The Bird in Flight - Ramblings

Where's Waldo?

nospam@example.com (Kevin) — Sat, 21 Jul 2007 14:27:32 -0600

Or better yet: Where's Kevin?

I'll give you a clue, I'm not actually manipulating any instruments and I'm not the woman.
Yep, that's me! I think that was during a VSD repair. Dr. Gilbert is the Peds CT surgeon I spent 6 weeks with last year. It was Awesome! I was talking to Dr. Ross (peds cardiologist) who was saying that Pediatric Cardiology is a cruel mistress, and that the good peds cardiologists don't just want to do it, they are driven to do it, like an artist. They can't imagine doing anything else. I'll continue to keep an open mind, but so far I think that's where I'm at!

Click on the picture for a link to the CHKD posting on Dr. Gilbert and the peds CT surgery team (all incredibly nice & generous people).

temptation

nospam@example.com (Kevin) — Wed, 24 May 2006 23:43:45 -0600

Congratulations graduates! Now that you will have some income I share with you a glimpse into the possible future, where everyone owns an apple computer with an isight camera......mmmmmm multi-person video chatting.....

Rang de Basanti (a 6 on the Kollins -10 to +10 scale)

nospam@example.com (Amit) — Fri, 17 Feb 2006 01:45:03 -0700

Rang de Basanti, Aamir Khan as a college student in the middle.

No country is perfect, rather it is up to us to make it so.
This theme permeates the new Bollywood film, Rang De Basanti, about a British filmmaker who comes to India to shoot a documentary about her Grandfathers life as a colonial jailor. According to the story, he oversaw the execution of four charismatic freedom fighters during the early days of the Indian Independence movement. Branded as terrorists by the British Raj, the strength and dedication of these men created a personal crisis for him as he supervised their torture and eventual hanging. The filmmaker casts five carefree college kids (including the forty something actor Aamir Khan hey, its Bollywood after all) to take on the roles of the condemned men. When a government corruption cover-up results in the death of their friend, a fighter pilot in the Indian Air Force, they are inspired into action by the characters whose roles they have taken.

Though their response is unnecessarily violent and a little bit preposterous, I couldnt help but think about the difficulty in transitioning between endless and circular debate and concrete action. A similar idea was presented at the Gandhi exhibit I wrote about. A quotation of his stays with me, Truth is my goal, Ahimsa (non-violent resistance) my method. With truth on my side I am invincible.

The Cage

nospam@example.com (Randall) — Mon, 23 Jan 2006 17:56:02 -0700

Spoiler alert here - if you haven't seen The Weather Man or Lord of War, I just might give away some key points. Plus, you really should see these films before I color your view of them with my viewpoint.

So Nicholas Cage has made two excellent films this past year that I have seen, both of which leave some pretty uncomfortable questions. The first is The Weather Man. Personally, I think this movie speaks a lot to the futility of the American Dream and to what my friend Eric calls the paradox of success (a book he actually let me). We live in a strange country where sacrifice of family and friends for the sake of your job is not only admired but expected. The question posed is, will we get the outcome we want, and will we like what we have done to ourselves? As for me personally, why am I working so hard now? Will it lead to the idyllic life, filled with love and joy and all that good stuff? Or am I heading down the inevitable path to 100-hour work weeks and watching my children grow up one weekend visitation at a time? Why the hell do I want to work that many hours anyways? Don't get me wrong. I love medicine, and I love the fact that I have a job where I'm constantly learning, constantly helping people, constantly making a difference in their lives as well as mine. I've always thought I have one of the most interesting jobs in the world, and I've just come to accept that the price to pay for having such a job is to work my butt off and sacrifice a great deal. The problem is that I want it all, I know I can't have it, and I'm not really sure I made the right choice. I don't know if I really want to sacrifice everything to have a cool job anymore. It's an uncomfortable thought to have, 4 months from graduation.

The other excellent film from the cage this past year is Lord of War. It is another brutal movie, in which playing the part of the anti-hero, he destroys everything he cares about. Good and evil are well defined in this movie, and the moral strong (the heroes if you will) are all the weaker for their strong sense of ethics. Those who live for principle, who dare to take sides, who strive to save a few lives in the huge conflict are ultimately rewarded for their efforts with absolutely nothing-the lives they try to save are lost anyways, and the change they try to instill never happens. Pleasant thought, huh? So is it pointless to live by principles? Does doing the right thing make any difference? Or should we really be doing what is convenient, what is necessary to survive? If this becomes the case, is there any point to altruism anymore? As cage so astutely states, "They say, 'Evil prevails when good men fail to act.' What they ought to say is, 'Evil prevails.'" Of course, the one flaw in living an unethical life is that it's never easy to live with yourself. Sometimes, it becomes so difficult to live with yourself that it is easier to die-or at least some characters in the movie seemed to think. Or maybe I'm pulling out messages that might or might not be there. I do like doing that. At any rate, the questions are uncomfortable since in general, I like the idea of living by principle and refusing to sacrifice one's character for a quick gain-even if I'm not particularly perfect myself. It's something to think about.

Oh, and apparently Nicholas Cage is going to be the sheriff in this year's remake of The Wicker Man. And National Treasure 2 is in planning. Awesome. If only there could ever be a movie to top The Rock. Paper or plastic?!

Happy Birthday

nospam@example.com (Randall) — Sat, 6 Aug 2005 01:00:00 -0600

Happy birthday to my sister, who turns 23 today!

how you doin'?

nospam@example.com (Umakant) — Wed, 3 Aug 2005 11:55:33 -0600

shy? me?? ok so it's taken me some time to post anything--i figured most people wouldn't want to know what's going through my head (it scares me sh*tless half the time).

so for those that know me, im a huge travel freak...specifically civil aviation (check out airliners.net...it's like my morning paper...no, really, i'm serious, i read it before i read the bbc news site). imagine my dismay to find that an AF A343 had just crashed off the runway at YYZ in a heavy thunderstorm thankfully, of 309 people on board, there were NO fatalities (except for the plane of course, which i'm pretty sure is beyond repairable seeing as how it apparently split in two and was engulfed in flames for the good part of a few hours). congratulations to the crew for a good job evacuating all the passengers safely...

Low res

nospam@example.com (Randall) — Sun, 31 Jul 2005 17:36:08 -0600

Anyone else feel the resolution of the photos is too low? A width of 480 is kind of totalitarian, imo. I think I'm gonna switch up the layout soon, to something without the ridiculously large sidebar.

So studying in earnest for step 2 starts tomorrow. I'm kind of easing my way into it. 30 pages yesterday, 50 pages today (hopefully, I still have 15 to go), and 60 pages a day with 50-100 questions on top starting tomorrow. Eek. It's been a long time since I've put in 8-12 hours a day in front of a book. I don't particularly want to push back the date of my exam though... Meanwhile, I'll try to write some sort of a personal statement, ask for letters of recommendation, fill out my residency application and figure out how to finalize my schedule this year, etc. And here I thought I was done with this applying stuff 3 years ago.

So I've been jumping from hobby to hobby recently, and I've picked back up photography recently. This blog is probably to blame. Let's see how long I can keep it up, and how far I can take myself creatively. I've never been a really creative person, so it's something that'll take some time to develop, I suspect. Photo Friday (see my last post) is my latest idea on how to challenge myself to stay interested. They have a new theme each Friday, and everyone gets to submit one picture a week.

Anyways, back to work.

Year 4

nospam@example.com (Randall) — Fri, 22 Jul 2005 23:47:40 -0600

Been a while. Okay, I felt kind of profound tonight, and so I started writing, but I just couldn't organize my thoughts. Tired. So here's a pic.

Mark, where are you?

Anyways, so year 4 hasn't been the amazing experience I was promised. Too bad. It's not all that bad though, and I have to say, it's nice not being a third year anymore. I miss all my friends though, and I miss having a team composed of my classmates. Fourth year seems to be full of rotations where I'll be the only person in my class on that rotation. Ugh.

It's funny though, how so many of the new third year students fear their upcoming surgery rotations. I remember mine fondly, as it was the only rotation I was part of a big team. There were seven of us from my class, and we worked together day in and day out for two months. Sure, it was a lot of hours, and a lot of blood, sweat and tears. It was still pretty incredible. It was the rotations like family medicine, where I would never see my friends at work, that were the tough rotations. I don't know how people do it.

And now a whole year of this. Weird. Anyways, I better get some sleep. Tomorrow starts my only full weekend off for this rotation. Maybe some studying. Definitely some time hanging out with friends.

The Two Faces of Medicine

nospam@example.com (Amit) — Wed, 22 Jun 2005 14:37:03 -0600

Its amazing how much time I can spend procrastinating three days before my last exam! Im trying to memorize my notes, but Im finding them much more interesting to read with my eyes closed. After an hour passed out in front of my books, I feel like I deserve a break. Perfect time to look up the origin of the staff and snake symbol commonly associated with the medical profession. It seems like there are two different symbols, one with two snakes and wings on top, and one with just one snake.

The winged staff is a Caduceus, the symbol of Hermes, the Greek messenger god. He is known as a great mediator, a diplomat, and best of all, the patron god of thieves! Insert managed care joke here.

The staff with one snake is the staff of Aesculapius, the Greek god of medicine. Aesculapius was trained by Chirion, a centaur skilled in the healing arts. Aesculapius disciples were among the first professional healers in western civilization. In fact, Hippocrates, aka Notorious HIP, was a member of the Aesculapius cult.

The confusion between the two began with a set of German medical texts that were printed with the Caduceus symbol on the cover instead of the staff of Aesculapius. The mistake was magnified in 1902 when the US Army Medical Corps selected it as their official symbol because they preferred its more streamlined shape.

Incidentally, Zeus killed Aesculapius in a drive-by lightning bolt attack after Hades, god of the underworld, complained that he was healing too many people. So I guess there is such a thing as being too good at your job.

Token of my love

nospam@example.com (Randall) — Tue, 21 Jun 2005 23:31:21 -0600

Man, that last post was depressing. I promise I won't always be like that. So I noticed that Kimi thinks I stole the lighthouse picture, eh? That's okay, you're super cute so I don't mind. You can have my coat and the picture. ^_^ (But if you still don't believe I took it, check out my reply in the comments section of that post)

So I was sifting through Jay's board to find the thread where I uploaded the original lighthouse picture, along with all the pictures from that evening, and I came across Toma's rendition of a photo we took:

Man, I was dying. I had forgotten all about that. The best part? I had come up with lyrics for our single, off the top of my head at the time.

Girl, when push comes to shove / I'm gonna be the one to rise above / Fly you from here like a dove / That's just the token of my love...

I can't believe he never deleted that off his server. lol.

Leeches

nospam@example.com (Randall) — Tue, 21 Jun 2005 13:29:54 -0600

Medicine used to be easy. A patient would come to you, sick, and you would do everything you could do to make the patient live, and honestly, more often than not, the patient would die (or heal, I suppose). There were no antibiotics, IV fluids, vasopressors, insulin drips, or mechanical ventilators. If you couldn't eat, no one could shove a tube past your ligament of Treitz or run a catheter into your superior vena cava and force food into you. If you couldn't breathe, no one would even think of cutting a hole in your throat to point a tube at your lungs. If you had crushing chest pain and fell over, no one would cut a hole in your groin and thread a balloon into the tiny vessels feeding your heart. If it was your time to go, you would go. The doctor couldn't save you.

Today marks the end of third year rotations for me. What a weird feeling. Sure, I have a big exam on Friday, and in August I take the step 2 (the next part of my licensing exam). My last day was pretty low key. I tried to figure out why one of my patients had a hypoglycemic spell, and whether another one was ready to try eating. We discussed the finer details of how neurosyphilis presents. Should we give this lady some blood for her sickle cell crisis? Rounds were moving briskly.

We came to this patient who has been our service all month. Dying of cancer, she was a mere shell of the vibrant woman who existed only a few months ago. The cancer had stolen all of her immune system from her, much of her blood and most of her coagulation system. We had been fighting a futile battle to keep her alive despite her complete lack of response to her cancer treatment. Finally, yesterday she had a stroke. But even a stroke can't kill you these days. So there she sits, 85 years old and at the end of her life, in a foreign room where everyone who talks to her wears masks, and who touches her wears gloves. Where the focus of her life has suddenly changed to chewing properly and how the sores on her back get bigger, from raising her children right and making a life for herself.

We had a conference, and the family finally decided to let her go. Let her go, but with antibiotics. Maybe IV fluids. She'll be unconscious, and mostly pain-free, but nonetheless, she will take a long time to die. Weeks maybe. What a painful choice to make. We have awesome power to save lives with antibiotics and pressors and fluids and ventilators. Amazing power. Power so great, I sometimes wonder how people even die anymore. With that power, though, we have to make these choices. We have to decide just how much we want to let go. It's not an easy choice, and it certainly isn't a simple one. Ok, you want to let your loved one go, but where do we as doctors stop? Would you like us to perform chest compressions? Shock the heart? No? How about intubate or ventilate? No? How about labs, or respiratory therapy, or fluids, or insulin, or heavy sedation, or...

Even we have limits, though. We won't kill. Take the most tragic person on our service. Eighteen years old and a brand new mother, this girl lies in a hospital bed. Helpless. Victim of a devastating neurological/autoimmune disease, she has become completely blind, paralyzed and in constant agonizing pain. She's in so much pain that the lightest touch causes her to cry out, and throwing our entire pharmacy at her doesn't ease it even the slightest bit. She's had over a dozen doctors try to fix her in this "visit" alone. I put visit in quotes because she's been at the hospital for three months now, with tubes feeding her and breathing for her. She's allowed to breathe on her own for two hours a day. Two hours a day. She can still hear, and she could still talk if not for the hole we cut in her throat to insert her breathing tube. Everyday we stop by, say hello, ask her if she's still in pain. We change some medications, talk to consulting doctors, and move on. Everyday, she lies there, staring into nothing, listening to the sounds of the TV. 18 years old. I try to imagine what I would be thinking about if I were forced to be locked in a room day in and day out, without being able to see anything or do anything or talk to anyone. I don't know.

Not that I'm suggesting we kill her by shutting down her vent or stopping her feeds. Even I'm not that cruel. It's not an easy position to be in, though. The fact of the matter is, she will not get better, and being in the hospital this long, it's only so much more time before she catches the bug that will eventually kill her. Until that day, she will mostly likely continue to be in constant pain.

I tell myself that with these awesome machines and medicines we have, we will save lives, and that the tradeoffs is that we're going to have some sad stories to tell. It's an awesome priviledge, and a painful one sometimes.

One More Week!

nospam@example.com (Kevin) — Mon, 20 Jun 2005 18:45:04 -0600

By this time next Monday I should be back home from having taken Step 1 of the USMLE! There's nothing more to say than I am in panic mode and feel totally under-prepared. I just have to keep reminding myself that everyone probably feels like this, I've been studying for weeks, and I am in fact adequately prepared. I've talked to a bunch of people that have already taken the test and almost everyone said they felt like they had failed the test after they took it. That's great! So here we have an 8 hour test, that you study and worry about for weeks, and helps determine what kind of residency program you will be able to get into, which after you take you feel like you've failed it. Can't wait! I am really looking forward to getting this behind me. I am also really excited about starting my third year clerkships. Orientation is on the 30th and then I start my psychiatry rotation the following week. My schedule next year will be psych->family->internal->peds->ob/gyn->surgery. Almost a perfect escalation from "easiest" to most intense rotation.

On another, non-med school, note: I'd like to congratulate my Dad (or you could say I'd like to give props to my pops) for getting one of his paintings admitted to a gallery in the Washington, D.C. area. He is part of an art league that holds classes and has their own gallery space in the Torpedo Factory in Old Town, Alexandria. Each month their members can submit artwork to be placed in their gallery. A panel of judges pick from hundreds of pieces submitted each month. So he will have one of his paintings displayed thru June. Here's a really bad camera phone picture of his watercolor:

Here are also two pictures (in charcoal) he has done of my Mom. He plans on doing a third to submit for the Torpedo Gallery.

And on a final note: after I take the boards on Monday the 27th I will be going back to Northern VA to visit my Dad, celebrate a belated Father's Day, see his painting up in the gallery, and pick up my dog. Oh, and also to eat in the GREATEST Thai resaurant ever. I've overheard people at this place tell the chef/waiter/owner that they have lived in Thailand and this is the best Thai food they've ever had. Randall has expressed interest in driving up to eat dinner there and my Dad has given the green light for people to crash at our house. So I was thinking maybe Tuesday the 28th? I'll see if we can get a few people up there b/c the more people at the table the greater variety of dishes we can share! Just let me know.

Wilson, I hope you're settling back in ok. Post some pics when you get a chance to let us know what it's like out there!

First entry

nospam@example.com (Randall) — Wed, 15 Jun 2005 22:15:25 -0600

So this is the first entry. I've never blogged before, but hey, why not now. I'm in the middle of the big medicine rotation, being worked to death, but learning a lot. I can't really feel TOO sorry for myself, considering my patients are probably as sick as they come. It's almost surreal, the strange fascination I have with the moments at death's door, and the heavy-heartedness I feel seeing my patients lying there without much hope left. Ugh.

Anyways, I'm doing this to set up a "blog" for Mark, who will be leaving our class this coming year to make an incredible journey to South America, both to provide some care for folks, and to grow in ways I probably never will.

Let's see if this picture thing works:

So this is Long Beach Marina. I took this a while ago, right before seeing Miss Saigon, back in the spring of '03. My dad's always had a thing for lighthouses, and I guess it's rubbed off on me.