The Winter Storm of 2009...

So apparently winters in North Carolina are what most people would call mild. Usually 40's-50's with dips way down into the 20's and 30's. Infrequently, it "snows." Meaning a few inches of slushy, non-stick snow. When things get "bad," people panic. Bread, milk, and beer (the essentials I guess?) go flying off the shelves like New Moon posters in Santa's Secret Shoppe in Junior Highs around the country. This last weekend, we had several severe weather warnings for the weekend. The Meteorologists billed it as a disaster, even going so far as to call it "The Winter Storm of 2009." With this sort of reporting, it's no wonder that the storm was all anyone was talking about. People were saying things like, "We're getting snow this weekend", "I'm not going outside that," and "It's getting so bad that we may have to reinact The Lord of the Flies or the Donner Party and what-not." I mean I was worried...

I got off of work around 8PM on Friday, and headed out to a friend's house for a little Christmas socializing. There were about 1-2 inches of slushy snow on the ground, and half of the people cancelled their RSVPs for the party because of it. When I got to the hospital on Saturday morning, this "storm" had people terrified. Doctors, nurses, janitors and anyone else who worked in the hospital were making plans like, "I'm probably going to spend the entire weekend in the hospital," "I should have gone to the store last night to get bread and milk," or "I may have to sell everything I own to buy a gun to shoot myself... it's really my only option."

So when I got off of work on Sunday (after ~30 hours of work), I was terrified about what might await me on the outside. I figured even if all the predictions were overestimations, I was still going to be walking into Santa's front yard. And this is what terribleness awaited me as I walked out of the hospital...


You can imagine how cold I felt...

My Front Porch Looking In....

I have had a lot of ideas in my lifetime. Some good, some bad, and some terrible. One of my more recent terrible ideas was to sell all of my furniture prior to moving to NC from WI. It all made sense at the time. I would sell my stuff for about what I paid for it in Utah, take that money and spend it on new stuff in NC. Thus recouping some of the money I had spent in the first place and saving the moving expenses that I would need to get the aforementioned possessions to NC.

This sounds great on paper, but that’s where the greatness ended for me. Things went south, well, right at the beginning. So early, in fact, that I am not sure I ever actually headed north. The problem started with my underestimation of the WI-used-furniture market. To say that I underestimated the robust nature of the furniture market in WI, is like saying the Grand Canyon is big, War and Peace is long, or my dad is argumentative. None of these analogies comes close to adequately describing the epic failure that was my underestimation, the massive nature of the Grand Canyon, the effort required to read War and Peace, or the frequency and intensity with which my dad likes to give me the business.

What does any of this have to do with anything? Well since that epic failure, I have been replacing my old furniture bit by bit while at the same time paying down my credit cards. The precarious position in which I find myself, reminds me a lot of our hunter-gatherer ancestors. You know, finding a little something here and a little something there (I know it’s a stretch but bare with me… it’s the closest I’ll probably ever get to feeling like my mountain man older brother). So, bit by bit, I have been adding my collection. I started with a couch; and, through the suggestion of my sister, added the rug. The ottoman was my own, most recent, decision. To make a long story short, it’s started to make my living room feel like home. I realize that I still have a long way to go, but even the little additions have helped me feel much more at home. Which as far away as I am from my family at this time of year… means a lot.

Happy Thanksgiving!!!

A lot to be grateful for this year! Including the fantastic vacation I just got back from here’s the highlights in “I’m-rushing-to-a-friends-house-to-gorge-myself” mode. I just got back from a vacation to Utah which included: visiting family friends in St. George, The Pizza Factory with my Currently-Cougar Siblings (and their families), fantastic seats at a Jazz game with high school friends, mini-Thanksgiving with the family, tour of my brother’s Castle, quick hunting trip into the same brother’s backyard (whose only interesting event was keeping an eye on my brothers and making sure they didn’t shoot me or each other), the BYU-Air Force game (reminded me of both the pros and cons of my BYU experience… fantastic overall, but easily downgraded at least one notch by a few tools who act as the proverbial turds in the punch bowl of Cougardom), and of course the cherry on top…. Seeing New Moon with my mom and sister! Seeing this movie with my mom and sister was like eating manicotti, super cheesy and soft in the middle but a great overall experience!

Charleston

So the first weekend of October, I went to Charleston, SC with some friends from work. The weekend went like this... This is a picture I took of Charleston from the top floor of a hotel we stopped at one night.

I was on-call on Thursday. Meaning I work up at 4:30 AM, and work from 5:30AM to 11:30 AM on Friday (30 work hours total). Get home, pack, finish some work from home. Leave for Charleston at 4PM (~36hours awake)... I sleep for the first 2 hours. Arrive at Charleston at 8:00PM on Friday, go out with friends until 3:00AM on Saturday. Get up at 9:00AM Saturday and go to the Beach until 4:00PM. Head downtown for dinner, go on a walking tour of the city. Go out with friends again until 1:00AM, then drive four hours back to NC so that I could go to church and my buddy could be on call. I drove while my friend slept so that he was as rested as possible for call (you have to make sacrifices to have fun.... My youngest brother can tell you all about it... he’d sacrifice ANYTHING for fun).

Story.... We decide to take a walking tour of the city of Charleston, that supposedly details haunted buildings in Charleston. What better way to kick off a night than heading out at 9:00PM and hearing scary stories. Here’s how I envisioned it... a guy looking like Vincent Price would take us around scary buildings in Charleston, as we jumped every time we heard an ominous board creak. However, in reality... our tour-guide (Stew) was more like Matt Damon from the Informant
dressed in khakis shorts, a khaki shirt, and (you guessed it) a khaki hat. The outfit was topped off with copious amounts of sweat, and the tour consisted of walking past (not into) “haunted” buildings, as Stew told us 3 historical stories and 1 anecdotal story (that was originally past on by none other than Stew Jr.).,

Stew’s story telling ability also consisted of the recitation of these stories complete with awkward, forced pauses for dramatic affect. (Note: these pauses were often ill-timed and just long enough to be annoying). Let’s just say, it wasn’t exactly “enthralling.” In fact, it was boring enough at certain points that, believe it or not, my friends and I become... ummm... disruptive?... Literally, I think it took about 2 minutes before my first obnoxious comment. It went something like this...

Stew takes roll of all the people who have paid to be on the tour, and the following exchange occurs (a picture I took during the tour of the renovated basement of a building 2 stories above where a pirate dungeon used to be).

Stew: I would like to welcome you a tour of historic Charleston. Charleston was founded in 1670, and consists of (rattles off statistics about the number of original buildings that exist from the 1700’s, 1800’s and early 1900’s). Do any of your have any guesses about what the most historical city in the U.S. is?
Simultaneous - Everyone in the group with a pulse: Ummm... Charleston?...
Simultaneous - The Lady without a pulse: Ummmm....
Stew: I’d also like to remind everyone of the city of Charleston’s motto, Aedes Mores Juraque Curat (She cares for her temples, customs, and rights), but she does not care for her sidewalks, roads, pavements, alleys or paths. And believe you me, this tour is a lot better vertically, than it is horizontally. So please be careful as you walk this evening, and watch your step so that there aren’t any injuries due to stumbling or falling.... (one of the soon to become patented pauses)....
Me: Wow!... That’s a long motto...
Everyone but Stew: Laughing....
Stew: Still pausing...

Who says you can't enjoy prison?...

Residency is hard... I am currently in the middle of a string of 20 days without a day off. Obviously it’s not ideal... Most of the time, it’s not even all that fun. I mean, I spend the bulk of my time doing paperwork, entering orders in the computer, reading/preparing to get “pimped” about anything from skin cancer to drug interactions to home health arrangements. A lot of times, I feel like the guys in this picture... However, there is a brightside to all of this (and it certainly isn't the money)...

To prove it, I submit the following stories. We’ll mark them Exhibits A and B.

Exhibit A. As an intern I don’t operate much So when I do get to the OR it’s very, very exciting. Last month, I met a patient with an occlusion in the artery to the leg. The patient came in with a lot of leg pain, and the patient's first morning in the hospital I listened closely and changed the patient's pain medicines (super small decision... but ended up making a big difference to the patient). When it became clear that the patient wouldn’t respond to medical therapy we decided to amputate the occluded leg... After talking to the patient about the procedure the patient still seemed unsure of the procedure but said, “I don’t care if that tall blonde guy is the worst surgeon in the hospital... I want him to do it...” I of course responded with, “Ummm, my hair is NOT blonde...” And we took the patient to the operating room.

It’s a simple procedure, we didn’t have any complications and I got to do a lot (which basically means it was the blinding brilliant light from heaven on an otherwise craptastic day). We finish, and as we’re leaving the operating room I had the following exchange with my chief resident:

Chief: Alright I’ll take the patient (PS we don't refer to everyone as the patient... it's just my way of keeping the patient's story private... see there I go again) to recovery, can you go talk to the family?...
Me (never one to allow complete ignorance or lack of skill to stop me from doing something), Sure.... yeah.... ummmm... anything in particular you want me to talk to them about?
Chief (quizzically): Why don’t you start with the surgery and see where that takes you?
Me: Oh... right...

I walked up stairs to the waiting room, and nonchalantly asked the patient's family to step out into the hallway (good or bad news I feel like it should be private)... Because I wasn’t sure where to begin, I started with, “Well we finished the surgery

and everything went well.” Thinking that would be a sufficient explanation of a relatively routine procedure, I opened a huge can of worms with, “Do you have any other question?” They in fact had exactly one million questions about how the procedure was carried out, what exactly we did, and how the patient tolerated the procedure... It only took about 5 minutes, but the calming influence seen on their faces while hearing an explanation of a relatively routine procedure is really why I do this.

Exhibit B. One night on call I was covering the burn unit (usually not a lot of big issues... more just little things throughout the night), but occasionally you have to “admit” someone. Meaning you go see them, get the history and examine them. This can be more or less involved depending on the degree of the injury. While on call an elderly patient was transferred in from an outside hospital following a really bad burn. It became apparent right away that the patient would not live through the night. The doctor in charge spoke with the family over the phone, and they quickly realized that nothing could be done. They said they would be on their way and hoped their relative would make it until they arrived....

The patient’s family arrived, and the patient passed shortly after. In the midst of an insane night on call, I had to go to the intensive care unit and pronounce the patient’s death. The exam itself isn’t hard, but explaining the procedure to the family, asking them to step out of the room, examining her and then speaking with them about the pronouncement was definitely something that makes you pause and think. I won’t get into everything it makes you think about, but it certainly makes you miss the family and friends you have at home. It also makes you grateful that even on those busy nights, when you don’t think you have time to breath, you still get to come into people’s lives at a moment they’ll never forget and be a positive influence. So I guess if I’m going to be stuck somewhere doing something... it might as well be something that gives me opportunities like this every day...

When good advice goes bad....

Saddest story: (and this is for my sister-in-law’s mom... she loves sad stories... she’s probably never read my blog, but if she’s anything like my brother describes she’ll probably start reading based on this story alone...). I was on call last week, and I was covering the transplant service. When you cover the transplant service if someone comes in over night for a transplant and you have to admit them (write a history and physical and put in their orders). So of course someone comes in over night... now healthy people don’t get transplants, so if someone comes in for a transplant it can dramatically improve their life, saving it a lot of times. Of course it’s not without risks... sometimes transplants don’t work... sometimes surgery doesn’t work... (I know... I’m giving away the ending). The sad part is this... a guy comes in with his huge family for the pretransplant admission. While I was interviewing them, they asked me, “If this was your mom or your sister what would you do?” I said that I would want her to go through with the transplant... and I absolutely meant it. Sadly, this man has not done well, to the point where they had to remove the transplanted organ (now every transplantable organ is very important.... that’s why they transplant them, because without them you die... see where I’m going?) and his poor family is holding a vigil outside the ICU (mostly crying), just hoping that another organ becomes available within the next few days (because again, you don’t last long). I walk by every day and look them in the eye, they don't look mad, or even sad really, they look helpless and afraid. I smile at them and nod, but it’s tough... it honestly breaks my heart. It's been an intense reminder of how much people rely on your answers for direction in the most vulnerable times of their lives. It's what makes my job the best and the worst job in the world, but knowing that there are ups and downs doesn't make it any easier when it's the worst job in the world...

At this point My sister-in-law’s mom can stop reading that’s where the sadness ends...

Crankiest Story: On a completely different note, I am slowly gaining a reputation as... how do I say this... someone who can sometimes, on rare occasion, not have a lot of patience. I know... I know... it’s hard to believe. The running joke is, “M, who in the hospital haven’t you yelled at?” (the short answer is... everyone at my level or below...) Well sometimes the rants become outrageous, but I honestly don’t think of them as outrageous at the time. I am just frustrated, and this is how my particular frustrations manifests itself... as an example, the computer system at the hospital was just changed. They “updated” our old system and we are having several “unexpected” problems (really?... we overhauled a computer system and we didn't foresee any problems?... really?). Because it’s only an update, it still looks like the old functional system. This only adds to my frustration, it's like a flashlight with a dead battery.... it looks like it should work, it feels like it should work, but it could not be any more useless... I guess that makes it more like a Democrat (but that’s neither here nor there). So after my work comes to a grinding halt for at least 2 hours on one particular day... I call the complaint desk, and the following exchange occurred:

Me: Umm... the charting program is down...
Her: What seems to be the problem?...
Me: Umm... the charting program being down isn’t enough of a problem?...
Her: What do you mean down?
Me (feeling myself getting snippier... see how I make it seem like I can’t control it? I'm like the incredible hulk of snarkiness): Ummm.... what part of down is confusing to you?... awkward silence... I mean, the program isn’t responding. And frankly, it’s really frustrating...
Her: I understand, but hopefully it won’t be down much longer...
Me: (avoiding the urge to ask her what she means by down) Ummm... Much longer?... are you kidding me?... This is ridiculous! How am I supposed to work if my sole means of accomplishing my job is taken away from me by circumstances out of my control...
Her: I understand sir...
Me: I’m not so sure you do!.... how would you feel if every day I came into your job turned off your computer, unplugged your phone, and stared at you for hours at a time? How much work would you be able to accomplish?... Well that’s how I feel right now... and it’s not a pleasant feeling....

The conversation of course ended with me apologizing for the problem not being this particular person’s fault and saying I didn’t mean to be mean to her. But man... I was on a roll... And yes, I’m trying to be nicer... but sometimes mean things just come out, I mean you should have heard what I said to the guy who runs the pizza line in the cafeteria...

UPDATE: After three long days (roughly 45 hours for me... and about 3,287 passes by the crying family outside the ICU) the guy finally got another organ... which he received and is doing great now... so long story short the family cries less...

Uncreative Title....

So now that I'm almost two months into this whole residency thing, I thought I would include an update along the same lines as my last one. You know, "Funniest," "Most awkward," "Most annoying..." and other such memories that struck me as memorable at the time... Honestly, (and you may have noticed without my saying so) I'm really verbose... I know... I know... it comes as a surprise, but it's true. So I decided to break it up into more manageable single stories...


On that note, here's the story I dubbed as Most Speechless Moment:


I was working on the floor (code for hospital) one day, and I got a call from my Chief Resident (code for “One of My Many Bosses, aka the Highest Resident Boss on my team). My chief says, “Intern (code for me... some day I hope to get a name), go see Ms X in clinic and tell me what you think.” Now a little background, my chief was in the operating room and not able to go see this lady so he asked me to... which is cool because I get to do things I normally wouldn’t be asked to do. I also get to see a patient and make a decision with at least the 3 minute walk down the hall before someone tells me what to do. (More background) Ms. X is a 63 year old woman who had been in the hospital the week before. She had a big wound that was now draining some clear fluid and needed someone from the team to see her (don't worry this is not terribly uncommon and very treatable). I show up to clinic to see her. I find her there with her sister (who had been taking care of her at home.... clearly two "women" cut from the same cloth). She’s sitting there in a wheelchair with her nightgown on and we had the following exchange:

Old Lady: Oh Dr. P, I’m glad someone that I know came to see me. I’ve had a lot of drainage from my wound and I’m worried (not her exact words, but you get the idea).
We talk for 20 minutes (which is a long time for me)... and at the end of 20 minutes I recap everything we talked about (I’m an excellent communicator... I get it from my dad).
Old Lady (in a very Southern-elderly-woman-accent):“Why no Doctah P, I believe that’s everything... unless there’s something else you’d like to tahlk about?... What should we tahlk about?... We could tahlk about sex if wahnt?...” (Her and her sister giggle wildly.... and I mean wildly...)
Me (probably blushing):....
Me:....
Me:...
Me:...
Me:... Well Ma’am, I’m not sure how much I could add to that conversation, so I’ll just get goin’ now (apparently, I have a printed Southern accent)... I will be back once, I have talked to your surgeon...

Her and Her sister: Still giggling wildly... “Ahlright Doctah P... we'll see you in a minute”

Me:... Ummmm.... "Alright... Ma'am?"

One down.... Eighty-three to go....

The first month of residency is behind me… seems like a good time to reflect on what my most memorable moments were for me…

• Loved peds surgery… definitely keeps it on top of my list of career options
• Making a ton of great friends among the residents… Really excited about spending the next 5-7 years with them…
• Rounding alone with the attending for the first time… It was cool because, normally we round as a team (which consists of 4 residents and 5 medical students) with the attending. Usually the attending listens while only the chief resident talks about the patients. The rest of the team usually only get asked either general medical questions or random tidbits that our chief doesn’t know off the top of her head. Doing it alone made me realize that I was more familiar with the intimate details of their care than I thought
• Doing a whole operation… even though it was only the removal of a port used for chemotherapy (making it neither difficult, dangerous, or all that interesting), but it was cool to do every step by myself (with direction and supervision of the attending of course)
• Not sleeping nearly enough… but that’s what I asked for…
• Signing out on my last night, and realizing how much I learned and how well I knew my patients
• Missing my family… but don’t worry only 83ish months to go right?.... right?...
• A new addition to the family
• Seeing how fast the G-monster and the A-lady are growing… tough to see kids every day and not think about those two…

Funniest hospital story: It’s sometimes sad to see how institutionalized some of the really sick kids become. They know the doctors, nurses, and details of their care better than I do, and you’re just grateful you didn’t have to go through childhood worrying about things like that. However, sometimes it leads to funny stories… When I was getting ready for the case I mentioned above about removing the port (it’s a catheter that can be left in someone’s vein for a long time so that you don’t have to get an IV placed every few days). The kid is in remission and doing great so the port is no longer necessary and coming out. He tells us how excited he is to have it out because he hates it… but he also hates, hates, hates anesthesia. He doesn’t want the anesthesia induced by the IV or the face mask because they both make him nauseous. We tell him can’t take out the port without it… he thinks for a second smiles goes, “FINE!” Sticks his finger in the air like a little general and goes “But I want Zofran after!” and lays day on the table with a smile. Now Zofran is an anti-nausea medication… and maybe you all know that but it was probably the last thing I ever expected the little guy to say… the whole room was laughing, including his mom.

Funniest outside the hospital story: I was having dinner with a collection of residents. We were at a medicine resident’s house, and she was talking about how much she loved Twilight. Some people were giving her a hard time, but everyone was talking about the movie, vampires, and a lot of other things my older
brother would love… to roll his eyes at. In the group is the girlfriend of another medicine resident (she’s a senior dental student and a super nice girl, that had never met me before). The conversation turns to the storyline of the book. Someone mentions that the author is Mormon, I think in a nod to the only Mormon in the room. The dental student says, “I know! I heard there are a ton of Mormon themes in the book…” (dramatic pause….) Looks left… looks right… smiles, and says, “Are any of you guys Mormon? (Silence falls on the room and worried looks cross some of the faces) Because…” At which point I interject, “I am…” Now this might be hard for you to believe but sometimes people have trouble knowing whether I’m being serious or joking (apparently the spectrum of my emotional expression ranges from sarcastic all the way to sarcastic)… She looks at me surprised, “Are you serious?...” I responded with another grin, “Uh, yeah…” She responds, “No you’re not… are you serious?....” As she flounders a little, the other three people who know me at the table say, “He’s Mormon…” (Awkward doesn’t begin to describe the mood… it is better described as excruciating… for her of course, because I was dying both inwardly and outwardly). She quickly explained how nice the Mormons at the dental school were and how much she respected Mormons… we made it through the rest of a very pleasant dinner, but I don’t know how many times I’ve seen people from the dinner and asked them, “Are any of you Mormon?...” and gotten a big laugh… Now if I can get that nice girl to stop feeling bad about asking such an innocuous question, the story will have a happy ending.

Adventures in Haircutting...

One of the fun parts about moving to a new place is trying new things. New restaurants, new cultures, new sights… However, that’s also one of the bad things about moving to a new place. When you think about the hurdles you cross in a new area, one of the most underestimated hurdles is the haircut… I know what you’re thinking… “He’s such a man! Why does he care about his hair?... I mean I thought he cut it himself with a piece of broken glass, for Pete’s sake?” And you’re absolutely right… maybe I am obsessing about this a little more than I should. However, as I moved from Utah to Milwaukee (where it took me 2-3 disasters before I settled on a place) and now to Chapel Hill I’ve had some interesting haircuts… Here’s the highlights:

• When I first arrived in Mil-town I was getting ready to go do dinner with some friends. Without saying too much I was definitely trying to impress the people I was going to dinner with, so I figured I’d get a haircut the day of this particular dinner (I mean nothing impresses people more than good personal hygiene). With all of my nervous energy, I head to the nearest SuperCuts (or something of that ilk)… the kindly haircutting fellow says, “How do you want your haircut.” After a moment of stunned silence with the classic, “Ummm… just a trim… I guess.” (I almost said “Like my mom always cuts it,” but figured it probably wouldn’t have gotten me as far as the answer I actually gave). He proceeds to start cutting, I relax a little bit until a moment later when he says, “do you want me shave around the ears?” Now, I had definitely memories of my mom shaving around my ears (although I couldn’t say with any degree of certainty whether or not it was during the same period that she was giving me mullets), so I gulped and franticly said, “Yes!” He proceeded to give me what I can only describe as a bowl cut for my ears, with a good half inch border all the way around. Now I have no idea whether the people I met that night even noticed, but I can tell you it’s hard to be yourself when you feel like you have a haircut that Opie Taylor would’ve made fun of…

• This is by far the most surreal of the stories… A few months later (after a busy test week in school) I decided to spend my Saturday off with a haircut. I proceed to find the nearest GreatClips-type place (and I will always remember this one as the definitive reason that I will never patronize one of the places ever again). I get in line and I’m called by a sweet little Chinese lady (I know she was Chinese because she told me she was). When I say sweet, I mean it… Definitely one of the nicest most caring people I’ve met in a while… I guess that’s why I feel bad when I tell you that her accent made her impossible to understand… Luckily, this sweet lady and I both admitted, at some point in the conversation, that we both speak Spanish (although my definition of speaking Spanish was definitely different than her definition). How do I know what exactly she described as “speaking Spanish?” Well because she proceeded to spend the rest of my haircut, speaking broken Spanish to me through a Chinese accent. The result you ask?... my hair was three inches longer in the back than the front (literally 3 inches!). I asked her, in both English and Spanish, to maybe take a little more off the top, and like the fantastic stylist that she is…. She took a little more off the front, before whipping the cape off with some Spanish flare…

• After completely swearing off bargain basement hair stylists, I went to a salon in CH (whose name we won’t reveal here). After getting a decent haircut, we went to the shampoo bowl. Unlike conventional shampoo bowl/chair sets… this chair did not move up and down… the bowl did. Only this bowl just tilted, and instead of allowing me to rest my head comfortably in the bowl it was like having a plexi-glass shovel rammed into the base of my skull. If this exact chair wasn’t used for shampooing hair in Medieval dungeons it should have been. So instead of spending the entire shampooing thinking relaxing thoughts, I spent it wondering why me? What had I done? The pain was definitely overwhelming and definitely enough to make me decide this salon is not one that I’ll continue to patronize…

I haven’t lived in Utah for a little over 4 years. Of all the things I knew I’d miss about Utah (the Jazz, the mountains, the hunting… well maybe not the last one), the one that I miss the most with absolutely no idea that I would’ve missed it this much are my mom’s haircuts. I mean between ear-bowlcuts, Chino-Spanish reverse mullets and the torture chair of death… I’d almost rather have a real mullet with lightning bolts, so long as it was my mom doing the cutting… you really can’t beat it.

Newbie...

So I've got a new job... you may have heard (link the graduation post). For those of you who don't know I started on pediatric surgery, and it's been a steep learning curve (especially, since my fourth year of medical school would never be described as "rigorous"). Every fifth day, I take call and cover the thoracic, urology, and trauma surgery services. That means that on call I cover anywhere from 50-65 patients (some of whom are in the ICU, and way too complicated for me... which means that if it's serious, I cover them by immediately calling someone else). It's definitely a far cry from a fourth year full of transfusion medicine, radiology, noon quitting times and a little bit of golf. The adjustment; however dramatic, has been a smooth one and I've never felt overwhelmed (there are too many people around waiting to take over for any feelings of inadequacy to set in). However, it is frustrating to be reminded on a daily basis that although you've spent years in school, you have very few practical skills. It's like getting punched in the face by Mike Tyson, only he's wearing pink boxing gloves with extra padding... so while there are plenty of benefits to pad the new job and make it look pretty... you're still getting punched in the face.

The pink gloves and padding...

• Every time, you page someone/return a page and the overhead intercom calls out Dr. P....
• When pharmacists call you on your day off to clarify prescriptions, that you wrote...
• When you walk into a room, and speak with parents and children of are sometimes rather sick and you get to see the look on their face when you can give them more information about their child's hospital course...
• Making a decision late at night, and finding out the next day that it was the decision the real doctors would have made...
• Getting paged by a nurse to do something, because hospital policy states that only a doctor can do it...
• Doing a procedure on the floor that someone else couldn't do, and successfully doing it...

Punches to the face...

• Answering the page, to learn that it's only your co-intern looking for someone to go to lunch with... and you can't go because you're busy.
• The clarification is only necessary because you prescribed a tylenol suppository for a 15 year old, instead of the oral medication like every other 15 year old in the world gets (it's only happened once)...
• The look on the faces of worried parents when, fifteen minutes after you've given the parents a long drawn out explanation, the attending comes in and completely contradicts everything you just said. Because he just got off the phone with another attending because they didn't want to talk through the intern...
• In the morning you learn that the correct decision you made over night, was neither important nor necessary (i.e. the nurse didn't see the order already in the chart)...
  Learning that hospital policies are silly and require stupid things like a doctor pushing down a plunger on a syringe... and of course you have to walk clear across the hospital at 3AM to do it...
• Doing the procedure and no one ever knowng, because the nurse never paged anyone else... so all your superior have to judge you are all the mistakes/"I need your helps"...
• Realizing that after all this, you've never loved your job more... So while someone who loves being punched in the face is clearly not a logical person, at least I'm a happy one...

Well off to bed... The hospital needs its punching bag...

If It's Real...

I’ve been through a lot since my last post… short recap of my trip to Utah:

• Family dinner with the Riddle Family
• BBQ with the Soelberg’s
• Teaching Matt how to apply an arm bar (including offering my own arm for him to practice on... he will debate who's actually made the decision to allow him to use my arm... him or me, but I maintain that it was me)
• Trip to St. George with Greg, Nat & Garrett (in which Garrett did his best 3-hour impersonation of a stabbing victim… I don’t remember teething being that bad…)
• Dinner at my favorite restaurant with 2 of my funniest/coolest cousins
• Trip to Golden Corral with the Phillips Family, in which my dad was suspiciously absent
• A smattering of blind dates

Needless to say, a lot happened during that trip. It’s hard to describe how much fun I had seeing everyone, and it definitely got me ready to head back to North Carolina.

Which brings me to the present… I started orientation for residency on the 17th. We practiced suturing in the morning and then in the afternoon it was off to the ropes course. For those of you have done a ropes course, you know exactly what I’m talking about. For those of you that haven’t done one, let me see if I can paint you a picture.

The way I figure it, the ropes course was probably invented by two friends (not unlike me and my best friend… very similar in a lot of ways, but extremely different in many many ways). The first friend (we’ll call M. Ropes) was probably like a modern version of Robin Hood… you know... into climbing trees, ropes bridges, cargo nets, and what not. Basically your average Man’s Man. The second friend (we’ll call N. Course) was much more touchy-feely and preferred to talk more about his feelings than to climb through trees… definitely the more sensitive of the two. So these two get together, and turn a portion of the forest into an obstacle course where you talk about your feelings... like Boot Camp for your feelings...

It was a lot of fun to do the ropes course and to get to know the people that I’m going to be spending 80 hours/week with for the next 7 years of my life. Everything was great except for the leader of the ropes course Dan (picture a young, chubby Mr. Rogers with short shorts on). During one portion of the course Dan asked each one of us to describe “how residency would be like an island for each of us.” The following exchange occurred between Dan and a resident that I’m calling Steve:

• Steve: Residency will be literally be like an island for me because I am going to be alone for a large portion of it. My wife doesn’t finish PA school until December so she’s staying in Texas until she finishes. I know it sounds cheesy but we’ve been married for almost 3 years so it’s going to be hard to live away from her (PS great answer… completely appropriate).
• Dan: (Dramatic Pause… wrinkled brow… pursed lips)… Steve… (another dramatic pause… apparently nothing says ‘I want this exchange to be uncomfortable’ like a good dramatic pause) If it’s real… (dramatic pause... clearly Dan is the Michael Jordan of dramatic pauses) It’s not cheesy…
• Steve: Afraid to answer….
• Awkward silence…
• More Awkward silence…
• Dan: Alright (dramatic pause… really driving his creepiness home)… who’s next?

After this and a few other awkward exchanges, we went to a ropes course that involved walking on a cable that was 30 feet in the air. This particular cable had another cable 10 feet above it in the air (for heaven knows what purpose)… they asked us get into groups of two and help each other across the cable… My partner and I had the ingenious plan of using our belts to make a zip line out of the higher cable (we of course would spring this Tango & Cashesque plan on the group once we got into the tree). As we’re about to ascend to the tree tops, Dan notices our belts hooked together in my partners pockets. Dan realizing what a liability this would be immediately makes belt-zip-lines illegal in this particular activity. As we protested Dan reports to us that it would be too much of a liability.

I responded, “Ummm… (dramatic pause) Dan… it’s ok for us to climb 30 feet in the air? But not use a zip line?... what kind of s@#$ is this?...”
Puzzled by my inquiry Dan responds with, “Shut the heck up and climb....”

OK, he didn’t really say that… but I didn’t ask him that question either… So I guess it's a wash. The good news is that I’m loving residency so far, and the people I work with seem to be amazing and I couldn’t be more excited about them.

My Life... Matt's Entertainment

Wow! It’s been a crazy couple of weeks since graduation. Including:

• Site-seeing in Nauvoo
• Ditto in Chicago
• 14 hour drive from Milwaukee to Chapel Hill… with scenery provided by every hick town along the way
• Setting up shop in Chapel Hill
• A quick trip from Chapel Hill to DC
• A quick trip back from DC to Chapel Hill to fly home to Utah today

I’ll pull out the GPS at some point to give you all the nerdy stats but suffice it to say, a lot of time was spent in the car. Which normally would have caused me to go insane, but luckily I had Matt as a travel partner… There was never a dull moment, including:

1) On a rainy day in NC I send Matt from the car to the apartment to get some paper so that we can formalize our plan for the day. Matt speedily returns from the apartment holding 2 sheets of unfolded white paper out in front of him. As he carefully avoided the trees the torrential downpour was unleashed on these poor flailing pieces of paper. (Now some say that I'm a patient man… but the other 99% of the population would disagree with them). As he gets in the car, it takes all my self control to say (only slightly snarkily), “Matt! What are you doing?” Matt gets this grin on his face like it’s free burrito day at Beto’s and pulls two other pieces of paper out of his coat… apparently this is his idea of a joke… he walked the rest of the day…


2) I had to get my brakes changes the day we left for DC, so as I do so I'm scouring the internet for a deal on a hotel room. Now a deal on a hotel room in DC isn’t like a deal on a hotel room in a lot of other places. It’s more like a game of let’s see how close to $125/night we can get without ending up in a part of DC that looks like the backdrop for a post-apocalyptic movie.



Finally after a good 30 minutes of searching I stumble across the hotel on the right. It is called The Churchill, and was built as a luxury hotel at the turn of the century. The pictures are the exterior of the building and the lobby of the hotel. The best part is that I found the room for just under my target… We arrive at the hotel, and for two days I have trouble falling asleep at night because I feel like I stole something… as we’re packing up to go Matt says, “This place is nice and all, but I don’t think it’s that much better than a Hampton…” To which I lovingly responded, “Fine next time we’ll find something a little nicer for you.”


Most of the above stories are true… Matt was a fantastic help and the move would’ve been literally impossible without the big guy… But don’t tell him I said that, otherwise we’ll all be getting wet note paper for the next 40 years.

Dr. Who?...

So graduation came and went. I know this for several reasons, including:

• My sister-in-law
• Amazingly thoughtful gifts
• An awesome family that came out to Milwaukee
• Great friends who joined them
• I'm not going to school anymore
• I am expected to show in North Caroline in a few weeks with more than a smile and a witty personality
• And of course the photo evidence…

Other than that not much has changed. I don’t feel better about myself (which makes me wonder if that’s because there’s not level of self-esteem higher than the one I’ve achieved), I definitely don’t feel more important (see the last parenthetical statement), the only pronounced feeling is gratitude for the each item mentioned in the list above.

On a less sappy note, the morning of graduation we went fishing on Lake Michigan. It was a beautiful morning with Captain Jay and Silent Tony. My dad, our family friend Jack, Greg, Me, Brian, and Mighty Matt all set sail at 5:30AM. The sea and weather complied to make the atmosphere enjoyable, but joking around while remembering such manly things as Dumb and Dumber, Tommy Boy, and Napoleon Dynamite was definitely the highlight.

Apparently, we caught some fish too. It’s a sensitive topic for a lot of the more experienced fishermen among us, so I won’t go into too much detail. Let’s just say if I talk about who caught the biggest fish then Greg, Brian, and Matt will get upset (Jack and Dad couldn’t care less).

On the way home my dad decided that we should scout out the location for the ceremony. The following exchange literally occurred with absolutely no embellishments almost no embellishments

Dad: Mike (I was driving), I think we should go see where graduation is going to be.
Me: That’s a fantastic idea, and if I knew where that was it would be an even better idea
Dad: We can find it
Me: Ummm…. How?
Dad: Don’t you live here?...
Me: … (stunned silence)

So after a fruitless search I get frustrated and just start driving home. As everyone is wondering where I'm going, I pull up to an intersection in downtown (which happens to have a red light). I stop behind the red light, and then proceed through the intersection slowly to assess the oncoming traffic.

During this time an older gentleman with a winter coat and sunglasses (odd since it was 60 degrees and overcast) walks into the crosswalk and proceeds to the driver side of my car. For brevity’s sake we’ll call this guy drunk/confused/old/angry guy (DCOAG for short… and I'm not sure if he was all of these but I know he was at definitely 2 of them) throws his arms up to about shoulder height and stares at me (apparently he’s well enough to walk across the street but not spry enough to walk around a mini-van).

I'm the picture of poise at this point so I calmly scream at the top of my lungs “WHAT?? WHAT DO YOU WANT??” I can tell DCOAG cannot believe all the walking he has to do on this day that he set out walking… it’s really gotten him in a foul mood. DCOAG probably hates it every time he goes to concert (because of the loud music). I'm certain DCOAG hates church (because of all the fuss about this God character). DCOAG loathes school (because of all this learning mumbo jumbo). DCOAG is one of these people for whom things just never seem to go right…

At this point DCOAG realizes defeat (I'm not pulling into oncoming traffic or backing into the car behind me simply to make his life easier) and he reluctantly goes around me. I make my turn and drive about a half a block to the next intersection… Just in time to see DCOAG jay-walk… Man, now he can’t even get cross-walks to move to accommodate him… no wonder he’s DCOAG…

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P-H-I-L-L-P-S… and the P is for Prolific

Just finished writing a history and physical of a patient that took way too long, then worked on a presentation about pelvic pain that didn’t take nearly long enough. After all that you’d think, “What drivel does he have left?” (and you’re within your rights to ask). Let me just say, “You’re about to find out exactly what drivel I have left!”

I flew back from an awesome trip to North Carolina that included:

• Being sick (with what I can only figure was swine flu)
• 90 degree weather (or as I like to call it, The Weather Wisconsin Forgot)
• Great food (even the delightfully disturbing vinegar based NC barbeque)
• An awful housing market (where $180,000 will buy you three small rooms and more Formica countertops than you know what to do with)
• Good times with some friends (new and old)
• Found an apartment to protect me from the above weather during my first year of residency
• An unfathomable lapse in memory (which led to a lack of reading material on the plane to NC)

Needless to say, the trip was memorable for several reasons. However, my lack of reading material was one of the most fantastic. Fantastic? How could it be fantastic? Allow me to explain… When I left William Osler: A Life in Medicine in the trunk of my friend’s car, I had no idea that on the way home I’d stumble across an equally enlightening and erudite book. Yep… you guessed it… I picked up The Maxims of Manhood: 100 Rules Every Real Man Must Live By. I'm not sure if it was the faux leather or the faux duct tape that first caught my eye, but needless to say that after 400 pages of A Life in Medicine (a book equivalent to mental lasagna… meaty, cheesy, lots of layers, and especially delicious) I was pleased to drizzle a little mental maple syrup (you know… sugary, thicker than water… but only water, and goes down smoothly) on top of said lasagna.

I liked the book enough to read it in two days. I laughed out-loud at some points and audibly disagreed with others. After a cursory read, I decided to find out how many of the points I had (denoted by an H), don’t have (denoted by a D), and the ones I need (denoted by an N). The breakdown was H – 81% (stuff I solidly have either by effort or default), D – 13% (stuff I don’t have or need usually involving alcohol), and N - 6% (stuff I was surprised to find I lacked).

I was proud to “H” the truly manly stuff like #9 Celebrate Birthdays Like You Celebrate Tuesdays, #27 Always Hold the Door For Women, #75 A Buddy’s Fight is Your Fight, and #98 Never Wheel Around Your Briefcase (a huge pet peeve of mine). I felt justified by H’s I’ve had all along, like #10 Never Take Sides Against the Family, #40 Properly Order a Steak, or #49 No Fake and Bakes. Littered along this trail of self-affirmation I found gems like #4 Never Say Blossom:

In a single day you could run a marathon, slay a wild boar, and uproot a tree
with your bare hands. If, at the end of that day, you say to your wife,
“Sugarplums, out little boy is really starting to blossom,” you have just
knee-capped an entire day of virility.

Or #97 It’s Only A Flesh Wound

Obviously there’s a time and place for admitting pain. Simple enough. But even then sometimes the true heroes—the ones who really matter—will inspire. Every guy knows these role models. For me, it’s two grandfathers who first fought Hitler, then fought cancer. In one particularly rocky stretch of treatment, a nurse asked Grandpa to describe, on a scale from 1 to 10, the intensity of pain. The man was in agony. Eighty years old—recipient of multiple Purple Hearts—and now he couldn’t breathe, laugh, speak or twitch a muscle without lightning bolts of pain. He looked at the nurse and calmly said, “Four.”

Not only were they funny, but it made me think of my own life. I remembered similar “heroes” or experiences where I’d tried to be heroic. Like when Greg and I used to work construction, and we were hurrying to strip a foundation on the morning of the Forth of July. We couldn’t let the forms sit on the foundation until after the holiday, but every single one of us had plans that we were hurrying to get to. We kept going faster, and faster and faster, until we were all running from the hole to the trailer. We’d run to the hole and as a 2-person-team (one pulling from the top and pushing from the bottom), we’d yank the panels out of the hole, catch them in mid-air and carry them to the trailer. One particular time one of the panels I was pulling wasn’t standing straight up (in fact it was aimed right at me). With my partner’s push of the panel and my pull from the top, I basically helped push myself off an 8 foot wall. I fell onto the rocks below and the 100 pound form landed on me. Like a real man of 15, I sat up and yelled swear words that are still hanging over Draper somewhere. I fought back the tears and was surprised by a lack of salty discharge from my eyes. I bit my lip and stood up to go back to work…. Cooler heads told me to slow down and asked me if I was ok. They told me to take a breather… They laughed that I even wanted to work. One of my white-trashiest idols of all time said, “you’re the toughest little kid I know.” The only person whose opinion truly counted (my brother) walked coolly over to me, and in his best impersonation of my dad, coldly said, “You’re such a wuss…” And he meant it!... If only I’d found this book sooner…

NO! It’s Actually Unacceptable…

I love traveling, whether it be to far away destinations or back home. New destinations are so exciting because I get to see the way other people live, explore new cities, and learn about the history of another location. Home offers a completely opposite, but more enriching experience. I get to enjoy locations that are familiar to me. I get to relax and be comfortable in an environment that I know. Most importantly I get to see my family again, and no matter how much we’ve changed it feels like I never left.

This most recent trip home was fantastic because I got to meet my new, beautiful, and sleepy niece (who may be the most germ free baby I’ve ever met… at least I hope she is… for her mom’s sake…). It was great to see my younger brother (who I am jealous of in every way… except of course his math/physics skills, don’t need ‘em… don’t want ‘em). I got to hang out with my favorite nephew who, if he doesn’t grow up to be a janitor (see brooms, love of), is going to be an awesome cowboy (rivaled only by my youngest brother’s future in cattle roping). I got to hang out with my favorite sister and watched her choked down what I can only describe as vinegar ice cream, and chatting about life (she’s so smart, strong, and kind… I wish I was more like her). I got to devastate my dad on e-golf (despite his 3 eagles and 1 double eagle… I'm not sure how he did it, but he always mentions a C++ class he took way back and that’s the only thing I can come up with). Other highlights include:

• My aunt’s phone ringing in church…
• My aunt, embarrassed that her phone went off in church, loudly saying her daughter's name from 5ft away to chastise her for making noise during the meeting...
• My cousin sleeping/kissing/cuddling/making out in church…
• My family texting about all of the above…
• Seeing my best friends, and catching up…

At this point, I know exactly what you’re thinking… “All of those things sound ‘acceptable.’” And you know what? You’re absolutely right… that brings us to my trip home. After a day on the e-course and e-packing (no wait the packing was real… sorry I played so much Wii this weekend I'm having trouble separating ‘e’ and realit-e), I was taken to the airport by my dad (still reeling from the losses) and my brother (still thinking about the Chinese food at home in the kitchen). Their minds elsewhere, they slowed to a roll and I jumped from the car…

I checked in using the US Airways Kiosk, which printed 1 boarding pass and 1 receipt for a boarding pass that says, “Please proceed to your gate for the seat assignment.” Well I mustered all of the patience in my being and waited to ask the ticket agent until he was done talking to the traveler he was currently talking to. Once they’d finished blathering, I said something like, “I just got a receipt instead of a boarding pass (sighing… furrowing the eyebrow…), what does that mean?” He assures me that everything is going to be fine, I’ll be able to board that flight but they have to upgrade some of the coach people to first class before they can give me my seat assignment. To which I responded (with a tone as skeptical as I can muster), “Are you sure? Because if I'm going to get bumped, I’d rather be bumped here than Phoenix…” Again reassurance from my ticket agent (I wish I could remember his name, but for the purposes of this story, we’ll call him Moron (he’s actually not coming up again, but I think it’s important to label him as such))

After flying peacefully sleeping all the way to Phoenix I exited the plane and walk to the adjacent (yes… adjacent… I was definitely not lolly-gagging) terminal and ask for my boarding pass. The lady goes, “We oversold this flight and you’re on the standby list.” She then used the skill of “blankly-staring-at-the-client-without-giving-any-additional-information-at-a-crucial-point-of-the-conversation-where-more-information-would-be-appropriate” technique that she must have learned in her mandatory 1 hour “Working with Real People Seminar” (where she was ironically working with ‘fake’ people). I could feel my frustration boiling to the top, and we proceeded to have the following conversation (we’ll call her Idiot… not because it’s appropriate to call her an idiot… more because this is a family oriented blog, and it’s not appropriate to call her what she is):

• Me: So what does that mean?
• Idiot: It means you may not have a seat on this flight
• Me: (trying to prompt her to follow a logical path of the explanation of what I can only imagine is a common problem in her line of work) When will I find out if I have a seat or not?
• Idiot: It’s hard to say…
• Me: Well this flight is boarding in 20 minutes, and if I'm not getting on it I need to have an alternative plan. Do you know how likely I am to get on the flight?
• Idiot: (after looking me up on the list) If I were you I would try to get on another flight, because it’s highly unlikely that you’ll get on this fl…
• Me: Are you kidding me?
• Idiot: No sir, do I look like I have a sense of humor or a modicum of creativity (she didn’t say that last part… I'm reading between the lines…) We can get you there by Wednesday afternoon at the very latest sir, if you’ll just be patient…
• Me: Ma’am, I am a medical student I have patients that I have to see in the hospital tomorrow morning (I realize calling this a stretch is like calling the sun warm. I was flustered though and I panicked, so give me a break). So Wednesday is unacceptable!
• Idiot: Actually sir, it is acceptable! I understand what you’re saying but these are our opti…
• Me: No! Actually Wednesday is still UNACCEPTABLE and NO! You actually don’t understand! I need to be in Milwaukee tomorrow morning, are there any other options?
• Idiot: There are 2 other options available. Both are horrible convoluted options that meagerly compensate you for the hell we’re going to put you through because we made a bad choice (again, reading between the lines). The first gets into Milwaukee tomorrow at 4PM and the second takes you through Kansas City tonight, puts you in a hotel and then flies you on another airline into Milwaukee at 7AM.
• Me: (processing this horrendous ‘solution’ (if you can even call it that) to this problem) So are you paying for my hotel and food tonight?
• Idiot: Here is a brochure describing your rights.
• Me: (not breaking eye contact) I'm not reading a brochure. How about we just review the options again, and then you can explain the brochure to me.
• Idiot: I am an idiot (this particular message was nonverbal but it definitely was no longer hidden between the lines).

To make this story less voluminous… I went to Kansas City last night. Fell asleep for an hour. Flew to Milwaukee this morning and I'm home now… and happy again. Because no matter how horrible the last few paragraphs were… the first few paragraphs made it worth it…

How Much?

For the last four years of my life, I’ve lived on student loans (as do most people in my line of business). It’s not a complicated process… in fact, the steps go as follows: 1) every winter I fill out a FAFSA and Loan Application, 2) sometime in the Spring I walk into the Financial Aid office at my school and casually say, “Give me the max Hoss (not actually someone’s name… or even something I actually call anyone… moving on…)” 3) I pick up a check for my living expenses in the fall.

The fall checks amount to what people on welfare typically call “poverty,” or “poor as #$%@” in other circles. The big money goes to the amount being paid to the school. That amount has always simply been “numbers” (at least in my mind). The numbers are also very tricky because they’re split up over subsidized, unsubsidized, Perkins, institutional, and private loans (I know…. It’s as complicated as it is mind-numbing…). The point is that I’ve never seen the grand total on one line of a balance sheet… Until last Friday (we’ll call it black Friday… and definitely not because I'm “in the black”). I finally saw a grand total… it had an effect on me that was different than any other number I’ve ever encountered. I immediately started to agonize over how I would pay it all back, and how long it was going to take, and how complicated it is to have to defer the payments until I can actually afford to make said payments… After seeing the number, I sat through a meeting that lasted an hour and a half. All I learned during that meeting was that if I don’t pay back the number, at some point someone will sue me (unless of course I’ve carefully filled out all of the paperwork that was too overwhelming/complicated to understand).

I'm not sure why I'm writing about this, as it sounds like I'm complaining about something I chose to do. Like punching myself in the face then complaining that it hurts… well it’s not that way. In fact, I live my life by a certain set of rules and rule #7 is never complain to anyone about the consequences of something you chose to do. So I'm telling you this because well… it was either this or writing about my recent mandatory urine sample. Luckily for you rule #237 is don’t talk about mandatory urine sampling… unless you absolutely have to.

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Acupunk'd

I have been getting headaches since high school. They always come the same way in. Around January or June, I start to get headaches… usually about 3-4 excruciating episodes each day. Oddly, I always run into the same problems with the insurance company providing enough medicine to treat them. We do the same song and dance about how I need more pills than they’re providing… It’s like a timeless tradition like high school proms, sweeps week, or Easter.

The latest “cluster” of headaches, has followed a similar pattern. When I started to run out of pills, I started getting desperate… not desperate like this guy... more like semi-desperate. Desperate enough to seek alternative treatments, and that’s where acupuncture comes in. I have a friend who told me about an acupuncture school that is just south of Milwaukee. I'm adventurous, so I figured I’d give it a shot, I mean what if it worked... and at the very least I'd have something to write about.

The acupuncture school is a lot like a normal medical school but without being hindered by silly things like science or ancillary diagnostics. Their history focuses on things like whether I'm hot or cold, whether I crave sweet or salty, whether I usually find myself hungry or satiated, and of course what type of personality I have. (In case you’re curious, my answers are normal, neither, not sure, and maybe assertive?... in that order). They also asked me where I work, and when they found out that I am about to graduate from medical school everyone got a little nervous. Answers to my questions started to come with trepidation, and nervous sweats. Seemingly finding strength in numbers, they started to visit me in groups of two and three. They also started asking questions about why I was there, and what I wanted to get out of treatment. It was like going on a bad first date with a pregnant girl... you both know what the other person's thinking and no matter how much talking you do it's never going to be less weird... at least for nine months or so...

Then we move on to the physical exam which consists of looking at my tongue and feeling my pulses (checking pulses is pretty familiar, as we check pulses in Western medicine too, but we derive far less from pulses than they do). I was told that my tongue suggests that my chi is stagnant (depending on which student you ask the chi can be a number of different things), and my exuberant pusles signalled a strong personality... maybe even assertive. It was disappointing that all of my pain was due to my lazy or distracted chi (no worries though, we’ve spent 3 visits trying to whip it into shape).

My treatments have gone as follows. My first visit I got 10 needles (1 in the crown of my head, 2 in each hand, 1 in each shin and 2 in each foot). The second time I got 12 needles (3 in my right temple, 1 in my neck, 2 in each hand, and 2 in each foot). The last time I got like 47 needles I swear, I felt like a pin cushion (5 in my neck, 1 that was 3 inches below my umbilicus, 2 in each hand, 2 in each shin, 2 in each foot, and 1 in each ear). They insert the needles then let me lay on the table for 20 minutes while the needles take effect (which is a surprisingly relaxing time).

If the regimen confuses you… well, join the club. Every time I’ve gone, I’ve asked for an explanation of their physical findings and their plan. When I ask for an explanation, most of the students get really nervous or start grinning like they stole something. They usually give me some rambling explanation with one of the following phrases mixed in:

• “This probably sounds weird to you…”
• “I wish I could show you a picture from my book…”
• “It’s tough to explain…”
• “The body has energy that accompanies the function…”
• “I'm literally making ALL of this up… does it even sound believable?”
• “I'm crazy… literally crazy!”
• (Two of these were actually how my mind interpreted things they were saying…)

The whole experience has been simultaneously foreign and relaxing at the same time, like taking a vacation to Mars. However, after all of this, it’s tough to tell if the treatment is “working.” I do know that at the very least it’s relaxing. I also know that it’s been fun, because I’ve forgotten how bewildering it can be to be a patient. When I go to see my own doctor, I know the questions I’ll get asked and what they’re looking for when they examine me. So I'm never uncomfortable, I never feel the alien nature of a medical encounter because I see similar encounters all the time. When things aren’t explained completely, I can simply rely on my own knowledge or textbooks that I have at home to fill in the blanks. On Mars though, none of the normal rules apply… so I'm left at the mercy of people who are speaking a completely foreign language to explain complicated theories regarding something that’s very important to me. Don't worry, the irony of having to take a trip to Mars to be reminded of what my front yard looks like is not lost one me.

Second Place Is The First Winner….

Have you ever seen those shirts that say, “Second place is the first loser?” (There’s no question mark on the shirt… I'm asking you if you’ve seen them). I would say that, for the first 28 years of my life, that particular saying could not have been more true. However, a funny thing happened on March 19, 2009… no not Nate’s birthday (although that might have been funny… I have no way of knowing). I'm talking about match day, when medical students around the country find out where they’re going to do their residency.

On match day, I learned that I’d be going North Carolina to continue my training, and that's where things got tricky. North Carolina was my second choice (do you see where I'm going?), but it turned out to be the first winner!

I couldn’t be happier, as North Carolina has a fabulous mix of nice residents, beautiful location, and exciting sports options (3 of the things I look for every time I decide where to go for residency). Although, the answer was somewhat bittersweet, because I found out that I would be spending the next 5-7 years away from my family. On the bright side, I feel like this will give me a great opportunity to end up in Utah eventually. So I’ll accept the fact that I will need to enduce ocassional airline travel in order to see them, especially if it gives me the the chance to return there in the end.

The whole thing got me thinking about seconds that ended up being firsts, here’s the list (it may not be 100% inclusive, but it's a good start):

• Me (This is where I am grateful no one reads this... because I can make outrageous claims)
• The Godfather II (in my opinion)
• George Bush II (I mean I can’t even really remember the older one, say what you want but the second one was memorable)
• WW II (way more memorable in my opinion)
• Terminator II (so they say, but neither is memorable to me)
• The OC Season II (trust me)
• Boyz II Men (it’s a stretch I know…)
• Derek Jeter (Way better than Billy Martin)

Note: Please just ignore Home Alone 2, Karate Kid 2, Look Who’s Talking 2, or any of the litany of horrible sequels known to mankind.

Umm... Are You Gonna Eat That?

For the past 4 years I’ve had church at 1:00PM, which is like literally having a 6 day week. You never do anything before 1 o’clock church, and by the time it’s over at 4:00PM and you get home, change, and eat it’s 6:00PM and the day is gone. It really ruins your ability to do anything else on Sunday (I of course am only referring to visiting the sick, my family, and other wholesome activities… and I'm definitely not referring to watching football or other unholy activities).

This late start time has never made arriving on time to church any easier. I'm usually about 5-10 minutes late once every four weeks (which is a big deal for me as I'm usually very punctual… I'm not bragging just saying that the late days are an aberration). So this past Sunday was my 25%, as I'm hurrying to church and driving like Mario Andretti or my brother Brian (they're equivalent). I glance off to the side of the road and there’s a Hispanic guy lifting a dead deer (road kill… definitely not shot) from the side of the road into the back of his Ford Explorer. This deer was not limber and newly run-over… full rigor mortis had set in and it was like watching someone try to move a 150 pound cardboard cut out. I couldn’t help but feel bad for someone that desperate, but at the same time be happy that I don’t live in Newton (where I'm sure this type of thing is a lot more common).

FYI: The above pictures comes from British Columbia's Wildlife Roadkill Identification Guide. Unfortunately, I cannot guarantee that it is accurate as this is only the 2008 edition, and I have no idea how much roadkill changes from year to year.

My Landlord is a Real Mensch…

One week ago, I had dinner with my landlord (we’ll call him ‘Fred’… mostly because that’s his name, but partially because he seems like a Fred). We got to talking about great places to eat. Fred’s been in Milwaukee for a very long time, and knows all the best places (as well as the nights those places have specials). Obviously, this makes him an indispensable resource. On this particular occasion, the conversation led to Chicago eateries and we had the following exchange…

Me: Any suggestions for places to eat in Chicago?
Fred: That depends, do you like Jewish delis?
Me: Wouldn’t know… never eaten in one…
Fred: There’s this great Jewish deli called, ‘Once Upon a Bagel.’ But it’s authentic Jewish food, so only go if you like pastrami and corned beef…
Me: Pastrami and corned beef?...
Fred: Yeah… do you not like those types of meat?
Me: Nahh… I'm just trying to wrap my head around the notion that other people wouldn’t like ‘em.

(For the sake of historical accuracy, Fred substituted the word ‘Jewish’ in the above conversation with the words ‘Jew’ and ‘Heeb.’ I just was just unsure as to the proper use of those terms, so I stayed away from his vernacular.)

So on Friday, a friend and I went to the Field Museum in Chicago (I took a personal day… I guess). On the way, I stopped at the aforementioned restaurant and ordered the lox plate while my friend had the corned beef hash.

Not only were the lox fantastic, but I also found out that I'm a fresser. The corned beef hash is another story… let’s just put it this way I have always felt that there are two types of people in this world, those who like corned beef has and those who have functional taste buds. For twenty eight years I’ve been faithfully and staunchly planted in the latter camp. After the meal on Friday I'm not sure I can honestly maintain that position. That’s how good the hash was… it was camp-changing… which is the biggest kind of changing I can imagine. Once Upon a Bagel also offers my favorite bagel… the delicious-but-difficult-to-find salt bagel. After pampering my taste buds, I got bagels, corned beef, and rye bread to go.

An hour later I was staring at the worlds largest and most complete Tyrannosaurus Rex skeleton in the world, but honestly it was only the second most impressive thing I saw that day…

Make Up Your Mind

I love Milwaukee… I love Wisconsin… I am not a fan, however, of a weather system (or any system for that matter) that can’t make a decision.

I spent December and January traveling to residency interviews, and being exposed to all different types of weather around the country. When I wasn’t traveling I was spending time in Utah, with my fantastic family.

I mention this because on the day that I left Wisconsin the weather was awful. How awful was it you ask? Well when I drove to the gym, at 10AM on the morning of my departure, the temperature reading in my car's dash said -7… again it was 10AM. Once in the care, the radio announcer said that the wind was moving at around 30 mph and that made it feel like -40 (no one quote me on these numbers… they are of course vague recollections after all). When I got to the gym and sprinted from my car to the door of the gym, I actually had to pause to make sure that I hadn’t stepped in front of the world’s largest arctic leaf blower. After realizing that it wasn’t a massive leaf blower… it was simply winter in Wisconsin… I put my hands on my stinging face and proceeded inside the building.

While I was out of Milwaukee, I got a number of emails from my school with warnings of severe weather in Wisconsin. The following suggestions were actually forwarded to me:

• Stay indoors as much as possible.
• If it is necessary to venture outside, dress warmly and try to stay dry. Exposed skin can become frost bitten within minutes, so minimize the amount exposed by wearing a hat or hood, a scarf or knit mask to cover the face and mouth, mittens or gloves, water-resistant coat and boots, and layered clothing if possible.
• Avoid excessive exertion. The body can lose a great deal of heat through breathing (warm air out and cold air in), which places additional strain on an individual.
• Carry an emergency pack in the car that includes blankets and travel with a cell phone in the event of an accident.

All of this made me laugh, as I was in Utah enjoying at least tolerable 30-50 degree weather, with lots of sunshine and occasional snow mixed in. When it was time to go home, I was genuinely worried about what the weather would be like. My worries quickly disappeared on arriving to sunshiney Milwaukee. I was treated to record highs (up to the 60’s), or as I like to call it “The Golden Age of Wisconsin Winter Weather.” I honestly did not know what to do about that weather, and may have even been in denial… you know like when you win a contest and say, “I can’t believe I won.” Or like when you grew up in my family and you say, “I can’t believe I only have a single complex.” You know that the outcome was expected, but it surprises you anyway?

So today I had planned to do a number of things, like: go to the gym, put up drapes (3 years too late… yeah… I know), and go out with the missionaries. I head out the door at 10AM (before you ask… yes, if it’s important to me it gets done at 10AM. I don't know why... it's just how I roll), and snow has been falling all night, the roads were awful, and I'm pretty sure several puppies froze to death (that’s right, snow kills dogs).

And I'm ok with most of those things (some more than others), but just be honest… Don’t tell me you’re going to be hot and then drop 7 inches of snow on me… Don't tell me you're going to be one way, and then as soon as I come to expect that behavior from you, you change your mind and decide to be the polar opposite. Pick a climate and stick to it! I hate this indecision!

PS I took like 15 pictures of the snowfall, but I couldn’t decide which one to use…