Mashup

The top 25 songs of 2009 mashed together to form another awesome pop hit! And it's totally dance-worthy! Get up and move that booty.

The thin red line

He wouldn't talk to my attending or chief resident, forcibly pushing them out of his room that morning, threatening to go combat style on them. "I've seen things you've never even imagined! I've done things you wouldn't think possible! I will hurt you!" he yelled at their retreating backs.

I was told to try again in the afternoon; maybe he would be a little nicer after he got more rest and some food in his belly. "But interview him out in the group space...he's here for homicidal ideation, after all," my attending warned me.

So around 1pm, I headed over to that patient's room and knocked on the door.

ME
Excuse me, Red?

PATIENT
Who the hell are you?

ME
I'm Michelle, the med student on your care team.

PATIENT
Student? Stop right there. I ain't having nothing to do with no students. I'm not some guinea pig for you all to experiment on.

ME
No sir, I'm not doing any experimenting - I just wanted to talk with you and see why you're in the hospital.

I smiled, trying to convince him that I was harmless. But he wasn't having any of it and he got up from his bed and started moving towards the door, presumably to close the door in my face. I started to back away, because even though he wasn't an especially large man, he was still cut a pretty threatening figure.

ME
Sir, truly - I'm just here to try to help you.

PATIENT
Help me? You don't know the first thing about helping me! You think you know anything about war? I've got some serious PTSD shit, and you think you can help me?!

Clearly, I had said the wrong thing. And he was angry now, yelling and swearing as he stormed out of his room into the common area. I apologized as I followed behind him. No, I didn't know what it was like to be in the army...but I did just have a lecture on PTSD by our residency director who used to work at the VA. Dr. Anzia? Perhaps he knew her?

He turned around to look at me and solemnly replied, "She's the greatest doctor that ever lived."

I nodded. He was calmer now, so I didn't want to say anything that might disrupt the milieu. He sank into the lab chair next to the nurses station. "You wanna know why I'm here? I'm here because in two days, it'll be the anniversary of something terrible. It'll be the anniversary of why I'm so dang messed up in the head. There was a helicopter accident. And everyone but me and three guys made it out. We lost everyone."

He started tearing up and his voice dropped to a whisper. All this had happened so many years ago, but it seemed like every little thing would set him off and send him back into those nightmares of war.

This time, he was walking along Michigan Avenue when he passed by a Vietnamese family. Seeing those children's faces immediately sent him back in time and he was reliving the terror. He thought he was back there, as he ducked behind planters on the street, jumping over railings, screaming at the top of his lungs, and generally just acting like a crazy person.

But he wasn't crazy; he just suffered from severe PTSD that had never been really treated. He was openly crying now, and feeling foolish standing in front of him, a towering giant in my 3-inch heels, I dropped to squat next to him. I thanked him for telling me his story, knowing how hard it probably was for him to relive it again.

We went through the rest of his psych and medical history quickly - finding out what pain regimen he needed for his terminal prostate cancer, what drugs had worked for his depression in the past, and lastly, what combo of drugs would work best for his PTSD. We finished talking about who he was seeing for therapy, and then after thanking him again for opening up to me and telling me his story, I went off to the med student room to write up my note.

I was proud of myself. I had taken this hostile patient and gotten some very pertinent information out of him. We had him on an antidepressant that he had failed twice before in the past, so we needed to change that. We had him on some Ativan but at such a low dose, it wasn't going to do anything for him. And he had bone metastases from his prostate cancer. Our current order - Tylenol for pain - clearly wasn't going to cut it for him. I sent a page to my chief resident, who texted me back with "strong work!" and I smiled. Maybe I am meant to go into psychiatry.

As I sat there typing up my note, happy as a clam, a nurse I had never worked with before knocked on my door. "Michelle, may I see you for a moment?"

My fellow teammate, whom I had excitedly told about my patient encounter, smiled at me. Clearly, she was going to praise me for having such a great bedside manner. He patted me on the back as I made my way out of the room.

NURSE
I saw you earlier talking to Red.

ME
[trying to be humble, but really, busting at the seams at what a great job I had done]
Yes. Are you his nurse? I looked on the board - I thought his nurse was Eva.

NURSE
No I'm not his nurse. But I needed to let you know that what you did out there in the middle of the room with Red was completely absurd!

ME
[shocked and honestly taken aback]
W-w-what?

NURSE
You were a pawn in his grand scheme! And you just ate it up, didn't you? Oh you young young thing. Red has been in and out of hospitals. I've been here for a long time and I can recognize that he's just here to get narcotics.

I sputtered, not quite knowing what to say. What had I done wrong? I know I'm pretty gullible, but my interaction with Red seemed genuine. He was crying, for chrissake! I hadn't taken him into an interview room, but that was on direct orders from my attending.

ME
Are you referring to how I was sitting next to the patient? I know that probably wasn't the safest thing, because he clearly could have punched me if he wanted to, but he was crying, and I really didn't think he was a threat --

NURSE
No! But that's another thing! He's a Vietnam vet! And you! You are this young Asian female, basically prostrating in front of him. Worshipping him! He was clearly enjoying this. You were right in the palm of his hand! Like a slave or concubine! I'm not saying that you are...but really. You were so subservient...ending the interview with a "Sir, is there anything I can get you before I go?"

I was shocked now. I would have understood if she were concerned about my safety. I would have understood if she had witnessed me crossing boundaries. But everything I had done seemed right in the realm of medical care. And honestly, I was a little offended. She had just compared me to a concubine! If that wasn't crossing a line, I don't know what is.

But I'm a med student, and we are the bottom-feeders in this hierarchy. So I gritted my teeth and smiled at her.

ME
Thanks Lee for the advice. I can see that you were worried about my safety, and I appreciate that.

NURSE
Now, no hard feelings between us okay? I'm just looking out for you. You're so young, you know. So young. If you have any more questions about anything, don't hesitate to ask me!

ME
Oh, I won't.

I smiled fake-sweetness at her and then went back to the med student room. My teammate whooped when I walked in the door, "Yeaaaaaaah!!! Did she just give you an honors guarantee??" I shook my head ruefully and told him what had just happened. He was shocked as well, "You know what? She wasn't there for the interview. She doesn't know what was going on. She's not even the nurse on our side! What the heck. She has no right to talk to you like that! And I can't believe she kept telling you that you were so young. Ugh. You should have been like, well, you're SO old! The old hag!" We laughed. I thanked him for making me feel better about myself, and then turned around to finish my note.

I still don't quite know what to make of it all. Looking back now, I realize I must have done something that set of the nurse's Danger radar. But what was it? Maybe I was squatting too close to the patient - he had been whispering after all. Maybe I should have excused myself to get another chair. And when he was crying, maybe I shouldn't have paused and patted him on the arm when he got choked up telling his story. There is a no-contact rule in psychiatry after all.

But at the end of the day, I have to remember that one of our psych lecturers told us we have to trust our gut. And my gut was telling me that this patient had been through a lot. He was angry, but for good reason. My gut told me that what this man needed at that moment was an ally. Someone who believed him and didn't think he was merely drug seeking. Someone who would listen to his story and emphatize. Sure, there are things I could have done to have made the situation better. But looking back, I doubt I would have changed anything. Regardless of what the nurse thinks she saw, I know that I was being professional but caring at the same time.

I might not be the best psych med student, but hey, at least I'm not jaded yet.

Tidings of comfort and joy

ME
Boo!

MARTIN
Ahhhhh! Hi. I bought your Christmas gift.

ME
What?! Already?! What did you get me?!?!?! AHHHHHHHHHH - I HATE SURPRISES!!! AHHHHHHHH!!

MARTIN
I just wanted you to know so I can make you suffer x 2 weeks. Hahahaha!

ME
AGH. You are so TERRIBLE to me.

MARTIN
Hahahahaha!!

ME
I think you should tell me. Or at least give me a hint! One every day! Yeah yeah! BEST IDEA EVER!!!!!

MARTIN
Okay. Today's hint = I bought you something.

ME
Nooooooooooooooooooooooo!! Dude, that sucks!!

MARTIN
A hint a day! That's your hint. Otherwise you'd never know.

ME
Hmph. I wish I never knew.

Gansta's paradise

It's a Harry Potter/Dangerous Minds mashup!! Hermione Granger teaching a bunch of inner-city kids? Genius.



Seriously, I haven't seen a parody this good since SNL's early days.

Is it bad that I wish they would make this movie purely so that I could watch it? This is box-office GOLD.

It's like you're a drug

ME
Ugh, I had McDonalds for dinner. Fries and a fudge sundae. And now I feel gross and disgusted with myself.

MIKE
Sounds like someone needs to go to some MA meetings (McDonald's Anonymous)...wah wah.

ME
Hahaha, I totally do!! I'm addicted to their fries and I think about them ALL the time. It's starting to disrupt my life. Hahaha, I'm laughing, but I'm serious.

MIKE
There you go. But you should determine whether it's abuse or dependence

ME
Oh it's dependence. I will do illegal things to obtain it. For instance, I will leave work early because I need to get some fries. Truancy! If that's not dependence, I don't know what is.

MIKE
Did you use to order a small fry, but now you have to order a large to feel just as happy?

ME
Yes! Now I have to order TWO larges. One to have later, because I worry about not having it when I really need it!! Like at 2 in the morning! McDonald's isn't open then!

MIKE
I think you hit at least 3 criteria within 12 months....Michelle, I'm afraid you've met DSM IV criteria for McDonald's Dependence

ME
Sigh. I've denied it for so long, but you're right. I need help.

MIKE
Diagnosis 304.90 - don't panic, you're not alone. Millions of Americans just like yourself suffer from this very same disease. But you can be cured. MA can help.

ME
Hahahah, this is such sad nerd humor.

MIKE
Michelle, McDD is no laughing matter.

Cute is what we aim for

This is the cutest thing I've ever seen. Seriously, if you don't smile upon seeing this video, you might be dead inside. Just saying.

There must be more

I was raised in a Presbyterian household. My grandfather was a prominent pastor in Taiwan and my family was always very involved in church and church-related activities when I was growing up. However, once I left for college, without my family around, I stopped attending sermons religiously. I still went every now and then, but it seemed like schoolwork and studying for exams started to take more and more precedence to the point where I was only going for Easter and Christmas. And as shocking as it might be to my father, I sometimes ate without saying grace. I had unfortunately become what the evangelicals would call a wayward Christian.

But I never lost faith. And I never forgot what I was taught – the doctrines, the stories, the miracles.

So once I started third year on the internal medicine floors, I figured I would be able to talk with patients about faith if they needed it. I figured I could say prayers and I knew most of the words to the hymns and songs. Bring it on.

Yet I was never asked to be part of my patients' faith-based healing. When I walked in the door, all my patients wanted were the concrete details. What were the LFTs like today? Were they low enough that the patient could leave? Did the cultures come back yet? Had someone determined the cause of the fevers?

I figured it was because I was lucky. None of my patients were terribly sick. All of them were going to walk out of the hospital. There was no need for prayers from me, really. They weren’t about to go off to that kingdom in the sky. All they needed from me was to know when they could go home. In fact, I think if I were to suddenly ask about faith or spirituality, I would probably scare my patients into thinking that they were about to meet their maker.

Then last week when I was on psych consults, it seemed like we were talking about religion and spirituality with everyone. We had one patient who wanted to leave AMA even though he had osteomyelitis of his sternum. He had refused blood draws and IV antibiotics, convinced that God - who had brought him back from a coma after a terrible car accident - would save him yet again, without our intervention. He wouldn’t cooperate with us, muttering prayers under his breath and tuning us out. We had been consulted to see if he would be eligible for involuntary hospitalization. He was a religious fanatic, to be sure, but perhaps he was delusional as well?

We were also consulted for another patient who was truly on his deathbed, when he told his nurse that he wanted to withdraw care. He was tired of living in the ICU, living on machines, unable to speak to his wife, unable to see his kids. The surgeons had called in the chaplains, and at a family meeting, I was struck by how the trauma surgeon kept referring to how it wasn’t time yet for the patient. That he had to have faith that he would get better. That there was a reason that all this was happening to him. There was a light at the end of the tunnel, and that light had nothing to do with taking him up to heaven.

It seemed like the doctors were using or disregarding spirituality and religion as they saw fit. The patient with osteomyelitis was diagnosed as a delusional schizophrenic. Sure, he was claiming to be a religious man, but my attending believed it was more a delusion than anything. And so we used that to involuntarily hospitalize him. He was a danger to himself and he needed to be kept in the hospital where we could monitor his infection, even if he wouldn’t let us give him meds. On the other hand, the ICU patient was someone who had lost his faith. And so we used that to say that he didn’t have capacity. He was too depressed to be thinking clearly. They had both wanted to withdraw care, but for completely different religious reasons.

One patient had too much religion and so we deemed him to have no capacity. Another patient had none, yet we also deemed him to have no capacity.

We deal with religion but not in the way I thought we would. So, I’m still trying to figure out how spirituality fits into modern medicine. How does hoping for miracles fit into something based on the scientific method? Where does the abstract fit in with something so definite?

I’ve always thought that it was a way of coping. Sometimes for the patient, sometimes for the family. And now I’ve come to realize that sometimes it’s just for me. In a field that is so concrete, I need to be able to hope that things can work out, even when all the numbers and all the images - everything - tells me that it can’t. I need to believe that miracles can happen so that I can get up every morning and keep going.

Taking chances

Life is calling. How far will you go?

I'll go to the edge and back. And I hope it's with you.

Let it snow

ME
When are you getting back in?

LISA
Late Sunday sometime.

ME
Btw, it's snowing in Chicago right now!

LISA
Oh crap! Seriously? A lot? I have to drive!

ME
Erm. To be honest, I closed my blinds because it was making my room too cold...but according to my gmail theme, it's snowing, cause there's snow on my inbox and chat boxes.

LISA
HAHAAH, I thought you had a weather app or something, but no, you're relying on your google theme?

ME
[embarassed]
It's actually kinda sorta pretty accurate.

LISA
HAHAHA

Back against the wall

He was a well-dressed man in his fifties. He had a history of bipolar disorder, avoidant personality disorder, and childhood seizures. He had been hospitalized 25 years ago for having suicidal thoughts and depression. When he was discharged, he was assigned a psychiatrist who would see him on a regular basis. He was doing well. But, when that psychiatrist moved away eight years ago, she tried to set him up with someone else in the practice. Yet given his avoidant personality, he just kinda got lost to follow-up.

So it had been eight years since he'd seen anyone for his mental health issues. And then today, he decided to call up the clinic and ask for an appointment.

Oh sorry sir, but the next available appointment isn't for 2 weeks. Will that be okay?

He paused, counting the number of days til he could be seen in his head. Sure, he replied hesitantly. Go ahead and schedule me.

And what shall I say this is for? asked the receptionist.

Oh, well, I made a pretty major mistake at work a couple of weeks ago, and I've been feeling really kinda anxious and guilty about it. And I think maybe my depression is getting a little out of hand again. He was being forthcoming and honest about his feelings. So the receptionist wished him a good day and hung up.

He walked into the ER three hours later. Why was he here? He couldn't really say why. So the ER triage nurses flagged him as a psych patient, and the psych team went to go see him. Was he depressed? No, not really, he said. He had made a mistake at work a couple of weeks ago, and his boss yelled at him, but no one was hurt and everything turned out okay. Since then he had had some suicidal thoughts. But they were fleeting - nothing serious, he claimed. He had thought about jumping out his window, but he couldn't do it. He knew it was wrong, he said.

And now sir? Do you have any thoughts of hurting yourself now?

No, he replied. Not at all.

The patient had called up his sister and brother (who lived just a couple of towns over), and they were waiting for him in the waiting room currently. His dad was awfully sick, so he felt depressed about his dad's worsening health. But that was it.

Any firearms in the house?

No, sir.

The psych resident on call wasn't sure what to do.

He felt uneasy just letting the patient go, but the patient wasn't having any suicidal thoughts now. And his family was here and supportive. And the holiday weekend was coming up. Did he really want to hospitalize this patient, when it seemed like all he really needed was an outpatient psychiatrist? Really, there were far more patients he'd seen who needed to be hospitalized and weren't, so maybe this wasn't the best use of resources.

Sir, I think I'm going to let you go with your family on the condition that you see someone in clinic soon --

Oh, I have an appointment for next Wednesday! the patient interjected.

-- oh that's great! Okay, and I want you to realize that there are a lot of people out there who care about you, so if you ever feel like you might be thinking of hurting yourself, I want you to call 911 right away. Or come into the ER again, okay?

The patient promised.

Thanksgiving came and went.

And then Wednesday came and went.

The patient didn't show up to his appointment. The attending's secretary left a message on his landline - Hi sir! You were scheduled to be seen today in the Mental Health Clinic - please call back so that you can reschedule!

The attending got a call back later that afternoon. It was the patient's sister.

Tearfully, she informed the psychiatrist that her brother had killed himself two days ago - jumped out his window to his death 57 floors below. No one had seen it coming or thought he would do it. Her other brother had had lunch with him the day before he jumped, and he had seemed okay. Fine, even. And before he had jumped, he had called 911. But by the time help had come - no more than 4 minutes later - he had deadbolted the door, refusing to let anyone in to help him. They set about trying to tear down the door, trying to find someone with a master set of keys. But thirty seconds before they were in, he had jumped.

---

Our lecturer finished her story. And we, the students, sat there in shock, realizing that many of us would have done what the resident did. He didn't fill any criteria for major depressive disorder, he wasn't endorsing any suicidal ideation, and he had a great supportive family. We would have sent him home, too. Yes, there was that vague I don't know why I came into the ER bit and the whole prior psych history, but he seemed stable. He had seemed like he knew that he needed some help and had set the ball rolling with the psych appointments and calls to his family. True, we weren't there, so we couldn't pick up on minor body cues and such, but it seemed like the resident had made the right call. After all, who wants to be stuck in the hospital during the holidays?

Our lecturer was telling us the key clinical pearls from the story - that safety trumps any DSM-IV diagnostic criteria. That if you have a weird nagging feeling about something, you're probably right.

In every field, there's a fatal end point. Heart attacks for cardio, strokes for neuro. In psych, it's suicide. We might not have lipid panels or MRIs to go on, but we have our gut and our intuition. And that's what we have to trust.

Open arms

I became a psych major in undergrad because I was fascinated by the stories. Fascinated by how the mind could create such elaborate illusions and perceptions. Fascinated that the individual could lose track of reality and become immersed in something that seemed all too unreal to me.

During the first two years of med school, my best units were the psych ones. The material was interesting, so I was willing to go above and beyond with the required and recommended readings. Some might also argue that the psych units were much easier than everything else. And I agree that the concepts certainly were much easier than memorizing every single muscle and nerve in the human body and all that preload/afterload physics crap for the heart.

So I was looking forward to starting my psych clerkship. This was where I was going to shine! Or so I thought.

My first day - my first hour! - on the psych consult team, we were sent to evaluate an agitated patient. He would yell out every ten seconds, all while flailing around in his bed. It got to the point that the nurses had to put him in restraints to protect him from hurting himself.

We could hear him as we approached his room - Mercy! Please! Mercy! Help me!- his cries falling on deaf ears as the nurses shook their heads. He had been yelling for the last two hours nonstop so they had resorted to just ignoring him, as inhumane as it might seem to the casual observer.

And now we were there, trying to talk to him. Mr. Schaffer - what's going on? How are you doing? How are you feeling? Why are you yelling? He stared at us icily. We were the bad guys, so he refused to talk to us.

We were all standing so far away from the patient. Then, remembering how my medicine team had commended me for my abilities to connect to patients and understand them, I walked closer and leaned over to reassuringly touch my patient on his arm. We only want to help you sir, I said soothingly. He became still, and I became hopeful that maybe what I was doing was working! And hey! Maybe I am meant to be in psychiatry. And then in the midst of my daydreams - out of nowhere - his fist, confined to mittens to prevent him from getting out of his restraints, whacked me across my arm and chest. F*ck you, he seethed at me.

I was fine - more shocked than bruised, but my resident quickly ushered me out of the room, while the attending tried to talk to him some more. She came out a couple minutes later, with no additional information.

She led us back to the team room, where she pulled out a handout on Personal Safety and gave us each a copy. I probably should have given this to you guys before we went to go visit Mr. Schaffer, she noted wryly, pointing to #9 - Stay an arm's length away from the patient during interviews, especially with aggressive and agitated patients. That qualifies even when they're in restraints, clearly.

I blushed.

The pager went off. Another patient. This one was convinced that he was an assassin. Could we evaluate?

Welcome to psychiatry, my resident smiled. Let's go!

Amazing love

I give thanks for:

my wonderful friends who were willing to crowd around a 4-person table for Thanksgiving Eve dinner,

Alton Brown's Good Eats Roast Turkey recipe (scientifically proven to work! and see above photo? It did!),

my boyfriend for learning how to carve a turkey from YouTube, 5 minutes before diving in with a knife,

my roommates - old and new,

all the delicious food that everyone brought,

all the laughter,

and

all the love.


I'm thankful to have met each and every one of you. You've helped turn Chicago into my home away from home. You are family to me.


Happy Thanksgiving, everyone.

Greatest story ever told

In case anyone feels like they want to see a romantic comedy, but don't have time to watch a full-length movie, here's Letters to Juliet. A three minute trailer that covers all the typical rom-com cliches and gives away the entire movie.



Seriously, what's in the movie that they didn't show in the trailer?

Just remember friends - the greatest love story ever told...is your own.

Marian, the librarian

So I'm studying at the law library - and I see people glaring at others talking on cell phones or eating lunch overly loudly. So when my phone goes off, I grab it and run out to the atrium, so that I can have a normal conversation and not disturb the peace and relative quiet.

I finish my phone call and when I turn to go back in, I realize - oh crap! I left my ID card at my desk. And now, I'm stuck at the turnstile. I turn to look at the librarian, who just saw me run out the doors three minutes ago, but is now feigning complete indifference, ignoring me.

ME
Um, excuse me?

[No response from the librarian.]

ME
[a little louder]
Sorry, excuse me? I left my Wildcard at my desk when I went to go answer my phone!

LIBRARIAN
Please don't speak so loudly! You're in a library!!

ME
Oh, I'm sorry. I can't get in, because I left my Wildcard at my desk!

LIBRARIAN
Are you a student here?

ME
Yes, my Wildcard's at my desk - I can bring it back to show you.

LIBRARIAN
Are you a law student?

ME
No, I'm a med student.

LIBRARIAN
I'm not allowed to let you in.

ME
I have access via my Wildcard - I just left it at my desk - I can go get it and bring it back to show it to you.

LIBRARIAN
I can't just let anyone claiming to be a Northwestern student into the library, you know.

ME
I promise I'm a student here. I've been studying here since 10am! I just went to answer a phone call, no more than two minutes ago. Um, if you want, you can escort me to my desk, where I promise, my Wildcard is sitting.

LIBRARIAN
[scoffs]
Yeah, because I have time for that?

ME
[speechless]
I'm sorry. I - I don't know what to do.

LIBRARIAN
[huge sigh]
I need you to leave something here as collateral, and then I'll give it back when you bring me your Wildcard.

ME
Uh. I'm not wearing any jewelry...

LIBRARIAN
[loud sigh, again]
YOUR PHONE!

ME
Oh right! Sorry.

So I hand over my phone. She heaves another great sigh, and then clicks the turnstile so that I can enter. I thank her and then hurry over to go get my Wildcard, which was a mere 25 meters away. I come back with the proof that I'm a Northwestern student, and she gives me the third degree yet again, lecturing the whole time about how I have to have identification on me at all times (because according to her, it's a felony apparently if you don't). She makes me fill out some random paperwork and makes me feel like an absolute criminal at the same time. I pause before the signature, trying to figure out what exactly I was signing, and she barks at me, "print and SIGN your name!" Yes ma'am. Right away ma'am.

As I'm doing all this, another student comes to the turnstile.

STUDENT
Excuse me, miss! I forgot my Wildcard at home.

LIBRARIAN
Are you a law student?

STUDENT
Yes.

LIBRARIAN
[clicks the turnstile open]
Happy studying!

Seriously, what the hell dude. She didn't even ask for his name or anything! Clearly, the moral of the story is this: forget about being honest - just lie. I should have known; I was studying with soon-to-be lawyers, after all.

Ugh, I'm so annoyed by her power trip. Totally unnecessary.

Cup of coffee

It was going to be another long day at the clinic. My preceptor had asked me to come an hour early and informed me that I'd probably end up staying until 10pm that night, since he had double-booked almost every time slot. Fabulous. Just fabulous. Mind you, this was the day before my shelf exam.

I figured I probably ought to get some coffee. And while I was at Starbucks, I saw a man that looked vaguely familiar.

I stared at him. Was he an old patient? Maybe one of my hospital patients? The thing is, I have a pretty good memory of everyone I took care of...and his diagnosis/condition wasn't jumping to mind. Where had I seen him before? I knew it was in a medical setting, but I just couldn't figure it out.

By that point, he had seen me staring.

He gestured at my white coat. Northwestern?

Oh, um yes, sir.

I'm a standardized patient.

Oh! Thanks! I knew you looked familiar!

He had gotten his coffee by this time, so nodding a goodbye to me, he walked out.

And that's when I realized that I knew exactly which standardized patient he was. I knew him from my first-year physical exam class. You see, he had taught us the male GU exam.

Seriously, so many of my classmates never see patients or pseudo-patients outside of the hospital. Why does it always happen to me??

Time for miracles

After a whole month of reminding patients daily how important it is to eat right and exercise on a consistent basis, I started to feel awfully hypocritical with my hospital cafeteria burgers and couch potato ways. Oh, TV how I love thee.

It also probably didn't help that we just had a nutrition lecture that basically told me to stop eating lard. And I can't walk up a flight of stairs without getting short of breath.

So last weekend, I threw out my Sunkist (okay, not really, they're just tucked away in the pantry for special occasions), and bought myself some rabbit food and something that promised me the "best body of [my] life."

Ladies and gentlemen, I bought Jillian Michaels' 30 Day Shred.

And it came in the mail yesterday.

So today, after a DASH-friendly lunch of salmon and roasted asparagus (thanks Grand Lux!), I came home after my more-brutal-than-expected clerkship test, puttered around for a little bit, and then figured I had wasted enough time putting it off.

I put on some comfy clothes, popped in the DVD, and psyched myself up to have Jillian Michaels yell and bring me down, as she does to all the Biggest Loser contestants. And we were off.

And holy cow, were we off. We were switching between windmills and pushups and jump ropes with only 3 seconds in between. Everything was coming so fast, I sweated through my clothes in just five minutes. I had to pause the DVD.

"And that's the end of the warm-up! Let's get ready for strength!" barked Jillian. (Except, she's actually quite nice and encouraging on the DVD and very different from her Biggest Loser persona. So there was no barking, per se, but it makes me feel better to think that I was so tired because she had beat me down.)

Yes friends, I had to pause the DVD at the end of the warm-up. I hadn't even gotten to the actual workout-workout!

It's still on pause. Maybe tomorrow I'll do the warm up + the strength exercises. And then the day after that I'll do the warm up + strength exercises + cardio.

Sigh. I am obese inside. But damn it, I'm going to be a lean fighting machine at the end of the next 30 days. Or the next 90. Just watch, it's gonna happen. I'm gonna make it happen.

Sunny day, sweeping the clouds away

To the street that always led me in the right direction, happy 40th birthday!

Can you tell me how to get - how to get to Sesame Street?

Watcha say

ME
Patient presents with a 6 month history of increasing depressive symptoms. He notes apathy, weight gain, and chronic fatigue even with 8 hours of sleep each night. He mentioned that he doesn't know what he wants to do with his life and feels somewhat lost.

PRECEPTOR
How old is he?

ME
Twenty-one, sir.

PRECEPTOR
How's his sex drive?

ME
No decrease in libido.

PRECEPTOR
Well then, it sounds to me like he's just lost his mojo - you know that reference right? Austin Powers?

---
Later that day, with a different patient:

PATIENT
[talking very very quickly]
I'm just super anxious and stressed out all the time. And little things will freak me out. I'm SO stressed out, I can't handle it. Like I was supposed to receive a package the other day, and they delivered it to the wrong apartment! And even though I got it, I was so frustrated, I broke down and started crying. Over a package! And then my boyfriend - even though I'm pretty sure I love him - I'll yell at him over stupid things, like him leaving the toilet seat up! Agh, just thinking about it is stressing me out!

PRECEPTOR
Would these things have bothered you two years ago?

PATIENT
I don't think so?

PRECEPTOR
Well, no offense, but I think you need a chill pill. Literally. Let's write you a prescription.

That's how country boys roll

Well, it's officially starting. My friends are giving up the single life for eternal coupledom.

One of our close friends got married this past weekend in Houston and it was absolutely beautiful. As were they.

Thanks for showing all of us such a fabulous time in Houston. For giving us an exclusive backstage pass to your culture and religion. For involving us in wedding games and traditions that had us covered in silly string, confetti, and so-called baby powder. For taking us to the best Tex-Mex in the world. For giving me a spoon when you realized I had trouble eating with my hands. For Shipley donuts, Jack in the Box 3am drive thru walk thrus, never-ending card games, never-ending wedding food, and a weekend full of sunshine, laughter, and friends.

It was really quite a wonderful weekend. And the cherry on top of this epic weekend was Northwestern's win over Iowa. Gooooooo Cats! And a big happy congratulations to Ameer and Insiyah.

Face drop

I'm on primary care this month and I got placed into an HIV niche clinic. So, as stereotypical as it may sound, I've seen a fair share of really gorgeous, fit, and well-dressed gay men in the last two weeks. For every patient, my preceptor sends me in first to get a quick history of why they're coming in. There's a lot of flu symptoms, various GI problems, and occasional back pain. My attending makes me give an oral presentation, lets me watch him try to find nonexistent physical exam findings, and then typically sends me on to see the next patient while he finishes up with prescriptions and last-minute concerns.

Last week, I noticed that quite a few of his patients had last minute concerns. I would be waiting to present the next case to him, and I would see him duck into the office lab and come out with a cup of liquid nitrogen.

Yup. Our patients had some genital warts that they didn't want to tell me about. Three patients, in fact. In one day. No joke. And no, not a single one of them mentioned it to me when I was taking down their problem list. Way to make me look like a terrible med student, patients. Thanks. Thanks a lot.

Later on that day, as my preceptor and I were sitting in his office writing up our progress notes, I summoned up my courage to ask him about the liquid nitrogen.

ME
So the office has liquid nitrogen on tap?

PRECEPTOR
Yeah. We see a lot of genital warts and it's just easier for me to do it. Since I've known most of them for quite a long time, I think they're more comfortable talking to me about it. Don't beat yourself up about it.

ME
Oh, okay. Thanks. [long pause] I actually had a favor to ask you...and of course, please feel free to say no, since I know it's kinda awkward and all that.

PRECEPTOR
Hm?

ME
Well, I know it's weird to treat a student, especially off the record, so again, please feel free to decline, but I've got a wart [pointing to right index finger], and it gets irritated a lot from just daily activity, and so I was wondering if you could burn it off for me...

PRECEPTOR
Whoa, what!? You want me to do what?!

Turns out, he wasn't looking when I was embarrassingly trying to ask him to burn off my finger wart. And given that he's used to burning off genital warts...well, it's easy to see how he got the wrong idea.

ME
[blushing like crazy]
On my finger! I have a wart on my finger!

PRECEPTOR
[sigh of relief]
Oh sure. Haha! That's fine. Just remind me tomorrow.

I never did ask him again about it. I figured my mid-clerkship grade was due soon, and the less conversation about warts - genital or digital - the better.

Trick or treat

Happy Halloween!

(See more awesome pumpkin carvings here. Seriously, these are so cool!!)

Say hey

I've got this song on repeat, because I just can't listen to this song and NOT smile. It makes me want to get up and move, and do good deeds and other wonderful things. "Seems like everywhere I go, the more I see the less I know, but I know one thing - I love you, I love you, I love you."

Hope you're all having a happy weekend - full of smiles, full of dancing, full of life.

The other side of the door

Today was my first day of primary care, and I found out that a couple classmates and I are working in the same group practice. After specifically asking my attending what she wanted me to do, I started to figure out the rhythm and flow of things. I was to get the patient from the waiting room and get vitals. Then, depending on what my attending had pre-decided with me, I'd either do a quick checkup by myself, or wait for her and do it together.

It was going well.

So I went out to the waiting room to bring the 2 o'clock appointment back, and then I saw him. The college grad from my neuro rotation. I had totally forgotten that I had set up his appointments for him, and he was to see his primary care physician today at 2:15pm.

I didn't know at the time, but his primary care physician is in the same practice as my attending.

"Mrs. O'Grady?" I called out, hoping that he was so engrossed in the magazine he was flipping through that he wouldn't look up, wouldn't see me, and I could pretend he didn't exist.

An old woman looked up. "Is it my turn, dear?"

"Yes, ma'am," I replied, cringing at bringing more attention to myself.

He did look up. And he did see me. "Michelle!" he said loudly, inquisitively.

"Oh hi there, Mr. Clark," I mumbled.

"Aren't you supposed to be on neuro?" he asked.

"Uh, no, I finished that rotation last week," I replied, willing my elderly patient to get her things together quicker, and to walker her way over to the door faster.

"Oh, so you're here now! Awesome! So I'll see you later?" he asked.

"Oh, I'm um, not working with your doctor, but I hope you have a good visit," I mumbled back, finally going over to help my little old lady with her things, and rushing her through the entrance door into the safety of my doctor's exam rooms.

I took an especially long history with Ms. O'Grady, but thankfully his physician's office is located in a completely different area from where I was. I never did see him after that.

But I guess I spoke too soon last time.

Seriously? What are the odds?!

Bad romance

[Day 1 of hospitalization]
It was a busy day on the stroke service. Our entire team was getting slammed, admitting people with migraines, TIAs, and stroke-like symptoms. I already had three new patients that morning. And then the ED paged us again. A young 21-year-old guy who had just graduated from college was downstairs with the Worst Headache Of His Life.

Worst headache of your life = subarachnoid hemorrhage = not a good thing.

"You think you can handle this one, Michelle?" my senior resident asked me.

"Oh, I've already handled it," I sassed back. Because when I'm stressed out, I say inappropriate things to people of authority.

"What?"

"Nothing," I mumbled, as I ran down to the ED to meet the patient. And after getting a CT scan of his brain and a lumbar puncture, we ruled out hemorrhage, and started the work up for dissection.

He ended up having a pretty severe vertebral dissection. So we started him on some anticoagulation, but because Coumadin takes some time to reach therapeutic levels, he'd have to stay on our service for a couple of days.

[Day 2 of hospitalization]
I saw him the next morning for no more than five minutes, as I was just checking to make sure he was still alive and not having any more complications. I didn't have any extra time to spend on him, since I had patients with lateral medullary strokes and actual findings on physical exam that I'd have to report during my oral presentations. He was just getting anticoagulated. He was a low-priority patient to me.

I went home later that night, and upon checking my email, saw that my patient had found me on Facebook and sent me a friend request. I ignored it, but changed my privacy settings.

[Day 3 and 4 of hospitalization]
I had class on Friday, so I wasn't in the hospital. And Saturday was my designated day off.

[Day 5 of hospitalization]
I got to the hospital pretty early that day. I had to preround on my patients and my teammate's since it was his turn for a day off. I decided to check on my college grad first, since he probably had no complications and would be leaving as soon as his INR was therapeutic.

ME
Hey, good morning! I haven't seen you in a while! How've you been?

COLLEGE GRAD PATIENT
Well, I'd be better if you had friended me on facebook. Where have you been the past couple of days? Are you avoiding me?

ME
Uh, oh, um - I had class on Friday and yesterday was my day off. And uh, I'm not on facebook much, so uh, yeah.

COLLEGE GRAD PATIENT
I'm just teasing. It's okay if you don't want to be my friend.

ME
[nervous laughter]
Uh, let's talk about any overnight events. Anything happen?

We delved back into health-related conversation. No pain overnight, no headaches, no tingling, numbness, or weakness. I checked the computer. His INR was 2.1 - just therapeutic. He'd be going home that day, as soon as I prepped his discharge papers, I told him. He was excited - he had tickets for some concert that night.

The next day, we were back to our normal weekly rhythm. I was typing up discharge instructions for another patient when I got a page from my senior resident - "come to ED, now."

I ran.

Apparently our college grad was back. Thinking he had probably gone out drinking or done some massive headbanging at his concert, my senior resident and I were convinced he had done something to exacerbate his dissection. He had told the ER docs that he was having a headache, 10/10 on the pain scale.

Yet, when we pulled the curtain aside, he was lying there in his bed, in no acute distress. In fact, he greeted me with a cheery, "Hi Michelle!" when he saw me. As we probed further, we found out that he hadn't filled his prescriptions for his anticoagulation.

We left the room to check his labs.

"Damn irresponsible college teenagers!" my senior resident muttered, as he clicked around on the computer to see what our patient's INR currently was. But before I could jokingly remind my resident that college grads aren't necessarily teenagers anymore, we saw the number. His INR was 1.5.

He was subtherapeutic, and would have to be rehospitalized. "Dang it," I echoed.

"Hey, was it just me, or did he seem too excited to be back in the hospital?" my resident asked me.

"Huh? Uh, I dunno. Well, yeah, now that you've mentioned it, I guess so. I'd be pretty bummed out if I had to spend the night here," I replied.

My resident cocked an eyebrow at me. And then he wrote in an order along with bed assignment, male nursing preferred. I didn't even know that was possible.

His INR was back to therapeutic levels the next day, so we were ready to discharge him again. We personally filled his prescriptions and set up appointments for him. There would be no excuses for him to come back to the hospital.

Later that day, while I was finishing up some progress notes, I got a Facebook message. From my favorite patient. It was lengthy. And to be honest, it started off quite sweet, thanking me for taking care of him and explaining things in layman's terms. Then, he started telling me about how he was new to the area and wanted to get to know me better, when he wasn't stuck in a hospital bed. Perhaps I would agree to dinner and a movie?

I shrieked. And my fellow M3 teammate sitting next to me immediately looked over, read it, and started cracking up. "Well, now we know why he came back to the hospital." "Shut up." "Are you going to answer it?" "Hell, no." "You should! Be like, dude, I saw you naked. You'd think I'd say yes?" "Oooh, that's so mean." "But funny!"

I didn't answer it. He had been discharged, and I'd never see him again.

Or so I thought.

Two days later, while I was hiding in a conference room studying, I got a page from my resident - "Get ye to the library and stay there until I tell you it's safe to come back to the floor."

I was confused, but like a good medical student, I followed my orders and went to the library.

An hour or so later, my resident called me. Apparently, my favorite patient had been back to the floor voluntarily. He was asking the unit secretary to page me and my resident overheard.

RESIDENT
Hey buddy, why are you back? And why are you looking for Michelle?

PATIENT
Oh, I uh, think I left something here in my room, and I didn't want to bother you about it.

RESIDENT
Let me just send something really quickly on the computer, and then I can take you to your room and see if you forgot anything, okay?

That's when my resident paged me with his 911 warning.

And that was my last day on neurology. And hopefully, the last time I'd ever have to hear about this patient. Because I honestly think I'd be okay never seeing or hearing about him again.

Hey good-lookin'

The characters:
A feisty 97 year old patient
My short and balding, but gracefully aging, neurology attending

ATTENDING
When was the last time you saw your doctor?

FEISTY PATIENT
Pshaw! I don't need a doctor. I've only seen a doctor TWICE in all these years. And I didn't even need the checkup!

ATTENDING
Well, I think you need an internist now for sure. I'll make sure we set you up with someone. Do you prefer a man or a woman?

FEISTY PATIENT
A man, of course! Can you make him young and good-looking??

ATTENDING
Hm. You want a young, good-looking internist. Well, I'm sorry ma'am - I'm a neurologist, so we'll have to find you someone else.

Say my name

NEURO ATTENDING
[droning on and on about something]
...blah blah blah, and so then we use clozapine frequently for that reason.

ME
But dude! Clozapine has so many terrible side effects...that agranulocytosis would not be worth it in my opinion.

NEURO ATTENDING
[staring at me]

ME
Um...or not?

NEURO ATTENDING
Did you just call me 'dude'??

ME
Of course not, my good kind sir.

In 1984 (who could ask for more)

Joshua Bell plays Bruch, Cafe des Architectes, triple chocolate mousse, raspberry cheesecake, green tea cream trifle, cupcake cakes shaped like fluffy puppies, really just way too much cake, sushi galore at Meiji, lots of birthday surprises and unsurprises, 8 lbs of crab legs (no joke!), neuro call, Cranium meets Taboo board game mash up, Godiva chocolates, the best friends in the world, and a really fantastic boyfriend.

Thanks much to everyone for helping me celebrate my quarter-century milestone.

Run this town

Google + Japanese animation = CUTENESS OVERLOAD!!!!

Looking up

Dear agony

I must have some mild form of Asperger's.

Seriously. There's no other way to explain how I can be so frightfully awkward sometimes.

So a couple of weeks ago, I met my friend Amy at a high-end grocery store. I had just gotten home from a long night on call, so my hair was a mess, my face was oily, and there was a peanut butter stain on my pants. She wanted to take advantage of a 15% off sale, and I just wanted to get some dinner. And since Amy is non-judgmental, I figured she wouldn't mind seeing me in all my dirty glory.

She didn't. But I really ought to know by now that when I look my absolute worst, I am bound to run into someone. (See here, here, and here.)

So as Amy and I were perusing the pastries and desserts, I saw someone familiar. Realizing who it was, I shrieked, grabbed Amy's hand and pulled her down to the ground with me to hide behind a large display of condiments. It was my first boyfriend. I haven't seen him in years and then on a day when I look terrible, I randomly run into him in a grocery store? What are the odds? Seriously, fate has a wicked sense of humor.

Amy yelped as I pulled her arm down. "Who are we hiding from?" she whispered. "An ex-boyfriend," I replied. She peered around the corner and upon seeing who it was, asked, "but wasn't that like five years ago??"

No, it's actually been seven years. One full dog year. What is wrong with me?

In the midst of our whispering, someone came up behind us.

"Michelle?"

It was him. He had heard someone cry out, and being a responsible doctor and all, had come over to investigate.

"Oh hi! We were just, uh, checking out these cool Frontera Grill salsas. Look at the crazy variety!"

Amy was cracking up, and after making up some obviously fake excuse about her cupcake being ready, she darted away.

We made small talk. Very awkward small talk.

"So, I hear you've moved into that new condo building along the river. It looks so nice!"

"Yeah, sadly, the monthly mortgage bill is not so nice."

"Haha. So how's your intern year going? Oh! My intern from last week is in your program!"

"Oh yeah? Who?"

My mind blanked. I had just spent a whole 80-hour work week with him, and I could not for the life of me come up with a name.

"Ummm, it starts with a J. Uhhh, oh JAMES! James! His name is James. Yes, James."

I said James four times. Count them. I don't know why, but I couldn't stop the word vomit.

"Oh, there are a few James. Does he have a last name?"

He was jokingly mocking me, but the thing is, again, my mind blanked. Seriously, I had worked closely with this guy. I had introduced him so many times to my patients. What was wrong with me?

"Oh last name! Yeah, he has one of those. [Nervous laughter.] Uh, it rhymes with moose. Tousse. James Tousse. That's my intern."

"Hm, I don't think I've met him yet."

"He's tall, incredibly smart, and All-American...he kinda looks like an Abercrombie guy."

He started saying something, but in the midst of my embarrassment over not knowing my own intern's name, I only heard the last bit: "....man, competition!"

It was my turn to say something, as he looked at me. So I blurted out, "oh he's not! He's married!"

There was an awkward pause. Did I really just say that? Holy cow, I did. WHY? Why did I just say that? I still have no idea what prompted my subconscious to associate competition with marriage. I floundered for words. "Oh you meant for chief resident! Dude, no, you're going to be great. Uh, I'm going to go find my friend and see how her cupcake came out...but good luck with everything and uh...I'll see you around!"

I high-tailed it out of there as soon as possible, my face as red as it would be after a couple of drinks.

What is wrong with me?! Seriously! It's been seven years!

Sigh. I must have Asperger's.

Digital monkey

After a week or so on the wards, my resident sat down and taught us how to get the Code Status from patients. It’s required that every patient be asked their code status, of course, and it was always a bit awkward that I would spend 40 minutes getting to know the patient, and then after I left, my intern or resident would see the patient for two minutes and quite informally ask them about DNR/DNI. Needless to say, the patients were always somewhat taken aback. “The medical student didn’t say anything! Am I going to die?! Are you expecting me to need to be intubated?” So my resident decided that it would be best if we learned how to get the code status, so that it could just be a part of our spiel. We practiced with each other and had a pretty standard speech set and ready to go when I would need it.

All I knew about my patient was that she was an 82 year old female who had an atrial fibrillation episode with a rapid ventricular rate. She was Russian, she told me in broken English after I walked in and introduced myself. No problem. I picked up the phone, dialed in the Russian language line, and we started having our conversation. The history went really well, even with the awkward pauses as we each waited for the interpreter to translate. In the middle of our conversation, I got a page from my resident - “Don’t forget to get the code status!!” After the initial butterflies and a couple of deep breaths, I reassured myself that I could do it. I'd practiced with my resident, with standardized patients - how hard could it be on a real live person?

So I pulled out the pre-written speech that my resident had given me, and I started my code status spiel. “Lastly, this is a question we ask all of our patients who are admitted into the hospital. Now, we think you’re going to be fine, but in case of an emergency – specifically, if your heart stopped or you had such difficulty breathing that you’d need a breathing tube or ventilator, what would you want us to do?”

She was smiling as the translator translated. And then as more of it got translated, confusion and shock took over. “You’re my physician! I came to the hospital to be taken care of by you!”

I reassured her that we would of course take care of her. I explained to her what we normally do during a code status, adding at the end, “so I’m just asking if you had wishes or beliefs contrary to this.”

She spoke rapidly in Russian with the translator.

The translator then broke from her translator role and told me that in Russian culture, it is taboo to talk about possible life-threatening situations, as my patient thought that it was essentially inviting in the devil. My patient didn’t want to make this decision, since she felt it was the doctors’ responsibility to determine whether to do everything or let her go.

I apologized, and ended the encounter as gracefully as I could.

When I went back to the team room and relayed the whole story to my resident. He nodded understandingly, told me to review her chart and said, “and if there’s nothing, just put her down as Full Code.”

She had never been to our hospital before, so there were no records for her. So, like a lemming, I did as I was told, and put her down as full code.

Two weeks later, I had a class on difficult discussions, and the issue of obtaining DNR/DNI status was brought up. We were told to never use specifics - don't ask about their heart stopping or breathing cessation, and NEVER ask if they want the care team to do everything. And of course, never assume anything. And NEVER go in alone.

I had done everything wrong.

Luckily for me, nothing happened. Her hospital stay was uneventful and she went home the next afternoon. But I can't help worrying about the Full Code status that is now in her chart. Because, chances are that she will return to the hospital with yet another heart issue, and another med student will interview her and she will again refuse to make a DNR/DNI decision, and some resident will tell that med student to review the charts. And there it will be - FULL CODE.

Use somebody

Remember how I had that patient and we lost her blood work and there was threats of suing and heads rolling and lots and lots of yelling?

Well, miraculously, she likes me.

She doesn't like my resident so much.

But she likes me.

So when it came time for her to be discharged, she pulled out her business card and told me to keep in touch.

I went through her discharge instructions with her, helped tidy up her things, pulled out her PIC line, and wished her the best of luck.

I went back to my team room and was finishing up my note, when my resident turned to me and asked how it went. "Oh, it was fine - there were no more threats of lawsuits at least! Haha, and oh, she wants me to keep in touch with her," I replied. My resident's eyes opened wide, and thinking that she thought I was going to breach some patient-physician boundaries, I quickly added, "Oh, but don't worry, I wasn't actually going to email her....because that would be strange and bizarre....and out of line, of course." But my resident shook her head and said, "No, you definitely should email her in a week or so to see how she's doing. The best way to not get sued is to show that our team cares about her health, and apparently you're our lifeline!" I laughed nervously, and promised I would.

So one week later, I wrote my patient an email asking how she was doing.

She wrote back within five minutes.

Perfect timing. I've been thinking of you and since I'm on my way to [Other Hospital] tomorrow for a second opinion and had to pick up my records yesterday, when I read them, I kept seeing your name. I'm torn between wanting them to find the unknown and being afraid the unknown may be something bad that was missed. Anyway, I'm in for a penny and in for a pound. I'll stay until they give us some answers.

I wrote back with something reassuring, and told her to let me know how things went during her hospital stay.

A couple days later, she wrote to tell me what the various care teams were saying about her condition. And at the end of the email was this:

But here's what I want to tell you; I have all the reports, etc. from your hospital; about 75 pages and the ones they keep referring to are your med student notes from the day I was discharged. You had all the final blood tests plus a good recap of my condition that day. Your name will be well known here at [Other Hospital] when this is all over.

I was shocked. Don't worry, I didn't let the last sentence go to my head; I know no one will remember my name at the end of the day. But on that day, at that moment, I had finally gotten the "good job" I'd been waiting to hear. True, it was via a second party and from completely different doctors than the ones I had been working with, but it was something.

And that little bit of something meant quite a whole lot to me.

I mean seriously, someone actually read my notes! And they were useful! I was useful. And really, that's all a third year med student can hope to be. I just want to be helpful. I just want to be part of the team, feeling as though I'm doing something that actually means something.

America the beautiful

Tribute in Light from 2002 (top) and 2009 (bottom)

I remember when this memorial was first unveiled in March 2002. It was such a simple concept and truly beautiful - light reaching all the way to the heavens to those we lost on 9/11. And perhaps it was a way to show that they were reaching down to us too. It was an image that reflected our loss but also conveyed comfort.

Every year I see the 9/11 tribute pictures, I'm always awed by how such a simple design works so well at eliciting such different emotions in the same heartbeat. Loss. Pain. Hope. Love.

This year, with the low-lying cloud cover over New York, the lights didn't go on to eternity as they have in the last seven years. Indeed, if you looked quickly, it was almost as if the Manhattan skyline had never changed. A fleeting glimpse of what could have been. And a terrible reminder of unnecessary loss.

It's haunting, but beautiful just the same. Achingly beautiful.

People say, "never forget." I don't see how we possibly could.

Light on

[ A rendering of the National September 11th Memorial and Museum at night]

Take a minute today and just reflect.

My kind of town

I LOVE CHICAGO! <3

And I loved this! From the giant 21,000+ modified wave to the disgusted, what-the-hell look on the girl's face when that first chick is dancing all crazy in the beginning. Oprah's reactions to the ever-expanding dancing crowd. The #1 proclamation at the end. And of course, the gorgeous Chicago backdrop.

Yes indeed, Oprah - this is the coolest thing ever.

Hey Olympics, think of what kind of spectacle we would put on for YOU. Chicago 2016! Back the bid!

In an effort to be more efficient and studious, I will not be blogging until the end of this month. You see, my roommate has changed my password to facebook, twitter, and yes, this blog. But I'll be back in a couple of weeks, with lots and lots of stories already brewing!

See you then!

My funny valentine

ME

Ugh. I had a bad day today...and I'm feeling really terrible right now. And unloved. And crappy. Ugh, I hate this. Can you cheer me up?

MARTIN

Sure! [sing-song] Michelle - do you know how much I love you? Let me tell you... my love for you is like dots in a line, and according to the rules of geometry, lines are infinite. And you know how my watch has to be wound up because it's an automatic? If it ran on my love, it'd never stop. And you know how stars die, but we still see the light? I love you as much as that, because the light keeps going. [pause] How about that?

ME

[dying with laughter throughout his speech]

Hahahahahaha!! What is up with all these abstract metaphors? Star light? Lines? I don't know if they even make sense! Shouldn't it be like a circle? A line?!

MARTIN

Yeah, I don't know why all my metaphors are all math and astronomy and physics and stuff.

ME

Hahahahahahahaha!

MARTIN

Fine. Fine! I love you as much as flowers, okay? No, I love you as much as rainbows. There.

ME

Soooooo, you only love me on rainy days. And your love dissipates after half an hour.

MARTIN

See? This is why the abstract ones are better.

ME

Okay fine. You love me as much as a dead star. Wonderful.

---

We the dreamers

There are some days when I feel like Charlie Brown. And on those days, I wonder why I don't just walk away.

There are some days when I'm absolutely great at what I do. I can take a history like nobody's business. Got a heart murmur? I'll hear it. Took some ilicit drugs last night? I'll know. Can't speak English? I'll translate. (Or find someone who can.) I'll gain a patient's trust with just a ten minute interview. I can churn out those H&Ps and get pharmacists and social workers to help my patients with a simple phone call, my charm on full blast.

Those are the good days. The football-kicking days.

And then there are the other days when I feel as though there must have been some kind of fluke in the admissions system, because there's no way someone like me - someone as dumb as dirt - could possibly have been admitted to this school.

I feel it when I get asked stupid "pimp" questions, where it's one of those either you know it or you don't situations, and you swear you knew the answer three months ago, but right now, on the spot, it's eluding you - the name of that syndrome that presents with watery diarrhea, hypokalemia, hypochlorhydria, and metabolic acidosis. (It's Verner-Morrison Syndrome, by the way. Also known as VIPoma, but apparently that answer isn't detailed enough for some attendings.)

I feel it when I present my oral presentations, and I'm asked pointed questions that ultimately make me realize that my diagnosis was all wrong. Or that it's fairly obvious to everyone else that I should have known to check for a folate and B12 level.

I feel it when I miss stupid study questions, and I internally yell at myself. "UGH! I KNEW THAT. WHY DID I PICK THE OTHER ANSWER? STUPID STUPID STUPID!"

Medicine. I hate it, but I love it. Even though it brings me down more often than not. Much more often than not.

And so, on those bad days, I yell and cry and rage against the machine, and the next day, I pick myself up to start all over again. Because I have to believe that I'm going to be able to kick that football. Maybe not today, but maybe tomorrow. Or the day after that. Or even the day after that. Gotta just keep running after that football.

AAUGH indeed, Charlie Brown.