Blog Reviewing Current Events Already Irrelevant

Justin Timberlake parodies Beyonce on Saturday Night Live while our economy tanks, and I worry about tween girls spraining their ankles. Besides being immediately outdated upon construction, what is the significance of this sentence? Allow me to metaphorize the Perfect Storm at hand.

High Seas

These are hard economic times. Stocks are falling, and women are rising. No, this is not a reference to Hilary Clinton’s rumored nomination as Secretary of State. Women are literally getting taller with the help of a 4-6 inch heel. Through a strange quirk of history the average height of stilettos increases as the economy declines. Don’t believe me? The Early Show would never lie to you*.

The Sou’wester

Who is Sasha Fierce? Turns out she is Beyonce. Like a phoenix from the ashes of Destiny’s Child, Beyonce is re-re-inventing herself for another bid at fame. To mark the occasion she has created an alter ego, signifying that she is both unlike Old Beyonce and a lot like Garth Brooks. She even has a new single, Single Ladies (Put a Ring on It). How very sad; pathetic ev-en. We have seen these stunts before – you weren’t fooling anyone Mr. Hyde – and by now our society surely has too much self-respect be duped again. This will never work out for Beyonce…right??

The Nore’easter

Saturday Night Live is crazy popular right now. This is no shock. SNL, the Daily Show and other late night outfits pay their mortgages during election season. Want to hear what Lorne Michaels has to say about this phenomenon? Pop some Ritalin and watch this Charlie Rose exclusive. If you don’t have a 35 minute attention span, just skip to minutes 27:29 – 29:00. In addition to the common "bump" in viewership every fourth November, this election season was one of those rare times when a politician (Sarah Palin) must compete with her own impersonator (Tina Fey) for attention.

The Lynchpin

The election is won, the winds of Change are sweeping through a very cold November, and SNL needs desperately to give me a reason to show up to church underslept. This brings me to Justin Timberlake, the center of it all. His Saturday walk-on performance was an instant hit, the likes of which we have not seen since…his last performance on Saturday Night Live**. Last week’s show saw Justin clad in a black leotard and heels, pretending to be a back-up dancer for the musical guest of the night. Beyonce Knowles, enter stage right*.

The skit went viral immediately – your coworker probably showed you the video on Monday morning – despite early attempts by NBC to litigate into submission every Youtuber who posted the video. But the aggregate will of Youtube is too great, and conspiracy theories were starting to make their way around the inter-nets. Or perhaps NBC and Justin struck a deal. The video remains on Youtube in some form, but chances are that my video embed* won’t work an hour after I post it. So like moths to the flame we are drawn first to the parody video, then to the real music video, and lastly to imitate what we see.

Step One: Watch the SNL video

Step Two: Watch the real music video in awe as Beyonce defies physics in 6 inch heels***. My point is illustrated by minute 1:28 to 1:40.

Step Three: Make her open the box. Woops! Wrong video**.

The Victims

Won’ someone please think of the children?! More specifically, I am worried about our newest little demographic, the tweens (preadolescents). Looking into the future, the headlines clearly read Girls in Mom's Heels Emulate Beyonce, Visit Hospital. These (hypothetical) tragedies are the consequence of colliding pop culture forces – the newest fad, hit single desperation, Justin’s mastery of the viral video, and a tween market share that will consume anything pop culture feeds it. Pity and ace bandages for all.

Conclusion

You have likely invested half an hour of your life consuming a blog rife with embedded videos, wikipedia references, pop culture buzzwords, misused punctuation, pompous**** vocabulary and occasional nonwords. You may feel a little emptier and a little older for reading it, and you are certainly no better off. But you were entertained.

To anyone who reads this, I represent only my own twisted viewpoint. If you are offended, please don't sue me.

* If the videos don’t work,

google: “hard times, high heels” video for The Early Show

google: "Gov. Palin Cold Open" for Sarah Palin on SNL

google: beyonce timberlake youtube for the viral video

** Too raunchy for Mom & Dad, but every college student in the U.S. remembers D!$% in a Box.

*** She hates physics too, dear.

**** I had to look up “pompous” while writing to ensure I was using it correctly. I have a problem, and admitting that is the first step to getting better.

Wordfind! How many Pop Culture words can you find? Famous names count too!

A Most Satisfying Burger

In the hopes of embracing more vegetables into my diet, I've been trying to cook something new once a week. I've tried out the whole recipe based cooking approach - the socially accepted way of cooking - but have often been sucked into a more "exploratory" approach to cooking:

Get a mind's eye picture of what I want, by

• Researching a couple of recipes for some dish and extracting an idea of a basic method;
• Recalling something I liked at a restaurant, and mentally reverse engineering it;
• "feeling like" eggs, or something sweet, or a burger (see below);

Take inventory...change plan

• "Man, I really need to get rid of those ________. I should use them too."
  
• "Mmm I want those leftovers too, somehow."
• "Oh no, I don't actually have (key ingredient)... ah well, I'll try it anyway!"

Get cookin' (Go go go!; salt, salt salt!; stir, stir, stir!; don't burn!)

Smell...think...review plan

• "OMG, I am so* gourmet!" Finish cooking, savor the dinner slowly, and contemplate future fame and fortune as a chef.
• "burnt / gross / dried out!" Feed the garbage disposal and curse into my cereal bowl.
  
• (Most common) Impulsively take the dish in a completely different direction, often with surprising success; this is followed by one of the options above.

So, I was feeling like a burger today when I saw this guy top a fried egg with chili for breakfast on TV. I remembered the "Gus Burger" from med school - a burger famous for being topped with an over-easy egg**- and decided that what I really wanted was a burger with a fried egg on it.

I fired up the stove (small skillet, med/med-high) and started emptying the fridge, collecting an egg, the last tomato of the season (sliced thick), a burger from last night, (should have gotten some cheese), pickles, ketchup, and mustard.

I fried*** the egg (over hard) first, then the tomato slices,**** adding salt and a dash of tabasco, and nuked the burger. I toasted the bun, assembled the burger, said "OMG I am so gourmet," and savored my success while I watched college football.

It has been a good Saturday.




*This italicized emphasis brought to you care of an in-depth discussion I had with an unnamed loved one regarding what my writing style is and what it is *not*.
** fun fact: also famous for being consumed at 2am by drunken undergraduates; this of course did not include me. I took the high road...to Pita Pit.
***I used butter, so I think I actually sauteed it. This smelled so good my knees got weak...
****Move 'em often, cuz tomatoes tend to stick to the pan and generally fall apart when I cook them this way

Tuckered Out

We've been travelling by car way too much recently. Euclid - I'm proud to brag - has done wonderfully as a passenger... no whining or "accidents." This picture encapsulates how Euclid, Katie and I all feel right now.


While I am too emotionally detached to sing the following to him directly, the picture reminds me of a lullaby I've always liked, "Godspeed" by the Dixie Chicks*.


Sweet Dreams, Math Man.


*If you look it up on YouTube though, you get to witness an interesting juxtaposition of sweet and soulful vocals (kind to the ear) against a punk rock-ified Dixie Chicks (harsh on the eyes). I will not give this video tacit approval by linking to it though.

Our Little Bundle of Joy...and Work

“Oh my GOD! He is so CUTE! What kind of dog is he? (Long-haired Chihuahua) Oh my GOD!! You know Chihuahuas always looked weird to me, but this little man is just DARLING! He just looks like a normal dog, only tiny and SO CUTE!!* Can I pet him? You are just SO CUTE! Yes you are! Yes you are! My widdlepuppywoogiewibble…it then decomposes into “Not English.”

This is how many people react our new puppy, Euclid. Those who know Katie and me are probably not surprised at the nerdiness of our name choice. I personally love the sound of the name, and that it is so very nerdy. As the above paragraph reveals, Euclid is a very charming puppy.

In fact, our walks are regularly interrupted by eager children and adults who want to fawn over him. Even people in stopped cars will melt at the sight of him. I occasionally see a silent “…so CUTE!” through a car window. Nobody can resist.

And Who can blame them? With his big eyes, tiny body, and hilarious way of bounding through grass, he is the puppy-est of puppies. In fact, he is currently trying to use his wiles to con me into to playing with him instead of blogging about him. Must…fight…adorableness!

Once upon a time, when I lived with my brother and sister-in-law and their 1 year old daughter, I learned a major theme in child rearing: They always need you. If you take time to do anything for yourself, you’re momentarily fulfilling your own needs at the expense of fulfilling theirs (with resulting guilt). Kids rule the lives of their parents, and it baffles me how parents keep sane. Seriously, Steve and Lara. You guys are amazing.

Raising Euclid has the same theme to a much lesser degree. Many of the things I do to Euclid would qualify as child abuse, i.e. having him sleep in a cage twice the size of his body, having him poop on a pad on the floor, and anything involving a leash. But many things are similar. I am always fretting about if he’s fed, watered, if he peed or pooped, if he’s tired, if he has toys, and most of all how to keep him out of trouble. I look for him every 30 seconds. I feel best if he’s nearby, so I know he’s okay. And most parental of all, I cherish the moments he is asleep, and when he is I creep around like a cat burglar to keep from waking him.**

Having a puppy is a lot of work and also a lot of responsibility. Everything we do now will shape little Math Man's future***. Fingers crossed we raise him right.

P.S. As any proud parent or puppy owner must do, I will continue to flood my blog with pictures of the little critter, and you will swoon.

*At this point a small squeal exits their mouth and, were they a dog, they’d be wetting the carpet.

** This is practically impossible, since Euclid’s ears are half his body weight and he can hear a pin drop 20 miles away.

***Math Man is my favorite nickname ever, and was thought up by Katie's roomate, Kelly.

I'm a year older, and my car is getting the presents

Prologue
Ever so observant of my car's condition, I have recently been obsessing that my brakes are wearing thin. I didn't hear the "familiar horrifying screech" that most often accompanies this milestone (a purposely engineered sound), but some brake pads don't have warning; they just start to grind. Every once in a while I would brake at low speeds and I could swear it was a-grindin'. My baby is in trouble! I immediately sought a diagnosis from my trusted mechanic and spared no expense*

.... yeah, right! If that had happened, there would be no story. I had final exams to worry about and no money, so I waited for a couple months until I had some free time** and found a sweet coupon for a free tire rotation and brake inspection (cue Jaws music here). I knew what I was entering into, I knew the risks (mechanic must make money for service), I did it anyway. Of course they thought the brakes had to be replaced AND they still had my car up on blocks (a nice bargaining chip on their part) so as to quickly and efficiently perform said service for me... to the tune of $265.71.

I don't care where you are from, that is insanity for a brake job. I looked at the estimate, and surmised (from my limited knowledge of brake repair) that there were some over-estimated parts costs (4 disc brake shoes don't cost $86, they cost half that) and some services that may be useful but may not be necessary. I was trapped. I 'fessed up: "I don't have that money, so you gotta give me 2 weeks" ... the mechanic looked worried, but said he thought my brakes could hold out that long. 15 minutes later I was riding home, feeling defeated. Then my car started squeaking, in that familiar horrifying screech-y way...how very convenient for the mechanic***

The Decision
I woke up on Wednesday feeling tricked and upset. Its my birthday, and Mr. Badwrench will not take this day from me. I ate my cereal and resolved to do the right thing. I would take my car to my trusted mechanic (Evans Auto), and explain the situation. He would pity me and make it right, for a reasonable fee.

But I didn't do that... for reasons I do not fully understand, and reasons I'm sure have nothing to do with logic. Instead, I started surfing the inter-nets, looking at brake pad prices ($30 - $40 for my car) and do it yourself testimonials. I looked again at my estimate and my blood boiled. This is way too much to pay! Other people do this themselves for pennies! I'm smart; why can't I do it too? I will not be taken advantage of; I will exact revenge by doing the opposite! I can do it! I felt capable and happy. I also had something to do today****

Preparation
I coached myself all the way to the brake supply, not wanting to reveal myself for what I actually was, a newbie with a socket set and a chip on my shoulder. Bought brakes, saved money, didn't look like a fool, and I was riding home, feeling great! Next stop, my local public library...

My older brother taught me many things*****, one of the most important of these I learned when I was an adult. When faced with a do-it-yourself task that you have no business performing, decades of training and experience can be replaced by a book spree at the library. Steve would often opt for checking out 8-16 inches of books (imagine them laying flat on the table, one on top of the other); and so would I. This fundamentally appeals to me, being able to "become a mechanic" through the might of my intellect and my ability to sit still enough to read large volumes of information for long periods of time. I left the library feeling I had already made this fool-hearty decision pay off, because if nothing else I would understand brakes much better and knowledge IS power.

(a great way to spend a Sunday evening: go to youtube, and enter "Schoolhouse Rock" under the search term. You're welcome)

Oh...crap
Putting a perfect plan into action in an imperfect world works out to be a cycle of euphoria, panic, self-loathing, and resolution.

Euphoria: I got my tire off, my brake caliper open, and I replaced the first set of brake pads in record time. This is a "happy time." See below for the new to old comparison. Technically I had more life left in these pads, but "some how" the one indicator managed to be squeaking...grrr, those filthy bad untrustworthy... I should have gone to my mechanic.


Panic: I am closing up the caliper, and tightening the last bolt (set human "torque wrench" to 80 ft-lbs). Just a little tighter, pause, maybe just a little tighter, pause, just one more *bam* the tension from the bolt gives way, as the overtightened bolt begins to shear apart -

- a torque wrench is specially designed to release tension at a given torque, protecting a bolt from an overzealous bolt tightener. This tool, $50 at your local hardware store, was specifically called for in the instructions. I disregarded these instructions and relied foolishly on my own discretion -

- at the exact moment the bolt began to shear, a wave of nausea rose from my stomach. In that split second, I was immediately aware that I had doubled my costs, and had firmly established myself as the foolish do-it-yourself moron.

Self-loathing: This is the worst part of doing something yourself. This is why you pay someone else to do something for you. And for me, this is a time when I realize that my dream of assimilating years of experience through a couple books is not possible, it is arrogance. The only antidote to arrogance is painful, costly, and embarrassing experience.

Resolution: For those seeking spiritual enlightenment, humility must be learned at some point. Humility is most effectively taught at the counter of NAPA auto parts. My one bolt cost around $16, and came with three parts I didn't need. Why? Well, they don't make very many of them, because they are rarely purchased by professionals who read and follow directions!!! I consider this to be a form of taxation. Wanna do something vastly beyond your skillset? Feel free! But please be prepared to pay "fools tax" for every stupid mistake you make. Add the $50 torque wrench - because Mark learns from his mistakes - and I was ready for a quick end to to misery.

The bolt replaced nicely, and I finished the second side with only one problem; the one bolt I had sheared on the left wheel wouldn't loosen on the right wheel. I sheared my sockets this time, and used half a bottle of penetrating oil trying to loosen the bugger. Then...finally...it was over.

Epilogue
I ended up spending $40 for replacement pads and brake grease, $50 for a new torque wrench, and $16 for my replacement bolt - well under the estimate from the bad mechanic, but nearing the ballpark of my trusted mechanic's usual fees (for work done on other cars). I don't have much interest in doing another brake job, but I'm glad I did this one.

Emotionally, it was a roller coaster, but I grew from it and learned that the trusted mechanic should be a first choice, not a last resort. I also learned a ton about brakes and my car. I now feel closer to my hunk of metal, plastic, and rubber. Oddly, my mistake-ridden success has left me feeling more confident as a handyman, if for the one reason that I would know next time how to do a proper job. This is how I often feel at the end of such projects: relief, humility, a touch of fear, and more confidence in myself.

And fatigue.

*Do what I say and not what I do. Find a good mechanic and show him/her some love (money).
**read: I'm between schools (summer break?) and unemployed. I have much free time.
***conspiracy theory 1: the jerk used his vise-grip to "help" the warning strip into a place he felt more accurately indicated when I should replace my brakes.
****I'm juggling applications too, but really I just apply, call-back, and wait. I need a diversion from the anxiety and self-hatred that is job hunting
*****One of these life lessons was that older siblings may pin younger siblings to the ground, lick their faces, and let the saliva dry (yes, it was disgusting) as part of their birthright.

"Statement as of 2:49 AM EST on December 05, 2007
... Snow Advisory now in effect from 8 am this morning to 8 PM EST
this evening...

Low pressure over the Midwest early this morning will move south
of the mid Atlantic this afternoon and evening. Light snow is
expected to develop across the area between 8 am and 10 am. The
snow may intensify for a period during the afternoon... before
ending this evening. 1 to 2 inches of snow is expected... except
perhaps locally higher amounts across central Virginia near the
Charlottesville area.

A Snow Advisory means that periods of snow will cause primarily
travel difficulties. Be prepared for snow covered roads and
limited visibilities... and use caution while driving."

Schools are on delay and could cancel classes. People are ffrrrrrreaking out over 1-2 inches of snow. Stock up on your essentials; we're going into the bombshelter until this whole thing blows over.

Thanksgiving in Iowa

This Thanksgiving, Katie and I visited her brother's family...in Iowa. Since he is a pastor out in the boonies, he can't leave his church during all the significant holidays, when I have time off school, so this was the first chance we had to meet. It was fantastic. We ate, sat around, watched football, and shopped from 12 midnight to 1:30 am on "Friday morning" (late Thursday night). But the most fun was playing with Evelyn (older) and Anna (younger), Katie's nieces. Hilarious pictures ensue:

The costumes were a "Christmas present" from Aunt Gretchen (Katie's sister). Katie shot 178 photos while they yelled "cheese", occasionally got fussy, and pulled on their antennae. It was chaos...but it paid off.


Anna taking a walk in my shoes:

Evelyn and Katie reading a book:

Danny (Katie's brother) and I wanted to try out the costumes. For the sake of sensitive stomachs, I am omitting the picture of Danny in the full get-up*. The costume didn't survive...


Thanksgiving was a great chance to be normal for a second; to be a way from the feeling that I really should be studying instead of _______. Now that I'm back, I realize the difference between school-time and break-time. I can get through the next four weeks, but I really can't wait for Christmas!

*For the record, that photo doesn't physically exist. Yet the image haunts you still! mwahahaha!

Fun at Language School!

Horseback Riding!













Holding Parrots!














Culturally sensitive, sustainable micro-enterprise!












Getting sacrificed!

A history book made of stairs!

















The temple I was sacrificed on!
















Katie can make rocks smile!

Dancing Jaguars! (its really a carving of a dancing jaguar)

The Kids

The easiest people to connect to are naturally the kids. We liked photographing, they liked posing then checking the camera to see how it turned out. For those who are confused, yes 98% of the Honduran population is mestizo. We did a service project on the North Coast though, and met alot of African descent Hondurans (Garifuna). It happened to be my favorite place, so there are more photos from there.

The People We Worked With

There once was a group of American students who wanted to see what being a missionary was like (see left). Katie and Callie were the leaders (black and yellow shirts next to each other).









There once was another group of Latin American students who were learning how to be pastors and missionaries (see left). The Latin American and American groups got sent out to very interesting and unusual places together. They had to learn alot about their teammates' very different cultures.

This is Matt, my friend from the American group.
















This is part of the family we stayed with when we were in language school. Katie, Callie, Matt and i went to language school together.












Katie, Callie, and one of the missionaries' daughters. She was adorable, and liked building dams in the river with me.

Honduras Pictures: Pretty Pics

First, these are some pictures for setting.



Canchias: the compound where we stayed most of the time











Mountains near Canchias

Copan Ruinas: tourist town where we went to language school

Copan: see the little moto-taxi? They're about 4ft tall. I had to constantly fight the temptation to just push one over
















The North Coast: for one reason or another we ended up on the coast a few times. This time it was for fun on the beach!

The Comedians reborn

This is a post I started in Honduras, but didn't have the internet connectivity to finish:

The Comedians, Graham Greene (1966)


The moment I walked in I was transported to another time and place, another life all together. I had walked out of a land of poverty, desperation, and chaos. I world of a different culture and language.

The restaurant was dim and candlelit, with a couple raucous Americans who, in my judgment, were a little too old to be drinking as much as they were. They had worn faces, deep smiles, and rosey noses. I felt a tension - unspoken but palpable, like someone is going to burst out with it at any moment - between the bar and the door to the outside...

Two worlds: the dirty, dusty, poor reality of present-day Honduras just beyond the threshold. Inside, an overly friendly college girl from the South - her dad owns the big house across the valley ... the only one you can see from here - and her dad's friend who's job is to look after her. He's a writer of novels, a thirsty one at that, but seems to find talking about his latest work to be less interesting than the lady next to him. His charge is overly interested in what we're doing in Honduras and whatever my friend is talking to her at the present.

There is not much more to the story beyond setting the scene. It is more of a portrait than a storyline. But it still strikes me how hard the place was trying to be American, and yet how out of place I felt when I was there.

News from the Mayan Ruins

Day 14: I hacked my way through dense forest to barter beads and bits of string with the savages in return for high-speed internet access. Four young boys ride stationary bicycles to power my laptop and accompanying wireless router.

Okay, its not like that at all. In fact, I am way too spoiled right now. To review the last few weeks: I first arrived June 17th, and during the following week I worked with a group of ~20 of Katie's church friends. We built three small homes for widows and especially needy families in a village about an hour away from where we are staying. For those of you following along with google world, it is nearby Lake Yojoa, the largest lake in Honduras.

The compound where we stay is quite rural. The nearest internet or telephone is at least 30 minutes away by car. Since our group is transported to and from the compound by cattle truck (its everything you imagine), for group members connection to the United States is nonexistent. The Honduran staff generally live in San Isidro (the nearest town, with internet) and have cell phones, so the disconnection is more of an intentional thing...like summer camp. That being said, it is a good thing.

So the first week was building houses, getting to know the Heart to Honduras staff, and trying to get my project off the ground - I got three interviews done, which is fantastic! At the end of the first week, the team returned to Ohio and left the Group of Four: my Katie, two other 20-somethings, and me. The four of us will be in Honduras for the rest of the summer, and our first order of business was to improve our Spanish - we left for language school in Copan Ruinas last Sunday.

this is where I get to the "spoiled" I live with one of the more upper class families in the town, and attend language school for four hours a day. While internet used to cost about $1/hour at the nearby internet cafe, I found out two days ago that my host family actually has a wireless router, which the father gladly hooked up (I don't speak enough spanish to understand why it wasn't hooke dup to begin with) leaving me with constant access to high speed internet...I am like a binging heroin addict fresh out of a week of rehab. I know I only have my drug for five more days before I have to go back underground for about 4 weeks. Just one more email before I quit...

One Liner

The reason you can't tell bleu cheese has gone bad is that it already has.

Headed South for the Summer...No, farther south

Observe to the right: a country I have never seen the inside of...yet. Honduras is a small Central American country with...people...and health needs...and other things.

That's about the extent of my expertise. But I want to know MORE, so I'm headed to Honduras for the summer - as our prof's have been reminding us, the last summer break we'll ever have...ever. Its like they want us to act out and "live" one last time before we're forced into the shackles of labor and debt for the rest of our lives. Cheery bunch.

"I'm going to Honduras" makes it sound like I woke up today and decided to spend six in a half weeks in the most rural part of a faraway culture I could find. In fact, I have had to fight long and hard to get people to let me, and in some cases give me money to, haul off to Honduras for the summer. I am doing a research project for my University and for an NGO that does short-term medical mission trips (among a host of other things) in Honduras. The study is simple in design - ask people about the health of four nearby villages, then talk to people about how the NGO and other health providers can improve their situation.

That being said, I have been leg-working, glad-handing, and application/protocol/grant-writing myself stupid to get from idea to reality.* You know, the hardest thing is to have any credibility whatsoever when the people you're working with are mentally comparing me with their college-age son. I'm twenty four (though I do in fact look fifteen), so when am I allowed to come and talk at the "adults table"?

So, all venting aside things are moving. Wheels are turning. I'm set to leave on June 17th, and I've got a bunch left to do, but it seems like I might just be able to still pull off four meetings -two of which are 6 hours away - move out of my house, oh and of course pass some pesky second year medicine exams (yikes!). This thing can happen!

More to come.


*Shout out to my Katie: Without her, I would never have gotten even halfway to Honduras. She makes my dreams a reality....<>

Maybe our Blogs Acutally Mean Something

My family, mostly on my mom's side, likes to take photographs. Lots of photographs. So many that I find many memories of my childhood are shaped and influenced more by the photos than by the true memories,
i.e. "camping" every summer at the cabins at Mohican: I can independently "picture" only two memories from our yearly visits there, but I can remember scores of pictures taken of the family floating in inner-tubes down the river, us kids playing in the tubes on land, and our then goofy looking parents talking, resting on hammocks...usual summer stuff.
So much of our family's history is told by photographs and the stories told while pouring over the photographs together.

This year Katie and I visited my extended family for Easter. In addition to the standard food, lounging, and discussion, there were photo albums and stories (mostly of an awkward childhood Mark). The most meaningful moment that night was when we went through an old scrapbook - long before my time - of my grandparents' marriage and honeymoon. They were younger than Katie and me (!), but getting married at that age was fairly common in early Colonial times (sorry Grandpa/ma, I just couldn't resist). We found a letter my Grandma wrote to her friend detailing their honeymoon - a roadtrip to New York State.

There are a few perfect moments in your life that can never be planned or re-created, and often we only understand after the fact. This was one of only a handful I've ever had.

Katie was reading the letter out loud for my cousin and me who were looking at other albums, scouting out more embarrassing childhood photos of each other. Gradually all of the conversations around us quieted, and faded out. Katie was now telling the story of our family's genesis to our whole family. As she read, we lived vicariously through the first of our grandparents' many travels. We drank in every detail as two fresh young newlyweds - barely grown farm-kids - got soaked on the maid of the mist, got lost in the foreign countryside of New York, navigated through terrifying traffic in NYC, and even got in an accident delaying them in Pittsburgh. Out of that letter came a side of my grandparents I had never seen before that moment. I learned alot about them, and grew to love them even more as I imagined them as newlyweds, young adults, my peers.

It was such a powerful moment that I got to thinking about family history in general. My siblings and I all keep blogs. Steve and Lara write about the trials and joys of bringing two beautiful children into the world. Rachel and Andrew are living their lifelong dream of biking up the West Coast and across the U.S. together, living out of a pup tent. I'm writing stories late at night just to keep myself from going crazy studying. Right now, we're writing to our family and friends, and to deal with the everyday. But maybe these blogs will become more. Maybe these blogs will be to our kids/grandkids what photo albums and old letters were to me. Someday 60 years from now, a family yet unborn might hush and listen together as someone reads my history back to me, learning about a Grandpa Mark they'd never known before.


Hopefully they'll skip my rant about cinnamon.

Esophageal Cancer

The phrase immediately makes me uneasy, as my thoughts gravitate to my first "patient", Mrs. B.

I was a ball of nerves, as I always am before doing something for the first time. But when I walked in I had gathered myself and I was all smiles. Other than some ugly tubes coming out of her neck, she was a calming presence. White hair slightly matted by days in a hospital bed, skin worn by hard work and a nasty cigarette habit, she looked frail. But she came alive when she saw me, the power of her spirit seemingly transforming her. We hit it off immediately, and talked like old friends about what had brought her to the hospital, and all the details of her harrowing past year.

It started with trouble swallowing. Food and eventually some liquids would just "stick" in her throat, and she wouldn't be able to swallow them. It started gradually, but after a couple weeks she knew this was no fluke. Something was seriously wrong.

The rest of the year was test after test, and liquid nutrition drinks - the only thing keeping her from wasting away - then the treatment (radiation+chemo). At first it wasn't too bad, but her long course of treatment quickly drained what little life she was pulling out of her Ensure cans. During the interview she made it clear she never wanted to go through that again. One more test. The tumor is still there, but smaller....a good sign.

Fours days after a complicated surgery and recovery, she was feeling great, swallowing most liquids and preparing to leave. i was smiling too. My first patient, an affable lady with a coherent story of her illness (most patients benefit from a little guidance I am learning), was a cancer survivor. How wonderful!

I proudly presented my ideal first patient - my success story - to the group. The attending gently but pointedly asked the group what we knew about esophageal cancer (nothing).

As I researched her illness that night, pride gave way to the icy truth. Esophageal cancer progresses especially quickly and silently, easily passing into nearby tissues and taking up residence in distant lymph nodes - gathering strength off the oblivious patient. By the time symptoms arise, most esophageal cancers have progressed substantially, resulting in an overall 5-year survival rate of only 10% - nine out of ten patients die within five years, treated or no.

Mrs. B was dying in front of my eyes, passing from living breathing companion to a ghost. My research for the following session became a form of grieving...figuring out what could be done, and what her chances really were. I was fighting - if only metaphorically - for a breakthrough to "save" her.

True, all of this was mental exercise, dealing with the newfound possibility of patients dying. I was supposed to be practicing the medical interview. I have years until I actually provide medical care to anyone. But it became real when I learned her story and took on her struggle.

I still think of her sometimes when I'm trying to sleep...never certain of whether I am recalling a survival story or a eulogy.

On the Horizon: MicroPractices

The good Doctor (Charles) says it best.....Click me!

The idea is that doctors use technology and unique business models to keep their costs super-low. This allows them to see fewer people per days -----thus see people for longer than, say, 10 minutes per visit.

A round of emails passed through the med school a couple months ago. Its very interesting stuff for most docs who - just like their patients - are really frustrated with the current doctor-patient relationship.

An article in USAToday...
and one in the Wall Street Journal (via DrCharles)....

This is something that makes me excited about medicine in my time. Yeah, yeah healthcare is broken and it'll only be worse in "my day". But unique and innovative approaches are going to turn medicine on its face, and maybe even "fix" healthcare in the process.

Playing Doctor

I gotta tell ya, I looked the part: dress clothes - no tie for hygiene and a little for rebellion (my dad understands); and white coat - pockets filled with instruments, reflex hammer, tuning forks, and whatever other crap might make me look legit.

Now I had to play the part: this was my first "solo flight" into a complete medical history and physical exam. We've been doing histories for months now, and I feel pretty comfortable with asking open-ended questions, letting the patient tell their story until they stop or their story starts "swerving around", asking some follow-ups or retelling the story as I know it, and being generally charming - side note: old people coincidentally LOVE me.

But today I have to poke, drum on, listen to, and occasionally whack (CVA tenderness) someone in just the right way, step back and look thoughtful, then do it some more. And further, my first time is on a fourth year med student, assigned to (quite convincingly) play a guy who has knee pain. He knows when I don't know what I'm doing.

"Where's it hurt, when, how bad, whens it worse or better, and who are you having sex with?" Of course that's not the exact progression! But it turns out, that last question was key...the kid had the Clap! (gonorrhea). For good form I did every exam there was - its supposed to be a learning exercise for me - but I saved the best for last, yanking back and forth on his knee while he winced and sighed. This guys was good at making me feel like a monster for hurting him, but that's part of the MD stamp I guess.

It was all completely pretend, and at times we'd break role and talk about techniques etc, but for about an hour it felt quite real. I felt both knowledgeable and like a complete fraud simultaneously. Afterwards I was completely drained. How am I going to do this every day, all the time?

The more I reflect on the experiences related to my professional development class (learning histories and physicals), the more I feel exactly the opposite from the above paragraph though. Only months ago, I was completely oblivious to the intricate art of Doctoring....how exacting the interaction is, extracting clues from the words a patient uses to describe their symptoms, and the subtle signs their bodies give up to betray the disease within. I feel like Encyclopedia Brown, my childhood hero.

I had a talk with a family doc at my church about the actual use of history and physical exam in diagnosing disease in these days of billions of lab tests and imaging techniques (ie x-rays, CT, MRI). While "seeing" the problem physically (imaging) or chemically (labs) appeals in its simplicity and covering your @$ from getting sued, what is truly gained other than a much larger doctor's bill?....seriously, that stuff is pricey.

Maybe talking to your doctor and having him drum on your liver is old-fashioned. Now are the days of full-body MRI's and Comprehensive Metabolic Panels.

The Long Version

Through one of the blogs I stalk, er I mean monitor I found Eschara, a website dedicated to scars and the stories they tell. I have been aching to tell my scar-story ever since. I submitted a contribution, but the 100 word limit for Eschara just wasn't enough to tell the story properly, so here's the long version:

I was an overcurious six year old. I had explored the chicken house many times before, so my grandpa allowed me out of his sight while he collected eggs.

I don't remember much of the incident, or what compelled me to stick my hand in between the gears of that auger, but I remember the cold terror of realizing I was in real trouble. He ran as fast as he could when I screamed, but the machine was closing in on my wrist before he could shut it off.

Tears come to my eyes just trying to imagine the horror he swallowed as he worked my mangled hand back through the auger, replaying the injury in reverse. The surgeons said I would have lost my hand if it had gone 2cm further. Instead, my hand is fully functional. My grandpa saved my hand, but I don't think he ever forgave himself for not watching me closer.

I started 1st grade markedly different from everyone around me. Everyone wanted to see what had overtaken my hand, but - like most 1st graders – they were unable to politely mask their horror when they saw what was left. I sometimes felt like the Phantom of the Opera, sometimes hiding my deformity, other times defiantly thrusting it forward, daring you to be disgusted by it.

When meeting new people, I always silently wonder how long it will be until I hear the familiar “Whoa, what happened to your hand?” and I launch into my well-rehearsed description of what happened. Most people tend to glaze over after “childhood farm accident”. So sometimes I lie first, and tell a story about feeding alligators in the Everglades – I always add the detail that alligators love marshmallows, and that seems to convince people I’m telling the truth. I then tell them the real story, but rarely the whole story.

My hand tells a story of a childhood wrought with injury and recklessness, but also of self-consciousness. My scar is smaller and faded now, and perhaps someday it will be barely visible. Although I will never look at it as a thing of beauty, the idea of losing it makes me strangely sad. I always hoped that somehow it might bring me closer to patients who struggle with their own deformity – making me a better doctor. Then again, maybe it will just scare children.