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I have a lot to do. I have some projects to complete, decisions to make. I have to find a job. Decide where to live. What type of job to do. I have an inbox that is always full of crap to deal with. I always have 10-20 more notes to write. I am completely apathetic about the whole thing. All of it. Shrug. Apathy. So naturally, I am trying to self-diagnose my affliction. The most likely diagnosis is depression/anxiety and this makes perfect sense. My abdomen was in such a tangle of horrible - i mean terrible - abdominal pain at the end of my clinic session today that I thought I might have to do the unthinkable…. go to a doctor. I couldn't even stand up straight anymore. But thankfully, I pushed through and did something much more productive and useful… Yoga. Just think, I could be in a CT scanner or under the gooey eyes of an ultrasound probe right now racking up thousands of dollars of expenses. I maybe could have even gotten shot up with some narcs. Thank goodness I know better...

So i'm laying here thinking with my green tea and some music. A familiar pattern.. Having the luxury of time to think happens to me in cycles, as most things do.. I'm off tomorrow. Hallelujah. I have a lot of random and unorganized things on my mind lately, but none have been all that significant or clear, so they have all been limited to my bulging, pester-ridden journal.. The journal that I'm sure would prefer I find better things to do with my time.. Also, as a rule, I have much less time to write about stupid crap in the Winter. I am playing in the snow. Leave a message. I'll call you back when I have time. See you in the Summer. Dear Journal, I am merely writing for courtesy's sake so that you don't feel neglected. But there are things.. Things on my mind. I have a hard time with these moments that make you think, is this really "it"? Is this what my life is? They happen to me all the time. I've thought about this a lot and realize that I and...

Cynics (Κυνικοί, Cynici) were an influential group of philosophers from the ancient school of Cynicism. Their philosophy was that the purpose of life was to live a life of Virtue in agreement with Nature. ...
en.wikipedia.org/wiki/Cynic It is well know that it is intolerable to be around a group of physicians together when you are "an outsider" (someone not in medicine), and we all acknowledge that fact.. I was with a couple tonight while at work who mentioned over our paper-plated "Thanksgiving dinner" they were thankful they are not both in medicine. I agreed with the sentiment immediately. I have never dated someone in medicine and have no intention to ever do so... It is probably nice on some level to have someone who understands your frustrations and feelings and schedule, but at the same time, I do plenty of that work via introspection of myself and chatting with colleagues.. I need to get away from that crap sometimes. In medicine, we often just kind of talk ...

I don't know if I've ever felt quite so lost. I feel like I'm floating in the air and waiting for the plummet, like when cartoon characters run off a cliff... they realize they are going to fall, but it's too late to do anything about it... I've been on this expressway for so long that I don't know how to exit or where I should go, but the road is ending anyway so I either have to exit or drive off of it. One of my major problems, I'm realizing, is that I have spent a lot of time talking about and thinking about my life on some larger and vague esoteric scheme, and a lot less time executing plans. Now that I will theoretically have some flexibility to execute plans, I'm completely paralyzed with fear. Except I don't even know what the fear is all about. Something, no doubt, as chiche and embarrassing as "fear of the unknown." And it isn't like I am afraid of failure, afraid to make the "wrong choice" or do the "wrong ...

I listened to this NPR show about a month ago by a food critic who lost his job and had to go on food stamps. Irony. http://www.npr.org/blogs/talk/2010/06/03/127403480/from-food-critic-to-food-stamps After recently having x2 conversations with very intelligent people who disagree with me about this topic, I think I will write it out. My written words find clarity or ambiguity, and I'd like to know where I stand... I propose a counter to the argument that poor people can only afford to eat cheap crap, and that this is OK because it is easy and cheap and they can't do any better than that.. I think this is a flawed argument for many reasons. #1. crap is crap, no matter what the reason is that you are eating it #2. Eating something because it is cheap and easy is just as easy and cheap as ignoring your general health... pretty expensive. #3. i simply do not believe there is this "great divide" that people talk about in the cost of disgustingly bad food and food...

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5906a1.htm http://www.dopl.utah.gov/licensing/forms/OpioidGuidlines.pdf http://health.utah.gov/prescription/ http://www.cdc.gov/nchs/data/databriefs/db22.pdf Ballantyne, Jane C. MD et al. "Efficacy of Opioids for Chronic Pain: A Review of the Evidence." The Clinical Journal of Pain 2008 Jul-Aug; 24(6) :469-78. Ballantyne, JC et al (2003 Nov). "Opioid therapy for chronic pain." New England Journal of Medicine 2003 Nov 13;349(20):1943-53. Eisenberg, Elon et al (2005 Jun). "Efficacy and Safety of Opioid Agonists in the Treatment of Neuropathic Pain of Nonmalignant Origin. Systematic Review and Meta-analysis of Randomized Controlled Trials." JAMA . 293(24) , 3043-52. Martell, BA (2007 Jan). "Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction." Annals of Internal Medicine. 2007 Jan 16; 146(2) :116-27. -----------------------------------------------...

I think I finally feel compelled to just go ahead and expose and explore the next level of this topic that I am interested in discussing. My disclaimer is that this is an opinion-in-progress for me... A controversial one, and it is not fully developed. Furthermore, by sharing this, I fully recognize that I am opening a topic to a potential audience of every kind of difference in belief systems surrounding this topic, experiences, ideas about what it means, and so forth.. However, that is part of what makes this topic so fascinating to me. Palliative care is fascinating precisely because of that variety of beliefs and opinions. I went to a lecture tonight hosted by a medical association composed of women physicians in Utah. I would argue that this is a very specific and self-selected group.. Still, it was startling to observe the differences in interpretation and opinion that surfaced during the discussion. The lecture was essentially about the topic of palliative sedation in cases...