Pregnant women of the world, please see a doctor AS SOON AS you think that you might be pregnant. Not only can you get a second pregnancy test, but you can start your prenatal care early. Fetuses need healthcare too, but the most important thing might be the first sonogram to estimate the age of the fetus. Combined with knowledge of your exact LMP (the first day of your last period), doctors can make better decisions about your healthcare...everything from deciding when you might need an induction to whether your fetus is growing normally.
I always wondered by doctors get very persnickety and anal about "dating" the pregnancy, but now realize that it is a fundamental and often underestimated part of the process.
Tuesday, January 27, 2009
respect
I often enjoy David Brooks' columns in the NYT, here is a particular quote of a quote for today:
"In 2005, Ryne Sandberg was inducted into the baseball Hall of Fame. Heclo cites his speech as an example of how people talk when they are defined by their devotion to an institution:
'I was in awe every time I walked onto the field. That’s respect. I was taught you never, ever disrespect your opponents or your teammates or your organization or your manager and never, ever your uniform. You make a great play, act like you’ve done it before; get a big hit, look for the third base coach and get ready to run the bases.'”
However, I disagree with Brooks' assertion that we must return to a culture more reliant upon institutional thinking. I am still a big believer in the philosophy of a liberal education, as Brooks points out:
"A few years ago, a faculty committee at Harvard produced a report on the purpose of education. “The aim of a liberal education” the report declared, “is to unsettle presumptions, to defamiliarize the familiar, to reveal what is going on beneath and behind appearances, to disorient young people and to help them to find ways to reorient themselves.”
The report implied an entire way of living. Individuals should learn to think for themselves. They should be skeptical of pre-existing arrangements. They should break free from the way they were raised, examine life from the outside and discover their own values."
Whether we devote ourselves to individualistic "thinking" or institutional "thinking" is not even the point; both labels describe certain automatic behaviors. We need to be capable of thinking (and I say this in italics) in a consciously unbiased manner instead of blindly following our own needs or conforming to the demands of society.
"In 2005, Ryne Sandberg was inducted into the baseball Hall of Fame. Heclo cites his speech as an example of how people talk when they are defined by their devotion to an institution:
'I was in awe every time I walked onto the field. That’s respect. I was taught you never, ever disrespect your opponents or your teammates or your organization or your manager and never, ever your uniform. You make a great play, act like you’ve done it before; get a big hit, look for the third base coach and get ready to run the bases.'”
However, I disagree with Brooks' assertion that we must return to a culture more reliant upon institutional thinking. I am still a big believer in the philosophy of a liberal education, as Brooks points out:
"A few years ago, a faculty committee at Harvard produced a report on the purpose of education. “The aim of a liberal education” the report declared, “is to unsettle presumptions, to defamiliarize the familiar, to reveal what is going on beneath and behind appearances, to disorient young people and to help them to find ways to reorient themselves.”
The report implied an entire way of living. Individuals should learn to think for themselves. They should be skeptical of pre-existing arrangements. They should break free from the way they were raised, examine life from the outside and discover their own values."
Whether we devote ourselves to individualistic "thinking" or institutional "thinking" is not even the point; both labels describe certain automatic behaviors. We need to be capable of thinking (and I say this in italics) in a consciously unbiased manner instead of blindly following our own needs or conforming to the demands of society.
Monday, January 26, 2009
Saturday, January 24, 2009
When I Grow Up
The favorite questions between classmates during this season are: 1) Are you taking a year off? and 2) Do you know what you might go into?
No. And no.
Throughout medical school, I always assumed that the right field would seem immediately and obviously perfect for me. Maybe it would be when I diagnosed my first ear infection in a 2-year-old in Pediatrics. Maybe it would be when I first saw an open abdomen under the bright lights in an OR during Surgery. But somehow, working on the theory that finding a medical profession can be as easy as love at first sight has...well...turned out to be harder than imagined.
Writing has always been a way for me to process emotions and explain decisions. But during third year, writing has been difficult due to time constraints, privacy issues, and my inability to sit down and ponder the journey that will be my life.
Stay tuned for future angst.
No. And no.
Throughout medical school, I always assumed that the right field would seem immediately and obviously perfect for me. Maybe it would be when I diagnosed my first ear infection in a 2-year-old in Pediatrics. Maybe it would be when I first saw an open abdomen under the bright lights in an OR during Surgery. But somehow, working on the theory that finding a medical profession can be as easy as love at first sight has...well...turned out to be harder than imagined.
Writing has always been a way for me to process emotions and explain decisions. But during third year, writing has been difficult due to time constraints, privacy issues, and my inability to sit down and ponder the journey that will be my life.
Stay tuned for future angst.
Wednesday, January 14, 2009
Fresno, CA
Fresno is an inland city located in California's Central Valley approximately midway between San Francisco and Los Angeles. In many ways, Fresno is very different from San Francisco...the median income for a household in Fresno is $32,236 vs. $57,833 in San Francisco according to wiki. There is a larger population of Hispanic and minority patients, and most of the Asian patients in Fresno are the legendary Hmong. (Legendary because Hmong culture is featured extensively in our required reading during medical school as part of lessons in cultural sensitivity, but rarely seen in San Francisco). In Ob-Gyn, our female patients tend to be younger, healthier, poorer, and less educated than patients probably seen at other hospitals in the Bay Area. A fair amount of patients are illiterate. Many are immigrants from other countries. Learning medicine in a non-academic center has been new and refreshing for me, and I have been able to practice my medical Spanish. I had wanted to do obgyn in Fresno because 1) it seemed like a good idea to do an away rotation to see new settings; 2) Fresno has one of the highest birth rates in CA; 3) I've never been to Fresno; 4) I wanted to practice my Spanish.
I haven't spoken much Spanish since college, and have been amazed again at how beautiful the language can be. Honestly, Spanish is more expressive and beautiful than English or Mandarin...and this is coming from a pseudo-Asian American English major. There are so many shades of meaning, and interesting quirks to think about...like how the term for giving birth is "dar la luz" (literally: give light), or why someone can be "estar muerto" (dead) when the verb "estar" implies a temporary state. Or even why someone can be "ser joven" (young) when "ser" usually implies a permanent state. Don't get me wrong, my Spanish is still fairly poor.
Another interesting thing about Fresno is the lifestyle...the buildings are spread out, there are gazillions of chain stores like Target, Starbucks, Costco, and plenty of parking and free high quality food at the hospital. The people in Fresno tend to be more open, friendly, less pretentious and more humble. :)
Monday, January 12, 2009
Tip #2: Wipe from Front to Back
Ladies, avoid getting UTI's by wiping from front to back (if you know what I mean).
Interesting NYT article on abortions in the NYC Dominican community: http://www.nytimes.com/2009/01/05/nyregion/05abortion.html?pagewanted=2&fta=y
ObGyn is fun! I enjoy working in the clinic and seeing different aspects of female reproductive health. Today I saw a few colposcopies for cervical dysplasia and worked up a case of bilateral breast pain. In the past week, there have been a few endometrial biopsies, some PID, a MRSA abscess, lots of prenatal appointments, and lots of birth control appointments. :)
Interesting NYT article on abortions in the NYC Dominican community: http://www.nytimes.com/2009/01/05/nyregion/05abortion.html?pagewanted=2&fta=y
ObGyn is fun! I enjoy working in the clinic and seeing different aspects of female reproductive health. Today I saw a few colposcopies for cervical dysplasia and worked up a case of bilateral breast pain. In the past week, there have been a few endometrial biopsies, some PID, a MRSA abscess, lots of prenatal appointments, and lots of birth control appointments. :)
Wednesday, January 07, 2009
Ladies, Keep Track of Your Period
Current in Fresno on my ob-gyn rotation. Fresno is a cool town, and medical students get free housing! So far, I like how ob-gyn is such a great mix of medicine and surgery.
Public Service Announcement: Ladies, PLEASE KEEP TRACK OF THE FIRST DAY OF YOUR PERIOD. In clinic, less than 25% of women know the date of their last menstrual period (LMP). This is just sad and pathetic, because obviously it's not hard to keep track of your period using a calendar, but rather indicates that medical professionals suck at teaching patients how take charge of their health. This will also come in handy not only if you're pregnant, but also if you show up at the Emergency Room with appendicitis...they will want to know your LMP.
Don't worry about anything more than the FIRST DAY of your period.
Public Service Announcement: Ladies, PLEASE KEEP TRACK OF THE FIRST DAY OF YOUR PERIOD. In clinic, less than 25% of women know the date of their last menstrual period (LMP). This is just sad and pathetic, because obviously it's not hard to keep track of your period using a calendar, but rather indicates that medical professionals suck at teaching patients how take charge of their health. This will also come in handy not only if you're pregnant, but also if you show up at the Emergency Room with appendicitis...they will want to know your LMP.
Don't worry about anything more than the FIRST DAY of your period.
Saturday, January 03, 2009
Raise Your Kids in Arcadia, CA
Sorry again for the lack of posts...surgery was busy and full of dramatic stories to be related soon. A belated Merry Christmas and Happy New Year! :)
Also just wanted to let everyone know that my hometown of Arcadia, CA was named the best place in California to raise your kids in 2009 accordinging to Business Week magazine! And the Rose Queen in the 2009 Pasadena Rose Parade is an Arcadia High School student! :)
See links: http://images.businessweek.com/ss/08/11/1110_best_places_for_kids/6.htm
Kid-Friendly and Cost-Friendly
By Prashant Gopal
Welcome to BusinessWeek's second annual roundup of the best places to raise your kids.
This year we are going state by state. Once again working with OnBoard Informatics, a New York-based provider of real estate analysis, we selected towns with at least 50,000 residents and a median family income between $40,000 and $100,000. We then narrowed the list of towns using the following weighted criteria: school performance; number of schools; household expenditures; crime rates; air quality; job growth; family income; museums, parks, theaters, and other amenities; and diversity. We weighted school performance and safety most heavily, but also gave strong weight to amenities and affordability.
Bear in mind with this list, the organizing principle was affordability. While the median household income varies by state, we purposely weighted the results to prevent pricing out most readers. That's why, for example, Greenwich, Conn., with its good private schools, low crime, and abundance of cultural amenities, was left out. It simply costs too much to live there.
Of course, there are other places that are great for kids which did not make this list. In many states the competition was extremely close. Moreover, we looked for communities that scored well across the board. So, while there might be places that offer more culture, better schools, etc., other factors such as crime or a high cost of living knocked them down.
Also just wanted to let everyone know that my hometown of Arcadia, CA was named the best place in California to raise your kids in 2009 accordinging to Business Week magazine! And the Rose Queen in the 2009 Pasadena Rose Parade is an Arcadia High School student! :)
See links: http://images.businessweek.com/ss/08/11/1110_best_places_for_kids/6.htm
Kid-Friendly and Cost-Friendly
By Prashant Gopal
Welcome to BusinessWeek's second annual roundup of the best places to raise your kids.
This year we are going state by state. Once again working with OnBoard Informatics, a New York-based provider of real estate analysis, we selected towns with at least 50,000 residents and a median family income between $40,000 and $100,000. We then narrowed the list of towns using the following weighted criteria: school performance; number of schools; household expenditures; crime rates; air quality; job growth; family income; museums, parks, theaters, and other amenities; and diversity. We weighted school performance and safety most heavily, but also gave strong weight to amenities and affordability.
Bear in mind with this list, the organizing principle was affordability. While the median household income varies by state, we purposely weighted the results to prevent pricing out most readers. That's why, for example, Greenwich, Conn., with its good private schools, low crime, and abundance of cultural amenities, was left out. It simply costs too much to live there.
Of course, there are other places that are great for kids which did not make this list. In many states the competition was extremely close. Moreover, we looked for communities that scored well across the board. So, while there might be places that offer more culture, better schools, etc., other factors such as crime or a high cost of living knocked them down.
Saturday, November 15, 2008
Surgery. 'Nuff Said.
Sorry for the lack of posts...I fell off the blogging bandwagon for a few weeks.
Currently, I just finished week 3/8 of Surgery at Mt. Zion/Parnassus. MZ is UCSF's cancer center, and I love being on the surgical oncology White service (the Gold service at MZ does colorectal cases). White surgeries include GI malignancies (whipple's, etc), liver resections, and melanoma.
Surgical oncology seems like a great field, there's a lot of satisfaction to be gained from whacking out a tumor.
P.S. It seems like a bad dream...how did Prop 8 AND Prop 2 BOTH pass? Since when do chickens enjoy advances in rights...while humans do not?
Tuesday, October 28, 2008
SAVE GENERAL HOSPITAL
San Francisco voters, please vote YES on Prop A to make San Francisco General Hospital earthquake-friendly.
SELECT trial halted!
As a prostate cancer/oncology geek, I have to let you know that the huge trial examining whether selenium + Vitamin E prevents prostate cancer (results were due in 2013) was closed permanently yesterday!
Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.
Juicy oncology gossip!
Discuss.
Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.
Juicy oncology gossip!
Discuss.
Tuesday, October 21, 2008
Intersession 2 and a Really Nice Weekend
Big Sur from the Lucia Lodge restaurant porchbest fish and chips ever
The MS3's are midway through Intersession 2, a week-long break between 3rd and 4th block. It's interesting that even though I had more free time during Family Medicine, I actually ended up blogging less. During Intersession, the students engage in a variety of touchy-feely small groups and lectures about medical ethics and professionalism. It's actually a good time to unwind and reflect on how we are changing on our journey to becoming doctors.
Last weekend after the Family Medicine exam was also extremely nice. To start, I spent an hour walking around Lake Merced by myself before sunset, which is something that I wanted to do for six weeks after glimpsing the beautiful lake through a window at the Janet Pomeroy Center (a fantastic center for children and adults with disabilities that FCM introduced me to via a community project). Lake Merced is beautiful; there are so many areas of the city that I haven't explored yet (the SF Zoo is nearby too).
Tuesday, October 07, 2008
Gingivostomatitis
I diagnosed my first case of gingivostomatitis this morning in a 2-year-old girl who had reported to the ED 5 days ago with a fever of 104 degrees. The ED thought thought that she had OM, and gave her amoxicillin. The next day, the patient presented with mouth sores and continued running a fever. Her gums were swollen and purplish, and she had oral lesions in her buccal mucosa, on her tongue, and soft palate.
After checking her normal TM's b/l and ruling out HFMD (oh, Coxsackie, I know you well after catching you during my peds rotation) and chicken pox (vaccinations UTD, no rash), the leading diagnosis was herpetic stomatitis caused by HSV-1.
Even though it was a relatively simple case, it feels good to have a solid differential and coming up with a diagnosis. One of the things that I enjoy most about the outpatient clinic is seeing new patients with fresh eyes, being the first person to examine a patient and figure out what's going on. For instance, last week, I saw a 3 y/o boy with a 6 cm cervical LN. I find myself enjoying acute/urgent care more than routine physicals/WCC/healthcare maintenance (but predictably enjoy the Pap smears, FOBT, PSA, and other cancer screenings).
In family medicine, I have also found myself having an irrational fear of pregnant women (having not yet done OB-GYN, pregnant women are a black box to me), and an extreme fondness for taking care of children who are acutely ill.
After checking her normal TM's b/l and ruling out HFMD (oh, Coxsackie, I know you well after catching you during my peds rotation) and chicken pox (vaccinations UTD, no rash), the leading diagnosis was herpetic stomatitis caused by HSV-1.
Even though it was a relatively simple case, it feels good to have a solid differential and coming up with a diagnosis. One of the things that I enjoy most about the outpatient clinic is seeing new patients with fresh eyes, being the first person to examine a patient and figure out what's going on. For instance, last week, I saw a 3 y/o boy with a 6 cm cervical LN. I find myself enjoying acute/urgent care more than routine physicals/WCC/healthcare maintenance (but predictably enjoy the Pap smears, FOBT, PSA, and other cancer screenings).
In family medicine, I have also found myself having an irrational fear of pregnant women (having not yet done OB-GYN, pregnant women are a black box to me), and an extreme fondness for taking care of children who are acutely ill.
Tuesday, September 16, 2008
Wish List: paJAMAs
When they start making flannel JAMA PAJAMAS, please tell me so I can get me one'a'those. Brillz.
Thursday, September 11, 2008
Welcome, MS1's!
Orientation for the youngsters started last week, but I just wanted to say "HI" on my blog to the fresh-faced med students who will be having their white coat ceremony tomorrow. Sorry for being a deadbeat MS3, you will probably never see me unless you like to shadow doctors at Moffitt (you eager beaver you).
Ironically, as a first year, I always wondered why we didn't meet any MS3's or MS4's, apparently they were too busy to mingle with the first and second years. Also, we never get to attend any UCSF graduations, so there is a particular divide between MS1/2 and MS 3/4, that UCSF could probably remedy to some degree. Anyway, it's just funny that now I AM the shadowy MS3 whom you will never meet, and therefore assume that I am aloof and a little bit eccentric (ah, first non-impressions).
Enjoy medical school, and for goodness' sake, HAVE FUN this year and next year. Enjoy the pass/fail system and relax (you won't listen to me, but i'll say it anyway). Try to go to class. Eat the hashbrowns in the Moffiteria. Avoid the hospital. Do what you love. Hang out with friends and family. Don't worry about the Boards until perhaps Nov.-Dec. of your second year. Be nice to the MSP teachers and don't be (too) mean to the small group leaders. DON'T BUY ANY OF THE TEXTBOOKS ON THE LIST!! (except for Netter's and Blumenfeld, which you can buy in May). YOU NEVER USE THE TEXTBOOKS.
Good luck, medlings!
Ironically, as a first year, I always wondered why we didn't meet any MS3's or MS4's, apparently they were too busy to mingle with the first and second years. Also, we never get to attend any UCSF graduations, so there is a particular divide between MS1/2 and MS 3/4, that UCSF could probably remedy to some degree. Anyway, it's just funny that now I AM the shadowy MS3 whom you will never meet, and therefore assume that I am aloof and a little bit eccentric (ah, first non-impressions).
Enjoy medical school, and for goodness' sake, HAVE FUN this year and next year. Enjoy the pass/fail system and relax (you won't listen to me, but i'll say it anyway). Try to go to class. Eat the hashbrowns in the Moffiteria. Avoid the hospital. Do what you love. Hang out with friends and family. Don't worry about the Boards until perhaps Nov.-Dec. of your second year. Be nice to the MSP teachers and don't be (too) mean to the small group leaders. DON'T BUY ANY OF THE TEXTBOOKS ON THE LIST!! (except for Netter's and Blumenfeld, which you can buy in May). YOU NEVER USE THE TEXTBOOKS.
Good luck, medlings!
Tuesday, September 09, 2008
Family Medicine
My family medicine rotation started yesterday, and it's been nice so far. The rotation is entirely outpatient, with no call nights and every weekend free...which is great because i never had a "golden weekend" for 8 weeks on medicine. In many ways, the family medicine rotation is different from other rotations, and not just because it's entirely outpatient, but also in terms of philosophy and mindset. There's an emphasis on continuity of care, being the medical "home" for a patient, and doctors can care for entire families throughout the generations. The "bread and butter" conditions for family medicine are chronic -- HTN, COPD/asthma, HL, CAD, DM. Psychosocial issues like substance abuse, domestic violence, or homelessness -- which can be swept under the rug by time constraints in an inpatient ward -- become more important during family medicine.
During orientation, the clerkship director asked us how patients have already been affected medically even before we see them during the first new patient visit. It was a confusing question, but it's not just past surgeries or vaccinations, etc. that affect a patient...other factors such as environmental pollution, McDonald's, and rising gas prices can affect someone's health. I never appreciated how family medicine can be a vehicle for advocacy for many different things in the "real world" that impact health and well-being.
On another (non med) note, the media has exploded recently with the debut of Sarah Palin -- i've never seen so much press on one person in one week. She has made the news interesting lately, to say the least.
During orientation, the clerkship director asked us how patients have already been affected medically even before we see them during the first new patient visit. It was a confusing question, but it's not just past surgeries or vaccinations, etc. that affect a patient...other factors such as environmental pollution, McDonald's, and rising gas prices can affect someone's health. I never appreciated how family medicine can be a vehicle for advocacy for many different things in the "real world" that impact health and well-being.
On another (non med) note, the media has exploded recently with the debut of Sarah Palin -- i've never seen so much press on one person in one week. She has made the news interesting lately, to say the least.
Thursday, September 04, 2008
Home Conversations
Home in Arcadia before starting Family Medicine.
After passing by Jeremy's old preschool, my siblings and I started talking about how we used to eat dirt, grass, and insects when we were in preschool.
"My friends and I ate ants," Jeremy said, "They were spicy."
"At least you ate them with friends," Samantha retorted, "I ate grass ALONE."
Love my family. :)
After passing by Jeremy's old preschool, my siblings and I started talking about how we used to eat dirt, grass, and insects when we were in preschool.
"My friends and I ate ants," Jeremy said, "They were spicy."
"At least you ate them with friends," Samantha retorted, "I ate grass ALONE."
Love my family. :)
Wednesday, August 13, 2008
the case of the bloody poo
Mike and I were trading stories about medical cases that we've seen recently. My fault, really, since I'm obsessed with medicine and can't stop talking about work (since that's all I do anymore, anyway). After I told Mike about my current patient with weight loss of unknown origin and a recent case of Q fever endocarditis, Mike told me the following pediatrics case that he saw today:
"Six-year-old boy, the story is that he took a dump this morning and it was bright red. No stomach pain, might have had a similar poop last night, no vomiting, heart rate is stable, no signs of dehydration or shock, kid is in no apparent distress."
"INTUSSUCEPTION!" I yell.
"No. So the resident does a digital rectal exam, and his glove comes out bright red and covered in poo. The resident smears his glove on a FOBT (a strip of paper that turns color when poo with blood gets smeared on it, even if the blood is not visible to the naked eye), and the strip never changes color."
"The strip should change color," I said, "so either the strip is defective or it's not really blood."
"Right, but what is it?"
"Meckel's?" I said.
"No. Then we asked the boy to pee in a cup. Why?"
"To check for hematuria or proteinuria?"
"No, even simpler."
"To see if his pee is red too?"
"Yes! Because eating too many beets can color your poop and your pee."
"Was it red?" I asked.
"No, his urine was not red."
"GI bleed?" I said, "he doesn't seem to be in distress. He's too young for colon cancer, diverticulitis, or ulcers.
"No. Give up?" Mike asked.
Yes.
"So the resident is totally clueless. We talk to the attending, and the attending laughs. He says that a couple years ago, when RED HOT CHEETOS hit the market, there was a huge outbreak of kids with bright red poo. And this was the case."
"Six-year-old boy, the story is that he took a dump this morning and it was bright red. No stomach pain, might have had a similar poop last night, no vomiting, heart rate is stable, no signs of dehydration or shock, kid is in no apparent distress."
"INTUSSUCEPTION!" I yell.
"No. So the resident does a digital rectal exam, and his glove comes out bright red and covered in poo. The resident smears his glove on a FOBT (a strip of paper that turns color when poo with blood gets smeared on it, even if the blood is not visible to the naked eye), and the strip never changes color."
"The strip should change color," I said, "so either the strip is defective or it's not really blood."
"Right, but what is it?"
"Meckel's?" I said.
"No. Then we asked the boy to pee in a cup. Why?"
"To check for hematuria or proteinuria?"
"No, even simpler."
"To see if his pee is red too?"
"Yes! Because eating too many beets can color your poop and your pee."
"Was it red?" I asked.
"No, his urine was not red."
"GI bleed?" I said, "he doesn't seem to be in distress. He's too young for colon cancer, diverticulitis, or ulcers.
"No. Give up?" Mike asked.
Yes.
"So the resident is totally clueless. We talk to the attending, and the attending laughs. He says that a couple years ago, when RED HOT CHEETOS hit the market, there was a huge outbreak of kids with bright red poo. And this was the case."
Friday, August 08, 2008
"that's all i can do"
Mr. D suffered from the lung disease that killed Evel Knievel -- idiopathic pulmonary fibrosis (IPF). The word "idiopathic" in medicine is a code word that means "doctors have no clue what the cause of the disease can be." As a result, Mr. D couldn't breathe anymore -- his lungs were like a pair of old dishwashing sponges left in the sun to dry. Needless to say, there wasn't much oxygen exchange happening. So Mr. D got a lung transplant -- just one lung because organs are in short supply and that's actually sufficient for someone to live. When you have a new organ, you have to take lots of drugs to keep your immune system down so that it doesn't reject the new heart/lung/kidney, but that also renders you susceptible to millions of germs and bacteria that would otherwise be harmless. So Mr. D came down with a fungal infection -- Aspergillus -- and a bacterial infection -- Pseudomonas.
When Mr. D came to the hospital for a short procedure, he seemed okay. It was interesting listening to his lungs, because his right lung (the "native" one with IPF), sounded like tissue paper crackling. His left lung had normal breath sounds. It was listening to two different lungs in one person. I was immediately struck by how equanimous Mr. D was, especially when I asked him if it was okay for a group of medical students to come by and listen to his interesting physical exam. He was a quiet, scholarly guy in his 50s with graying hair -- the type of patient with glasses and a copy of the New York Times on his bed.
After I switched services, Mr. D was ready to go home when something nearly catastrophic happened. He developed a massive bleed into the space behind his back -- his retroperitoneal space. The bleed was idiopathic. Mr. D landed in the ICU and suffered from acute renal failure --- his kidneys were in trouble.
A few days ago, I saw Mr. D while walking through the ICU and dropped by to say hello. Mr. D looked pale and sick, his head was tilted to one side, but he was still conversant. I nervously eyed a length of tubing filled with blood emerging from his body -- he was on CVVH, which filters the blood and helps out by mimicking the kidney. The doctors were thinking that he might need to go on dialysis for the rest of his life.
"Hang in there, Mr. D," I chirped.
He looked at me with tired eyes filled with weary, stubborn resignation.
"That's all I can do," he said softly.
When Mr. D came to the hospital for a short procedure, he seemed okay. It was interesting listening to his lungs, because his right lung (the "native" one with IPF), sounded like tissue paper crackling. His left lung had normal breath sounds. It was listening to two different lungs in one person. I was immediately struck by how equanimous Mr. D was, especially when I asked him if it was okay for a group of medical students to come by and listen to his interesting physical exam. He was a quiet, scholarly guy in his 50s with graying hair -- the type of patient with glasses and a copy of the New York Times on his bed.
After I switched services, Mr. D was ready to go home when something nearly catastrophic happened. He developed a massive bleed into the space behind his back -- his retroperitoneal space. The bleed was idiopathic. Mr. D landed in the ICU and suffered from acute renal failure --- his kidneys were in trouble.
A few days ago, I saw Mr. D while walking through the ICU and dropped by to say hello. Mr. D looked pale and sick, his head was tilted to one side, but he was still conversant. I nervously eyed a length of tubing filled with blood emerging from his body -- he was on CVVH, which filters the blood and helps out by mimicking the kidney. The doctors were thinking that he might need to go on dialysis for the rest of his life.
"Hang in there, Mr. D," I chirped.
He looked at me with tired eyes filled with weary, stubborn resignation.
"That's all I can do," he said softly.
satire on intellectual pretension
NYT yesterday, the most amusing, hilarious, mockingly pseudo-intellectual satire that I've read in a while. There are some valid points...have we become a society that values the aggregator over the creator? Is the mode of information delivery more important or prestigious than the information itself?
Lord of the Memes
By DAVID BROOKS
Published: August 7, 2008
Dear Dr. Kierkegaard,
All my life I’ve been a successful pseudo-intellectual, sprinkling quotations from Kafka, Epictetus and Derrida into my conversations, impressing dates and making my friends feel mentally inferior. But over the last few years, it’s stopped working. People just look at me blankly. My artificially inflated self-esteem is on the wane. What happened?
Existential in Exeter
Dear Existential,
It pains me to see so many people being pseudo-intellectual in the wrong way. It desecrates the memory of the great poseurs of the past. And it is all the more frustrating because your error is so simple and yet so fundamental.
You have failed to keep pace with the current code of intellectual one-upsmanship. You have failed to appreciate that over the past few years, there has been a tectonic shift in the basis of good taste.
You must remember that there have been three epochs of intellectual affectation. The first, lasting from approximately 1400 to 1965, was the great age of snobbery. Cultural artifacts existed in a hierarchy, with opera and fine art at the top, and stripping at the bottom. The social climbing pseud merely had to familiarize himself with the forms at the top of the hierarchy and febrile acolytes would perch at his feet.
In 1960, for example, he merely had to follow the code of high modernism. He would master some impenetrably difficult work of art from T.S. Eliot or Ezra Pound and then brood contemplatively at parties about Lionel Trilling’s misinterpretation of it. A successful date might consist of going to a reading of “The Waste Land,” contemplating the hollowness of the human condition and then going home to drink Russian vodka and suck on the gas pipe.
This code died sometime in the late 1960s and was replaced by the code of the Higher Eclectica. The old hierarchy of the arts was dismissed as hopelessly reactionary. Instead, any cultural artifact produced by a member of a colonially oppressed out-group was deemed artistically and intellectually superior.
During this period, status rewards went to the ostentatious cultural omnivores — those who could publicly savor an infinite range of historically hegemonized cultural products. It was necessary to have a record collection that contained “a little bit of everything” (except heavy metal): bluegrass, rap, world music, salsa and Gregorian chant. It was useful to decorate one’s living room with African or Thai religious totems — any religion so long as it was one you could not conceivably believe in.
But on or about June 29, 2007, human character changed. That, of course, was the release date of the first iPhone.
On that date, media displaced culture. As commenters on The American Scene blog have pointed out, the means of transmission replaced the content of culture as the center of historical excitement and as the marker of social status.
Now the global thought-leader is defined less by what culture he enjoys than by the smartphone, social bookmarking site, social network and e-mail provider he uses to store and transmit it. (In this era, MySpace is the new leisure suit and an AOL e-mail address is a scarlet letter of techno-shame.)
Today, Kindle can change the world, but nobody expects much from a mere novel. The brain overshadows the mind. Design overshadows art.
This transition has produced some new status rules. In the first place, prestige has shifted from the producer of art to the aggregator and the appraiser. Inventors, artists and writers come and go, but buzz is forever. Maximum status goes to the Gladwellian heroes who occupy the convergence points of the Internet infosystem — Web sites like Pitchfork for music, Gizmodo for gadgets, Bookforum for ideas, etc.
These tastemakers surf the obscure niches of the culture market bringing back fashion-forward nuggets of coolness for their throngs of grateful disciples.
Second, in order to cement your status in the cultural elite, you want to be already sick of everything no one else has even heard of.
When you first come across some obscure cultural artifact — an unknown indie band, organic skate sneakers or wireless headphones from Finland — you will want to erupt with ecstatic enthusiasm. This will highlight the importance of your cultural discovery, the fineness of your discerning taste, and your early adopter insiderness for having found it before anyone else.
Then, a few weeks later, after the object is slightly better known, you will dismiss all the hype with a gesture of putrid disgust. This will demonstrate your lofty superiority to the sluggish masses. It will show how far ahead of the crowd you are and how distantly you have already ventured into the future.
If you can do this, becoming not only an early adopter, but an early discarder, you will realize greater status rewards than you ever imagined. Remember, cultural epochs come and go, but one-upsmanship is forever.
Lord of the Memes
By DAVID BROOKS
Published: August 7, 2008
Dear Dr. Kierkegaard,
All my life I’ve been a successful pseudo-intellectual, sprinkling quotations from Kafka, Epictetus and Derrida into my conversations, impressing dates and making my friends feel mentally inferior. But over the last few years, it’s stopped working. People just look at me blankly. My artificially inflated self-esteem is on the wane. What happened?
Existential in Exeter
Dear Existential,
It pains me to see so many people being pseudo-intellectual in the wrong way. It desecrates the memory of the great poseurs of the past. And it is all the more frustrating because your error is so simple and yet so fundamental.
You have failed to keep pace with the current code of intellectual one-upsmanship. You have failed to appreciate that over the past few years, there has been a tectonic shift in the basis of good taste.
You must remember that there have been three epochs of intellectual affectation. The first, lasting from approximately 1400 to 1965, was the great age of snobbery. Cultural artifacts existed in a hierarchy, with opera and fine art at the top, and stripping at the bottom. The social climbing pseud merely had to familiarize himself with the forms at the top of the hierarchy and febrile acolytes would perch at his feet.
In 1960, for example, he merely had to follow the code of high modernism. He would master some impenetrably difficult work of art from T.S. Eliot or Ezra Pound and then brood contemplatively at parties about Lionel Trilling’s misinterpretation of it. A successful date might consist of going to a reading of “The Waste Land,” contemplating the hollowness of the human condition and then going home to drink Russian vodka and suck on the gas pipe.
This code died sometime in the late 1960s and was replaced by the code of the Higher Eclectica. The old hierarchy of the arts was dismissed as hopelessly reactionary. Instead, any cultural artifact produced by a member of a colonially oppressed out-group was deemed artistically and intellectually superior.
During this period, status rewards went to the ostentatious cultural omnivores — those who could publicly savor an infinite range of historically hegemonized cultural products. It was necessary to have a record collection that contained “a little bit of everything” (except heavy metal): bluegrass, rap, world music, salsa and Gregorian chant. It was useful to decorate one’s living room with African or Thai religious totems — any religion so long as it was one you could not conceivably believe in.
But on or about June 29, 2007, human character changed. That, of course, was the release date of the first iPhone.
On that date, media displaced culture. As commenters on The American Scene blog have pointed out, the means of transmission replaced the content of culture as the center of historical excitement and as the marker of social status.
Now the global thought-leader is defined less by what culture he enjoys than by the smartphone, social bookmarking site, social network and e-mail provider he uses to store and transmit it. (In this era, MySpace is the new leisure suit and an AOL e-mail address is a scarlet letter of techno-shame.)
Today, Kindle can change the world, but nobody expects much from a mere novel. The brain overshadows the mind. Design overshadows art.
This transition has produced some new status rules. In the first place, prestige has shifted from the producer of art to the aggregator and the appraiser. Inventors, artists and writers come and go, but buzz is forever. Maximum status goes to the Gladwellian heroes who occupy the convergence points of the Internet infosystem — Web sites like Pitchfork for music, Gizmodo for gadgets, Bookforum for ideas, etc.
These tastemakers surf the obscure niches of the culture market bringing back fashion-forward nuggets of coolness for their throngs of grateful disciples.
Second, in order to cement your status in the cultural elite, you want to be already sick of everything no one else has even heard of.
When you first come across some obscure cultural artifact — an unknown indie band, organic skate sneakers or wireless headphones from Finland — you will want to erupt with ecstatic enthusiasm. This will highlight the importance of your cultural discovery, the fineness of your discerning taste, and your early adopter insiderness for having found it before anyone else.
Then, a few weeks later, after the object is slightly better known, you will dismiss all the hype with a gesture of putrid disgust. This will demonstrate your lofty superiority to the sluggish masses. It will show how far ahead of the crowd you are and how distantly you have already ventured into the future.
If you can do this, becoming not only an early adopter, but an early discarder, you will realize greater status rewards than you ever imagined. Remember, cultural epochs come and go, but one-upsmanship is forever.
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