Toxic Epidermal Necrolysis

2007-07-23T14:16:00.001-06:00

June 10: I get in a minor fender-bender on Calgary Trail. Yes, I am an idiot, and feel free to tell me I should quit driving. My girlfriend is uninjured; my Mini, however, has a dented front bumper and two detonated front airbags.

June 17: I trade in my rental Kia Rio because a) the steering wheel vibrates like a Mexican space shuttle, and b) it smells vaguely like feet. The Toyota Corolla is marginally better.

July 10: I call the repair shop and ask what's up. Apparently they are waiting for a part from BMW, specifically an airbag.

July 13: "BMW tells me it'll be a week."

July 22: My airbag is not yet in place. Actually, my airbag is not yet in Canada. It's not even MADE yet, as it's on factory back order. In Germany. And it has to be shipped by boat, because it's an explosive device and can't be shipped by air.

Goddammit.

Things I hate

2007-03-22T17:51:00.000-06:00

1. 1-in-4 call. 89 hours of work this week, whoo!

2. People who stand on the escalator. It. Is. Not. A. RIDE. PEOPLE.

3. Estonians. I'm an obscure bigot!

don't want no sugar in my coffee

2006-10-15T12:21:00.000-06:00

In any modern city, you're liable to get patients who speak a multitude of languages. Fortunately, probably the most multicultural group of people in said city will be its doctors, so you're probably going to have a colleague who speaks whatever language your patient does.

Take last week; I admitted a guy whose primary language was Cantonese. He spoke a very tiny amount of English, but somewhat more than I speak Cantonese. My senior resident that night, by luck, grew up speaking Cantonese and English, so I watched as she got a much more complete history than I could have.

Now, being the culturally sensitive guy I am, I tried to pick up a couple of words. The most important word in any language for me is "pain," (and how fucked up of a statement is that, eh?) and "pain" in Cantonese sounds something like "tong" or "tung"; it's hard to tell exactly because it's an inflective language which all sounds the same to my white-guy ears.

So three days later the guy, who's had a catheter stuck in his penis for a few days (long story), pulls it out. This is more difficult to imagine than you might think, as there's an inflated balloon inside keeping it in place, so it's impossible to pull out a Foley catheter without some bleeding and, er, tearing.

I go up to his room and try to ascertain how much damage there is. I ask him, "where does it hurt?" and he looks confused. I point at his penis (which is only bleeding slightly) and ask him if it hurts, and he looks confused. I dimly remember from when I admitted him that Cantonese for pain is "tong," so I point at his penis and say "tong?" At this point he looks unbelievably befuddled and a little insulted.

After about five minutes of sign language and screaming "tong" he seems to realize what I'm getting at and says, "no, no pain." Whew! I go out and relate this story to my (also Cantonese-speaking) med student, and she starts laughing uncontrollably.

"No, no," she says. "'Tung' is pain. 'Tong' is sugar."

That's right, I spent five minutes pointing at an old guy's wang and yelling "sugar! sugar!" I can't imagine what he thinks of the health care system now.

Happy hospital thanksgiving

2006-10-09T23:36:00.000-06:00

Today, if you live north of the border, was Canadian Thanksgiving. Most people have their turkey on Sunday night, though, and leave Monday free for digestion and hockey games.

I missed my family Thanksgiving for the third time in as many years; it seems I’m always on hospital call on that holiday. This year I’d arranged my schedule so I could travel to my cousin’s wedding the previous weekend, meaning I had to make up the call on Thanksgiving weekend.

I’m not going to lie, it had been a rough few days. Friday I admitted something like ten patients to the hospital, which doesn’t sound so bad until you realize that each internal medicine consult takes like two hours if you do it right, or if you have to do any on-the-spot reading. So either you half-ass your job, or you don’t sleep. I’m not jaded enough to half-ass it yet.

Saturday, I slept.

Sunday, I was on ward call. Now, for ward call at this particular hospital there’s one resident on for all the internal medicine patients. That’s about 300 patients, several of whom are actively dying at any one time. Ward call, as one of my colleagues put it, “is like going to hell.”

Around dinnertime I was up on the fifth floor, trying to figure out what antibiotics to give to an alcoholic who’d inhaled his own secretions. This 70-something woman came up to the desk, asking if anyone would like a plate of dinner. I took a glance at the plate, and realized it looked a damn sight better than any hospital food I’ve ever seen before. Turkey, mashed potatoes, stuffing, carrots, and cranberry sauce. And gravy.

I asked if she’d brought this from home, and she confirmed that impression. Her husband wasn’t going to eat his home-cooked dinner today, and she wondered if the nice young doctor would like to have it instead? Considering I hadn’t eaten anything but coffee and vending machine Mars bars all day, I gladly accepted. I did have to ask, however, why her husband wasn’t going to finish it, and if he was OK if I had it.

“Oh,” she said, “I’d brought this turkey to give to him, but they put a tube down his throat to help him breathe today, so he can’t eat. We didn’t want it to go to waste.” I’m still amazed she said this without tears in her eyes. She assured me it was all right, and walked back to her husband’s room, leaving me standing there flabbergasted with a plate of delicious turkey in my hands.

It amazes me sometimes how well people are able to maintain their humanity in the face of the indignities perpetuated by old age, infirmity, and the health care system. And if I’m thankful for anything today, it’s that. Happy Thanksgiving.

Medicine ate my life

2006-10-03T20:43:00.000-06:00

So. Sorry about the downtime, folks, but it's been kind of... hellish lately.

I've been doing internal medicine the past month and a half. It wasn't so bad at the University; I usually would get home by 7 o'clock or so and have a little time to pretend to set up my new condo. By the way, I moved into a new condo about four weeks ago. Haven't done shit to get it set up, mind you.

But now I'm at the Alex (another big hospital). I am the sole resident in charge of my team, which currently has about 10 patients but will likely have about 40 after a couple of nights of admissions. My staff doctor is essentially absent. I am NOT FUCKING READY FOR THIS.

Also the power company shut off my juice and it took a week to come back on. I forgot to set it up in the first place, you see; I think a sign of how much this job drains you is when you forget to do very obvious and simple tasks in the rest of your life.

I'll see you all in a few weeks. Life will get better some day soon, this I promise myself.

He can die after I've had my coffee

2006-07-20T15:48:00.000-06:00

Those of you in the health care field may be familiar with the concept of "report", which is where nurses sign over care of their patients. This is, of course, supposed to be put off for a bit in the event of an emergency, but some nurses seem to look at it as a sacred time that brooks no interruption. Seriously, I'm sure more people die in those fifteen minutes when the nurses are shut in that little room...

Also, I don't know why "report" never takes an article. It's always just "report," or "in report." Like it's a city. Report, Alberta, population 8 angry nurses.

Which led to this conversation yesterday:

ME: Hey, could you -
NURSE 1: WE'RE IN REPORT.
ME: I know, but -
NURSE 2: Look, my shift is over and I just want to sign out and go home.
ME: Yes, I'm sorry, but -
NURSE 1: Come back in five minutes.
ME: THIS MAN IS HAVING A HEART ATTACK. HE IS IN THE PROCESS OF DYING.
NURSE 1: (sighs, rolls eyes) All right, all right...

I mean, fuck. Sometimes things can't wait for you to finish report, or finish your break. This isn't paperwork. This isn't a phone call you can put off until you've had your smoke. This is someone's life; and if he's having a heart attack "time is heart" as the saying goes.

This isn't to say that the vast majority of nurses aren't dedicated, caring and hardworking. But some seem to see their career as a shit job rather than a vocation, and that's when you run into trouble and dead patients.

Oh, the guy totally wasn't having a heart attack. But when you're having "9/10 crushing chest pain," best not to take chances, eh? So anyways, that's why I'm now pretty sure I'm known as "that asshole resident." Whoops.

great balls of fire

2006-07-13T17:09:00.000-06:00

Patient: Hi, doc. I've been ejaculating blood for the past week.

Me: Sweet zombie Jesus. I mean, any other symptoms?

Patient: Well, my left testicle has seemed really enlarged and sore lately.

It is; twice the size of his left, in fact.

Me: Yeah, that's probably what's causing the blood-jizz. This can be caused by chlamydia or gonorrhea; so, uh, any affairs lately?

Patient: Absolutely not! But I have been having some pretty active sex lately. I thought I'd injured myself.

Me: *chuckling* No, that's just an infection. We'll clear that right up. But seriously, if you've been going hard enough that you thought you fucked your balls off, good work.

Patient: Thanks, doc.

Hey, everybody! Watch the resident fuck up!

2006-07-02T19:38:00.000-06:00

Today was my first day as a resident. If I've talked to you recently, you probably know that I matched to Family Medicine (not quite Emergency, I know, I know...) here in Edmonton. If I haven't talked to you recently, we should chat, guy.

I started my rotations with Emerg at the University hospital - at 6 am, on the day after Canada Day. I was, of course, nervous beyond belief the night before. If I could put a finger on it, I'd say it was akin to that combination of excitement, joy, and gut-wrenching nauseating fear that you just won't be good enough that you feel right before you lose your cherry.

Or was that just me?

I couldn't sleep last night. I went to bed early - couldn't sleep through the fireworks. Shit, I missed the fireworks. I set my alarm to wake me early - 4:15, so I'd have plenty of time to wake up and prepare myself. The fact that it's cockmeltingly hot (that phrase is copyrighted, by the way) in my apartment didn't help. Finally I managed to pass out around 1:15.

When I woke up, it wasn't to the sound of my alarm for once. I think the sun reflecting off the opposite building was what got me up. And a good thing, too, because I woke up at 6:20 - 20 minutes AFTER my shift began. My initial response, of course, was SHIT SHIT SHIT MOTHERFUCKER. My next thought was that I'd set the alarm to 4:16 PM like the retard that I am. My next thought was that, someday, I'll look back on this and laugh.

Today is not yet that day.

Fortunately, I had a fairly easygoing staff doc the first day. He was, surprisingly, OK with my display of raw unprofessionalism. And, fortunately, I didn't cock up too bad on any of my patients. Yay.

In other news I passed all my exams, went to Spain for a month, became a doctor and also bought a condo. Life, she keeps you busy. And I wonder why I don't have time to clean my room...

Damn you, Seth!

2006-02-10T10:19:00.000-07:00

I'm off work for the next week and a half - conveniently, just in time for the Olympics.

It's ironic that I'm such an Olympics junkie, given that I have the rough physical coordination of a spastic CP quad patient (I can make jokes like this because I help treat them. That makes it OK, right?)

Anyhow, this has been making the rounds of the ex-GW blogs, and since I'm currently sitting at home in my bathrobe and boxers at 10:20 am, I figure now's as good a time as ever to fill 'er out. I was tagged by Seth, incidentally; burn in hell, Seth.

Four jobs I’ve had
* Bagel Sandwich Maker
* Data Entry Clerk at an immunization office; I know what shots you've had.
* Laboratory Assistant
* Doctor (pending)

Four movies I can watch over and over
* The Party (1968, Peter Sellers/Blake Edwards)
* Super Troopers
* 28 Days Later
* Ronin

Four places I have lived
* Edmonton, Alberta
* Yellowknife, Northwest Territories
* Kungshamn, Sweden (briefly)
* Kingston, Ontario

Four TV shows I love to watch
* Arrested Development
* Scrubs
* 24
* The Sopranos

Four places I have been on vacation
* Quintana Roo, Mexico
* Fairbank Lake, Ontario
* Puerto Rico, St. Thomas, Tortola (same cruise)
* Dinney World!

Four websites I visit daily
* Something Awful
* Wikipedia
* Globeandmail.com
* gmail.com

Four of my favourite foods
* Pepperoni and sausage pizza
* Pasta with bolognese sauce
* All-Bran Buds (no, really)
* This crazy fucking Indian thing with yogurt that my sister makes

Four places I would rather be right now
* On a beach somewhere in the Carribean, away from the hotels and the tourists
* Spain. Always wanted to go to Spain.
* In the emergency room (no, really)
* Montreal

Been a while, I know

2006-01-19T22:23:00.000-07:00

I'm briefly back home between interviews right now. Quick recap of the past few months:

1. Pediatric subspecialty kind of boring. ICU stressful but interesting; I got to throw in a few central lines, which is always awesome. Family med OK. Emerg elective in Kingston went well.

2. CaRMS did NOT go so well; landed five interviews off of fifteen applications. Only one of eleven for emerg went through; looks like I'll be doing family med emergency!

3. Just interviewed at my only five-year emerg program in Manitoba. Great program, and I think I stand a good chance at matching there. Unfortunately, I don't know if I can convince myself to live in Winnipeg for five years. I'll be having this debate with myself often over the next two weeks.

4. Next week will be interviewing family med in Kingston and Montreal. Drinks will be had.

Later, peeps.

The best turn-down EVER

2005-10-17T10:12:00.000-06:00

Most of your fourth year of medicine is taken up by the application for residencies. Those of you who remember speaking with me after I got into medical school may recall me saying something along the lines of, "all the pressure's off now, I'm a doctor no matter what!"

Ha.

Turns out it is, in fact, occasionally extremely difficult to get into certain programs - including emergency medicine, which is what I happen to have decided upon. The residency programs, overall, have something like a 33% acceptance rate - roughly 80 applicants for the 28 spots nationwide last year. Ouch.

The analogy I've developed to explain this is that I've fallen for the most beautiful, most popular girl in school, and everyone wants to take her to the dance. It's still worth the effort, in my mind, to ask her out, but I have to operate under the assumption that she'll say no. However, Emergency Medicine has a friend. This friend is named Family Medicine, and Family is easy. I mean, she will put out for ANYONE. She's not quite as attractive as Emergency, but she'll get you where you want to go - specifically, via the CCFP-EM program, which is a third year of family residency which lets you work in ERs.

I get the occasional disgusted look while explaining my analogy, but it's a decent framework.

Anyhow, a large part of your application for the residencies is your reference letters; you're essentially expected to get a reference letter for every rotation or elective you do in your field of choice. This is tough in ER, since you tend to spend very little time with any given doctor because your schedules rarely coincide. I've been trying to get references out of rotation coordinators, since they see all my evaluations from other doctors, but failed in the case of one from the University Hospital.

His excuse? "I can't give you a letter because I'm in rural Zambia."

Seriously. If I had a nickel for every time a girl turned me down because "I'm washing my hair... in rural Zambia, " or "I'm dating someone else.... from rural Zambia!" I'd be a richer man today.

I have to stop going after girls from rural Zambia.

Like a theme park, except with more agonizing pain

2005-09-14T17:32:00.000-06:00

For whatever reason, emergency shifts tend to have an overriding theme. Perhaps I'm just overlaying that onto my day, perhaps I'm subtly biasing myself when I pick through the charts, but I swear I can pick out a common thread to most days spent in the ER.

Yesterday, for instance, was an orthopedics day, specifically the Day That Everyone Broke Their Damn Foot. Ortho days are fun because the people are otherwise healthy and you get to knock them out and move bones back into place.

Today, by contrast, was Chronic Pain Disorder day. People with weird-ass conditions that specialists don't understand come in expecting me to help them. Fun! Some of them are well-versed in their condition, explaining what's been ruled out and what helps in the voice of someone tired of explaining to idiot medical students that no, they don't know why their bowel hurts so much, and that this dose of morphine is what they usually have. Some of them are just big old balls of crazy.

Sunday's theme was People With Disturbingly High Blood Alcohol Levels, but every day is like that at the Royal Alex, heh. We had one guy come in with a level of 99 mg/dl - by comparison, the legal limit on that scale is, uh, 17. Fortunately, he'd been drinking mouthwash, so at least he smelled minty-fresh. It almost, but not quite, masked the rancid urine odour which tends to permeate the Alex on Sunday mornings.

In non-medical news: Electric Six put on the best damn show I've seen in a while. They got indie-rock nerds dancing in the aisles, man. It was wicked. I also flirted with a cute industrial designer, who by utter coincidence was designing surgical tools for one doctor I worked with. Wish I'd got her number, but the show started unexpectedly early.

And the opening act covered Iron Maiden - and covered them well - which is always fun. I have an unironic, unashamed love for speed metal, and you do too. You're just too scared to admit it.

Three words

2005-09-11T17:09:00.000-06:00

Foreign. Body. Rectal.

Hey, did you know that if you lose a vibrator inside yourself, and it's still on, it'll run until the batteries die?

Did you know that that takes, like, a DAY?

How do I afford my rock and roll lifestyle?

2005-09-08T23:59:00.000-06:00

Obstetrics and Gyn(a)ecology is over, thank Christ. The only thing miraculous about birth is that something that large comes out of something that small. Also, to all the ladies in the crowd: GET THE EPIDURAL. PLEASE.

Emergency medicine is what I'm on now, two weeks of elective followed by four weeks of rotation. I love emergency, really; I've decided beyond a shadow of a doubt that it's what I must do. I spent most of third year wondering what I'd wind up doing; hell, I thought I'd be a psychiatrist becauase it was the only thing I hadn't hated. Well, that and you work like six hours a day for a quarter-million dollars a year.

But in the middle of my first ER rotation, I had one shift where we had two people who'd been shot by the cops while fleeing in a stolen car, one woman who'd had her face smashed in with a stereo speaker, three heart attacks, and one guy who tried to kill himself with pills and, when that failed, a very woozily-applied razor. So as I was stitching this guy's arm up - the wounds were a little weavy - I felt that hammer come down and smash me on the forehead. The sky opened up, beams of light shot down, and a voice said "THIS IS WHAT YOU MUST DO WITH YOUR LIFE."

And then the security guard gave me advice on stitching, because he used to be a surgeon in Russia. It was a weird day.

Now, one of the great things about emergency is that you only work 4 shifts a week; four eight-hour shifts. Compared to the 70-90 hours I was working on O&G, this is luxurious. Granted, the shifts are at odd hours, and your sleep schedule can get fucked up; f'r instance, I have to wake up in four hours, and I'm still wide awake because I woke up at noon today because I've been working weekends. Tomorrow's gonna suck... But the upside of all this is that I have time for the rest of my life. Time to study, time to update my blog, time to go to concerts.

In the next week, I'm planning on seeing three, possibly four concerts: local indie rockers The Mark Birtles Project on Saturday (they have a cowbell!), Metric on Sunday, Electric Six - my favourite dance-punk band - on Tuesday, and possibly Audioslave from the nosebleeds on the next Saturday. I haven't been to this many concerts since fourth year undergrad when I lived with the guy who booked all the bands. Now, I can do this through the magic of emergency.

Given the cost of tickets these days, I can also do this through the magic of debt. But that's why I get the high-income job in the future, right? So I can enjoy myself now? Racking up 20 large in debt a year isn't bad, right? Right?

Maybe I should start

Study study study

2005-07-12T17:38:00.000-06:00

(click to embiggen)

Took this picture last summer, at Batchawanna Bay, east of Lake Superior Provincial Park. Looks like an old Ministry of Natural Resources drop box; I just loved the look of the rusted outpost of our civilization completely overgrown by weeds.

Come to think of it, it's been almost exactly one year since I took this shot. The year in the interim has been long and difficult in some ways, rewarding and invigorating in others, and in still others perfectly scrumtulescent. Thank god it's almost over.

Pictures!

2005-07-11T17:42:00.000-06:00

Sweet, I finally got un-stupid about Blogger's picture function.

This is me today. Note beard; too lazy to shave.

More pictures to follow when I'm not cramming for my pediatrics exam in two days.

Maybe smoking isn't such a bad idea after all

2005-07-02T17:00:00.000-06:00

As of yesterday, July 1, 2005, every bar in Edmonton is smoke-free. On the one hand, this is great because a) now I don't reek like smoke when I come home, and b) now I'm not quite so prone to collapsing on a filthy, beer-stained dance floor in an asthmatic fit.

You can make the argument about 'personal liberty,' as regards one's right to smoke in a private establishment, but really, your liberty runs out when you harm me. And second hand smoke is pretty noxious to those of us with sensitive lungs, regardless of the semi-proven cancer risk. There are, of course, other risks, as evidenced by bitch if you burn me with that butt ONE more time it's going UP YOUR FUCKING NOSTRIL.

So, in general, I highly support the bar smoking ban, and I know it'll lead to me patronizing more bars that I would've avoided before.

Except.

See, one of the side effects of smoke is that it deadens scent. Your nose becomes less responsive to smells when it's in a smoky room, overpowered by the miasma of tobacco. And yeah, it can smell pretty bad, but it's an odour that you can deal with. Last night, because we left heading out to the bar until late, the only place we could reliably get into was the Commercial Hotel, one of Edmonton's finer dives. At first, it was fantastic, because hey! No smoke! Nothing to blur your vision of the 40-year-old cougar beckoning with her wizened hand!

However, we quickly became aware of an... odour... permeating the area in front of the bar. A straw poll indicated three in favour of 'vomit,' one in favour of 'spilled beer,' but he's an idiot so we went with 'vomit.' And chances are that smell's always been there, but it's been masked by decades of smoke that never got fully cleared out. So maybe, just maybe, as a nausea prevention tool, smoke ain't so damn bad.

Of course, the truly wise man will simply not go to bars that smell like the inside of a stomach. So we left.

***

Pediatrics is fun, but it's hard work. I mean, these are seriously the longest hours I've ever had. My last week on the unit I spent 90 hours in the hospital, not counting at home study time. Or, at least, I would've if I hadn't had my immune system collapse one day under the weight of all the viruses these snot-nosed little bastards drag in. Pediatricians must be invulnerable to disease after their residencies.

Peds is also kind of depressing. Most kids are healthy, healthy enough to come in, get checked out, and go home. But the ones in hospital are the ones that are truly fucked - cerebral palsy, quadriplegia, seizure disorders, mental retardation, the works. We call those the 'Dr. X specials' because one particular local doctor takes care of so many of them. And it's absolutely terrifying when you think that THIS COULD HAPPEN TO YOUR FUTURE KIDS. Seriously, it's enough to make you live in fear for an entire nine-month pregnancy.

What's even more soul-deadening, however, are the kids who have degenerative disorders, like Duchenne Muscular Dystrophy. I had a thirteen-year old who was wheelchair bound; he'll be dead by eighteen. How do you keep on a bright face for that? It's so horribly cosmically unfair, but you've got a responsibility to make the kid feel as though nothing is wrong. And that's goddamn tough to do.

Wow, that was depressing. I promise the next post will actually have some more upbeat content. If nothing else, the sun is shining and I'm about to go for a run. Use your legs, kids; you never know when you might lose them.

Cured by the power of ROCK

2005-04-11T23:41:00.000-06:00

There's a new radio station in Edmonton, land of the historically mundane and soulless corporate tunesmiths. Radio Sonic, broadcasting from a trailer by the side of the highway, promises to bring modern rock to the airwaves of the 'Chuk, and I'm as giddy as a schoolgirl having her first Sapphic experience.

For years your alternatives in this city consisted of a) The Bear, which was better before its playlist started consisting entirely of turgid nu-metal, and b) Easy Rock 104.9, which apparently every nurse must play by law at work. If it's supposed to be so inoffensive and calming, why does it make me want to hurt people, huh?

In any case, Sonic pledges to be cast in the mold of Toronto's The Edge, or at least what the Edge claims to be. So far I'm not disappointed; they're conducting their 'broadcast tests' and have been playing music that I actually LIKE. Yesterday morning I was driving home from a night on call at the hospital and heard 'Battle Flag' by the Lo-Fidelity All-Stars and shouted 'HELL FUCKING YES' to the apparent consternation of the elderly couple stopped beside me.

Jesus. Iggy Pop just came on. I need new pants. This station is like your cool friend who not only likes the same music you do, but has like a thousand CDs of obscure bands that you'd probably like if only you got to hear them once in a while. Well, I'm hearing them now. Thanks, you indie-rock music geeks!

***

Had an epiphany on surgery on Thursday. During clinic I had four separate patients compliment my performance to the preceptor; afterwards he told me he might get one of those per rotation for a student on a regular basis. So apparently I'm fantastic dealing with patients.

Now, don't think this is me getting all cocky. I'm distinctly AVERAGE when it comes to my level of knowledge, at least as applies to surgery. And I can't tie knots for shit. But at least now I have a better idea of where my strengths are, and that gives me some empirical evidence to base my choice of career on. D-Day is coming up in a few short months...

***

Holy fuck! The Clash! I'm in love!

A real horrorshow

2005-03-26T10:07:00.000-07:00

You do not know the stuff of nightmares until you've done surgery.

The setting here is an operating room: a poor, unfortunate gentleman with rectal cancer. It's too close to the end to make anything workable for an asshole, so the whole thing has to come out. The procedure, if you're interested, is an abomino-perineal resection, which basically means "we cut you in two places, one of which you're really not going to be happy about."

The upper incision is straightforward stuff; cut open the abdomen, divide the bowel, close off a few blood vessels and away you go. The lower incision involves spreading this poor bastard's legs apart, and cutting a hole about the diameter of a compact disc centred on his anus. Core that whole thing out until you reach the abdomen, at which point you meet up with the upper surgeon's hands. Oh, be sure to have the student standing behind the ass guy for maximum impact.

At this point, you've essentially got a sixteen-inch drilling sample, which you then have to remove from the patient. The easiest way to do this, of course, is to PULL IT ALL OUT THROUGH THE ASS. The whole mass is delivered like some horror-film version of childbirth, leaving a gaping cavity (which is, in fact, dilated at least 10 centimetres; time to push!). You can see daylight streaming in from the abdominal cut.

Closing up is pretty straightforward; the upper guy connects what's left of the colon to a permanent colostomy bag - no asshole anymore for you, sir! - and the lower guy just puts in a fuckload of stitches, leaving the patient a smooth plane like some rectal castrato.

At this point, the student will wish to go wash their eyes out with bleach. Let them.

Dragon's Tail! Monkey's Paw! Uh... Knee To Face!

2005-02-15T23:11:00.000-07:00

Sunday night I went to see Ong-Bak, a film which really marks a return to the best - and worst - of the early martial arts films.

In the pro column: ridiculous stunts, no wire work, no CG bullshit. Just absolutely insane physicality. It's the kind of movie that forces you to stop and say, in a strong, clear voice, "What the FUCK?" because some guy just got kneed in the chest thirty feet above the ground and fell. Hard.

Con: plot? What plot?

The main character's martial art is Muay Thai, which I'm guessing is the same thing as Thai kickboxing. It's a fluid, graceful, and remarkably asskicking art in the hands of Tony Jaa. However, two of its odder characteristics are a) a reliance on knees and elbows, which while powerful come with a severely reduced range as price, and b) a particular move I like to call 'The Shove of Doom,' wherein Jaa stands in place and pushes people. Crude, yet effective.

My personal favourite mixed blessing of this movie, however, is the enemies our hero, the marvelously named Ting, faces at an underground fight club. Each appears to be an exemplar of some particular form of martial art. They include, in order of appearance:

A) A gargantuan Australian man who appears much like what would happen if Slash had been injecting steroids into his arms in lieu of playing guitar solos with no amplifier during the November Rain video. His martial art appears to involve slapping people very hard and molesting women. In short, he's much like most Australians.

B) A skinny Asian guy with an afro whose skill appears to be shuffling his feet back and forth rapidly. I don't think he actually hits Ting at any point, he just stands there shuffling his feet like some kind of retarded minstrel show.

C) Some wordless white guy who fights exclusively with furniture. Seriously; every move the man makes involves hitting Ting with chairs, hitting Ting with tables, hitting Ting with bits of tables, or defending against Ting with the occasional sofa bed.

My goal in life is now to develop a martial art revolving entirely around furniture. I'll be the first Ikea-ka in history, teaching my devoted students how to manipulate the enemy's futons and affordable blonde-wood cabinets in such a way as to defeat them using nothing more than an Allen wrench.

Man, FUCK medicine. I have a new dream now.

Love in an Elevator

2005-02-15T23:08:00.000-07:00

The romance started quietly enough; I held the door for a woman. I wasn’t so much attempting to be chivalrous as simply polite, but she must have read more into my gesture than I intended. The smile she cracked lit up the hallway like a sudden dawn over the limb of the earth.

I turned slightly, took a closer look at the beneficiary of my courtesy. Shoulder-length brown hair framed high cheekbones, a pert nose, and disturbingly blue eyes. Her lips were twisted upwards on the right, a sardonic grin quickly replacing the beaming smile she’d displayed only moments before, perhaps realizing the ludicrousness of appearing so grateful for my not letting the door slam in her face.

“Thanks,” she said, with the barest hint of a laugh at the tail end.

“No problem,” I muttered. I was shocked at how gravelly my voice sounded, but upon reflection I realized I hadn’t spoken aloud in several hours. Paperwork and the drive home had given me the voice of a B-movie villain.

I cleared my throat and licked my lips, dried out from the winter air. There was a high-pressure system sweeping down from the Arctic, hugging the eastern edge of the Rockies and sucking the moisture – not to mention most of the fun – out of the city.

She raised an eyebrow quizzically, noticing my wandering tongue. Shit, I thought. She thinks I’m coming on to her. I thought some more. Wait a minute. Maybe I want to come on to her.

I let my eyes flicker downwards, just long enough for her to notice, but not for her to know that I knew she noticed. She was wrapped in a nylon parka, in the same red that would adorn a Chinese restaurant, for luck. She’d opened the garment in the parking garage, however, and practicality parted ways to reveal a deep brown sweater, horizontal stripes highlighting her breasts, the sweater tight enough to reveal a bra worn one size too small.

I moved through the door into the hall, and repeated “No problem” with a voice suddenly clear. Her mouth dialed up to the right even more, and for some reason she reminded me of Elvis Costello: Little sniggers/on your lips. I broke eye contact, turned, and sensed her follow.

We passed through the next door into the lobby, repeating the same social niceties – “Thanks no problem” – but with that sudden undercurrent of eroticism throbbing beneath.

I leaned against the mahogany rail, and stretched. The far edge of my vision caught her eyes searching me as I did so. Long-quiescent capillaries suddenly dilated, and I felt a surge of blood. I looked at the ceiling, my mouth a parody of her smile, and hoped she noticed.

We found ourselves the only two passengers on the elevator. She pressed the button three floors below mine, and our hands briefly grazed. Her skin was warm and just barely damp with sweat. She withdrew quickly, embarrassed, taking in a small breath through suddenly parted lips.

I smiled in a way that I hoped was reassuring, but which probably came out looking predatory. She smiled back, her cheeks now reddened.

The elevator jerked to life, grinding slowly up the rails. It was an old seventies model, the electronic beeps announcing the passage of each floor now as grating as my voice had been. We tried not to be caught looking at each other, failing miserably. Finally, somewhere around the tenth floor, I fixed my eyes on hers. She drew in a deep breath this time, her nostrils flaring from what I assumed was her arousal.

“Jesus,” she said. “Was that you?”

What? “Um…” I forced out.

“What the hell did you eat? Oh, Christ.” She looked away as my eyes began to water.

“Oh… oh, shit. God, I’m sorry,” I stammered, my deflating erection revealing my penis’ disappointment with me. “Look, I just started this new medication, and it’s got all these intestinal side effects…” The words rushed out despite the awful and immediately apparent futility of the situation.

“Yeah. Whatever. Just…” She broke off in disgust as the door clanged open at her floor. Her figure, mirrored in the battered steel side of the elevator, shook its head as it stormed down the hall. She gleamed through the film of tears now standing on my eyes.

Gasping for oxygen, I stumbled out of the elevator and into my apartment, sagging against the wall, too tired to move. Eventually, I picked myself up, tossed off my boots, and went into the kitchen to search for a meal with no simple carbohydrates whatsoever.

Rollin', rollin', rollin', fuck you Fred Durst

2005-02-10T21:35:00.000-07:00

So: I know it's been a while since I've posted much of anything on this blog. But that's because I've been busy, honest! Third year med does get kind of insane, to the point where you wonder whether you'll ever have time to do anything else with your life. But I'm assured it gets better as it goes along.

In any event, tonight I want to talk about a simple pleasure, [i]viz:[/i] rolling coins. My sister bought some little plastic coin rollers, and gave the extras to my mom, who gave the extras to me. This prompted me to go out and buy some of my own, and get the giant pile of coin off my desk.

The end result? $67.50 in dimes, nickels, and pennies. No quarters. It was a big pile, I'm telling you.

In any case, it's all part of my 'get my life back in order' plan. Step one is to clean the fuck out my apartment. Step two is to get back writing. At the present time, there is no step three; but really, is any self-improvement plan ever done? Can you ever say, 'OK, I'm perfect, don't have to work now?' Unless you're, like, NHL hall of famer Ken Dryden, you probably can't. I suppose the point I'm trying to make is that one shouldn't settle for how they are. There's always room for improvement. Especially in you.

Calgary: YEEE-HAW!

2005-01-10T01:20:00.000-07:00

I went down to Calgary to visit Ryan for a couple of days over my all-too-brief Christmas break. Fun was had by all, as well as steak. Lots and lots of steak. This at a place called the 'Cattle Baron,' which is a decent steakhouse despite the name, and not, say, an Arby's knockoff or possibly a gay bar.

Our initial plan was to hit Outlaws, a bar where Ryan's disturbingly attractive friend apparently works. Unfortunately, Outlaws is closed on Monday and Tuesday nights. Instead, we went to a) Frank Sisson's Silver Dollar Casino (And Bowling!) where we killed two hours and I learned how not to look like a complete moron playing blackjack. We also went to b) Ceilidh's, or one of the other infinite variant spellings thereof, which is an Irish-pub-cum-meat-market. Like most meat markets, but with a paler, more potato-oriented clientele. It's the kind of bar where the bartender...esses... get up on the bar and perform a faux-lesbian show, and then pour shots down the throats of bystanders. I'm only a little miffed that Ryan got his free and she decided to charge me $5.25 for mine. I'm not entirely sure what that indicates, but it can't be good in the long run.

The following day, once I'd recovered, we headed to the shooting range, which was brought up in the following conversation, had on the preceding day:

Me: Hey, a shooting range.
Ryan: Wanna go?
Me: Sure!

I figured, hey, when in Calgary, do as the rednecks do. It was pretty easy to get into the range - minimal safety lectures were had. Once in the firing range, I noticed several things. The first is that guns are very loud. The second is that I jump like a little girl when loud things go off within four feet of my head. The third is that ammo clips are a goddamn bitch to load. And the fourth, according to the range warden, was that my Glock was jamming because I was holding it 'limp-wristed.' That's right: I'm apparently too faggy to fire a weapon.

Still, it was admittedly fun firing off fifty rounds of a police weapon. But after we were through with a box of ammo apiece for the pistols, Ryan rented an AK-47. I got to fire off five rounds, the legal maximum for an assault-rifle clip in Canada. And man, those fuckers are disturbingly powerful. You feel the recoil down to your feet. The guy firing his rifle across the range creates a pressure wave you feel splash over your cheeks. You realize, 'man, I could take on the entire city with this,' which is why it's probably a good thing that the range warden is right there beside you with a loaded weapon on his hip, to discourage any Grand Theft Auto-inspired thoughts.

The gun store also sold bumper stickers, one reading 'Terrorist Hunting Licence - #911-01 - No Bag Limit No Season.' Wow. Those people sure are never forgetting. When they're old and grey, their grandchildren will ask them, 'What happened on September 11?' and they'll look up with moist eyes and say, 'Something I'll never forget.' But they'll forget anyhow, because they're old and old people do shit like that and the universe has a sense of irony.

Thoughts on White Christmas (1954)

2004-12-30T15:53:00.000-07:00

One of the more joyous Christmas traditions in which my family, and I suspect indeed most families in the civilized world, participates is the watching of Christmas movies. The Christmas movie is a peculiar entity, considering how gawdawfully bad most of them would be considered if they didn't involve Santa or snow or Jesus or some shit. Still, they do function remarkably well to get you into the holiday mood, and I really wish I'd done more watching in the days leading up until Christmas, considering how much time I'd been spending with patients with pancreatitis and how very un-Christmassy that is.

In any event, I spent the evening of Christmas Day watching the 1954 classic
White Christmas, featuring a somewhat sober Bing Crosby, a Danny Kaye in full camp, Rosemary Clooney before she got all humongous, and That Chick That Nobody Actually Knows The Name Of (Vera Ellen, for the record). Thoughts on my umpteenth viewing:

1) Wow, how was it a surprise when Danny Kaye eventually came out of the closet? The man was flaming. Right, you don't want to get married because you're 'scared stiff.' Uh-huh.

2) Didn't Irving Berlin write this song? Wasn't he Jewish? I guess it's pretty non-denominational. Not like Good King Wencescesincestislaus or whatever the fuck his name is.

3) The 'Minstrel Number' is pretty offensive when you remember what minstrel shows actually were, with the blackface and all. But what may be more offensive is that red plume on the back of Rosemary Clooney's ass. My family refers to this as her 'fartcatcher.'

4) Jesus, they've got, like, an entire army of gay men as dancers. You could storm Tikrit with these guys.

5) Heh, Nameless Dancer told Danny Kaye she was looking for a man who was "charming and gay." Heh heh. Oh, Jesus, I've been in Alberta too long.

6) Look, Rosemary Clooney freaked out and left for New York. And she brought her homosexual army with her! Oh, that one guy was in West Side Story. THAT'S where he's from.

7) Oh, shit, the tree fell over. No, really, the Christmas tree fell over during the movie and I missed the last half-hour trying to set it back up. There's sap everywhere. This sweater WAS new.

Bronchitis, Death, and Fruit Bars (In No Particular Order)

2004-12-17T20:41:00.000-07:00

In addition to being a lazy bastard (see below), I am also a sick one. Coming off a snowboarding trip to Panorama, I appear to have contracted the lung version of that dreaded medical student’s disease, the CancerAIDS. Might even be EbolaCancerAIDS, I’m not sure. But I do know I’ve been coughing pretty much nonstop, occasionally producing some blood, for the past three days. This is unfortunate, since I’ve just started Internal Medicine, one of the more demanding rotations, and not a time to be getting sick.

Things came to a head on Wednesday, supposedly my first night on call. It was hellaciously busy; the internal medicine service got six consults from 4 until 5, and at 9 PM we had 11 patients clogging the emergency room. Of course, as I’m new at this, I’m very slow in processing patients so I’d gotten one done by myself while the rest were split between the doctor on call and the resident.

Granted, matters were not much helped by the lung infection of doom. During one particularly nasty coughing bout, a passing nurse dragged me over to a thermometer, stuck it in my ear, told me my temperature was 38.2 degrees, and got the resident to tell me to go home. At that point I realized that a) I’d tell any one of my patients with a fever and coughing their lungs out to stay home from work, and b) I was probably not inspiring much confidence amongst the patient population witnessing me slowly die from oxygen deprivation. So I finished my patient writeup (only took 3 hours in total!) and bailed. Er, after I laid down on a cot until the walls started melting, that is. And I’ve been stuck at home, doped out on NeoCitran ever since.

The unfortunate aside to this is that a good friend of mine’s mother passed away of cancer that night, as it happens in the same hospital, on my service. They were aware that her son’s a medical student, so they kept her care out of the hands of those of us who knew her, but it still rams home the fact that, some (most?) of the time, there’s nothing anybody in medicine can do to save the patient. And we just have to sit there and watch them slip away. And it’s worse – so much worse – when you know the person going, and sit there helplessly while the nice woman who made you tzatziki and roast lamb struggles to breathe.

***

On to happier things: snowboarding! I still suck at snowboarding! The hill at Panorama was, sadly, covered in ice; since I’m still learning how to carve, I fall a lot, and falling on ice fucking HURTS. I probably only went about six hours total on the weekend before my knees and quads gave out, which is just as well given how much I’d been drinking. The weekend was fun as hell; however, I did realize that I’m generally happier sitting drunkenly in a hot tub in the mountains than falling down the mountain strapped to a fiberglass plank. Go figure. Oh, and the name of the resort (Panorama) is very apt.

I also made a fantastic discovery that weekend: Fruit Source bars. God, those things are fantastic; essentially, they’re compressed fruit, roughly the size of a small granola bar. Every (tasty) bar contains 3 goddamn servings of fruits and vegetables. Two of those and you’re set for the day! Say goodbye to scurvy, everybody! Your teeth are staying just where they are! Granted, we'll probably find out in a few years that ingredient number one is "Green, Soylent," but in the interim they're a good way to get all that heart-preserving fruity goodness.

So that’s my public service announcement for today. And that’s long enough, as well… My next update will be even more interesting, I promise: that’s where I talk about the morgue, and the Incredible Exploding Woman. Stay tuned!