I'll Vote for You, and You, and You

Tonight was a slow night on television. Which for me essentially means there was no Wipeout, American Gladiators, the Office, or noteworthy cartoons on air to watch. As a result I found myself tuning in to watch the Democratic National Convention. Curious, I switched back frequently between CNN's broadcast of the program and Fox News's broadcast. Not surprisingly there were differences. Although I cannot say this is by any means a comprehensive or even fair assessment of the two shows -- there was little rhyme or reason to when and why I changed channels and there were no standardized, scientific measurements of bias -- but the atmosphere for great parts of each presentation was clearly, significantly different. CNN gave much greater coverage of each stage of the convention where as Fox News frequently looped back to Sean Hannity who aggressively and incessantly attacked Obama as he is want to do. CNN's commentators, it appeared at least, got more caught up in the pageantry and excitement of the convention than Fox's commentators who seemed much more detached. (Likely having something to do with the fact of where each set of reporters were located: many of CNN's at the convention and many of Fox's outside it.) And where as CNN referred to Obama simply as Obama, Fox News took the time to clearly enunciate his full name, Barak Hussein Obama, at least once. Hmm. Alright. I look forward to watching the Republican National Convention next week.

I look forward to watching the Republican Convention for other reasons too, however. Better reasons. That's because for the first time in my short tenure as a registered voter I do not feel as if I am voting for the lesser of two evils. I do not feel as if I must grugingly chose between two leaders who will both likely lead us into mediocrity at best or calamity at worst. I am, for once, not tempted to vote for Nader. I am, I am surprised to say, happy with not just one candidate but both candidates. This is not to say I fully agree with both Barak Obama and John McCain. That is of course not even possible. I disagree with both of them on many things and on many things I agree with neither. They don't have all the answers like do. But I do feel that both men are honest, hard working, and intelligent individuals earnestly striving for what they believe to be the best for their country. In a country where politics is all too often politics and little more, these two men, I believe, have remarkably, truly, put their nation first. I was not intending on watching the Democratic National Convention, and certainly not on writing about it, but after watching a good share of it and observing McCain's congratulatory commercial I felt led to. Partially just to make a Nader joke, but mostly to record one of the few times I have been particularly excited to vote for the next president of the United States. Many people have often considered my views on the world negative -- I won the "Most Cynical Award" on my high school college trip -- but I have always felt myself to simply be a realist. And now, for once, I am really happy for our next chief executive. Whoever it may be.

Suck it, Emirates!

If I may be profane for a second.

Thank you.

Finally! After some six months of continuous effort, multiple phone calls, two parcels, and over ten emails I have, finally, received my reimbursement check from Emirates airlines for causing a missed flight and having to pay to reschedule! Finally! $100 for me! Generally I am all about fiscal responsibility -- maybe buy myself a nice US savings bond or invest in a mutual fund I'd say -- but, now, I think I may just spend it all on booze and loose women. Just to spite them. As much as a faceless, global corporation can be spited at least. (In all respect the company personnel were always very cordial and nice. Just slowly cordial. Very, very slowly cordial.)

So maybe I'll trick out my new bike. Maybe a horn? Gratuitous reflectors? Those rainbow colored click clack things you stick on the wheel spokes?

A Bit of a Cat Problem

I wade through cats when leaving the house towards work in the mornings. Cats waist high, fifty felines deep; it's a bit of a problem. Thanks to the generous daily donations of food and water by our next door neighbors the local tabby population is expanding rapidly and will likely soon blot out the sun. With cats in such tonnage also comes kitty waste, and that's also becoming something of a problem. For my roommate at least. Although I am not so fond of our not dog friends I do not terribly mind their presence all too much. Laura, on the other hand, seems to have a far more sensitive nose and far less patience. Generally speaking she's a fairly calm and collected person, but under the guidance of her parents who visited recently she has begun a war of attrition aimed at ending the scourge that is stupid, skittish, feral cats.

The solution, initially, consisted mostly of bleach. Lots of cleanser to cleanse the urine smell and burn the lungs of any animal lingering too long on the porch. Our front door briefly no longer smelled of tom cat tinkle but instead like a very heavily chlorinated pool. This was only the opening volley, however, in what was to be a bleach, moth ball, and ground black pepper triple offensive, and the very next day I arrived home from work to find a generous scattering of little white spheres throughout the front yard planters. It kind of looked like it had recently hailed had it hailed only quarter inch sized balls of ice, but the pungent smell of ammonia replaced the chlorinated pool smell making it obvious it was the moth balls. Is it working? I am not sure; I have been headed to work later the last few days and generally speaking the cats scatter to go about their cat business shortly after sunrise, but I believe the Gallos are stockpiling mustard gas just in case.

Unrelated to the current arms race, I took the USMLE Step 3 yesterday and the day before. That's all I got to say about that. If there's any secret police more feared than the HIPAA brown shirts its the Federation of State Medical Boards Stasi, and I fear I have already said to much.

Doubly unrelated, I bought myself a new mountain bike with my economic stimulus check. A 2008 Specialized Rockhopper! Yeah. Awesome. Basically it's a bike, and it's blue. The rest is all kind of muddled. There are apparently about 2100 different mountain bikes produced with varying ill-defined features, and I am pretty sure I purchased the Rockhopper mostly because I just subconsciously thought the name was outstanding. Anyways, consider the economy stimulated! I've done my part Mr. President!

Driven to Drink

Another week of clinic and another week of working late secondary to patient problems in the head. This time it was anxiety and panic. An otherwise uneventful morning clinic was made a good 2 to 3 hours longer by the theatrical shenanigans of one young patient who, medically speaking, was freaking out. This manifested itself mostly through exaggerated breathing which was entirely unnecessary as even when we slapped him across the face with some Ativan and his respiratory rate dropped into the range where the rest of us typically like to breath he continued to have excellent oxygen saturation of his blood. Unfortunately, the fact that his oxygen sats and vital signs were pristine were of completely no relevance to him as he continued to complain of anxiety, shortness of breath, and so on. Why did he feel this way? Who the hell knows. He couldn't say. Why was he still complaining of shortness of breath when he clearly was not short of breath any longer? Beats me. He couldn't say. How was this at all in any way different from the panic attack he had had only two months before in the emergency room? *Shrug* He couldn't say. He just knew something was amiss.

Of course there wasn't. He was just having a panic attack and all this was both consistent with panic attacks in general and past panic attacks that he had himself experienced in the past. We'd done a thorough cardiac and neurological exam, even, probably unnecessarily, ordered an EKG and looked into the possibility of a pulmonary embolism of which he had no evidence for, and we found nothing. Unfortunately, I am not yet confident enough in my nascent physician skills to say, "hey, buddy, get out of my exam room already!" and so we gradually titrated his Ativan till clinic ended, my supervisor came in to take a peek, and we gave him the choice to go home or to go to the ER. Next time I think I'll try grabbing his shoulders, shake, and exclaim, "get a hold of yourself man!" Maybe I can get a clinical trial published out of this.

And so now I drink. Not alcohol so much -- I still generally don't care for that -- but I have taken up coffee. These long hours and frustrating patients mean drinking tea three times a day will not suffice. Who wants to drink that much tea? Certainly not me. The alternative caffeinated beverage list included coffee and soda, but as the idea of a cold Dr. Pepper at 0700 did not sound terribly appetizing I decided to turn to coffee. I had never really enjoyed coffee in the past, but it turns out with a couple creamers and a couple sugar packets most things taste better. Unfortunately it seems even the added caffeine boost of 16 oz of generic Wilford Hall coffee cannot sustain my attentiveness any longer than the actual drinking of the beverage itself which makes me think: maybe it's just the act of doing something during lecture which helps me stay awake? Maybe I just need to keep busy somehow instead of passively listening/staring/dozing off? Maybe I should try milkshakes? I'll stick with coffee and tea for now, but if things continue on it may be milkshake time. And after that? A fifth of jäger? A nice club soda?

Internal Medicine with a Minor in Psychology

My clinic doth run over.

Officially each office visit should take 45 minutes of my time. Recently, however, this has not been the case. Instead I will have three or four 50 minute appointments and one drawn out and draining 1 hour and 15 minute one. This is not because I am just that thorough and kind hearted. But rather because my patients all seem to have a touch of the crazy.

Sometimes it's fibromyalgia with the patient reporting pain here, here, and here. Some pain there radiating back to the first here and sometimes becoming the second here. And that place over there has two types of pain. Oh and my hair hurts.

Sometimes it's chronic fatigue syndrome. Or myalgic encephalomyelitis as my patients like to call it. Or yuppie flu as I like to call it. They aren't the actual patients, their sick relatives in need of custodial care are usually who the visit's for, but patients' families can just as often be as much part of the problem as part of the cure.

Then there's the standard old major depressive disorder. Patient wants to kill himself, doesn't want to talk to anyone about it, and doesn't want to leave the exam room. Of course he didn't come in for depression. No, you cannot get a medicine appointment for a psych complaint. Instead you gotta be sneaky crafty. Don't want to ruin the surprise.

And lastly there's the undiagnosed bipolar patient talking incessantly, not answering questions, and generally providing no relevant information about his ailments to do either of us any good. Feel free to leave before I return from consulting with the staff physician about your diagnosis. It's not like you came to the clinic for medical care because, actually, I am still not sure why you came to the clinic today.

All in all it makes clinic interesting and for me leaving the hospital at 1900 or 2000 at night. The immediate frustrations aside I do not mean to convey that I dislike psychiatric patients -- and two of the disorders aren't even psychology related really. Crazy people are people too after all. It is just that I don't have enough time to take care of all the problems which actually threaten life and limb let alone the hours extra needed to take care of the problems brought about by bad humors and forest gnomes. I am training to become an internal medicine physician but to date it seems my end expertise will be that of a psychologist / orthopedist who occasionally dabbles in the diabetes and the common cold.

***As a general disclaimer: though I in general like to try and be an honest guy, with all the rules these days and the rise of the HIPAA fascist state I must resort to vagueness, generalizations, and outright lies when it comes to recounting my patient stories. Don't want to breach any privacy here and I definitely don't want a summary execution without trial.***