Wednesday, August 31, 2016

Mama Said There'll Be Days Like This . . .

It's a lonely job when things don't go well.

I cannot say that my work this week, at least thus far, has been especially uplifting for me personally. It's educational, certainly. Learning experiences abound in this aspect of my training. Cardiac surgery, however,  is not now, nor will it ever be my choice of course of  study or work. 

We all need to be exposed the very basics in every field of medicine to make intelligent choices as to our specialties. Furthermore, somewhere way down the road, I may be in a position where circumstances are so very dire that I'm the most qualified person to assist in a cardiac procedure. God help the patient if such is ever indeed the case. I am in my current rotation for a very good reason. I need to learn everything I possibly can from it and I need to put into it everything that I have to give. That does not mean I have to like it. Fortunately for me, because of a glitch in my scheduling, I'm here for only one week instead of the customary two. It may work out that I will put in an extra week in cardiac surgery next year. On the other hand, it may not work out that way. However it works out, I'll live with it.

Next week I'll have an unusual opportunity. My pseudouncle is visiting the hospital where I'm currently working in order to perform a thoracic procedure as a guest physician. The technique he'll be using is one that has yet to have been performed here in the hospital at which I'm currently assigned. He requested that I be allowed to scrub in for the procedure, and his request has been granted. I won't miss much in the way of my regular duties, as I am assigned to outpatient pediatrics for the next two weeks. The surgical procedure is set to begin at 5:30 a.m. If we're lucky, it will conclude by 10:30 a.m.  I'll then change out of my surgical clothing, scrub out, and rush to the site of my assignment, without, I hope, having missed out on anything too exciting. I do not wish to start off on poor footing with my next supervising physician.

Today was an especially rough day for more reasons than just one. We had a couple of myocardial infarction patients who were operated on as last-ditch efforts. The odds were against the patients, and the odds both times worked out the way odds are supposed to work. I was warned in both cases by the interns that  the surgeries were long shots at best, but it's still hard to see that in real life, things don't have as many happy outcomes as they do on TV and in movies.  I stood far back. There was nothing I could do, and no one needed me in his or her way. I did hug the son of the deceased afterward just because he looked so forlorn and it seemed the natural thing to do. I had a few tears running down my cheeks, but I wasn't blubbering, which would not have been appropriate, as I didn't even know the lady.  The attending physician said that showing compassion toward family members is a good thing, and that minor emotional displays are even OK.

I worked sick today. It was determined that my illness was a manifestation of colitis and not of anything contagious, and so I was told to remain at work.  I knew when I signed on for the program that working sick would occasionally be a part of the experience. I had to leave the surgical suites in the midst of two procedures. My superiors knew this was a possibility, and I was given the green light to exit whenever it was imperative that I do so.  The surgeon allowed me use his private bathroom attached to his personal office. I'd still much rather experience the barfing and other stuff that accompanies colitis in my own bathroom at home, but I was at least not stuck on the floor of a stall in a public restroom with God knows whom walking in and out of the stalls on either side. I borrowed cleaning supplies and gave the surgeon's private space a thorough detoxification after befouling it.

All things considered, if every day turned out the way today did, I would probably quit medical school and become a 900-number psychic, but chances are that not every day will be as depressing as today was.  The sun'll come out tomorrow. You know the rest of the song, so I don't need to spout anymore bullshit for your benefit.

Saturday, August 27, 2016

Future Doctors Being Denied the Benefits of Terms of the Geneva Convention in Order to Be Warned of the Evils of Pharmaceauticals

Colorful pills falling into open palms - Stock Image I'm not sleeping well, which is a pity, as I could use the sleep. Three mornings this week I had to report for work derangedly early, as in by 3:30 a.m. at the very latest. Two nights I was stuck at the hospital until 7:15 p.m.. Another night I couldn't leave until 7:46. Another night was the enchanting dinner party obligation about which I wrote. While it was very nice of the people to have invited us into their home for the evening, all things considered, I would have been more relaxed in a room full of rabid Mormon missionaries and rattlesnakes. That night I didn't get home until after 9:30.  

This morning my cohort has a mandatory meeting. It's scheduled for 7:30 a.m., which would feel almost like sleeping in (it's not true sleeping in if one has to turn on an alarm clock to be assured of not missing a mandatory meeting) except that I cannot sleep anyway. Along with other various and sundry reminders about our miscellaneous dereliction of duties and general slothfulness, we'll get to have The Drug Lecture once again. They seem to hit us with it about once a year. I don't think it's a random thing. I suspect we'll hear it again at least once before we graduate, and possibly an additional time for good measure. And I'm certain we'll all, no matter where we end up for our internships, hear it once more in a very big way just before we reach that milestone in which we become licensed practitioners and have the legal authority to write prescriptions.

The rationale for hitting us all over the head with this information is not lost on me. I understand what a monumental societal problem prescription drugs have become.  I get that we, once we become licensed doctors, will have within us the power to make the problem even worse. We will have the means both to turn ourselves into massive drug abusers or, even worse, to become part of the problem by writing frivolous prescriptions for attention meds, opiates, benzos, and possibly even medical marijuana for friends and relatives, or, even worse, to supplement our incomes. Statistically, one of the lecturers told us today, at least two of us will fall into each of those three categories of self-abusers, frivolous writers of prescriptions, or de facto dealers.  Maybe we actually will, or perhaps we will not. It' highly doubtful, however, that the lectures they're forcing on us will change the outcome for any of us. And I'm not suggesting that the drug talks be eliminated entirely. It seems, however, do be overdone ever so slightly.
Raptor Jesus suggested that they show us Reefer Madness so we could at least be entertained throughout the scare tactic process.

My complaint with their system is that  by robbing me of a morning of sleeping in and forcing me to attend five hours of lectures and meetings during a week when they already forced me to work 81.5 hours (counting the forced dinner frivolity, which was, by the time all was said and done,  more stressful than actual work) between Monday and Friday, they caused me to need the drugs they're cautioning us not take far more than I would otherwise ever have needed them. It's almost the equivalent to force-feeding someone a steady diet of nothing but sugary foods and saturated fats until the person becomes obese and his or her arteries become clogged to the point of needing Drano, then berating the person for flirting with cardiovascular disease, diabetes, liver disease, and colon cancer.  It's like they're giving us a lecture on the evils and dangers of guns, then sending us into battle without any weapons because everyone knows guns are dangerous.

My week may have been a bit worse than what the average cohort member went through, but by and large it evens out, and we're all dealing with the same nonsense. Most of us deal with it by consuming insane amounts of coffee. I cannot drink coffee. It [literally] makes holes in my colon. I've already had two segments of my colon removed. While coffee was not the culprit in the loss of my two sections of colon, were I to start drinking it, it would most certainly cause a loss of a third segment. I need all the calories my intestines can absorb. My body  cannot afford to give up many more chunks of bowel. Coffee is out of the picture as a solution. Even strong cocoa (as in the stuff Starbucks sells) has a similar effect. (I can handle the stuff that comes in Swiss Mix or Nestle packets if I dilute it with milk.) Beyond that, caffeine doesn't work quite as it should for me. It's somewhat slow-to-reverse-acting. I drag throughout the day after consuming it, then have extreme difficulty sleeping fifteen hours after I've taken it. An occasional Pepsi or Dr. Pepper as a treat doesn't cause major effects, but anything beyond that is more than my body can handle, particularly with the tachycardic effects ( increased heart rate) of my mildly elevated thyroid.

I shouldn't complain. One member of my cohort has lupus. House said it's never lupus, but in at least one case it is.  Another person has rheumatoid arthritis. Another member as hepatitis C, which, in addition to zapping his energy, will disqualify him from some residency positions. (A few people claim fibromyalgia, but I'm a bit skeptical where that particular diagnosis is concerned; I'll buy into it when it hits me, which, in true Karmic form, it probably will.) All I have is a colon that likes to develop holes and a tendency to be in the wrong place at the wrong time with insufficient inertia to provide adequate resistance when someone else comes barreling into me and knocks me down flights of steps or otherwise encroaches upon my course of motion. I will live through this. I'm not sure about the rest of them.

I just think it's silly of our protectors to repeatedly warn us about the evils of drugs while causing us to need those drugs about which they're warning us in ways that we never would have imagined would be necessary were it not through the regime that they're putting us. They went through it, so we, too, must run the gauntlet.

P.S. I've always known where my dad kept his prescription pad, and I can do his signature better than he can do it himself. Had I been truly interested in obtaining a supply of contraband either for my own use, for that of my friends, or for financial gain, I likely could have pulled it off successfully a long time ago. I do not deserve to be required to sit through any more of the drug lectures.

Innovative, huh?

Friday, August 26, 2016

Mini Post-Script to the Prior Post

Image result for two faces
This picture has little to do with my post except that the lady looks slightly like Avril.

I discussed a situation of etiquette, in my most recent blog. Those of us who were present made the decision to approach both the person whose manners were lacking and the dean of our program. It wasn't our intent, or at least not my own, to get the person into trouble. My rationale was that I didn't want to be blamed if the couple who hosted a group of us for dinner were to call and complain about a member of the party but not name the person, all of us might have been in jeopardy. The reason for approaching the woman herself was, at least in my justification, to be up-front rather than duplicitous about it.  i have no serious hope that anything Kal Penn might have told he would have changed the way she lives her life.  I do, however, find it easier to live with myself  in knowing that she was told both how the group felt and that the dean was to be contacted by one of us.

As it turned out, less than an hour after Dylan, who represented our group in speaking to the dean, left the dean's office, our hostess from the previous evening did call to complain about Avril's rudeness. As we thought might be the case, the hostess didn't name the offending party. The dean didn't let on that he had already been apprised of the situation, but he questioned the hostess to ensure that the picture as dylan painted it was accurate and that no one else was discourteous or otherwise poorly represented the school.

The rest of us are in the clear, but I have no idea what will happen to Avril. she can't really be kicked out of the program for exhibiting abysmal manners at a public relations function.  Transfers at this stage of the game in medical school are rare but not unheard of, and it could happen, though not likely without a second chance for Avril.  i wouldn't think that the people in power would be quite so concerned about what she might do  at future functions for our university, but rather, what she will do once she gets her degree from here that might tarnish the image if our institution. (Pun intended; this place is all colors of crazy now.)  I'm trying to adopt the mindset of the dean and of his advisory board. I suspect they'd love to unload her on some unsuspecting (or even suspecting) medical school that needs her high qualifications more than the school doesn't need someone with her social skills. Those in power would probably arrange her schedule to be so ugly as to be considered almost   (but not quite) harassment.  that's easier than officially inviting her to leave, which they could legally do, I suspect, if they were willing to take on the necessary documentation, but it might not be without a court fight. It would be much easier if she were to pack he bags voluntarily, which she might very well do if she were told that she would not receive a single positive faculty recommendation were she to stay.

But then, what do I know? Perhaps a similar action is being plotted behind my back as I type this.

We wouldn't know any of this except that there is a mole in the dean's office.

Wednesday, August 24, 2016

Picky Eaters, Manners, and Social Settings

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There's more than one way to display rude table manners.

At least once a year I have some sort of social obligation related to my medical school student status.  We're "invited," but we're expected to show up. I have no idea what happens if someone fails to appear without a really good excuse for not being there. I don't think anyone in my cohort has pulled a no-show on one of these events except once when a guy had a death in his immediate family.

One of the delightful social gatherings took place this evening.  For the particular gathering, we were invited in mid-sized groups (our group had eighteen medical school students) to homes of medical school benefactors. The particular gathering to which any given student was invited was based on a person's duty schedule but was otherwise somewhere between random and alphabetical.  I would assume almost every student there would have preferred to have been on his or her own sofa eating Subway sandwiches or microwave meals, but, at the same time, at least where my own group was concerned, volunteers went to a tremendous amount of trouble to prepare an elegant meal for us and to make it a special occasion. Not to recognize that such was done on our behalf would be ungrateful.

Tonight's gathering wouldn't even be noteworthy were it not for the behavior of one of my cohort mates. We'll call her Avril, though that's obviously not her real name. Avril is a picky eater. There may be some cultural and/or religious basis to at least some of her pickiness (though she doesn't keep kosher), but by almost any standards she would be considered finicky. On a day-to-day basis, I suspect Avril's picky eating habits wouldn't come close to my own, but  I know when to stir my food around on my plate and make it appear as though I'm enjoying the food that is served to me no matter what it is. Tonight, Avril's fastidious and hard-to-please nature made quite a statement.

She began by asking the hostess if the water in the pitchers on the table was bottled water. The hostess replied that it was filtered. "But is it bottled?" Avril pressed for a more specific answer. 

"No," the hostess replied.

"Do you have any bottled water?" Avril asked the hostess. The lady's husband went out into the garage and found a stray bottle of store-brand water, which probably wasn't what Avril had in mind if the expression on her face was any indication, but she took it, opened it, and poured it into her water glass, not even bothering to thank the host. The remaining seventeen of us looked on with horrified expressions.

Avril's knife had a spot on it, so she asked for a new one. I was seated directly across from her and realized what she was going to request before she asked for the new knife, so I quietly tried to get her to trade knives with me instead of troubling our hosts.  She responded to me, "I don't want your knife. You touched it," as though I had touched any part other than the handle, which I only touched when I picked it up to try to trade with her, and as though I was a known carrier of leprosy or of the Zika virus.  She made her request, which necessitated another trip to the kitchen by the hostess to produce an unspotted knife, which the hostess carried inside a cloth napkin, apparently to reassure Avril that she hadn't touched the knife.

Avril asked about the degree of organicity or organicness [I don't know which is the preferred term] of the contents of the salad. Avril asked if the rolls were gluten-free. When she was told that they weren't, she had the nerve to ask if gluten-free rolls were available. (They weren't.) At this point my brother, who was seated to her right, nudged her and whispered, "Knock it off! We're guests in these people's home, and you're being incredibly rude." She gave Matthew a death glare, then went on to explain in separate utterances why neither the prime rib, the chicken, nor the mixed vegetable coconut curry was up to her standards, though she took a generous portion of each on her plate and took one or two bites of each.

There was a rather noticeable rift as we departed. Avril was the first to go. Each of the remainder of us apologized to our hosts for her ungraciousness as we thanked them for their hospitality when we left.  We all got into our cars and drove around the corner and down the street a few blocks in order to be inconspicuous to our hosts. We parked by an elementary school and got out of our cars to discuss the matter. 

What does one, or an entire group, do when one member of the group behaves in such an outrageous manner? Were we all professionals, we'd simply choose not to invite Avril to another gathering.  We don't have that luxury, though, and if the hosts call the dean of the medical school to complain, they may not give Avril's name in leaving their complaint. We're all at risk of being stigmatized or worse by her total lack of civility.  We probably need to strike first.

Should one of us approach her or should we rat her out to the dean? We decided that both approaches were in order.

Kal Penn agreed to speak to Avril tomorrow. He nominated himself for the task because his parents are of the same national origin as are hers.  If she tries to pull the culture card in her own defense, he can call her on it.

I drew the short straw and would have been obligated to speak to the dean tomorrow morning,  but a nice guy named Dylan stepped up and offered to speak to the dean in my place since i've already had more recent contact with the dean than anyone in his or her right mind would want to have.  Dylan has a break in his schedule tomorrow morning and can plant himself outside the dean's office bright and early, and most likely will speak to him before our hosts have a chance to make contact if that's what they choose to do. I for one certainly wouldn't blame them if they were to complain. I don't know what the couple's annual donation to the medical school is, but I'd venture a guess that any future contribution is in grave jeopardy.

My gut feeling is that, while there might be a few technical aspects of etiquette that are specific to one's culture, such as not hugging the Queen of England unless she hugs you first or not wearing white at a formal occasion in China because it's considered the color of death there, for the most part, manners supercede culture.  Blatant rudeness is rudeness no matter where one's parents came from or where on the globe one is at a particular moment in time.  Beyond that, Avril was born, raised, and educated in the U.S.  She cannot validly claim culture as an excuse. I'm mainly curious as to whether her parents (one of whom is a pediatrician and the other of whom is a geneticist) would have been mortified by their daughter's performance tonight or if the fruit didn't fall all that far from the tree and if Avril's parents are every bit as boorish as their daughter is. 

Tuesday, August 23, 2016

Ear tubes, Undescended Testicles, and Jonbenet Articles in PEOPLE Magazine

This week I'm [very remotely] involved with thoracic surgeries, Since I've had only one day of it, I'll share more about it when I've been through a few more procedures.

Last week I worked in pediatric outpatient surgeries. I inserted a lot of IV's -- I'm good at getting the IV's into place on the first try even with tiny children; the nursing staff was impressed, and I've been told that they're not easily impressed -- and dealt with scared and cranky  [hungry] children in the preoperative stations. I did some post-operative work as well, but there wasn't usually much to do other than to monitor. I did remove the packing from a little guy's nose following an eye surgery that involved nasal passages as well.

Other than just a few sutures and a little work in placing ear tubes, I mostly looked on in horror as the others did their work. I scrubbed in for one circumcision.  There are valid reasons to have one's baby boy undergo the procedure, and there are valid reasons to avoid it. We all have our own opinions about the costs versus the benefits of the circumcision procedure, and nothing I can say here will change anything a reader already thinks about the procedure. (Nothing anyone says in the comments section will change my opinion, either.)  I cried more than the baby did during the procedure, though not as loudly.  The only other thing I will say about it is that I hope to have only baby girls.

The majority of the surgeries for which I scrubbed in this week were myringotomy tube placements, which are tubes placed in the ears to remove and to prevent recurrence of fluid in the ears. This was extremely common  in the 1980's, but later many doctors began to take a wait- and-see approach to frequent otitis media with fluid build-up; often a child will outgrow the tendency toward the condition by eighteen-to-twenty-one months. If the fluid is remaining in place for three months or longer, however, it's probably time to proceed with the tubes. Otherwise, hearing loss occurs, which is temporary but still impedes language development.  Myringotomy tube placements are currently the second most common pediatric procedure in the U.S., preceded by tonsillectomies.

Tonsillectomies (often accompanied by adenoidectomies) are far less common than they were as late as the 1950's through early 1970's, but are still considered the most common pediatric surgical procedure in the U.S. Tonsillectomies have made a bit of a come-back since the late eighties to the turn of the century. ENTs are once again concluding that the procedure is necessary in many instances, though it's not nearly so automatically done as it was in the 50's and 60's. I'm told it's almost 50/50  at best in terms of adults who grew up in that era who still have tonsils. I'm editing this to add that one tonsillectomy patient was admitted following what is routinely an outpatient surgery. She lost a bit more blood than was considered normal, though not quite enough for the necessity of a transfusion. Blood of the correct type was collected from family members in the event that a transfusion was required. She was monitored for three days, then discharged with no further complications, although I know from personal experience that complications from a tonsillectomy can occur later.

We had several optical procedures, most of which were to deal with the effects of strabismus, which is a misalignment of the eyes,  by cutting and reattaching eye muscles. I've heard from my mom, who underwent multiple eye muscle surgeries as an adult to correct the effects of Graves' Disease on her eye muscles, that it's an incredibly uncomfortable procedure, but the children were  troupers and complained only minimally.

We had inguinal and umbilical hernia corrections. We had several percutaneous pinnings, which involve insertions of pins to aid in the healing of fractures of small bones.  We had one orchiopexy, which is a procedure to lower a testicle not yet descended into the scrotum. The child was seven years old, which is an unusually late age for the procedure to be performed. The mom was convinced that the testicle would drop on its own based on a supposed similar happening with the child's uncle, but a boy can reach a point at which it is both cruel to him and dangerous to his reproductive health to wait any longer. The pediatrician had to play hardball to get the mother to agree to the surgery. Fortunately, the little boy came through with flying colors.

An eight-year-old girl confided to me prior to her scheduled tonsillectomy that her mother had given her a single piece of toast and a small glass of milk prior to bringing her to the hospital. I immediately paged the anesthesiologist and texted the information. The surgery was postponed. The father was unhappy with the mother, and the parents were upset with the little girl, with me, and with the anesthesiologist, but an empty stomach is needed to safely undertake any surgical procedure requiring general anesthesia and many that don't required general anesthesia. There are times when emergency surgeries must be performed without regard to when a patient's last meal was, but a tonsillectomy is not one of those emergencies. Chances are that everything would have been OK even had the surgeon gone ahead with the tonsillectomy, but it would have been an unnecessary risk to have taken. I hope the parents were not unduly hard on the child once they left, as it certainly was not her fault, and she was looking out for her own best interests in telling me about her morning meal. (In all honesty, I believe the little girl told me of the meal because she was scared of undergoing the surgery and thought having eaten might be her ticket out of surgery for the day, but that is beside the point. I told her that if I possibly could, I would arrange to be there on the day for which her surgery was rescheduled. I don't know how easy it will be to arrange it, but I'll try. I'm also not all that sure how much difference my presence will make to the child in the long run, as kids forget quickly, but I keep my promises; in this case, my promise was to do my best to be there.)

During a brief hiatus, I was standing near the nurses' station in the preoperative area when I noticed a copy of People magazine on the desk. On the cover was a glamour photo of Jonbenet Ramsey. This presented for me a quandary. I've been obsessed by the Jonbenet case since I first learned of it when I was a very young child, and have followed all of the developments as they were revealed by the media. On the other hand, People magazine is not a highly regarded publication in the medical profession. I'm surprised that even a nurse was brave enough to bring the magazine into the hospital. I really wanted to know what People magazine had to say about any new developments in the Jonbenet case, but I didn't want to be caught openly thumbing through People magazine.

When I thought no one was paying any attention, I quickly grabbed the rag, checked the table of contents, and flipped to the Jonbenet article. I tried to appear to be looking at the data on someone's monitor as I quickly scanned the article. I must not have been subtle enough. An ENT announced loudly for everyone to hear (in an area where almost no one speaks much above a whisper), "Alexis' IQ just dropped 80 points! She's reading People magazine."

For the rest of the day I had to endure obnoxious questions about Johnny Depp's divorce, about the Kardashians, Jenners, and Wests, about the apparently nasty divorce of two people I've never heard of named Johnny and Amber, about two equally unfamiliar people named Jojo and Jordan, about Gwyneth Paltrow's love life, and a host of other nonsense. I smiled through it all, as what else could I do? I had been caught reading People magazine.  I'm now getting all sorts of tabloids shoved through the vents of my locker. Why are all these people wasting their hard-earned money just to poke fun at me? I carefully check the front of each scandal sheet to ensure that it doesn't have a subscription label. If any doctor, nurse, or med student is ever stupid enough to taunt me with a tabloid to which he or she actually subscribes, the person will rue the day he or she ever passed along his or her rag mag to me.

Justice for JonBenét? A New Look at the Evidence and the Suspects| Crime & Courts, Murder, True Crime, JonBenet Ramsey

Monday, August 15, 2016

Pediatric Surgery, Life and Death, and Other Pressing Matters

I haven't dealt with life and death -- or with death, anyway, thanks to the God who controls such things; that will come soon enough --  much since my stints on the hospital floors began six weeks or so ago.  I'm not looking forward to seeing death up close and personal. We all saw it in a sense during anatomy lab times, but there's a palpable difference between pulling a cadaver out of a drawer designed for cold storage of expired bodies and actually watching a person take his or her last breath or experience his or her final heartbeat on one's watch, or even while one is close enough to observe it. None of us are technically high enough on the food chain yet that the death of a patient would be considered our responsibility as long as we didn't so something like carry  a knife into a ward and stab a patient. Someone higher-ranking should still be around to absorb the responsibility even if one of us were to have the misfortune of standing nearest the departing patient when the big event goes down. I'd still prefer not even to be inadvertently standing closer than anyone else, but sometimes those things are the luck of the draw.

Despite all the checks and balances in place so that not one of us is yet placed in a position of responsibility for the life or death of a patient, the unthinkable could happen.  Someone codes out and the call is made. No one shows up very quickly. What does a third-year-medical student do?  He or she does not, at least at this stage of the game, reach for the defibrillators. Chances are they're not even within reach and will arrive with the crash cart, but even were they available, lowly third-year students, at least at this stage of the year, should keep our grubby paws off the equipment until instructed to do otherwise by someone in authority. So what does one do? The correct answer is to begin chest compressions as soon as possible. If the hospital is functioning even close to as it should be, someone with more knowledge and experience and greater skills should be there to take over for you very soon.  

My situation for the next two weeks  -- outpatient pediatric surgery -- should be one in which the life or death of patients is not even in question. Yet we know that anytime a patient goes under the knife -- particularly when general anesthesia is involved --  serious risks including death are present. Some of us remember the situation in which Jahi McMath, a thirteen-year-old girl, entered an ambulatory surgical center for a tonsillectomy. She came out of the anesthesia at one point, but then had bleeding complications, which led to cardiac complications, and the rest is history. I believe she has been legally declared dead, though the status of the death certificate is currently under challenge. She is still being kept artificially alive by machines as her family and the system argue over the level of her brain activity.  (This is neither here nor there, but I have a living will. In the event that no one finds it and I'm found in any state between persistently vegetative and functionally brain-dead, all life-support measures need to be suspended. I want whatever drugs will make me comfortable [ideally 100% unconscious] , and I want hydration. I'll die of starvation but not of dehydration. I think my family understands and accepts this, though, even if they don't find my Living Will document.  And I'm not making a judgment call against the family of  Jahi McMath, who underwent the tonsillectomy and failed to recover. I'm merely saying what I want if my body finds itself in similar circumstances.)

The procedures of the patients for whose surgeries I will be scrubbing in are all relatively routine. As I once stated in another blog, however the very definition of "minor" surgery is that which occurs on someone else or on someone else's child. Things go unexpectedly wrong. Even though children facing outpatient surgery are in most cases are stronger and healthier than their older counterparts, potentially more variables exist.  Just as adults neglect to inform their physicians and surgeons of health conditions, medications, and other contributory factors, parents do the same  in relation to their children. Children withhold information fro their parents and, in many cases,  from their doctors as well.  Conditions that might be relevant to a patient's surgery are more easily overlooked by children, who in some cases are too young even to be aware of the conditions themselves, much less the significance of them.

This is where we, the third-year-medical students, come into play. We're the first personnel in the doctor chain-of-command to speak with the children on the day of the surgical procedure.  Children between the ages of eight and eighteen are arguably more likely to confide in us things they wouldn't tell their parents or other doctors. It's more important than ever than we take complete medical histories both from the parents and from the patients themselves, and that we speak with the patients out of the presence of their parents. We need to be aware of nonverbal cues that may indicate a need to press just a bit harder for information.

If it sounds as though I'm taking the job my counterparts and I do in paediatric outpatient surgery even more seriously than it needs to be taken, such is probably the case.  I don't want to come across as a conspiracy theorist when it comes to underage patients. They're not all hiding drug abuse, sexual abuse, inadvertent illness, or anything else from their parents, surgeons, and anesthesiologists.  There's usually nothing for them to hide.  At the same time, if they were hiding anything,  the third-year medical students, if they were to do their jobs well, would quite possibly have the best chances of uncovering whatever it is that the young patients were attempting to conceal.  

We, as the youngest members in the doctor chain-of-command, potentially (though such is not always the case) have the opportunity to most easily build rapport with young patients. We can often allay their fears and reassure them more effectively than can even those interns just a few years older than most of us, though most of them are more like seven years older than I am.

Any advantage we have in terms of rapport with patients, we more than lose in terms of credibility with parents. For that reason, we deal with patients more than parents in most instances. A notable exception to this might be  if something unexpected were to occur in the O.R., and the lead surgeon or anesthesiologist felt it was in his or her and the patient's best interest  to remove all extraneous personnel from the surgical suite. Were such to happen, a third-year resident would be assigned to sit with the parents in the waiting room and to answer questions and to be a source of support to the parents as best we could, which would probably be not all that well since we just spent the previous hours avoiding the parents because our communication skills with parents were typically somewhat lacking.  this is the sort of thing we hope and pray does not happen. We all want "routine" surgeries to remain as such. We all want the best possible outcome for all patients, but probably in no case is this more true than when the patient is a child or an adolescent.

I apologize for monotonous medical concerns. I will begin my outpatient pediatric surgical rotation in just a few short hours, and I'm more than a little nervous.

pediatric post-operative procedures

Saturday, August 13, 2016

Breakfast of Champions

It was a slow week for me in outpatient surgery, and I'm off for the weekend, which will be the case for the next few weeks. For the next two weeks I'll be in pediatric outpatient surgery -- a sub-rotation I've been eagerly anticipating. I do not wish to pursue rank-and-file pediatrics as a specialty (though I'll probably enjoy the pediatric clerkship/rotation), but I may ultimately choose a pediatric sub specialty. The plan is still at this point to stick with pathology or diagnostic radiology, but plans often change. My dad said I can follow any specialty I want and still work for him as long as I complete either any MD program or a chemistry-, pharmacology-, radiology-,  or pathology-related PhD program. My dad doesn't even care if I complete an internship, which is required in order for an MD to become a licensed physician. Because the internship will be the most intense and demanding year of my education or career (this year is the second-most demanding and intense), I'm tempted to take my dad up on the offer of opting out of the internship, but if I get that far, what's one more year of hard labor? When the time comes, I will question my sanity in regard to doing something I didn't absolutely have to do, but I don't want to skip out on it, then decide later that it's something I really should have done. Chances are that it will be logistically more difficult if I wait until later. If I'm going to do it at all, I need to do it two years from now and get it out of the way.

Because of drops from and a single transfer to the program, the people in this institution who have nothing better to do than to play around with numerical data have recalibrated the average age in our cohort. The mean age of third-year medical school students at this institution, as of July 1, was 26.0 years rounded to the nearest month. With Matthew's and my age having been 21 years, 6 months, and 29 days on the date the statistical average was calculated, we're considerably beneath the mean, median, and mode. This is not always considered a good thing, particularly in terms of gaining matches for internships and residencies.  It is, nevertheless, what it is, and there's not a whole lot we can do about it now.

It's a bit weird being in a life-or-death profession, or even being heavily into the training for such a profession, at a young age. Some people my age aren't even close to having made it through the chug-until-you're-no-longer-conscious phase of their lives. Others are already on the payroll in life-or-death jobs and may have been for quite some time by the time they reach my age. Law enforcement personnel, fire fighters, military personnel, and registered nurses quickly come to mind as such, but there are others. Third-year med school students -- even young ones such as myself --are far from unique in regard to carrying a heavy level of responsibility at often early ages. Still, I wonder if I'm trading part of my youth in return for I'm not sure exactly what gain. The decision has been made, however, so the only logical direction to go is onward.

I'm not saying much about a situation that came up a couple of weeks ago except to say that it has been resolved in such a way that neither I nor anyone else who works here will be subjected to similar treatment -- for that matter, any treatment at all -- from the person who created a bit of havoc in a surgical suite. I'm happy. Other issues incidental to the particular situation at hand arose, but we've reached consensus in dealing with the issues.

I'm not exactly sure why I'm telling anyone what I'm about to share. It was probably brought to the forefront of my mind by the prospect of dealing with obsessive and occasionally hysterical parents for the next two weeks. In any event, I shall relate to you a story my dad loves to tell. I have no memory of the incident; I was only 10 1/2 months old when it happened. I don't think I've told it before, but if I'm turning into one of those middle-aged people who repeats the same stories ad nauseum, please let me know and I'll delete it.

On a warm day in October,  Matt, who would have been close to 10 1/2 months old, was running around the house in just his diaper for a part of the day. My mom went to change his diaper. When she peeled back the tape and pulled Matt's diaper forward, she screamed as though she had seen the Zodiac Killer. It was a Saturday, so my dad was home. He went running into Matthew's room to see what the problem might have been. My dad said my mom was practically hyperventilating as Matt lay on his changing table.

She pointed at Matthew's scrotum. "He has a ringworm on his testicle!" she shrieked. "How could this have happened? And what are we going to do?"

My dad stepped closer to have a better look. He reached out and peeled the "ringworm" off Matthew's scrotum. He held it up for closer inspection, then showed it to my mom. "This 'ringworm,' " he told her, "is a Cheerio." 
(Cheerios were Matthew's finger food of choice at the time.) My dad  flicked the Cheerio into the diaper bin. "I'd glue it into his baby book," my dad added, "but a pee-covered Cheerio might be pretty gross after a few years."

If my mom hadn't been married to a doctor and had not had multiple brothers-in-law and even a few sisters-in-law who were doctors and/or nurse practitioners, the co-pays alone for the needless doctor and hospital visits Matthew and I surely would have endured probably would have forced my parents into bankruptcy court.


Tuesday, August 9, 2016

Judge Alex Sprained His Ankle

This photo of Judge Alex's ankle is from his twitter account; I do not own it.

In some sort of freak boating accident, Judge Alex Ferrer sprained his  ankle. Xrays indicated that no fracture is involved. In unusual cases, an osteochondral injury, which is a particular form of fracture usually to the end of a bone, can go undetected by a standard foot/ankle Xray. An MRI or CT scan (a CT scan is essentially a more detailed xray taken from more angles and may be necessary if healing doesn't occur on schedule or if pain continues to be greater than it should be after a given interval) is sometimes necessary. It is prudent to hold off on such diagnostic measures. CT scans, as do all xrays, expose a body to radiation. MRIs, or magnetic resonance imaging scans, are expensive.

With extensive ligament damage or tearing, sometimes the only reliable diagnostic tool is a surgical procedure, which would usually be accomplished by arthroscopy, where by minimal incisions are made and specialized cameras are inserted. If damage is discovered in such procedures, repairs can often be done using arthroscopic instruments, thereby minimizing trauma to the tissue.

Judge Ferrer has demonstrated an at least greater-than-average pain tolerance. He once chose to have an endoscopy with no sedation so that he could drive himself home following the procedure. While I personally considered his choice silly in that particular case, as surely at least twenty people living in his area would have been more than happy to have driven him home, it was nonetheless evidence that he isn't exactly pigeon-hearted in dealing with pain. He says his ankle hurts when he puts weight on it but not too much otherwise unless anything has changed since I most recently communicated with him.

Please join me in sending prayers and positive thoughts,  communicating good vibes, or doing anything else  that you are willing and able to do  to aid a person in recovery from an injury. Judge Ferrer is a physically active person who is probably going stir-crazy in not being able to carry out his normal fitness routine and in having to back out on previously scheduled jobs. He needs to be at or near physical capacity as soon as possible.

My knowledge of orthopedic injuries is limited to lecture notes and text materials in addition to personal experience from my own fractures and sprains and what has been communicated to me by medical professionals at the times those injuries happened. I have not yet fulfilled an orthopedic rotation, nor am I  -- quite obviously -- an MD, and am  thereby unqualified to dispense any medical advice of this nature. I am, however, at least one half-step ahead of a person who obtains his or her advice from wikipedia or other Internet sources. Furthermore, any reader who wishes to further investigate anything that has been discussed here is most capable of doing so, and if is so inclined,will do so himself or herself.

Friday, August 5, 2016

My Disinclination Toward Bucket Lists, New Year's Resolutions, and the Like. , , , And the Hypocrisy of the Formation of My Own Bucket List

Who would not relish the idea of seeing this in person?

I will initiate this post with a disclaimer that I don't actually believe in bucket lists. "Don't believe in them" might be too mild an expression for my disdain for the very concept. It seems to me that they rank almost as high as New Year's Resolutions in terms of disingenuity. If there's something about oneself that causes one to think one would benefit from eradication or modification any given improvement, make the change. One does not need an arbitrary date of January 1, Superbowl Sunday, Chinese New Year's Day, the Vernal Equinox, or any other date. It's not rocket science. I'm sure I've ranted about this before, so I will shut up about it. 

Bucket lists are borne of a similar vein, compounded by their pretentiousness. If one desires to accomplish something in his or her lifetime, I commend the person for his or her ambition. Desire to broaden one's horizons is a positive force at work in the heart,  mind, and soul of an individual. Requiring some pedantic sort of  list for such endeavors is the only aspect of the concept that I find off-putting. The need for such reeks of pretentiousness and of self-aggrandizement, as in,  "My  goals in life are so numerous and so very lofty yet equally intricate and sophisticated as to require a blueprint etched in stone in order for any mere mortal, even one so accomplished and internally activated as myself,  to have a prayer of attaining said objectives." Such emits vapors of  of self-aggrandizement and pretension -- indeed, the very embodiment of taking oneself too seriously and, in most cases, expecting others to do the same.

With all of that having been said, a time probably should come in the life of a young person -- whether a very specific time in one's relatively-but-not-too-early life, or whether a set of mental conversations taking place over time as one's late youth metamorphoses into bona fide adulthood, in which one articulates plans for his or her life, including but not limited to the arguably more frivolous ventures one wishes to eventually add to his or her repertoire of life experiences.

While there's no inherent harm in one having the pre-described self-conversation at a very early age, it should be noted that the goals one may set at the age of nine, which might include towering and salient ambitions possibly including being slimed at Orlando's Universal studios, meeting Justin Bieber (I would hope not, but one should never underestimate the vapid nature of a nine-year-old's aspirations) and matching Elena's (whoever the hell Elena is) perfect score in Uncharted 4: Thief's Run. Such objectives, absurd  as they may seem to you or to me as one's idealized culminations in life , aren't so out-of-line as they might seem at first glance when considered under the lens of perspective of a pre-adolescent.  As long as a kid in that age-range doesn't list among his aims in life, for the sake of argument,  an inclination to successfully plant and detonate an explosive in a place that will cause maximum carnage, or something similar, I don't harbor particular animosity toward his or her ideas at his or her present level of maturation in regard to what he or she should focus upon accomplishing in his adult life. For that matter, i don't really care in a negative manner what any kid or adult wishes to achieve in the course of his or her lifetime as long as it doesn't involve harm to others or a need, whether overtly planned and expressed as such , or simply through  a thoroughly lackadaisical approach to education,  that would result in his or her inability to support himself or herself once reaching adulthood.  The point here is that a child's goals should in most cases evolve into something more practical as he or she grows in wisdom and maturity.  

Furthermore, where a child is concerned, if the child has conversed with an adult important in his or her life regarding future goals and short-term objectives and optimal actions leading to the attainment of such goals, putting it in writing is probably a beneficial activity. Children are most often visual in dominant modality, and seeing some sort of graphic as to where they are at a given moment in time, how far they may have come since articulating a set of life goals, and how much as well as  specifically what remains to attain their goals might very well be a practical tool in helping them to achieve the goals they have set. It never occurred to my own parents to attempt such a thing, but I'm not presenting my own parents as paragons of excellence whom all other parents should seek to emulate. Beyond that, we're speaking of kids

Adults should not be in need of such bullshit in their lives. I'm not referring to daily or weekly to-do lists, which help many among us to function, some  of whom lead impossibly busy lives,  If making a list is necessary in order to ensure that prescriptions are retrieved from the pharmacy in a timely manner, that everyone involved knows who is responsible for retrieving children from school and/or transporting them to and from activities on a given day, that laundry is picked up, that parent conferences are attended, and that similar chores in relation to adults managing their own activities and lives are not forgotten, such is reality.  I'm not a person who complains of modern-day life and yearns for a return to the norms of the good old days, as living many aspects of daily lives in previous generations would have presented challenges in which many of us might have failed miserably.  For one thing, I wouldn't have cared to have lived before the appendectomy was a routine procedure. In the early eighteen-hundreds, I probably would have succumbed to a ruptured appendix and therefore had my life expire at the ripe old age of sixteen.  Such would have been the case for a great many of us.  Furthermore, I'm a fan of indoor plumbing. Beyond that, while female doctors have been around for quite some time, it wasn't long ago that gender discrimination existed to a large degree both in getting into the medical field and in securing patients once actually licensed  as a physician, while such is no longer the case. I'm not advocating that a return to the "good old days," whatever and whenever that might have been, would solve many of our problems. What I am saying is that life today is fast-paced, and daily or weekly written agendas, whether written in an old-fashioned manner or stored on one's cellphone, may be for many of us the only way to make things work.

Those are lists for the practical matters of what must be managed on a daily or weekly basis, however. I don't refer to lists delineating people's optimal expectations for their lifetimes. I began to delve into an exposition of such here, but the explanation took on a life of it own and overtook the intent of the blog. I saved what was written, and I may or may not share it in the near future.

Returning to the topic of bucket lists, I've given you my reasons why they are self-elevating, extraneous, and wrong on so many levels. Now I will violate my own principles and will proceed to reveal my own bucket list. I've accomplished many of the things I had hoped in my earlier years that I would get through.  I still have much left to achieve, though, and I would hope to have many years left to achieve these things. This list will probably change as early as next week, though the alterations will likely never appear in print here or in any private notation. If they're important enough, I'll remember them. 

Alexis List of Proposed Accomplishments and Experiences

1. I will travel to Australia, New Zealand, and Antarctica.

2. I will travel to places in Europe that I desire to see but haven't. I want to see
all of what the British Isles have to offer -- especially Scotland, though Wales and the Isle of man rank high on my list as well. I want to travel to Catalonia, where my parents spent a semester very early in their marriage. I want to see the Basque regions of Spain and France. I want to visit Austria. I would like to travel to Greece.

3. I will explore Ireland more extensively. I've been there, but I mostly visited relatives and competed in an Irish folk dancing competition in Dublin. There is far more of the country to see than that which I have already seen.

4. I want to have a drink (or two or three) in person with Judge Alex.

5. I want to spend time in person with Rebecca.

6. I would like to meet Knotty, Jaci, Donna, Marianne, Lil Gamble, Tina Ari, Amelia, Jojo, OzDoc, Joe Brown, Russ Carney, and  others I've known through social media.

7. I want to get my hands on someone's Mormon Temple recommend and go through the complete endowment process.

8. I want to be in the D.C. area when someone has displayed the "Surrender Dorothy" graffiti on the overpass directly under the visual of the DC LDS Temple, and I wish to see it before it has been eradicated and to photograph it. While putting the display in place might be fun, I don't feel as though it's something I absolutely must do myself. 

9. I don't wish to die a virgin, although such would certainly be preferable to being raped and killed in that order. I wish for my first full-scale sexual encounter (as well as any and all subsequent encounters) to be consensual. 

10. I want to visit all fifty U.S. states. I've been to thirty-eight.

11. I want to travel to the Isle of Chappaquiddick. I want to see the bridge where it all went down.

12. I want to see Billy Joel in concert.

13. I want to travel to a third-world country with the express intent of offering help. I'd like to devote time and financial resources to whatever it is that is most needed or that my skill set best enables me to do to in order to provide legitimate and needed assistance.

!4. I want to be in love with a person who is also in love with me.

15. I want the experience of  delivering a healthy baby. I don't wish to go into OB-GYN as a specialty, but I want the experience of seeing new life come into the world and of being the practitioner who supervises. I want my hands to be the first ones to touch a human life, even if only once.

16. I would like to have a spiritual experience that gives me a strong feeling beyond just what I learned in catechism that God is more than a figment of anyone's imagination, even if His or Her involvement with us was merely in the creation phase. And if it all really did start with a big bang, I'd like some sort of mental or psychic confirmation of such.

17. I want to own a really expensive and exquisite piano. The expensive  part is extraneous, but the instrument will not be as exquisite as I need for it to be if it is not pricy.

18. I'd like to travel to Cuba if and when the Castro regime or something worse is not in power.

19. I want to witness a tornado at fairly close range. When it gets too close, I'll be happy to take shelter in a cellar.

The existence of list, after having made the preceding comments, is quite possibly hypocrisy very nearly in its purest forms, but I've never claimed not to be a hypocrite.

Thursday, August 4, 2016

A Proposition

I'm not in any position to take on this project at the moment, but I have a very strong desire to get totally wasted and to commit some act of vandalism that is essentially harmless, or at least something that will be inexpensive to repair or clean up and won't cause a lot of hurt feelings. I would like the act of vandalism to be mildly clever or at least somewhat original. There's plenty of time to plan the details, as it may be a hell of a long time before I have any significant vacation time, and I'd really like for this activity to take place somewhere like rural Ohio or Indiana.

Let me know if you're in.

This one I like, but it's already been done.

Tuesday, August 2, 2016

Part 2: My Actual Encounter with Pat Summitt

R.I.P., Coach Summitt

If you read the prequel, you now know how I ended up, instead of at my uncle's tennis camp, at Pat Summitt's basketball camp on the campus of the University of Tennessee in Knoxville. Soon after the plane touched down in Knoxville, the flight attendant charged with handing me off to the responsible party or parties looked around until she located two very young women -- one fair-skinned with braided blonde hair, and the other light African-American with straightened hair -- wearing T-shirts with University of Tennessee Lady Vols logos who looked as though they could be basketball players at the baggage carousel. They seemed impossibly tall. They had been waiting for awhile, as they had dropped off campers leaving the previous session of camp a couple of hours earlier. Neither of them was Pat Summitt, not that such would be surprising to anyone. She had flunkies for such tasks. My uncle didn't transport tennis campers to and from airports or trains stations, either. The flight attendant checked the identification of the assistants, and bid me farewell. The girls who drove me from the airport to campus may have been recent university graduates who did not yet have full-time employment.  I don't think the NCAA allowed its athletes to work for compensation at summer camps or similar venues. Some may have volunteered, though.

I waited until my pink suitcase came into view on the baggage carousel. I had been briefly concerned that the basketball coaches or camp counselors or whoever they were  would think my pink luggage was too frilly, but they didn't seem to give it a second thought. They didn't seem to give my luggage much thought, period. The two of them stood back, leaning against the wall of the baggage room, casually conversing. 

There was some sort of an amateur women's bowlers' convention happening in addition to Ms. Summitt's basketball camp and whatever else might have been taking place in Knoxville that week. The baggage claim area was positively packed, mostly with larger-than-life ladies wearing shirts tackier than you could probably imagine. Were the shirts not so clearly identified as bowling shirts, I would have thought I'd met up with participants from a roller derby competition or perhaps a women's wrestling federation's local tour event. I recall a lady with a shiny  purple shirt that read, "Gutterlicious Bowlin' Babes" on the back, and her apparent first name, Arlene, on the front. Another woman wore a neon pink shirt displaying, on the front, bowling pins colliding with human female breasts, along with "Madge," which, I would assume, was the woman's first name.  On the back, boldly emblazoned, in black letters, was "Strike Out Breast Cancer!" It was a noble if slightly tacky depiction. "The Gutter Girls" were also represented among those waiting at the carousel for their luggage. Another woman's shirt said succinctly "Shut the fuck up and BOWL!" Probably the single most unique  shirt showed a bowling ball making contact with the central portion of  a set of nude human buttocks. Beneath this graphic illustration was the similarly creative caption, 'The Bowlin'oscopies."  Though I had initially staked out my spot along the baggage carousel next to Colma Jean, once I saw her tough and unpleasant expression and noted her "Bowlin'oscopies" shirt, I found another spot not as near the area where the luggage first came into view, but a considerably safer distance from Colma Jean.

As the baggage appeared, my large pink suitcase was among the earlier luggage pieces to come into view, but as I lunged forward to reach for it, I was knocked to the ground by Arlene's's bowling balls as Arlene hoisted her bowling ball carrier off the carousel and right into my chest without so much as a "Pardon me, little girl." I picked myself up from the hard linoleum airport floor and mentally prepared myself for round two of the game of attempting to retrieve my luggage from the carousel when what seemed like every bowler east of the Mississippi who weighed in excess of 180 pounds appeared to be competing against me. The second time I saw my pink suitcase approaching, I found what appeared to be  a safer vantage point from which to grab the large piece of luggage. Just as I reached for it, Madge of the "Strike Out Breast Cancer"  team hip-checked  me (though her hip met me at shoulder-level) out of her way and grabbed my suitcase herself. "How sweet!" I thought. "She's getting my suitcase for me!'

Then Madge took a closer look at my suitcase and cursed. "It ain't mine, dammit! All pink suitcases look alike."

Just as I said, "It's mine. I'll take it, please," Madge threw my suitcase so hard in the direction of the carousel that went all the way across the empty space of the U-formation of the baggage carousel and onto the other side. "Strike!" one of Madge's friends hollered.  I tried chasing it to get to it before it went through the back area again. The miscellaneous passengers were letting me through, but the bowlers weren't budging. The suitcase again disappeared from view.

As the suitcase made its third appearance, my keepers seemed to have decided they were going to be stuck in the airport for a long time if they didn't come to my assistance. I don't know how tall they were -- back then anyone over 5'7" looked practically Amazonian to me -- but their height and possibly (I hate saying this, but there may have been truth to it) the ethnicity of one of them were sufficient that even the lady bowlers allowed them through to grab my suitcase.

The suitcase finally in my possession, we made our way out of the airport. I tried telling the girl carrying that my suitcase that it had wheels, but she was insulted that I would think she would need them. I had to jog to keep up with them on the way to the van. "Could you believe the pink-haired bitch that threw her suitcase?" one said to the other.

"Language," the other girl said as she made a head gesture in my direction. I would liked to have shared with them that my dad regularly said in front of me words that may not even have been in their vocabularies, but I had the impression that they weren't terribly interested in anything I had to say.

When we reached the university van, the girl carrying my suitcase hoisted it into the seat directly behind the driver's and shotgun seats. I climbed into the very back row. 

'Don't you think that's a little rude?" the girl who didn't throw my suitcase into the van, who has assumed the driver's seat, said. 

I thought at first that she was speaking to me. "I'm sorry," I quickly said though I had no idea for what I might be apologizing.

"Not you. Her," she corrected me. She got up from the driver's seat, circled the van, and  removed the suitcase from the middle row of seating. "Move up," she told me as she pulled the suitcase from the middle row of seating. The suitcase was blocking the exit from the back row, but she had told me to move forward. Not sure of what else to do, I climbed over the back of the middle seat, scooted over to the side next to the window, and fastened my seatbelt. Both of the counselors laughed.

"What else was she s'posed to do?" The front passenger said to the driver.  "You told her to move, then blocked the exit with the suitcase."

"I like your style, kid," the driver said to me.

The two counselors or instructors chatted casually, occasionally aiming a question or comment in my direction, to which I mostly offered one-word responses. One of them eventually said, 'How old are you, anyway?"

"Eleven-and-a-half," I answered.

"No shit?" the blonde girl responded.

"Language!" the other girl again reminded her.

"I'm sorry. It's just that you look like you're about seven." (This was a bit of hyperbole. I looked eight easily, and could possibly have passed for nine.)
"The minimum age for campers here is ten."

"I know, " I told her. "I brought copies of  my birth certificate and passport just in case there were any issues."

"That was probably smart," the other one said.

We arrived at the campus dorms, parked, and headed inside. There was no line for registration because I was a day early. I doubt that parents have the luxury of sending kids a day early to many camps, but the price my parents offered for an extra day of babysitting must have been right.The driver stood by as my registration was processed. The lady processing registrations said to her, "You can go now. I'll take it from here."

The girl who drove me said, "I'm gonna carry her suitcase when she gets a room assignment."

The woman behind the counter said, "We let the campers take care of their own luggage."

"Look at her," the driver said to the woman.

Nothing more was said about it. I was given a lanyard that held my ID and room key and a slip of paper listing meal times and the time of the first meeting. Because I was there a day early, a few other girls and I would be essentially on our own for the next day. The woman behind the counter told us where we were allowed to go and what we could do, and pointed out a few older girls -- the few counselors on duty that day --  we needed to check with before leaving the immediate area. Two of the three girls were the ones who picked me up at the airport.

I made it into my dorm room. As I recall, most of the girls would night arrive until about twenty-four hours later, just before or after dinner the night before the basketball portion of the camp would start. I survived the first night with no roommate, and eventually made it to the first official part of camp. We stretched. The leaders did some sort of motivational spirit-type stuff [that I hated at the time and still hate] so that the level of excitement in the gymnasium would be such that we would all practically be speaking in tongues when the important people made their appearances. First the returning Lady Vols team walked in to the screams of the little girls in attendance. Then Pat Summitt herself entered the gymnasium.  It was almost as if either Jesus or Justin Bieber had entered our presence at the first sighting of Ms. Summitt. I tried to find a happy middle ground -- I wanted to appear sufficiently enthusiastic that the leaders wouldn't single me out as a trouble-maker, but, in later times of my life,  I didn't want to have to look back at myself at that moment and cringe with embarrassment.  

Once the hoopla silenced itself and Pat Summitt began to speak, the only sound that could be hear in the gymnasium was Summitt's voice. 'Welcome, future Lady Vols, " she began. You'll be almost as shocked by her next words as was I. "How many of you young ladies made your beds this morning?" she asked.

I tentatively raised my hand.  I only saw a few other hands raised. "Ass-kisser" a girl behind me whispered in my direction. One of Coach Summitt's assistants must have heard the comment as well. She motioned the girl aside. I have no idea what she said to the girl. At that moment I didn' t know if I was grateful to my mom for reminding me to make my bed or mad at her, though I probably would have made the bed regardless just from sheer force of habit.

We heard other words of motivation from Ms. Summitt, most of which I don't even remember. The only thing of substance I do remember hearing from her that morning was something to the effect that not everyone could be the very best basketball player, but that anyone could be the hardest-working.

It soon became very clear to Pat Summitt that I was far more mature and just cooler in general than was any other girl in attendance. Each evening when Ms. Summitt left the facility, sometimes with a few co-coaches,  to down a cold one at her favorite bar, she took me along with her, and didn't even object that I turned down the real thing in favor of root beer. The two of us obviously had so much in common that it was utterly natural that she would treat me less as a camper and more as a peer.

The preceding paragraph is, of course, 100% bullshit.  Pat Summitt was far too professional ever to have treated any camper in such a manner, and even had she done so, it would not have been I that she singled out. I was neither cool nor mature. I was not her peer then, nor would I be her peer now were she still among the living. I'll probably never be quite the person who could rightly have considered herself Pat Summitt's peer.  Such individuals are few and far between.

I should interject at some point that I am not, nor have I ever been, a basketball player. I have the eye-hand-coordination to dribble decently, and I am quick, but even now, I can barely reach the rim of the basket when shooting from the free throw line. As an eleven-year-old, the prognosis was even more grim. I was both fast and quick and could dribble well with both hands, as my dad practiced with me once we knew I would attend basketball camp, and could make reasonably accurate short passes, but I lacked the physical equipment to shoot the ball in any capacity.

I had limited interaction with Ms. Summitt.  I had a great deal of practice at being knocked to the floor during my time at camp. It seemed to me that the best response would be to jump up as quickly as possible. During one of such occurrences, Ms. Summitt was standing nearby. She stepped closer and told me that while in practice, getting up quickly when knocked down was the right thing to do, in an actual game situation, it would be harder to draw a foul if I jumped up too quickly. While I didn't need to pretend to be injured if I wasn't, it might be a good idea to count to five inside my head before getting up, and not to jump up too quickly when I did eventually get up. Another time when I was totally and unnecessarily leveled by a rather aggressive ten-year-old as Coach Summitt happened to be nearby, she picked me up off the floor.

One time for some unexplained reason, during a brief break time between conditioning and drills, when most of the campers had wandered outside because something mildly interesting (possibly related to the football tem, but I'm not really sure) was happening, Ms. Summitt noticed a cluster of musical instruments that had been inexplicably left in the corner of the gym. She picked up a violin with two fingers and held it up by the neck. "I wonder who thought we would need a fiddle. It's not good for much of anything in here." She paused. "That is unless someone here knows how to play " 'Rocky Top.' " 

Already having gotten a drink, I was standing nearby. "I could probably play it,'' I volunteered. 

She handed the violin to me. "Give it a whirl, kid." I walked a few steps to retrieve the bow, which she hadn't picked up when she grabbed the violin.

The violin wasn't all that far out of tune. Someone had probably played it recently, although it's still a mystery as to what any of  the instruments were doing in the corner of the gym. After a few quick twists of the fine tuners, it was playable. I quickly played each string with the bow, then went into a quick rendition of "Rocky Top," which my dad had so painstakingly taught me a couple of weeks before. He hadn't taught me to play it on an instrument, but I can play both piano and violin by ear and could then as well.

"I am impressed," Ms. Summitt complimented me. "I woulda sung along if you hadn't played it so darned high."

"I can play it in a lower key," I offered, and went into "Rocky Top" in the key of G, which was more suitable to Ms. Summitt's vocal range.  She sang enthusiastically and encouraged the few others present to join her. 

"Music Camp is that way," she pointed in the direction to the doors of the gymnasium as she took the violin from me and placed it back in the corner. I walked in the direction she had pointed to me. "Get back over here!" she hollered at me. "Your parents paid to send you to basketball camp. They probably figured you already know enough about music."

Tyler Summitt, Pat Summitt's son, was around quite a lot as I recall. I remember him asking me roughly once each day how old I was. After the first time, it was supposedly some sort of joke to him. I didn't find it especially funny. A  lot of the girls swooned over him. I didn't see in him quite what they saw, but he was a nice enough guy, lame jokes notwithstanding.

We received the vast majority of attention and instruction from the assistants, though Coach Summitt was there most of the time as I recall. On the final day, the campers were allowed to tour the Lady Vols' locker room, and Ms. Summitt and most or maybe all of the Lady Vols were available to chat with campers and to autograph our camp T-shirts or anything else we might have wanted autographed.

I approached Coach Summitt to have her autograph a copy of one of her books that I had brought along for the purpose of having it autographed. "Oh, it's the fiddler," she smiled as I handed my book and T-shirt to her for autographing. She asked me a little about my musicianship --  if I read music, if I had ever practiced "Rocky Top" specifically or was playing it for the first time when I had played it in the gym earlier in the week, how I even knew the song, what other instruments I played; in retrospect, it impresses me now that with the 300 or so girls in attendance and with our limited contact, that she was even able to recall the simple detail that I had been the child who played the violin days earlier. From what I've read, she was known for connecting with people in ways such as that and for remembering seemingly inconsequential details about people that others might forget, which makes the idea that it was Alzheimer's that ultimately took her seem all the more cruel. She then asked me my real name in order to personalized the autographs. After autographing the T-shirt but before autographing the book, she asked me, "Just how serious about basketball are you?"

I was unsure of how I should answer. "You can give me an honest answer," she told me.

"I'm not very serious about it," I admitted apologetically, looking at the floor as I answered.

"Look at me when you're talking to me," she commanded, though gently. "Basketball may not be a very big part of your life, but you came in here every single day and worked harder than almost anyone here. If you decide you really want to be a basketball player, you can keep working, and you'll get better. You're probably not going to be very big, so basketball might not be your best sport. but the important thing is that you know how to work, and you pay attention to everything the coaches tell you. Whatever you end up doing, if you put into it the same level of work and attention to detail that you have this week, you will succeed, Alexis."

I thanked her and collected my autographed belongings.

I left basketball camp as not the very worst player there, but certainly among the weakest. Neither God nor the mysterious workings of DNA apparently were thinking "great basketball player" when my body was designed. Still, basketball camp, as flukish as the circumstances creating my appearance there were and as ill-suited as my body was and still is to the sport, turned out to be far more of a positive than a negative life experience.

My life was not altered dramatically as a result of my five days spent at Pat Summitt's basketball camp, but I came away with a few pieces of wisdom I carry to this day. Know what your strengths are, but don't allow that knowledge to keep you from doing anything you really want to do. Hard work usually helps a person to succeed, whatever the endeavor.  Eye contact is important. And if you get knocked down, get up, but maybe don't get up too quickly.