On the edge of the maelstrom

The historicity of today compels me to at least note that I was aware of events. Today Congress rejected a $700 Billion bailout of the banking industry. I am both secretly pleased that the Bush administration's attempt to once again consolidate power failed, but I am also displeased that the banking industry appears about to slide into the abyss. I have no idea how this is going to affect me personally. If banks are unable to lend each other money, and consequently, lend their customers money, then presumably I might have difficulty in securing loans to live for the next two years. I don't fully understand the interconnections between retail and investment banking, so perhaps teh failure of major investment banks might not be as catastrophic as if the retail banks were failing. At least I have duly noted that on September 29 2008 I was scared as the stock market tumbled.

Becoming a Doctor

We had a lecture on psychological defense mechanisms in PPS a few days ago. Defense mechanisms are ways our psyche uses to cope with an adverse event, for example recieving bad news or coping with an illness. Denial, acceptance, humor, projection, or splitting are all subconcious or concious efforts to transform reality into a more palatable alternative. Dissociation is commonly found in the medical setting, especially in situations wherein the physician's emotions might otherwise compromise judgement; commonly we refer to this as being 'dispassionate' or 'professional.' The separation of emotion from analysis of the present is something we learn very early in medical school. For most, it probably begins with the first dissection in anatomy, where the expectation is that you will not be repulsed by the cadaver, but rather to just begin to treat the cadaver in a 'clinical' way, devoid of emotional overtones. Dissection, for me, was not the watershed event that many first years claim it to be, rather, in my dissociative way, I simply began the dissection. Most medical students I imagine, pretend to a greater degree of dissociation than they truly feel, since somewhere long before medical school we knew that doctors are not emotionally wrapped up in the illness, diagnosis, analysis, or treatment of the patient. The fact that most doctors probably aren't like this is irrelevant; what is important is that medical students think they ought to be dissociative in order to be a 'good' doctor.

I realized the frailty and insincerity of my dissociative defense mechanisms during our lecture on the pathology of head trauma. The lecturer was a forensic pathologist who spoke to us about the various injuries that can occur to the skull and how that injury affects the underlying brain tissue. She explained, with graphic pictures, just what happens when the head is run over by a tire, shot with a high velocity bullet, low velocity bullet, shotgun shell, stabbed, crushed with a hammer, crushed with something blunter, crushed from a low fall, high fall, and many other gruesome injuries. I could barely look at these images when looking up from my notes. The lecturer herself was pretty blasé, which I guess is understandable since this is what she does for a profession. It's curious that we strive to cultivate a degree of dissociation to normalize what would otherwise be repugnant.

The Balloon Glow

The Balloon Glow

Toys

I love our new apartment. We have a lot of space, a beautiful kitchen, and a neighbor who supplies the yard with beautiful flowers! We have been very happy here since we moved in July, and I am getting more in love with my new place as we slowly get it settled and organized. Yesterday, some friends came over and helped me set up our baby's crib and move around furniture in the baby's room (Thanks, Maggie & Bonnie!). Then I spent the morning putting away clothes, blankets and toys, and getting a little more ready for our baby. I think I'm nesting, but I do like how the apartment is turning out.

However, I had an experience today that made me realize how non-child-proof our apartment really is. I had some friends over for lunch today, and as I got ready for them to come, I cleaned and put more things away. I felt great about how organized, clean, and sparse everything looked. I got out some toys and books for the kids, and put on a movie to entertain them. I was feeling very proud of myself, until my friends' sweet little children educated me about what they really like to play with, and that things that we generally don't think of as toys...most definitely are!

My lesson: Kids' favorite toys are not generally the pretty books, wooden blocks, or stuffed animals we usually supply them with. Also, kids usually aren't that entertained (i.e. distracted) by Disney movies. These are the things that are much more fun to play with:
The Piano
Green Magic Markers
Magnets
Simpsons DVDs
Electronics (especially if they are attached to wires)
The Paper Shredder
The Bike Pump (which is more effective when used as a hammer)
Earplugs (the little foam parts apparently taste good, too)
Anything small enough to fit into small hands...which then goes directly into the garbage can.

I guess I'm in for a big surprise when our little boy starts moving around and discovering all of the excellent toys in our house. And to think, all this time, I have been worrying that we don't own enough toys to entertain our child! Apparently, instead of toys, we really need to be investing in child-proofing supplies!

October 1929, part II?

I am not very familiar with the world of international finance. It seems that the nationalization of two major investment firms in as many weeks is not good, though. I think that we might have ringside seats to another economic downturn like our grandparents faced. Hopefully I won't be reduced to selling apples and pencils on wall street. What will happen to medicine if we are faced with another depression? The last time we were in a depression, the Democratic president attempted to revitalize the economy with federal funds injected via public works projects, in the form of the TVA, CCC, and others. What will happen to the plans for centralized health care? Will a left-wing executive nationalize health care in an attempt to cover unemployed persons unable to ensure themselves? Will the government decide such a course of action is too expensive and unsustainable, despite its political popularity? People will always need doctors, for which I am grateful,but who will pay the doctor if nobody can pay for insurance because they're unemployed, or their employer can't afford insurance? During the last depression, health insurance was more or less an oddity. Patients paid their doctors in cash (or favors, or probably even in kind). The health insurance industry is more or less a relic of WWII when companies needed to provide incentives for workers in the presence of wage freezes. I'm probably betraying my profound ignorance of the health care system , so I will ask you, the readers, to post your thoughts and estimates for economic situation. Two of you I know were finance majors, so c'mon, be famous, and comment something constructive.



In other news, I bought a new stethoscope today. It's a Littman Cardiology III, and, as far as I can tell, is very nice. I find it peculiar that we buy expensive equipment before we really have an idea what we're looking for and what our preferences may be. The vendors at the equipment were really hawking their $600 panopthalmoscopes. What medical student has $600 to drop on something that is fastened to the wall of every clinic? Even the navy kids can't afford that kind of stuff.

Medical students are pretty ruthless with their time. Yesterday we had a lecture that was very difficult to follow, both because of the lecturer's accent, and because she chose to lecture at the level appropriate for 9th graders. At halftime, the entire class left, with the exception of about 15 people. Without exaggeration, there were no more than two dozen students left, from about 85 present initially.

Remnants of Hurricane Ike

This is the dregs of Ike as it hit our little home. We're doing ok, and the basement is dry.

Editor's Note: We recieved 5 in (12.8cm) of rain that day.

8 Months Pregnant...

And I feel like this lately:



Who's got the better waddle? The really pregnant lady or the duck? (Clarification Note: I am the really pregnant lady, and I am not in the video.)

Another trip to the ER

I judge people. There, I've said it. Today was day 4 of my shots, only one more round to go. The ER was really busy this morning. No traumas or anything, at least that I know of, just a busy day in the outpatient clinic. Oh wait, I mean ER. I was in the waiting room for about two and half hours to get my shot, which gave me ample time to watch and pass judgement on my fellow patients. The first thing I noticed was that, for the first hour and forty minutes, I was the only white patient there. I don't think there was anything special about that, since previous trips to the ED have shown a more or less balanced racial composition in the waiting room. Ever since our execrable class "Critical Issues in Healthcare", I have been more aware of my own attitudes towards racial issues. I'm from western Oregon, an area of the country which is nearly entirely racially homogenous. Surprisingly, my hometown also prides itself on respecting diversity. I guess that's easy to do when everyone looks like you, the only differences being in which gender you find attractive (your own or the opposite). I wonder how much self proclaimed respect we'd find if Eugene had a region of town like the north end of town here. Would Eugenenians embrace their violent, poor, black brothers as readily as their gay brothers? I doubt it, but I'm an inveterate cynic. I would wager that all the diversity talk would evaporate. Before I left home, I considered myself 'tolerant'. Faced with an opportunity to prove my tolerance, however, I'm rather disappointed with myself. Of course I'm not an overt racist, but I have discovered that outside of the insular homogeneity of my hometown that my attitudes are not quite as magnanimous as they ought to be.

On another note,
Today in the ED we had two sterling examples of people who don't know what the 'E' in ER stands for. One was a white woman who had a laceration on her finger. It was maybe 1cm in length, like you might get slicing an onion. You or I would have probably put a bandaid on it and called everything okay. The next patient was a black lady who had sprained her ankle 4 weeks ago (!) and was coming in for treatment with a loosely wrapped ACE bandage around her lower leg. I'm not sure if she was trying to scam the workman's comp system or what, but I'm pretty sure her case was not in any way emergent. Now, yours truly of course did not have an emergency either, far from it. It happens, however, that the only place you can procure the rabies vaccine happens to be the ER. Consequently, every week, I traipse my healthy little butt down to the ER for a $75 copay and a shot. $375 is what it costs to keep yourself free of rabies 'round these parts.