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In med school, I saw this graceful old southern lady. She had lung cancer. She spent her time sitting in her beautiful mansion on St Charles Avenue dressed up hat and all, protected from it all on hospice, waiting to die by smoking tobacco with her long cigarette holder. We didn't tell her not to smoke. I also remember an old 98 year old black man who had never been to a doctor until he finally went and found he had metastatic colon cancer. This guy was slowly wasting away by a window in the slums of New Orleans, where he grew up. His neighbors and family would routinely stop in and visit him. We checked his vitals, and he was surprisingly hypoxic. When we asked him if he needed anything, he said his pain meds made him feel better. Just please make sure there are enough, ma'am. That's all. We didn't strap an oxygen mask on or watch the numbers nervously with a continuous pulse-ox. We asked him what he needed. And finally, there was this one guy who was an ex-profess...

Held captive in the bowels of my community hospital in Utah over the past two months, I've been thinking about a few things I have learned about myself in the last year or so. Here they are if you're interested: 1. I'm not nearly as altruistic, optimistic, humanistic, or idealistic as I thought I was.. either that or I've just changed. I'm much more of a skeptical realist now. 2. I don't really want to be a family doc... this one has been a tough self-realization this year. 3. I'd rather not work than work. But unlike a significant portion of my patients, I recognize that I have to. 4. Jumping out of a plane is pretty fun. 5. I hate to owe money, but I think not having enough money is a really lame excuse to miss out on something. This has become a predicament in my life. 6. Utah is a beautiful, unique place, but it's no place to live. 7. I'm more of an east-coaster than a west-coaster, and actually truthfully westerners kind of bug me in a weird way...

I don't know if it was just because I was post-call on MICU and didn't sleep 1 minute of 31 hours, if I was feeling guilty about not knowing what to do with my patients and/or not particularly caring what was done to them (as long as it was after I left), or maybe because I just finished re-reading the House of God.... but something about today's rounds made me pay attention to what was being said.. I don't think any of it was as horribly intentional as it sounds written out.. because everyone is so jaded and exhausted and drained in the ICU that I don't believe they can be blamed personally. Actually, in fact both my attending and resident in particular are brilliant, amazing dudes, but penultimate assholes, and I just felt the need to share the actual words... I honestly haven't been able to sleep today without sharing this. So thanks for the vent. All of these conversations were had with sarcastic humor. I'm ashamed to say, Everyone laughed. Before you te...

Two tourists go into a bar. They don't know each other. Both are young and of different nationalities. He speaks some Spanish and decides to approach her. He invites her for a drink. She is alone and in town for a small time. In two more days, she will continue traveling. He will be in Antigua for one month. He came to work on his Spanish. The conversations flows as everything in the city: gently. They smile without effort and have more than one drink. Both are single and have two more days to define the end of this story. Independent of the decisions they make, for each of them, Antigua will be that night, that conversation, those laughs. Even when it is possible that neither of them will return to that city, they became the city for each other. The ruins are wounds that have not stopped recovering, warnings on the skin that turned Antigua into a city in permanent construction. For this reason, she needs her visitors so much, to exist again. The tourists come to Ant...

I had another slam-dunk affirmation of my decision to get away from all of this just this week. I have it every week, but here's this one. I spent a great deal of time this week on night float with this patient I loved and his friends. They're awesome. I loved them. The patient essentially got handed (during this admission) a hand of multi-organ failure with cancer on top of a previously generally healthy life. He decided to be DNR/DNI willfullly, understandably, as I would have done. He's now intubated. It was done while he was unstable and hypoglycemic... I'm so furious about all of it. I truly can't stand this anymore. Really. I'm too mentally and emotionally exhausted to fight this stuff, but I really want nothing to do with it on an emotional level. It's breaking me down. Not like," oh maybe when I'm not a resident I'll want to deal with this." More like, "get me away from this stuff that's raping my mental world." I ...

...As a conclusion to the ridiculous sous la table conversation that never ended,.... I think now that you believe some sins are unforgivable. I hope that isn't true, because I disagree. No sins are unforgivable and nothing is indifferent. From the queen of apathy, the situation is NOT APATHETIC. Some things are accidents. But I'd prefer for you to forgive them or condemn them than to cast them aside. Please, don't ever fall into apathy. It's not you. I don't think you will, but I suppose it's also a warning to myself. That is the easiest answer. Apathy. Everyone is right. No one is wrong. Or everyone is wrong. No one is right. And nothing matters anyway. Don't ever be like that. Life won't be worth living anymore....

Damn what a year this was!...This new year is a giant *reset* button for me. Finally finishing school, starting my career, single and free and moving away, starting everything fresh after a jam-packed and eventful year. Perhaps a little wiser for the wear. Guess later on I'll probably look back on this year as the time I started to grow up. It was a great year. Decided on a career finally, fell in love sort of, and had a hell of a time doing it. Had tremendous highs and crushing concrete-scraping lows. But that's how life is for an idealist, after all. It's either great or terrible or at least the constant struggle against apathy...C'est la vie. feb : life is so good ...so basically, everything is great. just enough, not too much, not going anywhere, all dreams, all play, no reality. i'm in that wonderful limbo in life that only comes around occasionally. it is a limbo where everything here and now is good, everything ahead looks glorious, there are no regrets of th...