Beware Greeks Bearing Gifts

The Air Force giveth and the Air Force taketh away. All for national security reasons no doubt.

Recently I was given the “opportunity” to “be recognized” for all my “hard work” researching by working harder in order to summarize succinctly all said research on a not very conveniently sized laminated poster. This poster would then be displayed briefly in a room somewhere for people to pass by with indifference. For those not so easily persuaded, the best poster presented would earn the presenter a trip to Toronto to the national American College of Physicians (ACP) conference to take place in the spring. Being the eager, young resident that I was I presented my research like a sucker.

And I won. I won the research poster competition, and so qualified for the national ACP conference and, more importantly, a few days off work in order to attend. Or so I thought. It turns out I won nothing of the sort. Unbeknownst to the majority of us it seems there is a clause that if there are heaven forbid too many winners from our program only the power point research presenters actually really “wins.” Truly we were all winners, yes, but the winner that got the prize was not me. In all fairness I only competed against other Air Force medicine programs and so had a roughly thirty-three percent chance of winning just by showing up and affixing my name and a doodle to a 3x5 card – which in restrospect is what I should have done – but I was not too happy. As consolation prize I was given a plaque, a hardy congratulations, and an offer to return to work promptly to resume my prior duties. Those duties being on call. I would have liked going to Toronto and I would have liked not thinking maybe something nice could happen for my efforts, but Canada’s full of lumberjacks and grizzly bears I hear and nothing builds character like profound disappointment so perhaps it's all for the best.

Meanwhile the research train continues. Where else will it take me? I can only wait and dread.

Eureka

After years of fruitless endeavor and untold hardship our efforts have finally paid off. We have found it. Where others have failed, we have overcome. Where Cabot and Cartier floundered, we have flourished exceedingly. Where Frobisher and Hudson were led astray, we have stayed on course. Where the combined treasuries of the Europe's monarchies came up empty, we have had success overwhelming. Etcetera, etcetera; the Northwest Passage is ours!

It took three voyages and countless man hours, but on the third and final trip, in the two thousand and nineth year of our Lord, we came upon the hallowed land long last. After years of searching, a route from the Vistana downtown (star B) to Olmos Basin Park (star A) via the northwest route* was finally discovered. A bike route free from coarse winds, perilous icebergs, and large poorly driven motor vehicles does exist! The first ill-fated voyage attempted the most direct route via the southern terminus of the park but resulted only in scurvy and discord at the heavily trafficked and unpassable Hildebrand Avenue. The second venture, only a few months later, similarly ended in disaster as the expedition was set adrift chasing empty trade wind after trade wind trying to approach the basin from its eastern summit. The most recent voyage would likely itself have ended in calamity as the intrepid explorers sailed dangerously north on their attempted western approach, but steadfast spirit and a trusty sextant allowed for the charting of a new course and the safe arrival at the appointed destination. A poorly maintained mountain biking trail littered in trash.

On the safe return to harbor raucous celebrations broke out. Crates of beaver pelts were unloaded, plans were made to subjugate the local indigenous populations, and war was declared on the French. The triumphant bike was placed in dry dock in the apartment storage room while the crew retired to a triumphant dinner of burgers and shakes at Freddy's. Trade with Russia is expected to pick up shortly.

Charted route: Third Voyage

* Nevermind that the route is not actually so northwest. It certainly *felt* like I was going northwest.

It's Just a Shot

Yesterday I got my H1N1 influenza vaccination. So far so good. It started with some sniffles but I believe my transformation is advancing along nicely. Soon I will be a government super soldier complements of classified, black document bioengineering. Unless I got my conspiracy theories mixed up in which case I'm becoming a remote controlled, Manchurian candidate. Or maybe a disfigured, brain-craving zombie? Teenage mutant ninja turtle with Guillain-Barré? At least I know no microchips were placed as I received the FluMist nasal spray instead of the injection, but maybe the nanobots burrowing into my brain would just have me believe that. Either way, whatever the result, I am comfortable with the knowledge that I am protected from the swine flu and any other man made virus monstrosity the Chinese government throws at me. Man, my DNA hurts.

Turkeys

Had Thanksgiving at Team Crabtree's place last week. It was, mostly, delicious, and the time was, mostly, a good time. Wanted to share a few pictures. And hate on a dog.

First, the board. The central hub of organization and scheduling. Why Adam and Ashley have a gigantic white marker board I am not entirely sure, but it came in handy when we finally started preparing dinner at 1100. Plus how else would we have remembered to dress Spanky the Chihuahua?

Second, the fixins. After hours of labor -- Ashley's not mine -- we finally had ourselves some food. From top going clockwise we have the cooked parts of the turkey, the less cooked carcass of the turkey, "rolls", my attempt at some sort of candied yam thing, some tasty stuffing, mashed potatoes, green beans, creamed corn soup, and a ceramic bird full of gravy. All in all a good dinner aside from a continuous background chorus compliments of Sparky the Chihuahua.


And, lastly, the what the hell is this? If you guessed Nerf football cut in half and placed in a Pyrex baking dish you would be only partially correct. For reasons unknown squash was on the menu until a prolonged bake yielded this. A very comfortable bike seat. Due to unforeseen complications in preparation the squash was ditched in favor of eating Patsy the Chihuahua instead.

For more Thanksgiving photos including pictures of Cupcake the Corgi, Sushi the... some sort of dog, and Spunky the Chihuahua; check it out! The rest of the weekend was spent playing video games. Just as the Pilgrims did back in 1776.

My Nation Calls

Today I gave my yearly urine sample for the standard military drug screen. In light of past years difficulties I actively prehydrated. And then prehydrated some more. After an unreasonably long period of time I was finally able to give them what they wanted, and I've never stopped peeing since. I am not sure how much water I drank exactly, but I believe it would be measured in buckets. Or perhaps barrels if we were talking small barrels. I anticipate the urine flow to taper off sometime in early December assuming I don't slip into a hyponatremic coma first. Until next year.

In other news they built an IHOP underneath my apartment. Stay classy, San Antonio.

(And bring me a donut shop...)

Corn Activities

A few weeks ago we went to a corn maze -- excuse me, maize maze -- and it was... fun? What to say about a labyrinth of produce? Is corn truly a vegetable? Thanks to a handful of flashlights and an excess of clues it was not terribly difficult or very scary. The kettle corn was delicious, however, and they did have a corn cannon with which to shoot corns out of. All in all it took about 45 minutes to complete and after eating a little more corn we went home.

Here's a picture of this year's corntacular challenge!

Standing in Mud for a Song

Last week, complements of Ro, I went to Austin City Limits. Without exaggeration it was the hottest, sweatiest, and muddiest I have been in a good time. Which, coincidentally, makes for a pretty good time. The temptation to slip and slide about the muddy knolls was present but I remained dignified. Plus no one else was doing it.

Although the two bands I truly wanted to see, Dave Matthews and Flogging Molly, had played the day before, I still got to see a bunch of bands I had never heard of (David Garza, The Dead Weather, and Heartless Bastards) and two bands I had heard of but, really, never heard (The Toadies and Pearl Jam.) It turned out one of David Garza's band mates also apparently does hula hoop tricks? By the end of the evening when Pearl Jam finally came on for their two appointed hours we were shoulder to shoulder with countless thousands of other people in what was likely the greatest exchanging of germs the nation has seen in years. I may or may not have been standing on top of someone. I definitely got to first base with the back of the dude's head in front of me.

Despite knowing all of only three or four songs, Pearl Jam was still pretty great. There was not a whole lot in the way of pyrotechnics or special effects, just deafening music that gave me phantom vibrations and tinnitus for about three days afterward. Crowd surfing was attempted but resulted in the guy being thrown over a shoulder and promptly into the gack, and moshing was impossible due to the complete inability to shift one's body weight. Live music it seems is powerful stuff even if much of it is unintelligible. I suppose that's why any respectable nationalist uprising or religious revival always has a good chorus. Post concert we ate at Wendy's -- and I do believe even the food tasted better.

The Pushiest Dog

Last week I house sat for some friends. After eight days of drinking all their Dr. Pepper I called it and went home, a resounding success. Aside from a brief visit from the police due to my inability to effectively turn off the alarm system the stay was uneventful. What was eventful, however, was their dog. Or rather, dang that's a pushy canine.

My friends are the proud owners of a Siberian Husky -- Sienna. How it survives in San Antonio I am not entirely sure, but I believe it hibernates in the freezer from the months of June to September. Although friendly and unassuming in appearance, she has the perseverance and single minded focus of... a Siberian Husky? Perhaps a very focused and relentless Siberian Husky. Regardless, when she wants her walks she will let you know, and she wants her walks all the time. My daily strolls proved insufficient, however, and so every afternoon upon returning from work I would sit on the couch only to be repeatedly, in 3-4 minute cycles, interrupted by a very eager Sienna. Typically she would bound up to the couch, get as close to me as possible, make a few mildly disconcerting-sounding dog noises, and then spin in circles a few times. If ineffective she would either then give me peace for a few moments or proceed to lick my legs. If I refused walks this loop would then proceed on for hours. And If I gave her walks then it was time she let me know she wanted to play, the whole process repeating itself. Unfortunately while her need for walks was satisfiable enough, her need for play was a little more difficult to meet. Considering she seemed happiest just jumping around the living room, though, perhaps she was demanding less play and more frolics.

Sienna aside, there were two bulimic cats to take care of as well. Thankfully they were relegated to the lower level of the house. Whenever I ventured to the kitchen, though, I would be welcomed by their incessant meowing to be fed no matter the time of day or time of most recent feeding. I would have happily fed them to their early obesity-related demises had I not been warned that overfeeding leads to throwing up behind the furniture so instead I agreed to ignore them and they agreed to keep meowing whenever I went downstairs.

The similarity in tactics shared amongst all the household's animals may not have been purely coincidental, though, as near nightly the dog would amble over to the top of the stair case where one of the cats would be waiting. After exchanging greetings or stares or telepathic cartoon thoughts, whatever, the cat would then carry on a 1-2 minute lecture during which, presumably, Sienna would take careful mental notes for the following day. I broke up one of these pow-wows one evening more out of curiosity than anything else, and the next day I returned from work to a 30 gallon bag of down feathers torn up and strewn about the living room.* A word of warning I dutifully heeded. No way I'm going out like a strange plastic bag of feathers.

I will admit though. As much as I at times wanted to, and sometimes did, yell at the dog to leave me alone, and as many times as I teased her with the leash when it was walky time, I miss her a bit. Dogs are one of the few animals that seem to make us love them more even as they drive us further crazy. She's a good dog, that Sienna. Her friendliness; her pushiness; her beady, red eyes and all.

* The destruction of the bag of fluff may or may not have happened after my pet conference interruption.

Internal Medicine: After Dark

I just finished Night Float. It was crap. It turns out taking care of people with the lights out -- though much like taking care of people with the lights on -- is much less rewarding. I should have seen this coming considering the omens. Within the first five minutes of the first shift my intern lost an eye to the tarp covering the scrub stacks. He was only briefly incapacitated and was left only with a small bruise on his eyeball, but for a short moment I was torn between resuscitation and calling to find his back up.

Anyways, Night Float. Six times the number of supervisors with none of the actual supervision. Plus medicine consults, plus 72-hour consults, plus out of hospital transfers, plus morning report, plus an endless cycle of freetriplescore.com commercials on late night TV. Add to all those new responsibilities a generous supply of next day second guessing and general orneriness from the primary teams, and myeh. Truthfully, I would of rather been kicked in the junk. Now we'd have to haggle over the details, but nevertheless, do it again, kick me in the junk.

The hours themselves weren't that bad mind you; I actually slept rather well. Similarly not knowing what meal to eat at any particular time of day was disorienting but three breakfasts in a row never hurt anyone. My interns were both by and large good, solid citizens, and work load wise we truthfully got off relatively light. It was just the nature of the job, of being subject to a multitude of divergent interests leading to an inability to sufficiently satisfy any which made Night Float a lonely, thankless task. I suppose it developed character, but only if paranoia is a character trait.

It's done and over now, though. May we never do it again.

Exit 25

This past month I earned my Geriatrician Merit Badge. In order to do so I had to start five campfires, diagnose ten cases of dementia, and administer twenty-five Exit 25 interviews. Thankfully the second and third tasks are related as it turns out there is no better way to diagnose dementia then to disorient the elderly and there is no better way to disorient the elderly than the Exit 25 exam.

Although the most recognized and often feared aspects of dementia tend to circle around the increasingly noticeable memory loss that slowly penetrates the minds of the afflicted, this is not the truly incapacitating aspect of dementia and the scare is only superficial. Memory loss makes life inconvenient and tends to sap away from us much of what makes us unique individuals, but it by itself does not lead to the helplessness commonly seen in demented patients. If you or I are forgetful we simplify tasks, standardize routines, write down lists and so on. There are a variety of ways to compensate and people are adaptive animals if nothing else. What truly makes dementia a terrible disease is its effects on executive function: our ability to plan and act. Without this there is no ability to adapt and, as the disease progresses, there is no ability to lead a normal life. Young children often have wonderful memories, it's the poorly developed frontal lobes which make them act as young, dependent children. And so that's why the Exit 25 interview was developed.

The Exit 25 is a series of twenty-five questions designed in a variety of ways to primarily test a patient's executive function and cognition. And it does this -- it seems -- primarily by disorienting and making as uncomfortable as possible the target of the interview. Although some parts are fairly standard consisting of the "remember these 3 objects" and "repeat these phrases," many are not. They range from tests of primitive reflexes and learned behavior by pushing and prodding on the patients' hands and arms in a variety of manners (and also tapping on their lips) while continuously telling them to "just relax", to asking them to stick out their tongue and say "ahh" for an uncomfortably long period of time, to a series of complex hand maneuvers that I still have not quite completely mastered myself. The best parts, however, are the ones I can rarely do without laughing.

The first is simple enough. Complete part 19 and then suddenly and without warning clap closely and loudly by the patient. If they do nothing but eye you curiously then they're in the clear. If they look about or motion uncertainly that's one point on the dementia scale. And if they clap back at you, a phenomenon called echopraxia, then it may be time to take the credit cards and car keys.

In a similar vein, the best portion of the test also consists of an abrupt, awkward transition from regular questioning. Part 10 is followed by a three second silent stare into the eyes of the interviewee followed by a polite and matter of fact "thank you." If the patient responds with a questions like, for example, "what the hell are you doing?" then they're good. If they again get anxious and flustered that's one point against them. And if they say, "you're welcome," well it may be time for a death panel consultation. My favorite response to date has been a panicked, "is this part of the test?! Is this part of the test?!" with simultaneous darting of the eyes to every part of the room.

In all seriousness the Exit 25 interview seems to be a consistently effective tool for screening and monitoring dementia, and will likely be an increasingly important one as it is more extensively used. Unfortunately I always feel bad doing it on my patients. It also takes a good twenty minutes to complete the whole bloody thing. Considering the main measure seems to be confusion and disorder, I almost feel as if yelling and shaking a gnarled stick at the elderly for a minute could have much the same sensitivity and specificity at a fraction of the cost in time. It's a shame I won't be going into geriatrics; I could have revolutionized the practice.

The best part of geriatrics was not terrorizing the elderly; however, it was the absence of call and two day weekends. Beautiful. And the worst part, conversely, wasn't trying to then persuade demented people that they were in fact demented, but rather the senior citizen two handed handshake I now find habitual. For whatever reason I found myself clasping with both hands the single hand of patient and/or accompanying family member in a gratuitous gesture of friendship. They seemed to appreciate it well enough, but some of my colleagues not so much. Men weren't meant to double hand clasp the hands of other men, and many a muffled look of befuddlement has been exchanged between myself and another as a result. It is either a sign of my great empathy or my folie à deux that I have become more like the elderly in treating them. Or perhaps it's just two more points on the dementia scale.

The Long Delay

Intern year is done. Let us reflect.

The best way to describe my sentiments on residency to date is: one long delay. For three years my life will be on hold and, hopefully, once these three years are over with I will emerge from hibernation three years older, a little smarter, a little slower, and a little more grizzled; ready to live my life once more. Aside from the rapid accumulation of medical knowledge I do not anticipate this experience netting me anything of significance. Which is a shame, because most of it has nothing to do with residency.

Don't get me wrong. I dislike residency as much as the next medical resident. It's just I don't have very good reason to. Aside from my ample complainings already documented, it ain't that bad. Things are busy and the hours are long, but not so long as to preclude a life outside the hospital for those with enough pluck. Unfortunately that life never seems to have taken place. I don't often do the things I like for lack of like-minded friends, don't often spend time with good friends for lack of common interests, and my chastity has never been less questioned. I got no God, no dog, no woman, waning patriotism, and little time or idea where to find these things. I'm not sad or mad, just frustrated. I've got it good -- That is one thing I do know even if I don't always feel it -- but unfortunately blessings don't necessarily a good life make. And so I wait. Twiddle my thumbs a little longer, hold my breath a little longer, futz around a little longer. (Longer with Big Red!) Keep going to work because that's what I do, and keep going home because that's where I live. I wait for the job to reset, friend pool to refresh, and for the time to once again look forward to something.

So that's how I feel about intern year. I did a lot of things, and then I moved on. End of Act One.

At least I got money. Mmmm assets....

A picture from my apartment. If only I had a balcony. Or a little gratitude.

A Profit Motive for Your Life

Eddie Spaghetti is a man of means. Looking to multiply those means he looks around for a good investment. Upon doing so he discovers Jose Conseco's Steroids and Bats Emporium. Jose, wanting to expand into the baseball business as well, is in need of some fresh investment capital. They talk, they sign contracts, and shortly Jose Conseco's Steroids and Bats Emporium becomes JC's Steroids, Bats, and Balls Super Center. The very first day Joe, Mo, and Flo all arrive in need of steroids, bats, and balls respectively. They collect their products, pay the cashier, and the transactions are completed. Everyone is happy; it's a fine business. It is not from kindness that Jose sells Joe, Mo, and Flo their goods, however, nor the charity of Eddie which leads him to lend money to Jose, but rather because what they all hope to obtain from the deal: profit. It is the profit motive which compels them to act, and it is the profit motive which makes them good people.

Eddie Spaghetti, now enriched, looks for another business opportunity. He finds Darryl Strawberry and his Baseball Glove and Medical Insurance Warehouse. Looking to expand, they talk, they sign contracts, and shortly D. Strawberry's Baseball Glove and Medical Insurance Warehouse expands into four neighboring territories. The very first day Joe, Mo, and Flo arrive at the store all coincidentally in need of health insurance. They peruse the options, discuss with the agent, and the transactions are completed. Joe and Mo leave with insurance, but Flo does not. Flo, it seems, is from San Antonio and her diabetes, polycystic ovarian syndrome, hairy chin, and compulsive cigarette use have precluded her from being insurance eligible. Mo has chronic medical issues himself, having lingering lung problems from contracting tuberculosis while working in the Peace Corps years back, and so has to pay a higher premium, but he is simply happy to have any coverage at all. That year Mo's tuberculosis, thought beaten, returns and is found to be multi-drug resistant. Due to pre existing condition exclusions and high copayments Mo is later led to file for bankruptcy. Some people are happy, some people are not; it's the health insurance business. It is not from the stinginess of Darryl that he denies Flo coverage, nor the greediness of Eddie that leads him to reject the claims of Mo, but rather because of what they all hope to obtain from the deal: profit. It is the profit motive which compels them to act, and it is the profit motive which makes them bad people.

As often stated I make no claims of being an economist. I did my two semesters in college, found them to be moderately interesting, and then moved on. Pareto efficiency and fiduciary relationships tend to give me seizures. Thankfully, the economics of health insurance are relatively straightforward. Whereas in most industries the profit motive spurs towards better products for less money produced more efficiently -- by practically speaking reducing costs and competitively pricing -- this is not so with the business of medical coverage. Instead in the health insurance industry product supply and demand are both constrained by the nondiscretionary nature of most medical care, cost management is limited by the science of medicine, and negative selection drives insurers to discriminatory distributions of coverage. Practically speaking, profit is obtained by maximizing coverage of healthy people and minimizing coverage of the sick. This may work for a large percentage of the population that is healthy or only mildly ill, but it will never and can never succeed in providing adequate care at reasonable prices to that sizable segment of the population with serious, chronic medical disease or the significant portion of the population that will find itself one day burdened with the same. It is not because of lack of competition nor lack of compassion, but simple, straightforward economics. You can not make money off of a Down Syndrome child and there is no profit to be had from lymphoma and leukemia.

And so socialism.

Socialism as a theory is currently empty. It is no way to run an economy. Nevertheless, there are lessons to be learned and numerous possible isolated applications to be had, and it is essential that we as Americans, with our historical fear of anything smelling of communism, remember this. Especially in our current and likely numerous future debates about health care. Socialized fire protection, socialized police security, socialized national defense, and socialized park systems are all industries long since collectivized, and happily so. Although there is today some debate about further privatizing education and many utilities the fact is for most these industries' histories they have contributed to a better and more prosperous nation and even today they continue to provide reliable, cost-effective business to those desiring their services. Few complain that the police department has a monopoly on preserving domestic order or that there is no competition to watch over our parks and maintain our monuments. Whether we realize it or not, we are in many ways a partially socialized nation already. Somethings are best tackled in spite of any profit that can be derived.

Such it is with health care. We can tweak and adjust, modify and massage, hope and pray, and we will never find a comprehensive solution or even a partial coverage solution at a reasonable price using private coverage. No matter how deductibles are calculated or plans are managed, medical insurance will remain expensive and outside the hands of a good number of people. Even Obama's hybrid system that satisfies no one and confuses everyone will not likely significantly change things. Universal coverage on the other hand abandons the false pretense that money can be made providing adequate health care and simply focuses on doing the best for the most with what we've got. It will certainly add some to our waits and reduce some efficiency, no doubt, but what do we have now? Our hospitals are already full, good people already fall through the cracks, care is already being rationed. Without the burdensome bureaucracy that accompanies herding a dozen different insurance programs and without the waste pervasive in the system as a result of poor communication and repeat testing the added costs would by most calculations likely be minimal. If the entire rest of the Western world can get by doing it -- if the French and the Italians can manage it -- certainly we can do one better. In the end universal health care is much like democracy; it is not a great option, but it is certainly the best one. There is, unfortunately, no "good way" to take care of people. And nothing makes this more clear than the economics of it all.

The OECD, US, and health care.

Medical insurance and bankruptcy.

Conservative case for universal health coverage.

Socialism!

The Great Pee Pee Mystery

Today, from roughly 1100 to 1700, I waited for an old man to pee so that I may take it and look at it under a microscope. Around 1715 I was given word that the long awaited urination had taken place. Briefly taking care of other urgent matters, I attended to my wee sometime around 1745 only to find it was nowhere to be found. Some masked stranger had run off with my urine. I asked the nurse, she didn't know. I asked the patient, he said "a doc" took it. I asked my interns, they were clueless. Somebody, for whatever clearly no good reason, had absconded with my wiz. I was upset. Although few will every appreciate this, there are few things more frustrating then waiting an entire day for urine only to have it disappear. Nevertheless it seems to be the running average for Williford Hall these days. Most labs get sucked up by gremlins in the vacuum tubes, most daily radiographs become every other day radiographs by the x-ray tech fairy, and half of our electrolyte panels seem as if the masked stranger himself is urinating in them yielding the wildest most ridiculous and inaccurate of results. Wilford Hall, you're too much for me. I don't know what to do with you.

Someone will pay dearly for the pee, though. Someday I will have my revenge.

I Should Have Been a Christian

I love the ladies, but the ladies, well, apparently they don't love me.

Or at least so suggests the informal polls that are Match.com and E-Harmony.

After six months of the former and three of the latter, it can conclusively be said that we, myself and the ladies, can both do better. By and large the women I fancied did not fancy me back, and by and large the women who fancied me seemed to be either entirely unaware of what was written in my profile or not particularly picky in their mate. It appeared that most of my attempts failed at or shortly after introductions, and most of their attempts never made much sense. Why women who did not share my interests or goals or even any of the "what I am looking for" criteria would think we would have any significant romantic connection is admittedly a bit beyond me. Perhaps there's intimacy in having absolutely nothing to talk about.

My failed attempts at wooing aside, the greatest realization I came to amongst all of this woman hunting is that perhaps I ditched the Christian faith thing a bit too early. Although this is an entirely unsubstantiated assertion, it seemed the more a profile directly or indirectly referenced Adonai the more fetching the woman was. (Either there is a significant lack of devout Christian guys leading to a surplus of devout Christian women or religious zeal and Internet access correlate directly with attractiveness and amicable disposition.) Unfortunately, part of being pious for most involves dating only the like minded, something about 2 Corinthians and unequal yoking, so that meant no matter how fabulous and charming I was, or how much I begged and pleaded, further discourse was right out. I was left to choose from only the nonbelievers and carnal Christians. To think, if only I had not turned to empty hedonism so quickly I could right now be enjoying myself some empty hedonism. Oh, Lord, you're an ironic one if nothing else.

This is not all to say that I missed out, though. That I feel somehow as if my experience was incomplete or that I pine for an endless series of what ifs. Perhaps had I still been waving the Christian flag I would have met the love of my life -- I would have at the very least had a larger pool of possibilities -- but I don't care for such perspectives. You do the best with what you got, learn, and move on. I certainly cannot choose my faith or will myself to believe, and I definitely cannot go back in time even if I could wear religion like a hat. But dang, man, there're some cute Christian ladies out there.

So the six months went by. At first I felt uneasy about regularly judging and assessing whether I was interested in someone or not based solely on their profiles and pictures, but this gave way to acceptance, then amusement, and then finally disinterest. It seems the appraising of maidens like all things gets boring in time. I did meet a few girls throughout it all -- a young woman whose every conversation seemed to return to Friends being a lame knock off of Seinfeld and another polite lady whose conversation style consisted of an endless stream of unconnected questions, amongst others -- and I found it interesting to see how different people chose to sell themselves -- it seemed there was a pretty even balance between tomboys with a girly side, party girls with a dorky side, smart girls with a pretentious side, and characterless nitwits -- but the pickings got slim, I got self centered (or rather more so), and so the time came for my departure.

Curiously, the very last message I was to get the day my Match.com subscription expired was from a pleasant young woman from Georgia. In it she stated that she had seen that I had seen her profile (an odd feature of Match.com), and not typically catching the eye of dudes hundreds of miles away she out of curiosity clicked to view mine. After reading it she felt inclined to write a brief message stating simply that she did not see why I was on Match.com, that my profile was not typical of the profiles on the site, and although she imagined it would be a brief venture she wanted to wish the best of luck to me with my search. That was all. Very sweet. Very nice. Very random.

And I give up.

Befuddlement

It was the best of times. It was the worst of times.

Or so I am frequently told.

Frankly, I don't find the times very enjoyable. In all honesty, though, I have no idea how to interpret them. These times apparently be confusing.

Relatively speaking us Air Force residents have got it easy. Compared to the internal medicine residencies of yesterday where interns and residents were shackled to their wards, forced to work while sleeping, and generally treated like so much chattel, we live lives of luxury with slashed work hours, broken chains, and alleviated patient burdens. Everyone always says it was harder back in the day -- and I am inclined to believe them -- nevertheless I am also inclined to believe that back in the day there were infrequent CT scans, no MRIs, only a handful of blood tests, and a pharmacy consisting mostly of a few penicillins, ergotamine, and phenobarbital. Twenty patients ain't so bad when all you can do is lay on hands and hope for the best.

Beyond that we've got it easy in other ways too. Compared to many civilian programs we work less, see fewer patients, are paid better, and likely are showed more appreciation by our patients. And compared to the hobos living immediately outside my apartment at least I have more to come home to than cheap booze and some invisible pets.

In absolute terms, however, residency is so much balderdash. We still work harder, longer, and with less perks and less confidence than the vast majority of Americans. Our job is in its very design constructed to make us feel continuously ill prepared so as to constantly compel us to learn. And through a legacy of estrangement many who teach and guide us have no great sympathy for our lot.

So how am I supposed to feel? Frustrated that it's not better? Happy that it's not worse? Thankful that I get to train for the unique career of my choosing or upset that all I do is train for the unique career of my choosing? I am undoubtedly incomparably blessed, but this particular blessing comes with an odd trial before the spoils. I have no means of measure and so am constantly wavering between emotions; I find myself muttering under my breath perhaps more than is healthy, and am thinking of joining the hobos.

Perhaps they'll let me take care of the invisible cat.

Breaking News

We interrupt the previously scheduled post-election coverage of demonstrations in Iran in order to provide you with this late breaking news:

Michael Jackson is still dead!

Initially thought to have died on June 25th, 2009, a repeat autopsy was undertaken today to confirm that the legendary singer-song writer is still in fact deceased. He is. Further memorials and tributes are likely in light of this breaking revelation. Many have called for an official day of mourning to be followed by a national day of remembrance and a week long world wide candle light vigil. A stirring audio-visual tribute is scheduled for every multimedia awards show to take place for the rest of the year.

We will return to your regularly scheduled program once we have sufficiently beaten this story into the ground.

Welcome to the Circus

For my final act of intern year, a grand menagerie! A collection of things that shouldn't be; a hospital of patients that are not sick! Gather one, gather all to the myth, the mystery, the *greatest* show in history; the last month of inpatient Internal Medicine as an intern!

The Man Without Symptoms!
Straight from Bavaria and to our show exclusively, the man without symptoms! Not a single complaint. Not a single problem. Flawless, painless, soreless and completely disease free; solely in need of a complicated CT scan available only in our very own military institution! Watch as he is not only hospitalized, anesthetized, dialyzed, and lesion localized, but also canonized, exorcised, and cannibalized all over the course of a three day hospital stay. The man has no business being here but because no expense is too small and no admission to the hospital too trivial we will admit him for your viewing satisfaction anyway!

The Respiratorical Horror That Wasn't!
Also for your exclusive entertainment a man so sick, so ill, so reportedly toxic and pernicious, you'll be surprised to hear it's *all* fictitious; the man with a COPD exacerbation so stable it's exasperating! His symptoms are at baseline. His oxygen requirement is unchanged. His breathing is unlabored. He looks altogether all too good; but for a limited time only he will be admitted directly from clinic to receive the same care he'd of received at home!

The Woman that Communes with Spirits!
Next. Born with a terrible gift. A young woman scourged by the Almighty with a supernatural talent lain dormant for centuries. Our very own telegraph to another world. The Woman that Communes with Orthopedic Surgeons! She will be brought to the hospital for reasons unworldly, her care will guided by voices emanating from the very ether, and her entire stay will be determined by a presence heard but never seen! Truly, lads, you have not lived until you have communicated with those not living! Commune with the orthopods for just one shilling! *Never* has health care been so thrilling!

The Amazing Record Player Woman!
Imagine now madams and gents: every day the same thing, every day the same thing, every day the same thing. The next poor woman is bound by an inescapable cosmic cycle to call the police weekly raving of impending robbery at the hands of her neighbors. She is captured in an unbreakable celestial loop to be brought to the hospital on a seven day circuit to be treated for the exact same dementia. She will see exactly the same physicians. Decline exactly the same tests. And be discharged to exactly the same home exactly the same way every time; just like clockwork! It's a rotation so accurate you can mark your calendar by it -- I kid you not! And you're in luck with this one, folks, because if you miss this week's show just come back next week for the encore!

The Phantom Fibrillation!
And if that wasn't enough, friends, gather closer as I speak to you of a phenomenon that some say doesn't exist. A phantasm that materializes only to vanish seconds later. A cardiac conduction abnormality that few have ever seen! The Phantom Fibrillation! The poor bearer of this accursed arrhythmic spirit -- a gentleman from our very own town -- is forced to walk the Earth waiting for his next atrial possession. Come awe at the reports from the ER of his shortness of breath. Then astonish as the same ER reports him to be symptom free! And finally astound as we admit to monitor him, test him, and pursue a workup that could just as easily be done at the cardiac clinic anyway! Now we cannot guarantee that the specters will present themselves, but we *can* guarantee that if they do it will be an event you will not want to miss!

The Golden Crap!
But that's not all. No that's not all at all, folks. Don't even think about it -- not a bit! Our very last act -- our very last sensation, the topic of tomorrow's conversation, an aberration of constipation; ladies and gentleman I present to you the Golden Crap! The man has not pooed for days, some say months, possibly even years! Many have tried to disimpact him but some say he is undisimpactable. He will come into the hospital for one day and one day only to have what many believe will be the most expensive bowel movement ever!

(And cue curtain.)

In conclusion: sometimes my life is like a circus. But with less funnel cake.

Something's Fishy with this Fish

Fish. Some are pretty to look at, some are fun to catch, some keep the jellyfish in line, and it is said that altogether they are all an important integral part of the food chain. Not my food chain, but someone's food chain they say. That was until yesterday.*

Although sushi currently seems to hold the title of "greatest thing ever," I have always personally been under the impression that mankind did not discover flame broiling simply to have another task added to his day and in which to potentially cripple himself with, but rather because he once killed something, immediately took a bite out of it, and thought, "man, there's gotta be a better way." Persuaded at times by family and friends to occasionally question these assumptions I have always been disappointed and have always been told that that particular place either did not have very good sushi or just not very good sushi at that particular time. With odds such as these even if it turned out sushi was delicious I doubt it would be worth the culinary gamble you need to go through in order to get the good stuff.

Similarly once or twice I have deigned to try fried fish under the belief that fried batter makes everything better, and while this is still universally true, better does not necessarily translate into good. Fried catfish and fried Chinese-body-bone-and-eyeballs fish would taste better still without the catfish and bodies, bones, and eyeballs.

I have also since been fed salmon, tilapia, cod, orange roughy, and likely other tasty sounding but not terribly tasty tasting fishes only to be unimpressed every time. Canned tuna continues to be an offense to both my taste buds and my nose buds.

But I had not, until recently, tried ceviche. The thought of adding acid to fish for whatever inexplicable reason just never sounded appealing to me. It turns out, however, that a handful of hydrogen ions and a little bit of denaturing of proteins are exactly what is needed to take the fishy out of fish. I am still not entirely convinced that there was in fact fish in the dish, but I am repentant. I was wrong. I am sorry fish eating people of the world. Fish, or at least the fish served in the ceviche at Rosario's, is in fact palatable if not enjoyable to eat. What else can a little bit of acid improve? Liver? Gibblets? The global economy?



* In the interest of full disclosure. I had actually had one prior occasion where I sampled and did not die from eating fish. The butterfish in Hawaii is actually quite good if you can get all the bones and what not out of it. But come on; it's called butterfish. It's like God was demanding it be eaten.

No Dogs Allowed

My favorite movie as a kid was a toss up between Garfield's Halloween and Snoopy, Come Home. The first was and always will be great even long after Garfield ceased to be amusing to me. The second is possibly the saddest movie I have ever seen. Or, at the very least, the saddest animated movie I have ever seen. The most glaring memory which seems to daily reinsert itself into my thoughts, however, is the line, sung slowly in a deep voice, "No dogs allowed!" sung just about whenever Snoopy tries to go anywhere or do anything in the movie. I will likely go to the grave with that as the chorus in the back of my mind.

This last weekend I felt Snoopy's pain. I was thrown from a swanky Houston club, the Drake, for no good reason at all. Officially it was because of my lack of shiny shoes, but I believe reverse racism somehow played a role. Either my awesomeness or my excellence were clearly being discriminated against here, perhaps both. Although I could not hear it over the thumping base emanating from the club, I believe a distant baritone could be heard saying, "No tennis shoes allowed!" I had even specifically put these not shiny shoes on (and a button up shirt and pants) per the request of my friend, Ro, who I thought had been properly informed specifically to avoid such discriminations from happening. After failed attempts at then going to see a movie and renting a movie -- they were both closed -- we ended up spending the night playing two man Trivia Pursuit until Ro experienced trivia fatigue and began feeding me the answers in order to bring the game to its long delayed conclusion. Clearly the people of the Drake missed out.

In other news, I finally stopped at a Buc-ee's (the Beaver) Gas Station on the drive home just to see what there was to see. It was nice and clean and full of jerky and various Texas themed knick knacks. Oh, and about 3,000 people. I have never before and likely never will again see so many people in an isolated gas station in the middle of nowhere. Although I am not sure, I think this to be a good thing.

"Arrr, I think you be havin' a bit too many peg legs there, matey!"

A Teeny Tiny Place Called Home

Photo Safari!

This is a picture tour of my new apartment at The Vistana. It's located immediately adjacent to Christus Santa Rosa and El Mercado downtown, and is currently home to about 32 other tenants and 13 hobos. The objective of the tour is to catch all the Pokemon.

(click on the photos for extra super huge mode.)




So... say you were to walk through the front door of my apartment. It might look something like this.


Excited yet?

If you were to immediately turn around you'd probably then see this.



Nice.

Now supposing, just supposing, you had turned around on a slightly different axis you would have seen this.



My that chair looks pretty relaxing. And a coat rack slash hat holder? Brilliant.

Here's my kitchen. Or at least the part of it I could merge into one photo without it getting all wonky.




That white box has been there for about 2 weeks now. I have absolutely no idea why I have not moved it especially seeing as how it annoys the crap out of me every time I go into the kitchen. The box aside, though, as you can see I have some lovely black appliances to distract from the fact that I don't have a single drawer wide enough to stash my silverware.

Now if you were to keep moving by, say, oh six or eight inches you would now see this.



My kitchen table now sits three, but seeing as that is two more than it typically ever needs to sit that's just fine. Plus one chair has ready access to the dishwasher. Convenience is a must!

Turning 90 degrees to the right and...



My bathroom. With a hangboard on top of it. Does it go there? Probably not. Was there any other place for it? Certainly not.

Inching into the bathroom you see the antrum of the washroom itself.



Phenomenal. The laundry basket may or may not end up being a permanent fixture there depending on whether I can find somewhere else to squeeze a big yellow laundry basket.

A little wider angle now.




So we got some teals, we got some green, some cherry, some tan. Does it work? Maybe a little bit. This is as good as it gets people.

And at the distal end of my washatorium is the toilet.



What a lovely toilet. Unfortunately there was no room for a bidet.

And of course the shower itself.




The pressure is terrible, but I like my new shower mats. I wish more things were made of wood. This apartment would go from "pretty good" status to "pretty great" status pretty easily if there was just more wood. (that's what she said.)

Having completed the bathroom subtour we head back out.



Goodbye bathroom.

Skipping the kitchen we get to the living room/bedroom/office.




Much like the big white box and yellow laundry basket I really do not have the slightest clue as to what to do with the giant fish. As such its place of rest generally rotates between the bed or the couch depending on which I want to use at the time. In other words, its sole purpose at this point is to inconvenience me. I am taking suggestions though.

Now here's the bed/office from a slightly different angle.




You cannot appreciate it, but the bed, desk, and book shelf are pretty much all wedged together. I think it's a masterful use of space. And possibly a fire hazard.

Here's the window.



I am contemplating adding my hanging garden baskets to either end of the window and possibly even screwing in the window baskets below the window itself. Perhaps that will be plant overload, though.

Here's a Psyduck.



And the living room all altogether now.




Breathtaking. Simply breathtaking. The little picture gallery isn't completely done, and, yes, one of the pictures is upside down, but it's pretty spectacular nonetheless. Even from a distance. Note now the hand crafted coffee table constructed from American pine, refurbished couch with throw pillows imported from India, individually blown glass candle holders created in Greece, and a state of the art 19-inch television entertainment center with DVR. Truly this is lofty living indeed.

Quick look back at the kitchen!



Yeah the kitchen light is partially obstructed by the huge metal air conditioning duct -- yet another way in which this place was not designed terribly intelligently -- but too much light just makes bananas go brown anyway.

Here's the kitchen with the lights off!



The picture sucks, but I threw some Christmas lights atop the cabinets seeing as how there's enough space to support a small family of five up there and this is what it looks like. Amazing -- take my word for it.

And done. Didn't think the tour would ever end? I didn't either. There was just so much to see. Man what a blast.

So who got the Jigglypuff? and the Wigglytuff? and the Kookookachu?

Let Them Use Change

Something interesting. Perhaps.

I heard recently on the old radio that new studies in economics could suggest alternative ways to tackle the recession. Briefly detailed, the first study consisted of paying gas station customers $5 for filling out a brief survey before they went in to pay for their gas. Depending on how they were given those $5 determined how they spent it. More specifically, those given the cash in the form of a five dollar bill typically ended up placing the cash in their wallet and moved on with their lives; while those given five individual one dollar bills typically spent a small portion on drinks, candy, and corn nuts; while those given five one dollar coins typically spent the most leaving the store with nothing but Big Gulps, a handful of lotto tickets, and a receipt for their short sightedness. The lesson: either people just really hate one dollar coins and strive to relieve themselves of them as quickly as possible, or smaller denominations of currency leads to increased spending.

To further push this point home a second study was cited. In this study, women house cleaners in China were given a week’s worth of their salary in varying denominations. Those given larger bills tended to save while those given a giant wad of small bills tends to splurge frivolously.

So the practical recommendation? If Obama wants to stimulate the economy, or if Bush wanted to back in the day with his tax rebates, he should refrain from sending out bulk sum checks. Instead give everyone change. Flood the nation with Sacajawea dollars and people will be consuming again in no time.

And I agree. Although likely not terribly practical to dispense sackfuls of coinage, it does make sense that if people feel that they have a lot of something of little value, say a handful of small bills, they will spend it more freely than if they feel they have a few of something of great value, say one or two Grover Clevelands. I can even say I have consciously experienced this effect myself, which is why I propose we go one step further. Let’s join with our transatlantic, Western brethren and adopt the euro! If economists thought people spent one dollar coins fast, they haven’t seen tourists go through shiny silver and gold two euro coins. Not only do they pack greater value into a single coin, but with exchange rates as they are we get even more bang for our buck. Hand a man a handful of euro change, and he will be poor and penniless again in no time. That, my friends, is some serious stimulus spending.

A Series of Poor Decisions

I have made... a series of poor decisions.

I could of had a V-8! *Bonk!*

Anyway.

I decided to pursue some research. Expand some horizons. Advance our collective knowledge. Enter endless amounts of data into an unwieldly sized Excel spreadsheet. It has, unfortunately, like the velociraptors of Jurassic Park, now escaped my control and started opening doors with its razor clawed hands. My research block ended a week ago, and yet I still find myself researching. I will still be researching next block no doubt, and likely researching to my grave. I did not imagine that I would like the whole empirical approach to problem solving -- much preferring the impulsive assertion approach instead -- and the rigorous testing of hypotheses never sounded like much fun to me, but I was curious and so I did it anyway. Mistake! Hours and hours and hours later, and I still have not effectively answered what the risk factors for Clostridium difficile infections in thermal burn patients are. In fact, now knowing how arbitrary the research process is, I am inclined to believe we will never find out. I will have an answer certainly, but that answer will mean beans to me. Plenty to the people who read the research perhaps -- ooh flouroquinolones do lead to C. diff! -- but I will know the secret. Research is madness. Truly it hasn't been that bad, I did get great delight from learning computer shortcuts that made my data gathering more efficient. I like to think I have made "data monkey" into a respectable vocation.

I also decided to assemble my IKEA bed frame a few nights back. At about 2200 hours. Unfortunately it took much longer than the anticipated two and a half hours I expected, and so two days later and some sleeping on the couch I was still assembling the dang thing. I would like to say once assembled, seven or eight hours in total, I had accidentally assembled a magnificent gazebo a la the Simpsons where Homer builds a barn instead of a pool, but all I had in the end was a simple wooden bed frame. With drawers. A simple wooden bed frame with drawers that I now had curiously hostile feelings towards.

And then I decided to use the restroom at work. Upon doing so my pager dumped off my belt and into the toilet. I will leave it up to the imagination what was in said toilet.

Good night ladies and gentleman, you've all been great!

And Now For Something Completely Different

The car! The car! It is here! And it...

is...

beautiful.

After a prolonged stay at the port where it took two weeks to change out four tires -- and likely retrieve 40 lbs of hashish from the wheel wells who knows -- my car has finally arrived. Without a bike rack -- the one extra aside from the "hot chocolate" paint job that I paid for -- but it has arrived nevertheless. And let me tell you, friends, it's pretty great. Driving out in the open air is the only way to drive. It's the way God intended it. Now it's the way it will always be. At least until the day the complicated, convoluted electrical wiring keeping the whole thing together goes haywire as all expensive technology is destined to do. Till that day, however, I will drive a little happier and a little sweatier. Sweet.

The coolest feature, though, was one I was entirely unaware of: the colored light palate. With the flick of a switch the in-cab lights rotate through an array of assorted colors from orange to red to purple to blue to green. The lights are all fairly small, mind you, and you can only really appreciate it at night in the country with a new moon, but I will still say it is rad. Radical even.

I will miss truck, though. Truck's been good to me, and aside from the jettisoning of it's passenger side mirror a while back it has held strong. Truck, if you're out there, reading this, I miss you man. You stay safe now you hear.

Let's Play Jeopardy!

We play two types of Jeopardy at Wilford Hall. One fairly entertaining and always educational. The other, well it kills a little bit of me every turn of the game.

The first version involves Morning Report. We break up into teams and do Jeopardy in the regular TV fashion complete with little hand buzzers. It's pretty great. 'Nuff said.

The second version involves the few pleasant rotations we have each year. In order to complicate them and instill a pervasive sense of fear we are periodically put on "jeopardy." For a number of days were are required to carry our pagers with us wherever we go in the rare case that someone cannot come in for work and a substitute must take his or her place. For some it is an uneventful moment in time that passes before it is even realized to have begun. For others the rare moments seem to rarely be rare. And for some, namely the married men amongst us, it is a chance to strike it rich at the Impregnate Your Wife Lotto. With enough planning, and enough of some other things as well, a beautiful new baby child can be brought into the world right in the middle of one's ward month or ICU block ensuring a garunteed week of paternity leave to, you know, assist the wife with child care and stuff. It is the scourge of childbirth that has created such a terrible taste in my mouth for jeopardy, and I blame paternity leave for all of it.

At this point I would go on about how when we cannot come in due to illness we either still come in or come in once the rigors have stopped while paternity leavers seem to always return 7 days later fully rested, I may then segue into how I rose from bed one morning vomiting and yet still reported for duty, and I could then follow that with even more raving about how every jeopardy I have been on this year, save the one I covered for a friend, has resulted in me being jeopardized, but I will instead end my rant here. Let me just say that Jeopardy sucks, I hate it, and come on people! Enough with the baby making already!

(or let me in on some of the baby making action.)

The Organic Squirrel Gets a Bike Helmet

Last week I visited my sister and her family in Molokai, the Wild West of Hawaii. Or, at the very least, the slow country cousin of the same.

But, alas, they have grown so old. And acquired new pets it seems. Averaging about 1.3 dogs annually over the years -- as most seem to meet an early demise either runned over on the dusty streets immediately outside their house or gunned down in some forlorn, whiskey soaked saloon in Kaunakakai proper -- I was expecting some sort of dog but not quite the household I was welcomed by. On arrival I was greeted by three lovely, and taller, young nieces (Moriah, Sarah, and Lily) and three cute, and excitable, young canines (Mash Potatoes, Summit, and Monkey Pod.) Add to that a bitey rabbit named DC, a kidnapped chameleon named Gus, and about 3.5 million ants of various shapes, sizes, and colors, and I felt right at home.

Once settled we then began my grand packaged tour. First a meandering hike to Haipuapua Falls in Halawa Valley (we shot for Moaula Falls but got lost,) then some time at the beach, followed by Easter at Lane's, a luau, a trip to the Kamakou Preserve (where we absconded with Gus), some more time at the beach, and lastly a brief bushwacking to the Iliiliopae Heiau (one of Hawaii's largest temples and a site of human sacrifice) which concluded properly with me climbing a tree in an abandoned orchard to wack down some oranges with a stick. Life was good on Molokai. Simple and satisfying.

There was also considerable hormonal moodiness, not nearly enough lunch meat, and too much Moriah horse collar tackling Lily into a concussion to be certain, but that is part of the family experience. You're not supposed to get what you want, just three square meals a day, a roof over your head, and a body in your personal space.

If I had wanted boring I would have stayed in San Antonio.

Molokai mo bettah.

Freedom Isn't Free

Freedom isn't free.

But it sure comes cheaply for some people.

While in DC I went to Arlington National Cemetery. On a coincidentally dark and drizzly day I meandered all throughout the acres and acres of bleached white, uniform tomb stones. Although I did not feel any particular great emotion at the time -- I am a robot after all -- on my walk back some strong feelings did stir up in me. Being in a city built, in part, on the legacy of Ancient Greece I felt led to prophesy. An oracle a la me.

Four years from now the world will not end. The United States will not become a socialist state. Terrorists will not win. Obama will not reveal his hidden Islamic faith. And real Americans will continue live quite responsible lives, work in their communities, or lie dead in the soil.

I am not often angered, but one thing that angers me is the frequent insinuation, or outright exclamation, that supporting Obama or the current administration in any way suggests a deficiency in love for your country. As if being a Republican makes you more a true-blue American than being a Democrat or nothing at all. The converse was undoubtedly murmured here and there with the prior executive and it certainly came as a surprise to some that the Patriot Act did not in fact lead to fascism, but the sentiment has never been so frequently whispered, from what I can tell, as it is now.

Supposing establishing your conservative credentials did somehow give one a "Genuine Patriot" merit badge, being such an aficionado would not give whatever cause of the day it is one's championing any more credence. Correct my misguided, half-American understandings if they're wrong, but votes are not tallied based on nationalism and the nation's concept of civil discourse was not founded on jingoism. Partisanship is nothing new, and, truly, partisanship masquerading as love for your country itself is likely ageless, but the newest incarnation of it still saddens me. If you want to fight for your country, join the military and fight for your country. If you want to serve your country, join your church or local service organization and serve your country. If you want a better nation for your children, live a responsible, productive, considerate life that will make a better nation for your children. But please, save the rhetoric for your internal monologue. We're Americans; we're better than this.

Besides, I am the greatest patriot. Make me king. George Washington would have wanted it that way.

Plan B in Washington DC

First came Rhode Island, then came Niagara Falls. Or so was planned. Thanks to the quirkiness that is my good friend Anne, however, we failed to communicate, and instead of coming out during her week of vacation I came out out during her first week of wards at GWU. I was bummed. I do not say "bummed" very often, but, truly, I was bummed. My long held dreams of viewing the majestic cataracts and talking Canadian with a bunch of Ontarians were dashed. Thankfully, however, we had a backup scheme. Or I did at least, I only saw Anne for a total of about 30 minutes the whole time, and that was the Cherry Blossom Festival.

Cherry blossoms, though lovely, do not make for very wild and wacky or even very interesting stories. They were located primarily around the Jefferson Memorial, and were mostly whitish pink. I don't think they smelled. I am not entirely sure if these trees subsequently produce cherries from said spent blossoms though I am compelled to think not. I saw the American History Museum, Arlington Cemetery, and the National Botanical Gardens as well, and that, was that.

But to the point. Photos.

From this year, 2009,

and

Last year, 2008, when I was at Andrew's AFB.

Some day I will see Niagara Falls. Some day. And maybe, just maybe, I will actually see my friend Anne as well.

Rhode Island at Speed

I visited a friend in Rhode Island this weekend. And she broke me. We took a 12-13 mile bike ride to some town starting with a B, Bicleff? Burkholderia? -- the name is not important as once we got there, about an hour and a half later, we promptly turned our bikes around and headed back the way we came. When I queried about the possibility of perhaps stopping in this town for lunch, or even, dare I say, entering it, I was instructed that there were sandwiches at home. Twelve to thirteen miles back the opposite direction. Of course this was followed by a 6 mile hike in Newport thus completing my tour of Rhode Island.

Her well intentioned sadism aside, Megan is good people, and the resulting achilles tendenitis aside, I enjoyed Providence. It seems like a nice little city. Never having been to Rhode Island, though, I was surprised that there were areas of undeveloped land. For whatever reason I was under the impression that the entire state was one giant neighborhood. I also did not realize the state was owned and governed by the Dunkin' Donuts corporation. Clearly I have only lived in this country for a short time.

The highlight of my two days in Providence, however, was my headline photograph. Isn't it beautiful? Well positioned, great balance, (almost) excellent coloring and contrast. And it was all taken while facing backwards and pedaling at a 7-8 mph clip. I believe I have developed a new Pulitzer Prize category: Action Photography Taken While Simultaneously Engaging in Action. Clearly this is a category long overdue.

Anyways, here're my other photos from Rhode Island. They're ok.

All the Wrong Places

Turns out I'm a teeny, tiny bit shallow. Or perhaps a bit more than that. Maybe a lot more. I have, for a variety of not terribly good reasons, recently joined an on-line dating site, and although I like to think that my new found shallowness is a result of the process requisite in the internet dating system, the reality is I just don't like horse lipped girls. If in a smile I see a line of a teeth and a line of gums instead of two rows of pearly whites, I click on through. And of course if I see too many pearly whites, a full mouth reminiscent of something terrible I cannot quite recollect, I get a bit terrified. And then there's girls with eyeballs too close together. And girls with moon facies. And girls with "a few extra pounds."

It has been about a month or so since I have started these Internet dating shenanigans, and it has been interesting. I have learned a lot about a lot of things. Mostly, though, I have learned that there is big money in Internet dating these days. People give you money for simply hosting nothing more than a glorified classifieds. It's genius. But the empty money pit that is Match.com aside I have also learned....

That although at first I felt bad for the... if I may be a bit blunt and wholly lacking in sensitivity... ugly, women out there who just want a little love too, it turns out that, if their prior relationship status and other demographics are any evidence, they get more than their fair share of loving. Specifically full contact, sweaty-style sexual loving. Hopefully with the lights off.

That I cannot stand people who punctuate, spell, and capitalize however and whenever they choose. I by no means majored in English composition myself, but if you cannot manage enough energy in this match making endeavor to actually hold the shift button while striking your key of choice or correct an obviously misspelled, indecipherable collection of consonants I begin to worry about commitment levels.

That I apparently every two or three emails write something so terribly offensive, personal, or just plain creepy as hell that the ladies are compelled to terminate conversation with me without further comment. Perhaps it's the, "so when are we going to do it?" I sometimes interject with. Maybe I shouldn't close every letter with that?

And, lastly, that this is all making me into a pretty terrible person. I have enjoyed the experiment, if you will, but it breeds primarily self centeredness and personal myopia. Constantly you are asked to decide if a woman measures up to whatever standard it is you have decided to measure them by. Constantly you are compelled to ask yourself what it is *you* want in a woman. Constantly you are focused on your life, your desires, your lack of love. Perhaps in the end I will meet Miss Super Awesome and our love will multiply making this not just an exercise in critically appraising the opposite sex, but the reality is I, and it seems many others, will likely not find anyone and all we'll have to show for our efforts is a whole lot of hours focused on what we want. This isn't to say greater insights of a character building nature cannot come about -- and certainly often you must first identify your flaws before you can rectify them -- but I would gamble when all is said and done a few months from now all I will have collected is a list of physical traits that irk me and a slightly smaller bank account.

But on a happier note. A Smithsonian dog with goggles.