Escapism

Just picked up Hemingway, again. Not that I have time, but who can deny this mental vacation:
""The house was built on the highest part of the narrow tongue of land between the harbor and the open sea. It had lasted through three hurricanes and it was built solid as a ship. It was shaded by tall coconut palms that were bent by the trade wind and on the ocean side you could walk out of the door and down the bluff across the white sand and into the Gulf Stream."
- "Islands in the Stream," Ernest Hemingway

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Because it's...

February. Hallmark season. And I'm a sucker for Cole Porter. A new playlist; something old, something new, something lovely for you.

Stunning!

The above is a rendering of the cultural arts center as part of the new cultural district to be built in the UAE's city of Abu Dhabi. It is so awesomely cool it can never be built in the US. Ever. Because we like our buildings clunky and chunky, like our expanding waistline.

Frank Gehry is contributing, and so are several other internationally famous architects. The building above will house a concert hall, some exhibition space, and probably a gift shop or two.
Abu Dhabi is trying to build its tourism industry. I guess if you put bucket loads of money together with the williness to embrace modern design, you get fabulous in return.

[sigh] If I weren't in fear for my life because, well, the whole gay issue, I'd so go there to visit.

A missed diagnosis?

"Come, I want to show you something."

These are the words that I dread, especially since coming from my attending, they usually mean some kind of test. So far, doing rounds in the hospital has been fun because the challenges have been reasonable. Take a history. Conduct a physical. Present findings to the attending. Check, check, and check. I'm beginning to sound like I know what I'm talking about. "CBC creat and BUN are high, but not stable so I'd hesitate to calc a GFR. Crit's high, and she's hypenatremic; I think she' dehydrated. We should watch her drip, and monitor that IV antibiotic dose... "

This case, however, was something else.

"Come on, I want to show you something."
"Okay. Should I grab the chart?"
"No, just come. She' my patient. I want you to do an H&P on her. Right now."
"Right now...in front of you? And everybody else?"
"Yes. You up for it?"
"[me thinking: OMF...shit.] sure!"

Half an hour later, I had no idea what was wrong with her. Imagine my relief when the attending himself admitted he didn't know what was wrong with his patient. Still, it was a peculiar case: young mother comes in with diffuse, non-radiating abdominal pain for past 72 hours. Has not had a bowel movement due to her pain. Urination and urinalysis was normal. Abdominal CT scans were unremarkable. Blood count was normal. Electrolytes were normal. No burst appendix. No signs of appendicitis. Everything was so normal, in fact, that there was nothing we could do but give her a morphine drip for her ever present, ruminating, tear inducing pain.

She was a young, pleasant woman, just delivered twins via C-section four weeks ago. She said everything was fine until 2 nights ago when she woke up with 'extreme abdominal pain'. Apart from the stress of dealing with twins and a five year old daughter, she seemed a happy new mama. My attending was flummoxed. The radiologists who looked at her CT scans were flummoxed. Surgeons were coming in droves to examine her, checking out the C section although her scar was healing nicely. By the time my shift ended, we still didn't know what was wrong with her. The attending promised me he would let me know what happened. And I went home.

It wasn't until I was well on my way that a question I'd brushed aside earlier bubbled up to consciousness: "What was that bruise on her belly?". It was the size of a fist, no evidence of skin break indicating that it mostly likely was a blunt trauma of some kind. But I didn't ask her about it. I don't think my attending asked either. We had noted it on the physical, but both of us ignored the finding and continued to look elsewhere for clues: in her lab results, in her CT, in her history...everywhere but the place that now seemed ripe with clues. Come to think of it, the bruise looked to be about several days old--its edges have begun to heal, but the center was still a deep purple. How could it be that numerous other doctors before me had examined her and not a single one remarked on her charts the patient's explanation for her abdominal bruise? Did all of us forget to ask?

A recent article in the Boston globe criticized doctors for a phenomenon call 'attribution'. It was basically an attack on the way doctors think, the way we are taught to think along the lines of stereotypes, salient classic associations that help us make standard diagnoses but too easily make us miss other important clues. Sure, the bruise could have been nothing. But I doubt anyone of the doctors know for sure. I don't know what happened in this case, but I suspect that had she been black, young and poor as opposed to white, suburban, and well to do, many more doctors would have paid more attention to the orange-size bruise on her belly and asked more questions about the stresses that can wreak havoc on a young family regardless of race or socioeconomic. They would ask if only to rule out a diagnosis of domestic abuse. In retrospect, it could have been the most important question of all.

A question of Faith.

I wrote this letter to Andrew Sullivan recently, regarding a post that was a reader's response to an ongoing dialogue between Andrew Sullivan and Sam Harris, book author, intellectual, atheist. I doubt Andrew sullivan would answer my email, but in any case, my questions were genuine, and so I post them here. You can go here to read the AS post that inspired my response.
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Dear Andrew,

I am an avid reader of your blog. I am also a person of no particular faith tradition, having been raised Buddhist but without parental compulsion to practice it. I, however, have a Catholic boyfriend, and while I do not understand his devotion, I deeply respect it. It is with this general outsider perspective that I feel compelled to respond to several points in the reader's email regarding Sam Harris that you have posted.

Your reader is right. Religious books are not just books. Rather, they seek to offer guidance on how to conduct a virtuous life. They are moral texts. However, this says essentially nothing about their origins. Humans have been writing moral texts about the nature, the mystery, if you will, of life since the beginning of recorded history. Many gods and goddesses have come and go, and we today largely relegate these figures to the realm of myths. What primarily differentiate religious texts from nonreligious ones is a reflexive reliance on the supernatural to lend credence and power to particular moral systems. The question thus remains: why rely on the divine? Is it because the Judeo-Christian's 'God is Truth' as you say, or is it because invoking the divine can do so much: help enforce moral points, assuage human fears of the unknown, provide a sense of collective identity...etc?

One should not doubt the power of these books to change lives, to structure moral behaviors, to beget civilizations. But these are all end products of religion that, again, do not answer Harris' central assertion: Why couldn't it all be bogus? Clever human solutions for human concerns? As your reader claimed, most of us need religion to show us 'proper conduct' based on 'very old traditions'. But if anything, this need lends Harris' suggestion of an earthly origin for all religions even more weight. Just because something is old doesn't make it right or supernatural. If most other 'ways of knowing', to use a Harvard coinage for general education, are undoubtedly products of human curiosity and our desire to understand, why not also religion?

Moreover, to dismiss the charge that writers of religious texts are 'regular guys', as the reader tried to do, is avoiding the issue. While I agree that they are not merely regular guys in the sense that anybody can fill their shoes, the possibility exists for their inspirations to be earthly, not godly. First, the human population bell curve certainly allows for outliers with extraordinary intellects like Newton and Einstein, and religious writers of old are probably of a similar lot. By most accounts, Einstein was not divinely inspired; why couldn't this also be true for religious writers? Second, assuming that religious writers felt ecstatic exhilarations they interpreted as divine inspirations, there is little external proof to let us know that such ecstasy is, indeed, 'of the Spirit'. Essentially, those of us who are not religious must take these writers, and by extension all religious persons, at their word. The question remains to be why, and in today's global climate of competing religious systems all claiming to know Truth while threatening to tear the world apart with ideological differences, can we afford to?

Going back to the practical benefits of religion, I fully empathize with the reader for commenting that nonreligious moral philosophies do not seem to help us navigate everyday life. Ignoring the problem of jargon and non-intuitive, highly abstract arguments commonplace within contemporary philosophical discourse for just a moment, these philosophical models are fundamentally scary for most of us in their general supposition and acceptance that we are free moral agents (to a great extent) without anybody above. By suggesting that human existence stands always at the brink of oblivion--with no afterlife, no external judgments or punishments for virtue or vice at the end of time--the question of why we should lead an ethical life, whatever that means, becomes very troubling. However, it can be simultaneously exhilarating, liberating even. An answer that includes a self-imposed responsibility for decency, kindness, and virtue, irrespective of cosmic rewards, is, at the end of the day, the formation of a personal moral compass and the beginning of an ethical life. While religion may claim this compass to be a gift of 'God', a hypothesis of human origins for such a phenomenon represents, for some, the true ecstasy of existence.


With great respect,
PLN

kewl. the future

bloody

I just devoured a blood orange, and my fingers now smell of citrus. My room wafes scents of citrus too. The rinds are drying in the wastebasket, curling slowly.

So this is boredom.

it's been 2 years

I don't know what to do for our anniversary. We have so little time, he and I, busy with school, not to mention the odd timing. But oh, what I wouldn't give for just 3 days to fly to Bermuda. Sand bars of pink coral, crushed over millions of years into a fine powdery blush. Salty breezes. Emerald waters. We'd rent scooters and zoom up and down Hamilton, maybe head out to St. George's Sound, or just lounge around Coral Beach. Brunch at the Royal Yatch Club. Dinner at the Waterloo.

I know he'd like it. If only we had the time.

Massachusett's heartland

Decisions, decisions. It's about that time of year, the rite of passage: picking medical clerkship schedule. The clerkship is our first real exposure on the wards as clinicians in training, learning trial-by-fire. The school keeps telling us this is the light at the end of the tunnel--only we don't know which end we're about to get. In the midst of cramming for pathophysiology, studying for the USMLE, deciding on clerkship, I am now presented with an additional choice of spending my *entire* third year in Western Massachusetts. The only obvious drawback: it's in Western Massachusetts. Rolling hills of snow. Amber waves of nothingness. Medicine 24/7.

I'm a cityboy, always have been. I like my cafes around the corner, my local grocery pretentious and pricey, and my company queer. This is a big decision. Of course the school knows; that's why it is trying so hard to make the site attractive, promising a dedicated staff to care for the 30 odd medical students all from my school (without the added competition with students from other medical schools that would happen if I were to complete my clerkship in Boston), and brand spanking new facilities with state-of-the-art technology and dedicated teachers. I could pursue 1 uninterrupted year of research on top of my medical clerkship, have a mentor of my choosing, and potentially, get some really nice recommendations out of the experience. To a 'gunner', as we'd like to call those in the medschool class who are always willing to go one step beyond to best the competition, this sounds like a heavenly opportunity. It probably is.

I cannot deny the fact that I can personally benefit from this arrangement. Third year of medical school really boils down to 2 things: getting honors on all clinical rotations and really good recommendations. Since many medical schools stopped recording grades for the first two year of training, residencies can only use three markers to gage candidates: board scores, third year clerkship grades, and letters of recommendations. If I go, I will have a good chance of maximizing my return on 2 of the above criteria, and the one year of research can do nothing but add to my chances of landing a better residency. Somehow, a place at MGH seems more possible, and an eventual life in Boston more certain.

Many of my friends are not considering this option. They say that the 30 that end up at this hospital will be the gunners of the class, thus distilling the competition and raising stress for everyone involved. We are largely stuck with each other the entire year, although everyone will have his own rotation schedule. Relationships will be strained because of the distance. Medicine 24/7 is never healthy. Life sucks out there.

For now, I have not made up my mind. I do like the reduced stress of having everything at one site within 5-10 minutes of where I will live, and having clinicians who will know my name, know my needs, and see me not as another lowly medical student groveling for grades, but one who might actually want to learn something. The site visit next week should give me a better gut feeling for the place. So many of life's major decisions are really based on instinct anyway, why should this be any different? Additionally, I'll see who is actually interested, and if indeed this distillation effect everyone fears is actually happening. Whatever. Bring it on.

Early gaypril

I've had a traumatic holiday season. In lieu of this, and the fact that I will not have a social life for the next six months due to studying for the boards, the music player will now feature really really gay club music, for a very long time. Rock out with your (for some, metaphorical) c%*k out sort of thing. The older playlists are still around, but they will be featured less frequently. You can select for other playlists under the 'user profile' section of the finetune media player.

The new playlist has Cher. What could be better? Oh and, Oxford street refers to Oxford Street, Sydney, where the party never ends. If you're ever in town, do check it out. The drag shows are a hoot!

So queer

So I've been home for a couple of days now, sipping eggnog, eating cookies, watching the Home and Garden TV channel on basic cable. I know what you're thinking...but save it for now. For those who aren't in the know, HGTV is what happens when Martha can't stay up 24 hours a day to entertain you with her table setting skills and home baked Christmas ornament extravaganzas; somebody has to take up the slack. Personally, I alternate between HGTV and Animal Planet to watch monkeys go at it...while reviewing for the USMLE. Isn't life rich?

HGTV has been even more interesting since I last watched TV (about 3 months ago). I don't know who they think their target demographic is, but pairing programming about how to coordinate draperies and wall color with techno beats is just deliciously subversive. So much so that I had to tell myself several times while watching a kitchen redo in an idyllic suburban home that behind the sound stage is not the 'Ramrod' on Oxford Street, and indeed, half-naked go go boys are not about to burst onto the screen to show me how to faux finish my rustic chicken-wire fence.

Are they *that* attuned to the fact that only straight women and gay men watch this channel? And if so, are straight women really enticed by rhythmic techno bass beats and the scintillating repetition of synthesizers? Who the hell cares, I know, but it's quite funny to view even HGTV's more 'manly' shows with hyper-buffed carpenters rebuilding a barn through the lens of a leather bar musical experience. Surely, suburban housewives are getting a kick out of this, even if they don't realize it. And the gays, who can forget the gays...

Cascada and decoupage? What could be better!

Pathological Liars

There are certain kinds of duplicities that I can understand; the closet, for example, is one of them. I've been guilty of this, and while it lasted it was not pretty. Nonetheless, I'm out of it, and am so glad to have done so. Having gone through the process, I empathize with those who come out and feel the need to reinvent themselves, usually in an effort to be more true to who they are on the inside. What I don't understand, though, is the attempt to hide an entire part of one's past in the process of self reinvention. Of course, this is largely futile because the truth always comes out, especially in a closed universe such as college where everyone has overlapping circles of friends.

Aggravating is the fact that the attempt is directed at me. Aside from insulting my intelligence, this person has demonstrated to me that he is immature and idiotic to boot. And to think, I've been nothing but kind and civil in the past. He and I joined the same singing group, but due to circumstances, he didn't have a good time. Regardless, I'd like to think that a mark of maturity is the ability to separate the person from the circumstance and maintain civility. On both counts, he has failed miserably. I suppose I could have seen this coming; I have learned how this man treated other people in the group, acting like a spoiled brat most of the time while lying through his teeth for all of the rest.

The whole world knows this man is gay. I hope he realizes that, and also realizes that no one gives half a rat's ass. Despite this, he tries to hide/deny any association he has had with the singing group or people associated with it in the past, going as far as ignoring facebook-friend requests and casual eye contact on the street. For him to think that he can openly date a good friend of mine now but still carry on ignoring me is rather juvenile. While I can empathize with this man's desire to wipe the plate, hide the skeletons, and paint himself a new gay face, it's stupid to do so by blithely denying any association with people who knew him from before. That's not coming out--that's just fucked up.

Deep down, I fear for my good friend and dread his ability to always find the most duplicitous of drama queens to carry on relationships. This kid, in particular, is just bad news. I don't care how much he wants to reinvent himself; he can dress up shit with nice clothes and mask the stench with perfume, but at the end of the day, it's still shit.

when lecturers try too hard

A recent jewel of usage in my lecture notes reads:
"In contradistinction to the localized forms of scleroderma....etc"

Um, how about 'in contrast to' . I know, it doesn't quite compare to the quasi-intellectual ring of 'contradistinction', but it's a better companion to the rather plebian text, riddled with ill-conceived modifiers and utterly lacking in niceties such as subject-verb agreements. I've been reading too many horrible examples of writing so far in the medical literature. At first, that was funny; now, it's just irritating.

wallet biopsy

So err, I'm very embarassed to admit that I've spent, to date, over 1000 dollars for this USMLE step 1 board exam business. 470 dollars to sign up for the exam, and close to 800 dollars worth of review material. I suppose it is rather sad that one would need to buy comprehensive review books when arguably medical school is supposed to teach all this material in a comprehensive way. However, it is a fact of life that school curricula (specifically at this school) are blissfully ignorant of the type of material and presentation that is on the USMLE. To put it another way, as a friend recently confesses, my knowledge base is more like a disparate series of wooden rafts bound together with twist ties, and life thus far at this medical school has been spent jumping from raft to raft, adequate enough to avoid drowning, but not good as a base for anything substantial. To be fair, many classes here are taught remarkably well and are comprehensive. But it's a pity that those courses are in topics that are considered minor on the USMLE, otherwise know as 'low yield'. The truth is, there is simply too much basic scientific material to be presented, and while a broad knowledge base is the aim, the result is often spotty coverage. To be really thorough, this process of basic science education would probably take 4 years, if not more. The content based exam, alas, tries to ensure some kind of uniformity in medical graduates, and that is a commendable goal. That still doesn't make studying for it any easier. Or cheaper.

some technical stuff

This page is best view with Firefox 6.o. You will need macromedia flash version 8.0 at least to hear the audio player. look in my 'links' section on the right for the download. thanks :)

musical jetset

I'm not sure if anybody actually listens to the music player (to your right, yes right there, you can scroll through it with your mouse--it's like and Ipod shuffle, refresh the page if it doesn't work right or seem to go forward no further), or it's just me, but I rather like my portable music collection. The last one was jazzy, snazzy, and rather classy in a hotel lounge sort of way;) This next one may appear disjointed, but fear not. I sifted through various personally nostalgia-inducing musical numbers out there and have gathered here those that to me carry a sense of place, a kind of mood, a marker for memory. This is my audio eau-de-toilette, if you will, a whiff of songs to remind me of places/events/experiences I've sampled throughout the years. From Tokyo lounge to Shinto shrine, to semi-authentic South African beats reminiscent of morning Safaris, to Fado, to Latin clubs, to Bollywood, to Middle Eastern fusion, to East Asian rock, or to American classics, the music will linger in dainty Paris, get lost in old Indochine, dabble in Tuscan flair, meander through a rainy London, bask in the Bermudan sun, dine in New York, and land at Hollywood's version of Bostonian life.

So go ahead, leave it on like you would a radio station. After about 20 songs or so, it will stop, and just refresh the page and a new set of songs can be played. Have a listen, fast forward through what you don't like, and stay awhile. Happy travels:)

And oh yes, there's Christmas somewhere in the mix. 'Tis the season and all, you know.

Fate? hmmm

I have recently developed a love for boiled cabbages.
Mike should be very happy. This is meant to be.

Think about it;)

Family Matters

I, for one, am happy for Mary Cheney and Heather Poe, her partner of 15 years, who are expecting a baby girl! The 'base' is none too happy about this, of course. They invoke a lot of biology in their pseudointellectual attacks, and since I privy myself a biologist, I figure I'd take a stab at their questions here. A telling excerpt from the social conservative right, and my responses:

"1. How did the exclusive sexual union of these two women bring about this conception?"
It's basically a turkey baster. and a sperm donor. The donor could be unrelated to the couple, or could have come from, in this case, Heather's family, to confer the child with biological relatedness to both Mary Cheney (who is carrying and we are assuming the egg donor) and Heather Poe.

"2. What does it mean, from a biological nature to realize that a man WAS in fact necessary for this conception to take place?"
It means exactly that genes are needed from different sex parents in order for successful conception to take place. By the way, it is stupid to gleam morality tales from biological facts (infanticide is practiced all over the animal world, should we do it too whenever there's a famine?). This fact, in otherwords, is amoral, and dictate nothing about moral behavior, or the moral worth of the child. However, it does say plenty about the deep drive to have children and raise families, regardless of orientation, and the general desire of humans to use technology to overcome biology for human ends. That is significant.

3. What does it mean to the supposed "intimacy" that "two people share" which was intended by the Creator to be a function that creates life, to be forced to include a third party?
Intimacy is relative, and so is religion. As for the third party issue, infertile hetersexual couples are 'forced' to consider this option too if they want to be biologically related to their child. This is part of the human (social/biological/both?) instinct to share genes with one's progeny. Sure, one can argue that this instinct needs to be abolished in contemporary society, and I'd entertain that notion, but for the time being, gay couples and infertile couples have similar biological obstacles, and gut wrenching choices still need to be made.

4. Doesn't it make a rather strong statement that biologically speaking, the sexual union these two women share - is in fact, scientifically speaking - inadequate?
Sure, it does. But our society's treatment of people should not be based on their supposed evolutionary worth. I refer to Hitler and the eugenics movement. To muse on the biological meaning of infertility or sexual orientation or genetic mutants within the human germ line is one thing, but to talk about whether these people deserve their dignity as human beings is an entirely separate, and more relevant, issue. I suggest a reading of the US constitution as a starter.

5. Is it healthy for a society to celebrate inadequate sexual unions that lead to everything except what it was designed to be?
Good question. Is it healthy for a society to at least respect all infertile couples' struggle to follow their instincts to build families, as we have already done for infertile heterosexual couples? Isn't it healthy for society to allow people who have disabilities or genetic defects or anything else that causes them to fall short of biological human 'norms to live free of stigma, prejudice, and discrimination?

6. Knowing from scientific data that children excel best when given the full and natural parental structure of one mother and one father, is it moral to bring a child into such a scenario - purposefully, simply to stroke one's own desire to have a child - sort of like a new handbag, or pair of shoes?
First of all, what data? Second of all, well referenced studies have found that children with 2 gay parents do as well as children in straight 2 parent homes. (see/search Ellen C. Perrin, MD.-Tufts). But the moral question is a different matter; is it 'moral' for children to be raised in 1 parent homes? With their relatives instead of their biological parents? In foster care/adoption? Such a hypothesis of morality ignores and belittles actual human conditions that often fall far short of idealized norms. And yes, having a child should be a purposeful decision; that's not debatable. Finally, is it ever apt to compare the overwhelming biological and social drives to have children with the desire to buy a pair of shoes? Now that is an immoral and incoherent analogy.

Nostalgia: Hiro-o

Finally, the Office of Student Affairs had something I wanted to read. Ignoring the piles of useful but depressing fliers--gems like 'Pass your boards with Kaplan review!’ or 'Join the Army Corp! Free medical tuition!'--as I looked for something to pass the time while the secretary was away, I instinctively grabbed at a sliver of red poking through, finding something most gloriously unexpected. "Study Abroad Opportunities". I flipped through the glossy pages, mumbling to myself happy thoughts about a simpler, more decadent time (read: college). I'm sure something like this had been misplaced. It should be in the Dental school's office, at least these people have time to spare. Whose cruel joke is this, flaunting and taunting med students with words like 'leisure', 'introspection', and 'humanity'?

Whatever. I'll take any bit of escapism I can get. The brochure is pretty standard, offering chances for college credit at Beijing U. or language immersion classes in Florence. Been there. Loved it. Next.

And then I found the ad for Tokyo. The content I skimmed right past, but the pictures--this was my photo montage. There they were: the Hiro-o stop on the Silver line. Japanese schoolgirls in uniform knee-high socks, smiling with funky hair and peace signs posing for the camera. Ropongi at night, with glitzy lights and a million people rushing across its streets. A steaming bowl of Udon. I know, these are all standard commercial images some underpaid intern probably found on the Internet and slapped together for the study-abroad office. Still, they brought back memories of my home stays in Hiro-o, gregarious British and American ex-pats who host us year after year, sponsoring bbq parties at the Harvard Club and black tie events in 100+ degree weather at 99% humidity. I remember the confusion and panic that accompanied the end of every performance, the onslaught of Japanese high school students storming the lobby to purchase our overpriced wares. I tried to answer their questions while furiously scribbling my signature on napkins and shirts and CD jackets, smiling, nodding, posing for pictures, overwhelmed by it all. And then there was Ropongi, the party district, decked out in nightclubs and chocked full of hip harajuku girls ignoring cat calls from what seemed like roving packs of American frat boys, drunk and obnoxious. Giants ads were everywhere: Suntory Whisky, Tom Cruise promoting shampoo, 24 hour game arcades. Jamaican hustlers who lined the sidewalks of Ropongi, greeted all who walked passed them in every language imaginable, beckoning for customers, often succeeding with Americans and fanny pack-wearing Russian tourists. In the middle of all this sensory over- stimulation, quiet moments were rare and special. But they could be found, like the calming sound of trickling water in the gardens of Shinto shrines, so many of them tucked away behind narrow streets around Hiro-o. Beautiful solitary spaces these were, with immaculately kept bonsai landscapes and air that tasted of incense. I miss it all, especially those steaming bowls of Udon with shrimp tempura in rich dark broth, ‘student food’ for 500 yen (5 dollars), dirt cheap compared to any other meal to be had in Tokyo. This city was an amazing, perplexing place.
If only Mike could see it the way I saw it. If only we had the time and money to go. If only...

And so it begins:

The free-fall.
I have to sign up for the step 1 USMLE tomorrow. This is the firstpart of the medical licencing board exams. The exam is in June. My, how time flies.

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