The Spitting Blogage

All this hooing and hawing from the White House sure sounds like the desperate gasps of someone in fear. If the House goes the way of the Donkey that will give the Dems 2 years to impeach. Ya think Bush is scared because he knows just how easy a case it will be to make?

I learned today that a long-time friend from highschool has come into some money. His father hit the jackpot in the California SuperLotto and has received the second largest payout  ever by the California Lottery. 110 MILLION dollars. Yes:

$110,000,000.00

Of course, that's pre-taxes and other unspecified expenses, but still an assload of cash. They opted to receive a one-time payment and the check came in the mail recently. I don't really know what else to say. I'm still kind of in shock myself. But I'm pretty sure he should pay for dinner next time.

On Thursday afternoon, while on my internal medicine outpatient rotation, I interviewed a patient who, like all older men, had an enlarged prostate. My preceptor decided it was a good opportunity for me to practice the rectal exam. I had only performed the rectal once before in one of our training sessions and that was many months ago. But it only took that one experience to show me how unpleasant it is.

In any case, I asked the patient to lower his pants and lay on the table in a fetal position. I put my gloves on and the doctor put some lube on a tissue for me. After greasing up my index finger I prepared for the moment of truth. I said to myself, "Just do it quickly and get it over with." I moved to the end of the table. I spread the cheeks to get a view of the sphincter. And just as I was about to plunge... the man's cellphone rang. It was one of those really loud, obnoxious rings too with some song I didn't recognize. He reached down to the pants around his ankles and pulled out the phone. I thought he would just turn it off and we could continue. But did he do that? No. Instead, he answered the phone and started talking. At this point I couldn't help it. I just started laughing. What should I do? Should I wait for him to finish? The doctor didn't think so. He gave me a little wave to signal I should go forward with the exam.

And so I did. I will probably never have another experience quite like it. Index finger in the anus of a stranger. Probing his apple-sized prostate. Checking for masses. Performing a stool occult blood test. And all the while, him speaking on the phone, totally unphased. As if nothing at all were going on. Now that is medicine.

Did you know that caffeine actually dampens your desire to kill people?

According to this study published in the European Journal of Social Psychology that's what they found when they took a bunch of liberal, euthanasia-loving ho's, fed them OJ (of which half were doped with caffeine), and forced them to read a bunch of anti-euthanasia propaganda. The half who imbibed the caffeine were more likely to adapt their views to the pro-lifer stance.

Hmm? Only if there were some sort of ingestible substance that was cheap, easily distributed to the masses, addictive, and made the consumer susceptibe to suggestion. That might be cause for concern.

I finished my 2.5 weeks on the inpatient internal medicine rotation on Saturday. I had more experiences than I care to (or am legally allowed to) type up right now. I had a patient with an abscess on her back that cultured oxacillin-resistant staphylococcus aureus. I got to probe the abscess, which turned out to be extensive. I had another patient with a large pleural effusion (possibly secondary to lymphoma metastic to the lungs) for which I got to do a thoracentesis (I stuck a needle in his chest to drain the fluid). My team was great and I learned a lot from my attending. Basically, I had a great time even though I slept not.

Now I'm at an internist's clinic in Alhambra. Outpatient is different because I see about 8 patients every day and don't get to do complete physicals and histories. The patients aren't acute either and I see a lot of people who are just in for a check-up/prescription renewal/nothing. The doctor seems to know what he's doing and he pimps us more than my inpatient attending, but it isn't mean-spirited. I'm getting more sleep but I miss inpatient. I think the learning curve was steeper.

Still waiting on my board scores. Should get them anyday now.

I started my internal medicine rotation today in LA County Hospital. I'm on this service for three weeks and then I do outpatient internal med at an as of yet unnamed location.

I'm on call this Saturday and the next, which means that I'll be working the next two weeks without a day off. If I can survive this next two weeks with a bit of dignity I'll feel much better about the rest of third year.

I received a recall notice for my Prius today. Apparently the intermediate shaft of the steering wheel is in danger of cracking under certain driving conditions (i.e. turning the wheel into a locked position while moving at a slow speed or hitting the wheel against a curb). This can lead to loss of steering control. They say it'll only take an hour to fix. I hate liars.

Also, I spent the last four days in Lake Tahoe with good friends and spent a good deal of that time helping to solve PerplexCity puzzles. Google it. It's engaging.

This article is really nothing new, it considers the impending decline of the American superpower, but it contains a funny quote from Jeffrey Immelt (CEO of GE):

"More people will graduate in the United States in 2006 with sports-exercise degrees than electrical-engineering degrees," says Immelt. "So, if we want to be the massage capital of the world, we're well on our way. And don't we all love when we get a happy ending?"

OK, I added the last part. Personally, I don't think this sounds too bad. Of course, there are drawbacks to not being numero uno, but massages far outweight any of them. Seriously though, I recently heard a report on NPR about a study showing that Americans are more unhealthy than other industrialized nations even after controlling for every conceivable factor (i.e. health care, work hours, diet, exercise, etc.). It's my personal belief that there is something inherent about the structure of our society that is destructive (to us and others). And while there are many good things to speak of about the U.S. I think a change would be welcome.

I've spent everyday of the last 15 days in the library. Actually, I should say libraries because I split the time between Pasadena Public and Norris Medical. I get there around noon and leave at closing (usually at midnight). When I get home I put in a few more hours before crashing. There are 26 days left before I take step one of the United States Medical Licensing Examination and I will spend everyone of those days, also, in the library. This is all after having already studied for and taken the cumulative exam at the end of my second year of medical school. Even with all of this work, it's difficult to say how well I'll do on the exam. My scores on practice question sets are fluctuating by about 20% at the moment. I'm gonna try upping my caffeine concentrations. I might also try punching myself in the crotch everytime I miss a question. You know, for negative reinforcement.

This is a paraphrase of what Senator Trent Lott had to say about the showdown between Congress and the Executive Branch:

"I am perfectly willing to get it on with the administration and take it right to the Supreme Court..."

I'm sure he is perfectly willing to get it on with the administration. I'm sure he's perfectly willing to get it on with the Supreme Court too. I think Senator Lott is just willing to get it on with anyone, in any place, and at any time.

Link

Yesterday marked the day of 40 days and 40 nights left until the boards. From now until June 30th I'll be wandering in the desert of medical review books and Q-bank questions.

I'll go without food or water, without sleep, and without spiritual fulfillment. I'll ask hellishily introspective questions like, "Why don't LDL receptors make it to the surface of the cell in type IIa familial hypercholesterolemia? Is it incorrect folding in the rough endoplasmic reticulum from abnormal chaperone proteins? Or is it inappropriate binding of apolipoprotein-B?"

I'll wander in the ethereal planes of obscure minutiae such as, "Multiple sclerosis is associated with HLA-types A3, B7, DR2, and Dw2" and "Polycythemia rubra vera is more closely associated to chronic mylogenous leukemia than to multiple myeloma."

And much of it will help me very little next year on the wards.