Saturday, December 30, 2017

Exmormons - My favorite and least favorite posters at Rfm

I've had enough mirth for one day. it's now time to blog inappropriately.The subject of this blog is my least favorite and favorite poster s on the Recovery from Mormonism board. Few enough of them actually read here that i'm not terribly worried about offending anyone.

My very least favorite person ever to post on Rfm was a jerk named MJ. He no longer posts there. He was extremely rude to me the first time I ever posted there. I noticed later that it probably wasn't personal, as almost everything he ever posted was rude to someone. He blasted my Uncle Scott because my uncle had to work when my aunt was sick. MJ said he would NEVER work when someone he loved was sick. I don't know what kind of a job he had, but if you're in a surgical residency or fellowship, which my uncle was, you must work when you're told to work, period. Other people came to my uncle's defense, but MJ continued to be his usual insulting self.

Others of whom I'm not especially fond include Steve Benson. He's a grandson of former LDS prophet, seer, and revelator Ezra Taft Benson. My perception of Mr. Benson is that, just as close relatives of Mormon leaders esteem themselves and are esteemed by other Mormons, Mr. Benson acts as though he expects to be esteemed on the message board because of who his grandfather was. That's precisely the sort of caste system I'm trying to avoid in shunning Mormonism, so i'm not going to be a party to it on the message board. also, his posts are often incredibly long. they might be interesting if they could be condensed to about one-fifth their usual length.  if I knew Mr. Benson better, i might have a totally different perception of him.

Others of whom I'm not terribly fond include pollythinks, who seems not to be terribly bright. If her absence of brilliance is due to senility, I apologize a million times. we're all going to get old and a bit dim someday. If, however, it is garden-variety ignorance not incident to age, I take back any apologies.  also on my unfavorite list is paintingnotloggedin, also known as paintinginthewin. I'll cut and paste one of her typical posts. 
"For those who are't familiar with Max Erhmann's poem (1952) entitled, "Desiderata", it has eight stanzas. An excerpt which has rung in my mind a resounding positive voice admist the mixed messages, catch 22s, neglect and abuse I was growing up through with everyone else in my family, Erhmann extended an invitation to life as member of a bigger family , a universal family, which begat me not a tribal family or a biological family or an adopted family or a ward family or an office family or a school family or a band family
lline 34) You are a child of the universe
(line 35) no less than the trees and the stars
(line 36) you have a right to be here"
because this vision is bigger than one linguistic tribe, one biological tribe, one dogmatic tribe where neither sacred secret handshakes keys nor tribal biological blood unity frequently required for entrance at the door (not to mention no place for phenotypic diversions into nether regions on the family tree no one is acknowledging in the club.) Beyond name stamped on with a registrar's stamp beyond nail polish the color of your nails beyond the Barbie ism the molly Mormon of your humanity or not whines the typer wearing whose Wesco factory second boots stomp on the floor while fingers chipped nail polish still convey their life meaning"

She may be a very nice person to those who know her in real life, but her posts are, to me, random and non sequitur. She avoids capital letters (except to sometimes use them randomly) and punctuation as though use of it might cause an outbreak of the plague.  actually, the same can be said about any or all of my least-favorite posters at Rfm except for MJ. i'm confident that even in real life he's not an especially nice or delightful person.

Posters there whom I really like include Knotheadusc, SCMD, laperla, Cheryl, Summer, Amyjo (a little out there on the woo-woo scale but seems genuinely nice and sincere), Lethbridge Reprobate, Matt, Donna (not around much anymore), Raptor Jesus, Cricket, and L. Tom Petty. With L. Tom Petty, I mostly just like his name. I'm sure I'm forgetting someone.

This picture isn't terribly pertinent. I just liked it.

Wednesday, December 20, 2017

Saturday, December 16, 2017


I am on a three-week-plus-one weekend  hiatus from medical school. I am officially halfway through my fourth and final year. in  technical sense, I am more than halfway through the year, because I have five weeks of unscheduled time in my final two quarters. Part of that time should be devoted to studying for Step 2 of the USMLE, but the studying can be done at my leisure and in my pajamas, or even in bed if that's how and where I choose to study. Furthermore, there's  easily time for a two-week vacation. I've already one all the interviews I need to do for my match list for residency. The time is mine to use as I see fit.

I have an additional four discretionary weeks, with which I have elected to redo my sub-internship because illness and injury rendered my initial attempt at sub-internship  a less-than-realistic look at the life of a pediatric surgeon. I passed the exam easily, and my supervising attending surgeon very likely would have cut me sufficient slack that my ratings would have been fine, but I felt that I would be taking advantage of circumstances to allow the marginal completion to stand as fulfillment of the requirement. (I think I met the minimum number of hours with twenty-five minutes to spare. I'm  unaccustomed to cutting corners quite so close.) I'll have the same supervising attending surgeon, and there will be sufficient time for him to write a letter of recommendation for me at or near the conclusion of the rotation. The letter he will write following my second effort will almost certainly be more effusive than would the one he would have written were I to have requested it following the initial experience. And, in a worst-case scenario, if I were to be stricken with another illness (I'm knocking on the ebony grand piano with one hand as I type with the other even though I'm not all that superstitious), the two endeavors combined would certainly allow me to log an acceptable number of hours in the subspecialty to consider the two combined trials to equal one full and  legitimate sub-internship.

That, however, is more than enough shop talk. I'm on break now.  Let's talk about something more compelling . . . such as novel means by which people have murdered others. I don't mean to be overly morbid, and I'll probably end up scaring myself to the point that I cannot go to sleep. Matthew is out tonight, and there's no guarantee that he will make it back here tonight with or without his date, and were he to make it back with his date, they might be too preoccupied with what they're doing to notice any cries for help that I might send out.  C'est la vie. I shall stick to my announced topic, and if it keeps me awake or gives me bad dreams, I'll deal with it by sleeping as late as I choose to sleep tomorrow.

I just read an article about a man who was convicted of suffocating his girlfriend with  bubble wrap. Why bubble wrap of all things? Did he bring the bubble wrap to their shared apartment with the express intent of suffocating his girlfriend, or did he just happen upon it during one of their frequent conflicts. Authorities had been summoned to their home on four prior occasions; in three of the four calls, the woman was determined to be the aggressor, but in the fourth call,  the deceased accused her eventual killer of trying to choke her.  It seems to have been one of those "can't live with him/her and can't live without him/her" sorts of relationships. We'll never know whether or not she could have lived without him, but she obviously couldn't live with him since he killed her with bubble wrap. I'm inclined to believe it was a heat-of-the-moment scenario. The convicted killer was a physician's assistant. Surely he could have come up with some way of killing her that presented at least a slight challenge for the coroner in determining the cause of death. From what was written in the article I read, it seems that he didn't even bother removing the bubble wrap from her face and disposing of it before calling his place of employment and asking the receptionist to cancel his appointments for that day (which was really quite considerate of him; they never heard from him again) and taking off in her jeep to travel  from their home on Hilton Head Island in South Carolina to Florida. He was arrested nearly six weeks later in Pensacola.

In what I would consider an even more gruesome murder, biochemist Larisa Schuster was convicted of killing her ex-husband Timothy by submerging his body in a barrel of hydrochloric acid.  This case hit a bit close to home. My father was marginally acquainted with both the victim and the killer.  The former couple's divorce was extraordinarily acrimonious, with the major bones of contention being custody of the couple's son and division of property. Schuster's biggest mistake, other than the killing itself, was probably enlisting the aid of an employee in the killing. Once authorities had evidence against the employee, he almost immediately commenced with melodious canary-like warbling.  Schuster took the stand in her own defense, but the jurors didn't find her to be an especially sympathetic witness or defendant.  I have included her picture, which in part solidifies the jury's reason for not finding a great deal of credibility in her denials. Just looking at a picture of the woman gives me a serious case of the willies.

While, for all practical purposes, with plastic surgery being off the table as an option for anyone facing trial for murder, one is essentially either blessed or cursed by the God of DNA in regard to physical appearance, cosmeticians and stylists have been known to work wonders and to create optical illusions with the tools of their trade. (Recall the makeover of Jody Arias, whose trial and makeover happened after your trial. Still, the idea of making the most of a defendant's appearance existed long before Arias' makeover. I'm merely using her as an example for the readers. If a defendant cannot be made to look conventionally pretty, at least present her as someone for whom  a person would  turn one's grocery cart around mid-aisle in order to avoid coming face-to-face with  because she freaking scares the bejeezus out of anyone with the visual acuity to identify nothing smaller than the ginormous E on a Snellen Chart.) You know you're on trial for rendering your husband defenseless with a stun gun, then placing his body in a barrel and pouring enough hydrochloric acid to immerse him for the purpose of dissolving his body, and you're so sadistic that you cannot be bothered with killing the man before letting the hydrochloric acid have its way with him. You're educated, and you understand that juries are swayed by appearances, and this is the most favorable makeover you could manage? Seriously?

In a 1988 case that, as far as I was able to discern, to this day the identification of the killer remains unsolved, the murder weapon was identified. A large loaf of incredibly dense pumpernickel bread, perfectly matching the indentation found on the skull of the late Sir Reginald Hemsley-Doddingdale (no, I'm not making the name up; people in Great Britain actually have such names) was found next to the body of the deceased.  The question of whether the pumpernickel loaf was baked to an extra-firm consistency with the intent of creating a murder weapon or someone actually intended to eat the bread remains unanswered just as is the question of who did the unspeakable deed.  If Brits routinely eat bread that is  hard enough to kill a person who is stuck in the head with it, that might offer at least a partial explanation for the stereotypically unsightly state of dentition of the majority of Brits who are not members of the royal family.

Jerome Henry Brudos, who was later discovered to have severe anger issues related to his mother, killed four women and attempted to kill two others. Brudos had a colossal foot- and stiletto-fetish, and in at least two cases kept a severed foot of his victims in his freezer. He stole and sometimes wore stilletos and women's undergarments. He did a few other things too disturbing for me to share with you. One of his victims he kept hanging from a pulley in his garage for weeks so that he could have sex with the corpse. he was married, and his wife was not allowed to enter their garage without first announcing her presence on an intercom he had set up for that purpose. He typically donned stilettos to masturbate after each killing.  In his prison cell, he kept catalogs of women's shoes, which he claimed were essentially pornography to him. I don't understand why authorities allowed him to keep the catalogs or anything else that gave him sexual pleasure. He had the right to live, in my opinion, but not to be sexually gratified. If the color gray had provided sexual gratification to him, authorities would have had the right to remove every trace of the color gray from his environment.

Just over ten years ago in a small town in Idaho, bras and panties began to disappear from apartment and dormitory laundry facilities. Initially the thefts were sufficiently subtle so as not to create undue alarm. The owners initially thought their undergarments had been misplaced. (For the record, the guy wasn't stealing LDS undergarments that are worn by endowed members of The Church of Jesus Christ of Latter-day Saints; Victoria's Secret was closer to his preferred genre. The bra-and-panty thief eventually grew bolder, and would steal all of the bras and underpants from whatever laundry facility he visited, leaving no doubt in regard to the theft.  Security cameras were set up, and the culprit was identified. The bra-and-panty thief was the fourteen-year-old son of  a couple who were prominent both civically and religiously. His father at the time served as bishop of one of the local LDS wards.

The fourteen-year-old boy was charged with petty theft, to which he pled guilty in exchange for a sentence involving no incarceration. His name was withheld because of his age, though the town was small enough that his identity was soon known to everyone who cared to know who lived in the town. I know of this and of his identity because a relative of one of my relatives was one of the victims of his theft.    In the allocution that was required in exchange for avoiding any time in juvey,  he admitted to sometimes skipping school when he knew his parents would not be home. He would string a rope across his room from which to display the undergarments as he masturbated. His disgraced family soon, with permission from the court,  moved out of state.

In the eyes of the law in most if not all jurisdictions, stealing underwear is no different than stealing anything else; no enhanced sentence is given because it was women's underclothing that the young man happened to steal. The reality of this, on the other hand, is that we're probably talking about one very sick puppy here.  He isn't yet -- at least as far as I know -- anywhere near the classification either of the flying dumbo who used bubble wrap to smother his girlfriend or of any of the other murderers whose cases I have detailed here.  Yet something about this case is more than a bit discomforting. The young man by now is a young adult of roughly twenty-four years of age.  Did anyone follow through with the counseling that was almost certainly a condition of his probation? If so, was the counseling provided by a mental health professional who is certified and highly trained who is highly trained and well-versed in the nuances of sexual deviancy, or did the kid merely talk once every week or two to his Mormon bishop, a volunteer lay leader who doesn't even have the three to six units of course work in pastoral counseling that a mainline Protestant pastor or a Catholic priest would have been required to complete unless by sheer coincidence the Mormon bishop happened to be a mental health professional in his day job?  Did he go on to serve an LDS mission among an unsuspecting population?  The issue could be one of nothing more complicated than a struggle with sexual identity. Perhaps his fondness for undergarments typically worn by females stems from his own desire to wear such undergarments, which, in the culture in which he was raised, would not have been considered an acceptable option. That,  however, would have to be considered a best-case scenario.  The other possibilities are much more alarming. Will his exploits someday be featured  on A & E or on Oxygen network? Only time will tell .  .  .

Friday, December 15, 2017

Everything You Never Wanted to Know About Eye Diseases and Procedures to Repair Them

This week has been far from the most focused week of my education in regard to my training in the specific domain to which I have been assigned. My supervising attending physician has been contracted Type A (H3N2) influenza. He was vaccinated, but we know that none of the vaccines are 100% effective; such is particularly the case with the H3N2 variant, which has mutated to some degree from the deactivated version of the virus in the vaccine.

The attending physician began showing slight symptoms Saturday night, but shrugged them off. By Sunday morning, He was feverish with chills, sore throat, cough, headache, body aches -- all the classic flu symptoms. He did the nasal swab test and found that he had type A H3N2, and immediately began taking Oseltamivir, otherwise known as Tamiflu.  Because he started the antiviral drug so soon after symptoms, he will be able to return to work in order perform his scheduled surgeries today.  Even though I had the flu vaccine, because I had spent a large portion of Friday, when he might already have been contagious even though he wasn't yet displaying symptoms, I began taking Tamiflu.  I will stop this weekend because it's not the end of the world if I come down with the flu during my time off; I just couldn't afford to miss any more work due to illness.

I spent Monday and Tuesday in the emergency room. Wednesday I scrubbed in for the surgeries of  two ophthalmologists who presumably owed favors to my attending ophthalmologist.  I certainly was doing no one any favors by being there, but part of the job for physicians and surgeons at a teaching hospital is teaching, so such doctors have little choice but to tolerate the likes of me. If they hate operating while medical students  stand on tiptoes to look over someone's shoulders, then ask what are probably stupid questions, they find other jobs at non-teaching hospitals, because we're not going away at any time in the foreseeable future.

The ophthalmologist whose work I observed and assisted deals with neuro-ophthalmology, a sub-specialty relating to diseases of the nervous system that affect the eye, typically  involving control of eye movements, vision, and pupillary reflexes.  The surgeries with which I assisted Wednesday were mostly corneal and retinal surgeries. It's all mostly very delicate work, but I don't find the corneal and retinal procedures to be quite so interesting as are the neuro-ophthalmological procedures.

I did get to see a corneal transplant (penetrating keratoplasty) on Wednesday.  I was very lucky to get to view the procedure. The doctor I observed typically only does maybe four of such surgeries a month spread out over ten days of surgery for a given month. Corneal transplants aren't quite like vital organ (or bone marrow) transplants whereby tissue compatibility is a major issue.  With a kidney transplant, for example, tests are run to locate specific antigens in the tissues. Six particular antigens are likely to cause rejection of the organ if they are not well matched. Such is not usually the case with corneas. The cornea isn't naturally a particularly vascular area unless disease has caused new blood vessels to form in the area, which introduces immune cells to an area that normally wouldn't have them.  The corneal transplant procedure is most often successful with compatible blood type between donor and recipient, but further cross-matching has been found to be irrelevant.  If a person has had one failed corneal transplant, his or her odds of tissue rejection are considerably higher for future transplants. The corneal transplant I saw was a first-time procedure for the patient, and all appeared to go well. He will take steroids for several weeks, which reduce the risk of tissue rejection.
Is there anything we don't treat with steroids these days?

My attending physician told me to stay at home and to sleep yesterday. I am finally off steroids and am able to sleep.  I'm not sure why i needed a day off two days before I begin a three-week break, but
I didn't want to look into the mouth of the proverbial gift horse.  It felt almost decadent to sleep so much.

I'm now at the hospital anxiously awaiting the arrival of our first surgical patient of the day.  we have a few eyelid surgeries, a few eye muscle surgeries, one orbital decompression, and one lower lid blepharoplasty. In this procedure, tissue from the roof of the patient's mouth will be harvested and transplanted to the patient's lower eyelids. This is usually a cosmetic procedure, but in this case, thyroid ophthalmopathy has caused the lower lids to partially retract, causing considerable discomfort and lack of eye closure and excessive corneal exposure in addition to the obvious cosmetic issues.

We should be finished with surgeries by mid-afternoon, at which time I will be singing along with the late Rev. Dr. Martin Luther King, "Free at last! Free at last!" Thank God almighty I'm free at last!"
I'll be free for three weeks, anyway.

Monday, December 11, 2017

The Whos of Whoville, Pecking Order, and Office Politics as Opposed to Political Office

The attending physician who supervises me is too ill to work, which is extremely rare around here.  What's wrong with him is no business of mine, and, beyond that,  it's best not to ask a whole lot of  personal questions around here, especially since the person about whom I would be asking is one of two people in the entire practice who speak to me, (with the fellow being the other, and the fellow is attending a forum in Chicago), so inquiring as to the nature of the attending ophthalmologist's illness or, for that matter, about anything else,  would be the rough  equivalent of asking my questions to the potted plant next to the office entryway.  I suppose I could ask Siri.  Siri at least wouldn't give me the death gaze.

The  supervision of med school students around here is a chain-of-command sort of thing.  (To be fair, such is the case in all specialty areas, but nowhere else here is it more evident.) You may have heard the expression "Shit runs downhill."  So does the supervision of medical students and their glorified counterparts, the interns and residents. (I won't clump fellows with residents and interns; fellows have been certified in at least one area and therefore worthy of at least a modicum of respect.) An attending physician or surgeon  is on record as being responsible for a med student's oversight and evaluation. Sometimes the attending physician or surgeon has another doctor, called a fellow, gender of the person notwithstanding,  who is certified in at least one specialty and is working to earn certification in an even more narrow field of medical specialization or is fulfilling a fellowship purely for the purpose of picking up additional experience in the field before practicing independently, or, in some cases, is fulfilling the fellowship solely for bragging rights -- for the rightful  entitlement to claim he or she trained under a particular specialist.  The attending physician can lawfully delegate almost any duty to the fellow. The fellow, if there is one, as second in chain of command, can further delegate his responsibilities concerning oversight of med students or of virtually anything else, down to his or her underlings -- the residents and interns. In the field of ophthalmology, the attending specialist or fellow then passes all duties related to the med school student that he or she can lawfully abdicate onto a resident doctor. If there an intern somewhere in the chain of command, the tasks related to supervising the student are then surrendered one rung lower still to him or her. The attending will  lead grand rounds, at which time he or she will ask salient questions in attempt to catch the med student unprepared and to make the person look and feel foolish, and the attending ophthalmologist will be the official author of any and all comments written in the student's formal evaluation, although sometimes said comments have been known to resemble evaluatory comments written by residents and interns  closely to the extent of  seeming to be almost verbatim from residents' or interns' informal evaluations of the student.  It couldn't be, though, that the attending doctor is too lazy to come up with his own original thoughts in evaluating a medical student. It would seem far more likely, I'm sure you would be the first to agree, that it's a simple matter of great minds functioning  in a correlative or consubstantial manner.  Totally. How could anything else be the case?  The bottom line here is that the attending ophthalmologist is still the primary @$$ that seems to require almost constant kissing, but  positing oneself into sufficiently close proximity to the designated @$$ to be kissed is gained by smooching the @$$es of  the underlings who stand between the med student and the God of Ophthalmology, whomever that God might be for a particular med student. The Religion of Medicine is both polytheistic and relative. (Again, it's essentially true of all specialties, but nowhere is it more true than in the specialty of ophthalmology.)

The situation here with regard to this specialty is, then, unique. My particular attending physician has no interns, residents, nor other medical students at this time to supervise. He is here for one academic year only, on loan from another institute of higher learning.  His contract dictates that he is responsible for no interns or residents but will (and does) oversee one fellow, whom he selected from a field of several hundred applicants. I'm not sufficiently knowledgeable in the game of  "Who's Who in the World of Ophthalmology" as produced by Parker Brothers, Milton Bradley,  or whomever else markets board games today, but my attending ophthalmologist would at least seem to be one of the more prominent Whos in Whoville, ranking somewhere between Little Cindy Lou Who and The Mayor.   Yet, paradoxically, he chooses to have as his underlings  one fellow, zero residents, zero interns, and one medical student  every second rotation.  I drew either the long or short straw, depending upon how one views it.

There's no one for me to hide behind in this rotation.  It's just the attending ophthalmologist, the fellow, and moi.  I either know an answer or I don't. Most of the time I do actually have the correct answer, but not always.  At those times when I don't, know, there's an awkward silence as the attending and the fellow look at each other, then back at me. . . except for yesterday, when the fellow admitted, "I don't know the answer to that, either. " The attending ophthalmologist and the fellow broke into loud laughter.  I stared at them unresponsively until the attending said, "You have my permission to laugh, Alexis."  I then laughed along with them.  While it might seem inconsequential to someone who has never played this game, even something so seemingly trivial as laughing along with real doctors, who may very well be laughing at me (as opposed to laughing with me; there's a huge distinction between the two) isn't to be taken for granted.  The topic is addressed even in  The Holy Bible, in the third chapter of The Book of Ecclesiastes. There is a time for everything, and if you want to survive in the world of medicine, you best learn when to laugh along with your superiors at a joke or, conversely, when to suck it up, put on your best poker face, and know that you are the joke.

In any event, both doctors supervising me are away at least for the day. The attending physician appears to be aware that the other doctors in the practice and their staffs are not overwhelmingly fond of me for reasons I have yet to deduce. They're not overwhelming fond of my attending physician or of his fellow, either.  Such should not be a source of consolation to me; I should be a bigger person and should want my attending physician and his fellow (who in this case is not a fellow if one uses gender on which to base the determination) to be liked by those with whom they work. It is, however, a major source of consolation to me. It helps me to feel a whole lot better to know that while, yes, they certainly hate me,  it is not just I whom they hate. And truthfully, I don't think my attending physician gives an opossum's anal orifice whether or not the other doctors in the practice and their wives,  daughters, sisters-in-law, daughters of former missionary companions, and the rest of the motley crew that make up the staff of this practice have any .regard for him. (It does bother the fellow a bit, though; she never says anything about it, or at least not to me, but I can see it in her eyes.)
He just comes in each morning with his coffee (which he needs to pick up from the hospital before coming to the office because God knows there will be no coffee brewing or percolating or whatever it is coffee does to cook itself in the office), greets them all  warmly as though, he, too,  had been one of their missionary companions. (The ophthalmologists in this practice honest-to-goodness became acquainted when they all served in the same mission at the same time.)

My concerns about my supervising practitioner are three-fold.  Numero Uno: I am genuinely concerned about the the man's state of health. He's a kind and decent person who has treated me almost as a colleague from the moment he first was chosen to oversee me.  Numero Dos: If what he has is contagious and is transmitted through airborne means, I've been exposed. I spent most of yesterday in close contact with him. (To any DIRTY-MINDED PEOPLE: my concern for contagion extends only to those illnesses transmitted via shared air and space. I was not boinking or even kissing the guy. He's gay.)  Numero Tres:  If he doesn't get back quickly,  or the fellow doesn't return in a timely fashion, I'll eventually have to be supervised by one of the practice's  blockhead MDs, which would be everyone there holding a medical doctorate other than my attending ophthalmologist and the girl who is his fellow, who is not to be confused with the guy who is his husband (and who is extremely hot, by the way; multiple framed pictures can be found on the walls of his office; if my husband looked like that, I, too,  would plaster his image on every available surface).

The ailing attending ophthalmologist texted me to say that for today I should just hang out in the E.R. and help where I'm needed. He told me which ER physician to whom I technically report today, because if I'm on the job, someone is responsible for my supervision, but that the physician-in-charge would not bother me if I did not bother her.  So far I've stitched boo boos of children and adults, removed a broken Skittle from deep within a child's nasal cavity, held a child while an orthopedist straightened a green stick fracture of  the child's radius and ulna (the two bones of the forearm), assisted in the neurological evaluation of a patient who slipped and hit her head on the concrete sidewalk t her school,  cleansed a wound from a dog bite, and sent a patient off for a CT scan of the abdomen in a case of suspected appendicitis that turned out to be appendicitis, and listened to the complaints of  three urinary calculi sufferers and one likely drug seeker claiming kidney stone pain. I'm pretty sure that dealing with drug seekers will be the aspect of this job that I will hate the most.  I cannot feel someone else's pain. just because a person's symptoms that don't seem to be 100% legitimate to me doesn't mean that the pain isn't real.  On the other hand, if word gets out that a gullible ER doctor will write a prescription for opiates to anyone who can say, spell, or pantomime  hydrocodone,, this ER will become the Haight-Ashbury of the new millennium.  Fortunately for me, I don't yet get to decide which patient gets the good drugs and which patient is handed a piece of paper bearing what the patient considers to be the most offensive expletive in the English language: Ibuprofen.

I do not own this video. To whomever is the rightful owner I express my appreciation for allowing me to have it on my blog for however long you allow it to remain here.

In acknowledgment of the season upon us, I offer a picture of  Little Cindy Lou Who.

Wednesday, December 6, 2017

These dreams go on when I close my eyes. Every second of the [day] I live another life.

This is probably my next dream just waiting to happen.

My schedule has been unconventional lately.  The attending physician -- a very compassionate man, by the way  -- who is supervising me doesn't want to put undue strain on my still-recovering eyes, so he's trying to match my work schedule with my natural waking cycle, which is incredibly kind of him. It probably helps that I'm in an ophthalmology rotation; an ophthalmologist might be expected to be more concerned with recovery from an ophthalmological condition than might, say for the sake of argument, a gastroenterologist.

The steroids I've had to take have wreaked havoc with my ability to sleep. Initially I would be awake for sixty hours or so straight, and then crash for four or five hours, then repeat the cycle.  Each week I decrease my daily dosage of steroids by ten milligrams. This has improved the quality of sleep slightly, but only slightly. What now happens to me is that I am awake all night. I was reporting for work in the morning, then either turning into a virtual zombie or literally falling asleep standing up by around 2:30 p.m.  It would be ideal for me to simply work a full med student's night shift, which would be from around 8:00 or 9:00 p.m. until somewhere around noon the following day.  Ophthalmologists, however, don't work night shifts. They became ophthalmologists, for the most part,  so that they would not have to work night shifts. I would be working largely unsupervised by those charged with teaching me what I need to know about the field of ophthalmology.  This would , of course, be counter-productive to my medical education.

We've reached a compromise. I report to the hospital at 2:15 a.m. I check on admitted patients who have undergone eye surgeries or are suffering from eye conditions, and I make my own assessments of any patients in the emergency room suffering from eye symptoms.  As a non-MD, there's really nothing I can do for any of these people. I'm there primarily to annoy them. (If anyone is in grave discomfort, a non-specialist MD on staff can at least prescribe pain medications for the patients I've evaluated. I make my recommendations to them.) Meanwhile, I write my own reports as to my findings concerning their conditions or progress. At around 7:00 or 7:30, the attending ophthalmologist directly supervising me makes an uncharacteristically early appearance at the hospital to check my reports and to check on patients himself. By 9:00, we make it to the office.

The lead RN/office manager glares at me for the next three hours, until she goes to lunch, except when I am in exam rooms administering preliminary exams to patients and sitting in on actual physician exams. I man the phones during the lunch break, giving the paid answering service a pointless reprieve from taking the calls from our office. There's little I'm authorized to tell a patient that the anonymous receptionist from central casting could not tell him or her.  It's essentially "Dial 9-1-1," "Go to the ER immediately. Have someone else drive you there. Do NOT drive yourself!,"  "We'll see you later today. I don't have the authority to give you an appointment time; you will need to wait until our actual receptionist returns at 1:15 and returns your call," or "You should be seen tomorrow or in the next few days" and ditto about not having the authority to schedule an appointment, or "You need to speak to a nurse. I will have one return your call ASAP."  "You're fucking crazy" should be one of the optional responses as well, but it's not on the approved list of comments I'm authorized to make to patients.

Then at 1:15 the full crew returns minus the attending physicians and fellow. Doors are unlocked. The intern and resident begin seeing patients. The lead RN/office manager resumes her glare at me. At 1:30 the fellow returns and begins to see patients.  At 1:45, the attending physicians return unless they are performing surgery at the hospital, which they do on a rotating basis.  My supervising physician's surgery day is Friday, so on Fridays I remain at the hospital with him until he has completed his surgeries or until my waking hours have expired, whichever happens first.

At 2:20, I am kicked out of whatever building in which I happen to be. I rush home so that I will still be awake while driving myself there. I jump into the shower to rid myself of the filth of  germy patients, trying hard not to fall asleep in the shower. I have fallen asleep in the shower, which is one reason I shower instead of bathe. It's more difficult to drown in a shower than in a bathtub even partially filled with water. I do not wish to suffer the fate either of the late Whitney Houston or of her daughter,  the late Bobbi Kristina.

I quickly comb though my tangles, throw on pjs, and crawl into bed and almost immediately fall into REM sleep. It's supposed to take more time to reach that phase of sleep than it is currently taking me, but I'm in dreamland within minutes of my wet head hitting the pillow. I wake up roughly three hours later in the middle of whatever dream I'm having that is so amazingly vivid and real to me that I have a hard time convincing myself it isn't real.  Yesterday I dreamed that there was a sandstorm of Desert Storm proportions going on outside that was so severe that no one was allowed to go outside for any reason. I honestly believed I didn't need to go to work tonight until Matthew came home and told me there was no sandstorm. Another afternoon I had some bizarre dream I cannot exactly remember except that someone in it had painted spots all over Ashley Madison, our cat, and that she now had a job at the hospital and had to be taken to work by six p.m. Matthew made noise that woke me up when he got home. I came out of my room and told him that Ashley Madison was late for work, and asked if he was going to drive her thee or if I needed to do so. He looked at me as though I was crazier than the late Charlie Manson on one of Charlie's not particularly lucid days. Another day I had a dream that I found a cockroach infestation in our pantry. I woke up and called our contracted pest control company, which answers calls after hours, to report the infestation and to schedule an emergency spray job. Roughly an hour later I realized there was no cockroach infestation. I had to call the pest control company back and say, "Never mind"  like I was Rosanne Rosannadanna or whoever it was that always went off on faulty tangents on SNL, then, once she figured out she was barking up the wrong tree once again, just said, "Never mind," as though that excused everything. I didn't even bother explaining about my dream. The receptionist wouldn't have believed it. She would just have thought I was a lunatic. Instead, I apologized and totally lied, saying my younger cousin was visiting and had made a prank phone call to her.

These steroids are killing what's left of my sanity. I just have another two weeks of them, though. By then, I'll be on winter break. At least my sleep during winter break shouldn't be disrupted, either in duration or by the deranged dreams I've been having.

My dad's solution to this problem is that once I wake up, he says I need to either go to the loft area upstairs or very carefully walk downstairs and sit in a recliner  and do nothing except turn on the TV. He said not even to flip through the channels with the remote because I might have had a dream that I was supposed to order one hundred pay-per-view movies or buy something like ten- thousand dollars' worth of Marie Osmond's dolls on one of those home shopping network channels. He said I should sit in the chair, vegetate, and look at whatever happens to be on the screen until reality hits me and I realize that whatever I experienced in my most recent dream was just a dream. He said not to leave the condo unless I actually see flames or smell smoke really strongly. He said not to dial 9-1-1 unless I actually see with my own eyes, once I am up and sitting in the recliner, someone I don't know know burst into our house through a door or window. He said not to call anyone other than my mom or him until I've been awake for at least an hour. He told me, above all, not to call or text Judge Alex or, for that matter,  any judge or MD, because they probably have the connections to have me locked away for a mandatory seventy-two-hour evaluation, which at this point I would almost certainly fail.

The terrible thing here is that I can't think of a better solution. There is no joy in Mudville when I am forced to rely on the advice of as big a wack job as my father because I can't come up with anything better on my own.

I do not own this blast-from-the-past video. To whomever owns it, thanks for allowing it to remain here for however long you allow it to remain here.

-sent from work because I didn't have the heart to wake a sleeping post-surgery patient for no good reason at 2:15 a.m.

Sunday, December 3, 2017


                      23 -- the baby version of an adult

That's right; I have reached the age of twenty-three, which in and of itself grants a person no privilege of which I'm aware, but does get a person closer to such milestones as the right to serve as a U.S. representative, a U.S. senator, and even as POTUS. I'm still twelve years away from that last one, however. Furthermore, have I no intention whatsoever of seeking any of these posts. If nominated I will not accept, and if elected, I will not serve.  I doubt there's much a chance of that happening, anyway. I won't even serve as Surgeon General for the same reason Dr. Sanjay Gupta has said he would not accept the position: paradoxically, the U.S. Surgeon General does not perform surgery. I want to perform surgery.

My brother and I made a bit of music tonight in the city, and won a tidy little wad of cash to split evenly as a result. Matthew shared his birthday cash from dear, sweet Grandmere with me. If she hears about it, it's probably the last check he''ll get from her. Or maybe not. Time alone will tell. My relatives are so freaking weird.

My dad Fedexed a new viola bow to me. I had been using the one that originally came with the instrument, but it sucked. The new one is sublime. My parents deposited cash into both my brother's and my bank accounts. In general, we need money far more than we need stuff. A couple of years ago they could give us all the medical paraphernalia we would need, but we now have it and just need money for upcoming expenses, especially those associated with moving to wherever our internships and residencies may be. Internships and residencies pay, but barely a living wage for a single person. Fortunately we're both still single and have no dependents to support with what will be meager earnings.

I just read two blurbs: one about what sucks about being twenty-three, and the other about the advantages associated with the age. The downside is, for the most part, at twenty-three you need to stop acting like a kid but you're still essentially the baby version of an adult and people look at you a halfwit. On the positive side, you're not judged so harshly for your cluelessness as you will be in the future, because society and people like Judge Judy still view you as an idiot.  Furthermore, nothing you do at the age of twenty-three matters unless you want it to, as long as you don't kill or maim anyone, which is far from a given if you plan to begin your medical internship at the age of twenty-three. Sometimes a person cannot win.

I don't think you can win, period,  in being twenty-three,  except to the extent that you still qualify for your parents' medical insurance if you need it, which I don't. I'm covered independently.

                     the iconic April Ludgate turning 23

I don't often promote artists here except for Phillip Phillips, but I received my copies of  Cherie Call's Christmas CD Gifts, and it is beautiful. A few of my lucky friends will receive copies courtesy of me. Even if you're not LDS, you may find, upon hearing her music (particularly the non-Christmas songs in my opinion) that she's one of the greatest ever to have used song to tell stories.. 

Friday, December 1, 2017

Worse than Gumby and Pokey Having Sex with Davey and Goliath: KEY LARGO: Arguably the Worst Movie Ever Made

Imagine these four in any configuration of your choosing. It's still less traumatizing than being forced to watch Key Largo in its entirety.

I had to spend time with a patient during the day and into the night yesterday. He used the one of the hospital's luxury features to request a particular movie. In this case it was a particularly bad movie.Thank goodness my work week is complete and I even have a long weekend as a result of having put in excess hours. I need the extra hours to recover from the trauma of having been forced to sit through the movie Key Largo. If you thought the song was bad -- the one sung by Jim Jones look-alike Bertie Higgins about having it all just like Bogie and Bacall --  don't even attempt to
 watch the movie.

It's an asinine plot. It starts with a character played by Bogey going to a hotel in Key Largo in the post-winter off-season to visit the widow (Nora)  and father (Temple) of a former military comrade who didn't make it through the war alive.  The character played by Bacall almost immediately develops the hots for Bogey's character despite being a relatively recent widow.

It also involves a a motley crew of fishermen and fisherwomen who are actually just criminals. They, too, are hiding out at the resort on Key Largo, with a boat waiting for them,  in the post-winter off-season when a hurricane unseasonably strikes. A sheriff  and his deputy show up show up looking for a couple of Osceola Indians on some minor and probably trumped up charges.

A group of Osceola Indians, including the two for whom the sheriff and his deputy are looking,  show up to take refuge from the immediate post-winter hurricane at the resort, where they usually take refuge under such circumstances. The posing fisherpeople take everyone else hostage and won't let the Osceola Indians inside.

The deputy comes back and gets himself killed by Curly and boated into distant waters, then thrown in the Caribbean by the worst of the bad guys -- Curly, I think.

Curly is desperate for entertainment and forces one of the female fisherpeople guests, who may or may not be one of the criminals, Gaye Dawn, who also happens to be an alcoholic,  to sing some gawdawful song called "Moanin' Low"  a capella in exchange for a drink.  The actress portraying her is not a singer and assumes she'll just lip sync to an actual singer's voice, but the director forces her (at gunpoint? I wouldn't be surprised) to sing the song without even first rehearsing it. She sings it so horribly that Curly refuses to give her the drink. The Bogey character ignores Curly and gives Gaye Dawn her drink anyway.

The sheriff comes back. Curly or somebody forces Temple to lie to the sheriff about the deputy's whereabouts. Then the sheriff finds his deputy dead in the water. The hurricane brought his body close enough to shore to be found. Curly  tells the sheriff the Osceola Indians killed the deputy. The sheriff inexplicably believes him, and plays judge, jury, and executioner, shooting and killing the Osceola Indians. The sheriff leaves with the deputy's body.

Another contingent of the criminal element arrives from Cuba with a large sum of counterfeit money. Curly and his henchmen must escape but for some reason cannot take their original boat, so instead take one owned by the hotel, forcing the Bogey character to pilot the boat for them because he has boating experience. Curly inexplicably pays temple for the criminals' stay at the hotel. probably using the counterfeit money.

Frank throws one bad guy (Ralph?) overboard, shoots another, then Curly comes up from the lower deck and gets killed in gunfire. Anyone else who is bad is killed, I think. Part of the criminal gang was elsewhere, but the Coast Guard captured them.

Gaye Dawn tells the sheriff he was duped into killing the Osceola Indians Nora and f/rank forget all about Nora's late husband and Frank's former comrade and hook up. I don't know what happened to Temple, and I care even less than I know.

According to Bertie Higgins, they had it all, so why the hell did they agree to make that horse shit movie?

I would rather be forced to watch Davey and Goliath have an identical Claymation-simulated  gun shoot-out with Gumby and Pokey (or Claymation-simulated human-on-animal sex, for that matter) ten thousand times  than be forced to watch even a thirty-second clip of this movie again. It is going to give me nightmares, not because it was scary but because it was the most deplorable attempt at a movie that I could ever imagine. If I ever see that patient's name on a docket again,, I am calling in sick even if I have to hit my other foot with the bulky part of someone's computer charger and break it (either the foot or the charger or both) to get out of watching any more movies the patient chooses.

   I've said it already, but I'm sure Jim Jones and Bertie Higgins were twins separated at birth.

And just because the song will run continuously through my head all night,  wouldn't you love to have it run through yours as well?