Some Things I REALLY Do Not Like

If it appears docile to you, you are easily deceived.

There are things in this world I do not like.  The list is far too long to share in its entirety in this forum, but I will highlight at least a few of the very banes of my existences. I shall not refer to my list of dislikes as pet peeves, as first of all, I dislike the term, and secondly, I don't think the term fits what I'm talking about here. Pet peeves are little things that get under your skin and annoy you. Sometimes they annoy you for very good reason, yet still are sufficiently trivial that a genuinely rational person would not allow himself or herself to become worked up about them. 

An example of this sort of pet peeve would be my Aunt Celine's Number One Pet Peeve of all time, which is sentences that end in prepositions. Just how hard and fast a rule the "don't end sentences in prepositions" directive is or ever was is very much in debate, anyway. Beyond that, unless one is an English teacher, who gives a flying rat's a-hole? Aunt Celine's youngest child has a case of diaper rash that, upon a casual glance, more closely resembles shingles or jungle rot, fire engines are  at least once every six months dispatched to Aunt Celine's address because she's left the house for lengthy intervals with vile concoctions baking in her oven  that were, if the truth were to be known, probably unfit for human or canine consumption even if cooked at the proper temperature, and her eldest child is being formally adopted by other members of the family because she has refused to speak to him because he returned from his LDS mission eight months early due to an intestinal condition that cost him several feet of his large intestine and almost cost him his life, yet Celine is bothered that the next door neighbor's child said to her, "You can't come inside our house. My parents said that when they're not home, no one except the family is allowed inside."  

Another example of a pet peeve would be that of a person who has a particular problem with something along the lines of  a woman (or man; I don't wish to be sexist or to assume anything here that I shouldn't)  applying lipstick or other cosmetics in places where Miss Manners or others of her ilk would say cosmetics should not be applied. Perhaps it is true that it's a breach of etiquette to touch up one's lipstick in church. (Then again, perhaps it is not. I don't actually know because I don't care.) But for the sake of argument, let us agree that lipstick should not be applied or reapplied in church.  If a person goes against that rule, precisely who is being harmed by the practice?  The person who applied his her her lipstick? If so, he or she interfered with the quality of his or her own worship; it would seem that the matter would be between himself or herself and God.  If the depth of another congregant's worship were so transient that the mere view of a person applying lipstick inside the sanctuary of a church  caused the viewer to lose his or her spirit of reverence or otherwise lose his or her connection with the deity, it would seem that the person's connection with the Father. Son, and Holy Ghost, or whichever members of the standard Godhead that  one professes to sanctify would have to be classified as tenuous at best.  While most of us would agree that, while in a public place, pulling one's full Mary Kay cosmetics tray from one's handbag and going through one's complete beautification routine, from exfoliating to clarifying to concealing to all the other steps the Patron Saint of Cosmetics has deemed to be essential, might be considered a slight faux pas as well as a mild act of eccentricity. Still, unless it happened to be disrupting a presentation or process (I cannot imagine it being allowed in a courtroom, for example) or otherwise taking attention away from a person who held the floor, few of us would care very much about it  beyond mentally questioning the level of  civility or refinement of a person who would engage in such behavior.

My list is of something entirely different than pet peeves. I could fill a book longer than the Book of Alma (the longest book in the Book of Mormon, for those of you who are lucky enough not to know that) with things that I very strongly dislike in terms of foods, but in the interest of making a somewhat uninteresting post even less interesting, I'll limit myself to two item related to food. If the list ends up including more than two items related to food, I'll come back and edit this part of the post to reflect that number, and no one will ever be any the wiser. How I would have hated being a blogger back in the dark ages of typewriters.

I very strongly dislike mountain lions. Call them cougars. Call them pumas, Call them house pets. Whatever they are, I don't like the things. I shall go so far as to commit blasphemy by suggesting that gd screwed up when he created mountain lions. I understand the life cycle and the balance of nature and that if there were no mountain lions, there would be too much of something else that would possibly be even less desirable than mountain lions. I think God should ponder the issue very seriously. I think He could come up with something other than one of the two creatures that prevents me from even spending a night in the outdoors again as long as I live.  The other creature keeping me out of the wilderness at night is the bear -- mainly grizzy, but black bears [who aren't necessarily black; that's just their name] are scary to me. yet for some probably irrationally reason, I'm not so grossed out by bears as by mountain lions. I wouldn't care to come face to face wit either of them, but if one were allowed to remain on the planet while the other were to be sent elsewhere, i'd keep the bears and send the mountain lions away. Far away.  I don't like wolves or coyotes, either, but we just don't see quite so many of them around here, so they're less of a vexation to me. If they start appearing more frequently in my neck of the woods, they, too, could end up on my list.


I do not like those pencils into which you insert the lead -- I think they're known as mechanical pencils.I cannot be convinced that they're in any way superior to  standard pencils. I don't want to use them.  Where they're concerned, I'm capable of minding my own business . . . to a  point. I've spent a few of my days off working as a substitute teacher. As a teacher, I despise those mechanical pencils with a passion that most people reserve for serial killers and people who drive with blood alcohol level in excess of three times the legal limit.  Students of all ages who have mechanical pencils spend so much time messing with them -- partly because the devices malfunction on a regular basis but partly just because they're there to mess with  -- that they almost never get any work done, and often those students messing with the mechanical pencils manage to distract other students from matters upon which they should be focused, although what could cause  a mechanical pencil to be exciting enough to distract a person from anything is, to me, one of life's great mysteries. Simple things for simple minds, I suppose. hen I subbed, I gave one warning to the class about mechanical pencils. After that, if I caught any kid using one for anything other than writing, i took it away until the tnd of class and gave him a boring yellow  #2 pencil to use in its place.

I do not like my food to touch. My mother has an issue with this one. She'll make some smartass remark like "the flour and the eggs are touching in that cookie you're eating. How can you eat it? You don't like your food to touch!"

Or my grandmother will make her favorite response to my quirk, which is, "It all mixes together in your stomach, anyway."  Once when she said that, my Uncle Michael, who has a stomach of steel, mixed all of his food together on his plate -- just stirred it up as though his fork was a makeshift Cuisinart -- then proceeded to eat every bit of it, making my grandmother gag.  

"What's wrong, Mom?" he asked her. "It all mixes together in your stomach, anyway." My grandmother never again complained to me about my not wanting my food to touch.

I'm not an absolute nutcase about it. My maple syrup can touch my pancakes. A salad can have lettuce and cucumbers and whatever -- as long as it's not anything too weird -- and I'll eat it.  But if I have spaghetti on my plate, I don't want my bread touching my spaghetti. Actually, I don't want my bread touching anything. My taco can have meat in it, meaning the tortilla and the meat can touch. I may occasionally even allow a bit of cheese in my taco. I don't however, want my lettuce in it. I'll eat the lettuce separately. Most casseroles are massive instances of food touching each other, which means mostly I do not eat them. If i'm at someone else's house for a meal, and the food touches each other,  I play with my food and make it look as though I'm eating in order to avoid offending my host.

I do not like TV commercials about sensitive subjects.  My mom said it was really embarrassing when feminine hygiene products first began to air commercials on TV. A girl might be watching TV with a date when all the sudden, along came a commercial about panty shields with wings that fly would right up a girl's legs and protect her underwear.  It was probably almost as embarrassing for the boys as it was for the girls. One time following such  commercial, my mom's date actually asked her what was the difference between a pad and a tampon. Now she would probably grab a note pad and draw a diagram for the guy, but she was more reticent when she was seventeen.  My grandfather wondered through the living room at the time; he told the kid to ask his mother if he was really that curious. And now all those sexual enhancement drugs must have their moments of air time. I like the parts about if a guy has an erection lasting more than four hours, he should seek medical attention.  I always though it was one of those disclaimer put on the box and in the commercials just because it's theoretically possible,  sort of like the disclaimer on the box of one of the old desktop model computers my parents bought. It said the computer should not be used in a shower stall when the water was running. Some idiot somewhere must have done that once, and then tried to sue because the instructions never specified NOT to use the computer while taking a shower. I assumed the Viagra or cialis or whatever enhancement drug it was put that disclaimer there just in case someone really did have a four-hour erection, though they knew it would never happen. Guess what? It did happen. I can share this because I saw it as a patient in an ER waiting room recently and not as a physician -in-training, which means I'm not violating any laws of confidentiality. I don't know the guy's name and didn't pull out my cell phone and snap a picture, so it would be difficult for me to commit any major HIPAA violations here. Anyway, from the looks of things, this guy must have been one of he ones with an erection lasting for more than four hours. It's for real, folks! The poor guy appeared to be in absolute agony.  Even though I really needed to be seen pronto, I asked the nurse at the desk to take him first, PLEASE. I couldn't stand to watch it in progress any longer.

There are more things I REALLY do not like, but I must go to work. Some poor soul's sternum is waiting to be sawed open, and I need to be there to catch every detail of the action.

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.

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

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?

Mini Post-Script to the Prior Post

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.

Picky Eaters, Manners, and Social Settings

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. 

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.

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

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.

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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.

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.

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.