My first and only instinct was to gasp for air as frequently and as strongly as I could. That and scream. Interestingly enough, however, the experience of getting out of the water was remarkably enjoyable and satisfying. Despite the air around the lake being relatively chilly itself as well, removing myself from the pool was profoundly calming and warming. With just a shirt and some pants on I felt great. Relaxed and rejuvenated even. My heart may have been a little worse for wear, but there’s a satisfying feeling that comes after experiencing nature’s stress test. I had absolutely no desire to jump in again at that moment, but one of the best moments was walking back to camp, damp from the lake, and headed to some hot chocolate and a couple dozen rounds of Speed.

My pictures....
Ben's pictures....
Jay's pictures....

Freaky Deaky Melatonin

Which brings me to my next point.... Don't smoke crack.

Now as far as abusing over the counter, natural health supplements on the other hand... feel free to experiment. Actually, that stuff's probably just sugar pills and overpriced plant refuse. Nevertheless, as benign as much as the unregulated health supplement industry probably is, some of it will affect you, and not always in the ways you intended. Case in point for myself: melatonin. Not quite the same at St. Johns Wart or hanging crystals from your door jams as it is in fact a chemical that readily, normally exists in your body; it is similar in that there haven't been too terribly many published, verifiable studies done which show any merit to ingesting it on a regular basis. At least as far as I can tell. Allegedly, however, it is supposed to aid with sleep, regularize your sleep/wake cycle, fight cancer, and generally make for a fantastic day. For me, on the other hand, it mostly just makes me crazy.

My roommate and some other friends started taking it after a medical school lecture a few years back shared with us the boons to be had. Upon discovering this I of course had to join in. I don't have terribly much to do work wise now, and so could feel free to sleep in as long as melatonin felt I needed to sleep in for. Unfortunately, that's not what melatonin had in store for me, however. Instead about an hour after I took it and was already lying in bed I started to feel jittery. The weird twitchy feeling was quickly followed by an intense tired sensation and that shortly thereafter by my first sleep for the night.

My first sleep also brought my first dream which involved a series of fire alarms with the last one leading me out into the rainy night all alone only to be robbed at knife point. My assailant tried to take me to his car for whatever nefarious reason and, as he was going to the driver's side and lighting up a cigarette, that's when I made my break for it. After a smirk and a long drag on his cigarette he gave chase and, within a few minutes, I woke up. Disturbed but still very tired I quickly feel back to sleep.

And so we come to dream two. Dream two involved an evil clone of myself who of course had to be subdued and, later, a demonic teddy bear who, though not very strong, you knew was gonna mess you up if he got the chance. Run and go get a knife to cut you with was my guess. So that dream took its course and next thing I know it's about 9:00 in the morning. Time to get up and do some work. Unfortunately melatonin was not done with me, however, as I felt all funky dream-like for the first hour or so. Within an hour after that I was asleep again in my chair at the computer instead of being productive with my studies. In light of passing out while sitting upright, I decided to concede defeat and take a nap for a few hours. The nap was thankfully a pleasant one, but after all is said and done I have to say, "what the heck melatonin? Why you gotta be like that?" If that chemical really is normally in our brains it was put there by the devil.

And as a final note, after sharing my experience with my roommate he happily informed me that both he and he girlfriend had had vivid dreams when they first started taking melatonin too. Yeah, thanks for telling me.

WTF?!

I am not usually one to curse -- in fact the only ones I usually do ever use (hell, damn, bastard) are usually said in jest -- but there has come a time recently when, truly, I wanted to yell out, "what the fuck?!"

During my Infectious Disease rotation in Ohio I was given one of many brief overviews of the internal medicine programs available up in Dayton, and the physician advising me -- an otherwise normal, amicable guy -- informed me that at that program I had the wonderful option of moonlighting if I wished. For those not entirely familiar with the term (and I had to look it up to make sure I wasn't completely misunderstanding him), "moonlighting" is when you go mercenary. When you're off the clock at whatever hospital you work at you go work at another hospital for additional cash and exposure. Really a great way to earn both from what I hear, but in light of the greater things in life -- say everything not medical related -- I feel it's hardly just compensation. I wanted to respond with a loud, "why the hell would I want to do that?!" Work eighty hours a week only to do it for another 8 or 10 on my one day off?! I imagine one of my eyes momentarily deviated to the side before I paused and replied with a smile and nod. Seriously, though, I have never before in my life truly felt the urge to scream, "what the fuck!" before until then. Now I feel I can truly empathize.

Fightin' Words

In 1942 the Supreme Court determined in Chaplinsky vs New Hampshire that not all speech was in fact free. In this particular case "fighting words" were determined to be words which conveyed no ideas, possessed no content, and served no purpose other than to incite and illicit violence; they were to be considered unprotected. Much has changed since then, legally and otherwise, but nevertheless I feel the initial precedent still stands. If someone tells me some fightin' words, I should be able to round house kick them in the spleen. Why do I feel this strongly about the matter you may ask? Well let me tell you....

Much of medicine involves the fine art of interpersonal communications. While giant brains are certainly part of what's required, a tongue that chooses its words wisely goes a long way as well. Unfortunately all too often some people neglect the latter, and instead feel inclined to say whatever it is that happens to pop into their head. When this occurs in isolation it is ignorable, forgivable, and forgettable. When this happens on a daily basis they become inescapable, rage- inciting obsessions. Or so it seems to go with me.

One such example is the ever popular phrase that is especially in vogue on the wards: "he knows his shit." Commonly if not always used to express the thought that such and such resident/attending/student is particularly knowledgeable in whatever field is under discussion, the random unnecessary insertion of the vulgar "shit" gives it a jaded, street-wise edge thus identifying the deliverer of the remark as someone who knows his shit about what he's talking about. Bushy-tailed young medical students still full of ethics, sugar, and a desire to please would never say such a thing to express such an idea; this phrase thus deftly lets everyone know that whoever said it is not some silly bushy-tailed young medical student. If only it wasn't used by everyone. Unfortunately the fact that people still use it only serves to identify them as (A) bushy-tailed young medical students trying to grow up too fast or (B) oblivious idiots who have been around long enough to know it is an entirely over-used and not particularly liked phrase but continue to use it anyway. In either case the person is clearly in need of a punch to the mouth.

A second example seems to exist only in the hallowed halls of surgery. Attend any Morbidity and Mortality Conference and in short time you'll hear the word "gestalt" so much you'll think it's echoing off the walls. This is a particularly interesting case for a variety of reasons. I personally think "gestalt" is a pretty great word. Succinct, intelligent, manly sounding. Unfortunately for all the same reasons it appeals to every surgeon. In what is often an ongoing battle of egos where every little point counts and so every little word counts, "gestalt" nets at least a triple word score. Nothing takes the fun out of German words, however, like a surgeon. If a good word can be so over used by obnoxious people as to inspire eye rolling instead of a smile, I think it deserves to be included as a fighting word.

Lastly, to further infuse our discussion with history, I will draw reference from the recent Hollywood action hit "300." If the story is the least bit accurate you can be rest assured that calling any half decent Spartan an Arcadian is fully asking for a powerful spear thrust to the midsection. In case you have not seen the movie and are not entirely familiar with the plot, the Spartans must defend Greece from the Persian hordes using nothing but raw machismo. I believe the movie can best be summarized with a paraphrasing of a scene involving King Leonidas and a crippled gentleman wanting to join his army.

Crippled gentleman: Blah blah blah, glory of Sparta. Can I join your army?

King Leonidas: Ha ha ha, silly Quasimodo! You cannot be a Spartan. The strength of Sparta is in the phalanx -- which conveniently we will rarely fight in during the course of the movie -- and you're entirely too disfigured to fight in such a manner. For SPARTA!!!

Spartan Chorus: Haroo! Haroo! Haroo! (Or some other unrecognizable noise.)

Persian King Xerxes to cripple: Hey, dude, bow before me and I'll make you pope!

And credits.

Hopefully all the above examples make my case for me. Some words should not be said. And if they are said whoever says them should certainly get what's coming to 'em. The Supreme Court cerca 1942 demands it!

The Gaping Chest Wound Dove

There are few reasons for which I would travel to Houston. A million dollars, my upcoming Step 2 CS exam, on my way to some greater destination, true love. Perhaps in such situations I would begin to think about it. There is one situation, however, in which I would without hesitation pack my bags, put on my drivin' cap, and head on out; and that situation is a trip to the zoo. Until this last weekend I had never been to the Houston Zoo, and now after having gone I am free from that obligation and can once again safely keep my distance. I also visited a college friend and did not visit another college friend, but it turns out people change, consequently friendships change, and well that was that. Let us not get distracted from the matter at hand: zoo.

My college friends aside, my Pediatric intern pal Ro did accompany me and in keeping with previous performance I once again failed to take any pictures of merit. Unlike last time at the USAF Museum, however, this time I didn't so much take bad pictures as fail to take any pictures what so ever. Perhaps one day I will get used to all this. At least I'm remembering to take my camera with me; that's a start. Regardless, the Houston Zoo is nice, but largely unexceptional. Probably would have been more enjoyable had it not been so hot and humid, but I'm fairly confident that's not a meteorological possibility for Houston so I won't hold it against them. There were two memorable experiences, however, which warmed my heart or at the very least amused me.

The first was small child feeding the meerkats cotton candy. His mother scolded him the first time, but once the cute, friendly little meerkats went absolutely out of their minds for the pink confection, she found it in her heart to allow her son to throw a little bit more to the one meerkat that didn't get any. I don't know if the meerkats had had experience with cotton candy or not and were thus able to recognize it for the treasure that it was, but soon as sentry meerkat saw it fall into the enclosure he was all action. Down from his upright position resting on his haunches and scrambling wildly to retrieve his prize, he was followed by another meerkat who just happened to be sticking his head out of one of the many meerkat holes. They wrestled a bit for it. Growled a bit for it. And promptly chewed and licked it all up till, a few seconds later, the sizable cotton candy chunk was gone. It was certainly not natural and certainly objectionable, but yet also oddly amusing. Kind of like tapping on the glass of an aquarium as a kid. You kind of know already that it's probably not good for the fish, but you want to see what happens anyway. Likewise, I think everyone was fully aware that the meerkat diet does not normally consist of highly refined sugar and red food coloring, but, well, we've never seen a meerkat with diabetes before and we just kind of wanted to see what would happen. And then we moved on to the next exhibit.

The other highlight of the zoo, and only one for which I have a photo, is the Bleeding Heart Dove also known as the Gaping Chest Wound Dove, Gunshot Wound Dove, and Cutaneous Fistula Dove. Of all the crazy and beautiful birds at the zoo, and they had a remarkably extensive collection to their credit, this was the coolest. The little earth-bound bird's name was true to life. I'm not sure what evolutionary purpose it serves -- perhaps predators do not want to mess with something that can take small caliber rounds to the sternum -- but whatever the cause, it was one impressive bird. And now for your viewing pleasure, my "best" photo of Gaping Chest Wound Dove:

Gone a Soldiering

After a two year long hiatus I have once again incorrectly donned my BDUs and headed off for a brief active duty tour with the United States Air Force. Zoom!

Wright Patterson AFB in Dayton, Ohio, is an immense installation occupying a large portion of the surrounding area. If you look at it on a map you may think, "dang, that's a big base." Well, not quite. The area encased by acres of razor wire and blocked off gates is indeed quite large, but it turns out its mostly well watered putting greens and hazardous sand traps. Aside from the hospital it seems that much of the base is offices and golf courses. I can't complain, though, the less personnel there the less likely it is anyone will notice I've almost completely forgotten what I'm doing. And they have the most unbelievable wooden playground I have ever seen. Some day I will make a pilgrimage with my own kids here; it will be glorious.

One of the greatest truths I feel about the military is that it does the best with what it's got. Sometimes this is quite a lot, and sometimes it's not much. In this modern era of ours medical doctors are frequently somewhat hard to come by generally speaking, and this shortage is particularly acute for the armed forces. Few doctors want to undergo further teaching, testing, and training all for a bit less money and with little say on where they get to live only to be yelled at in the end that they're doing it wrong. As a result the military frequently has to go out of its way to limit the extra burden it places on its new recruits and so sends them off to things like Commissioned Officer Training (COT) hoping in one month to teach them everything they need to know about being in the military. The end result is perhaps a few more doctors, but they're all doctors that march crooked and salute funny.

And so with this in mind I returned for another month of the airman's life with a significant degree of anxiety. I was reluctant to leave my hotel room -- more formally known as the Visiting Officers Quarters -- for fear that I was doing something wrong and when I did do so I made sure I moved as efficiently and discretely as possible so as to avoid attracting any attention to myself. Thankfully the hospital, as it is itself composed of mostly high ranking COT medical graduates, was particularly laid back, but even there I was not free. On the first day I got ten demerits for having with me the wrong colored backpack and a week or so later I received a couple more for wearing my hospital ID attached to my BDUs outside the hospital's doors. Aside from these few infractions, however, I was mostly safe and within a few days was once again at ease. I did have one last incident of note, though, involving twice running into the same foreign military officer and not knowing what to do either time. Do you salute? Does he salute? What rank is he anyway? Are those stars? He can't be a general; looks too unimportant to be a general. Why do all these foreign uniforms have so much flare on them? Is he staring at me? Oh god, now what? Stare back? He's not moving. Keep staring. Stare harder. Now look away. And... pass. I still have no idea what exactly I was supposed to do, but after awhile I've learned you get comfortable with that feeling.

Anyways, the Air Force business aside, the residency program was, I felt, not so bad. The hospitals looked fairly nice, free food at the awesome Miami Valley cafeteria, much more attractive nurses than down in San Antonio. What was disturbing on the other hand was the people involved. Although I don't think any of the attendings were bad people per se, many of them seemed to feel obligated to have an uncomfortable, unpleasant working relationship with their residents and interns. The residents seem to have gotten used to this. The interns seem to have become depressed. I honestly felt an air of melancholy while I was in the hospital. The place just seemed unhappy.

My interviews were mostly a huge waste of time. I suppose many of the staff need to get at least a rough idea of my personality, but that's all they got as few questions were asked and each session was mostly a brief conversation and a good series of hand shakes. One of them didn't even ask me any questions aside from how I was liking my rotation. What bothered me, however, was not the general silliness of the interviews with the Air Force folk, but my one interview at Miami Valley. The woman knew nothing about me aside from the limited information on my personal statement which was short and vague in compliance with the military's requested word limit, and yet she chose to ask me, "are you the first doctor in your family?" "What makes for a good attending?" "What do you like about our program?" What do I like about your program?! Uhh, pass? I don't like your program. I wouldn't be applying for your program if I was not limited to it and two others one of which was recently destroyed by a hurricane. How about your cafeteria, that seems pretty nice. Do you actually want to know anything about me? And so our interview went. Thankfully the other fourth year HPSP student I interviewed with felt much the same. If I'm gonna be arrogant and presumptuous at least I can be arrogant and presumptuous with friends.

My interviews aside the rest of my stay was mostly joyous. The Uniformed Services University of the Health Sciences (USUHS - pronounced "yoo-shuss") students were all for the most part friendly and cordial. Went went about town most weekends, listened into the Sheryl Crow concert (who knew the woman had so many famous songs?), and even visited the much talked about Oregon District (in Ohio Oregon is apparently pronounced "Ore-eh-gone") which consisted mostly of scarcely occupied bars and adult erotica stores. I also made it to the USAF Museum; a surprisingly enjoyable and interesting experience. Also a ridiculously difficult place to take pictures in which, combined with my naturally poor picture taking abilities, produced some pretty crappy photos. Ohio, as a whole, I feel is not a bad place to live. I wouldn't mind coming back the residency program notwithstanding. It's definitely different than San Antonio, though the obesity's the same, but in many ways it's an enjoyable different. We'll see what the Air Force says.

As a final thought, it seemed most streets on base were not named with historical figures, important geographical landmarks, or really anything the least be significant or inspiring. Instead they were things like Evergreen Wood and Doe Brook. If ever tasked with naming the roads on the base I end up at I'm definitely going to be living on Exploding Freedom Avenue.

Pictures!

Oh, and it turns out I do like Infectious Disease after all.

His Culinary Excellency Presents...

After extensive training and a rigorous application process I have finally obtained the long coveted title of His Culinary Excellency from one Tyler Jorgensen. Although I'm not sure if he's accredited, the honor is an honor nonetheless. Mostly, though, I'm just happy I managed to make a couple dozen enchiladas and tacos without losing any fingers. The pleasure of ordering about assistants was delightful as well.

The Mexican feast aside, the rest of the weekend at Tyler's lake house was super. Not much happened, but I believe that's what's supposed to happen at a lake house. Angie smashed up Tyler's croquet set and I learned I cannot ski to save my life. The end.

And now for some photos....

Valerie and Tyler's pics

Paul's pics

Rachel's pics

Asstreasure

Is this picture awesome or what? Yes, that was a trick question. The answer is this picture is double awesome. Two times more awesome than anyone can be expected to handle. Believe it or not, my friends, but that giant glowing orb is the moon. Although it may appear to be the sun or a thermonuclear device, it in fact was a near full moon rising above the rocky crags of Chisos Basin in Big Bend. I do recall actually saying " what the hell is that?!" after initially suggesting to Annie it was some sort of freaky cloud. Amazing.

Anyways, to asstreasure. No real purpose to this post. Just wanted to share the picture and a brief amusing story. I've been working for about the past hour on my personal statement for the Air Force residency match -- which, true to military form, is a uniform, boring, and strangely rigid in organization and structure document -- when I realized the thesaurus tab on the right side of my Microsoft Word had "asstreasure" planted right in the search box. As I have been working in the visiting officers quarters' "business center" along with 3 or 4 other people sitting directly nearby anyone who cared to steal a glance would think, "that man is looking for a synonym to 'asstreasure!'" The reality of the matter is far less amusing. A long story short, I had been searching for another word for "strength," and the eventual result of my fruitless search, disorganized cutting and pasting, and laziness was that somehow I had combined in the search box the word "treasure" with the first part of the word "asset." And now everyone in the Air Force thinks I'm a butt pirate. Thank goodness for Don't Ask, Don't Tell.

And now when I do spell check blogspot conveniently highlights every instance of asstreasure. Fantastic.