La Cucina Povera Pt 2

This is what I ended up doing

I call it 'Box wine & Morel Ribollita alla Genovese'

rehydrating the dried morels in box wine with a bit of smoked green tea leaves thrown in
taking more of the tea leaves, plus whole peppercorns from the hand mill, powderized in the coffee grinder
spice powder added to smoked paprika, mixed with flour
dredged the morels in the spiced flour, reserved soaking liquid
pan fry the shrooms in olive oil - when browned, remove to paper towel
mix shredded carrots with honey, some of the soaking liquid, garlic paste, and bit of balsamic vin.
sweat the carrot mixture in the oil
add chopped baby carrots, then crushed tomatoes, cover with chicken stock
simmer until carrots soft
add macaroni sans cheese powder
simmer until cooked through
thickened with cubes of stale hotdog bun

meanwhile

reduced remainder of mushroom soak liquid to consistency of syrup
mixed with remainder of pesto

add dollops of the morel/green tea box-wine reduction + pesto to the soup
serve with splash of olive oil

Necessity + Poverty = interesting sandwiches

I'm back in my actual apartment for the weekend, having spent the week in temporary housing provided by the medical school during my outpatient pediatrics rotation in Manchester, NH about an hour away. Being broke, with my kitchen staples divided between two residences, has left me with an interesting dilemma - namely how to feed myself on the cheap. So I decided to make a game out of it, creating meals today with only what I can scrounge from the pantry, cabinets, and fridge - i.e. out of condiments, old spices, and things not eaten for a variety of reasons (and which happen to have a near infinite shelf life). So far:

Breakfast:
Scrambled egg tortilla wrap with basil salsa
using:
the last 3 eggs in the apt
whole grain mustard
sharp cheddar cheese dried to the consistency of parmigiano
juice from a jar of capers
the 2nd to last tortilla
last of the premade pesto
and Kahlua

I scrambled the eggs mixed with the grated cheese, mustard, smoked paprika and S&P, wrapping them in the pan- toasted tortilla, then drizzled with a sauce made from the pesto, caper juice, and a dash of kahlua - which sounds strange but came out strangely wonderful.

Lunch:
Tuna melts

stale wheat bread
last cans of chunk tuna in water
capers
whole grain mustard
hippie organic vermont salad dressing
fresh cracked pepper
Velveeta "cheese"

Having used my last egg, I replaced the usual mayonnaise with a mixture of stone ground mustard, capers, and something called "Goddess" organic salad dressing. The I shaved some velveeta from a 2 pound block - a legacy of my room mate Kendall- and toasted the sandwiches in the panini press for a surprisingly decent lunch.

The interesting meal will be dinner, as protein sources are running low along with, well, everything else. I may have to break down and buy some supplies with the change from the floor board of my car.

But I still have:
1 can crushed tomatoes
boxes of kraft mac n cheese
1 tortilla
3 slices of stale bread
some dried morel mushrooms
1 quart chicken stock
half a bag of old baby carrots
spices, and condiments

I will think on this and keep you posted.

an infamous list

i) Nikki and I have decided to incorporate a not-for-profit together- which will basically be a repository for donations we can use to give away to charities we support, buy supplies for food pantries, books & art supplies for kids, and the like. It will take us a while to get the paperwork filed but until then, rather than than giftcards, or clothing, I'd like to request small donations with the designation "To Be Given Away."

ii)
1 Tyrolean hat (size yet to be determined)

iii)
1 Badger Bristle Brush


iv) Fiddle + guitar lessons

v) language lessons

vi) beer brewing supplies

vii) money to set aside for travel

"the gurney piloted out, its wobbly wheel painting a sanguinous serpentine stripe"

This post is a bit overdo but it's taken me until this slow, long weekend to accrue enough sleep to have the energy to tell stories.  So without further ado,

I was on call last week at the Dartmouth Hitchcock Med. Ctr., the academic center of the Dartmouth med school and the only level 1 trauma center in region between Boston and Burlington VT.  Generally, surgery call consists of trying to steal snippets of sleep next to a half eaten sandwich and a never-opened textbook, being paged intermittently to the emergency room for traumas arriving by ambulance or helicopter.  Usually the page precedes the trauma arrival by 15-45 minutes depending on the situation, giving the pagees time to make their way to the trauma bay and 'suit up', which entails pulling on layers of lead aprons, impermeable gowns, gloves, face masks and hoods while readying fluids, medications, and imaging equipment.  This happens for every trauma of a sufficient urgency, regardless of the patient's condition.  So sometimes I will wait in a crowded room sweating, only to have a completely conscious (usually drunk) guy with a bruised head yelling about why he shouldn't be here as he vomits on everyone.  Cases like this are anticlimactic and frustrating, not that I'm angling for people to be obliterated by motor vehicles, but if I'm going to lose an hour of sleep I'd like to at least learn (or suture) something.  

So the other night, after a couple of these pukey/boozy dudes, I arrived a bit late to a trauma page and since the room was nearly full, took the advice of my intern and went to see a patient in the walk-in side of the ED for a suspected hernia.  After examining this patient I returned to the workroom next to the trauma bay, which was oddly silent and empty.  I didn't make anything of this until I noticed that my resident's coat, and face, shoes, and floor beneath the shoes were covered in flecks, and spots, and splashes of cartoonishly red blood. As I was processing this image, she put her hand on my shoulder and said, "GO TO THE O.R., WE CRACKED A GUY'S CHEST IN THE TRAUMA BAY. RUN."  And so I took off at a dead sprint through the ER, up the stairs into the operating suite, pulling on a mask and following the ever widening path of maraschino cherry-red blood into the last and largest OR in the hospital.  The operating table looked more like a meat counter than anything else, with intestines like link sausages being efficiently parsed and bundled over a moist quivering mass of shuddering human meat.  As I put on gloves, I was told that the patient had apparently been struck by a car and found unresponsive by the ambulance crew.  His blood pressure had bottomed out once in the helicopter and again in the ER, necessitating the opening of his chest like an old dictionary to look for an obvious and easily reversible cause of bleeding.  When none was found, the surgeon took hist fist and jammed it into the man's torso until his aorta, a blood vessel the size of most household pipes, was compressed against the spine- maximizing the blood flow to the brain at the expense of the (relatively) expendable lower half of the body, as they sprinted his gurney into the elevator for emergency surgery.  

Now, aside from the excitement of the sheer brutality and turmoil of the events, for the medical people involved in a situation like this there exists an additional sub current of tension- namely the knowledge that an open thoracotomy in a blunt trauma situation (like this one) carries a >95% mortality rate.   With a steady stream of arterial spray escaping the left lung, the trauma surgeon and chief resident took turns compressing the aorta was the other gowned and gloved.  After the first few minutes they signaled for me and my classmate to scrub in to help hold the organs and steel retractors as they searched for controllable sources of bleeding.

I stepped in, my waist against the open right chest wall, wielding the hand suction as the chief resident stapled off a mangled chunk of lung and systematically inspected the surfaces of the heart and chest wall for pulsing arteries.  Once the spurting from the lung was resolved, and the heart itself cleared of punctures, he dove his fingertips into the constantly filling crater-lake of blood between the heart and left lung as I tried to clear his view by holding back the beating heart while applying suction.  For the next 15 minutes we grappled to tie off the internal mammary artery, famous for it's use as in Coronary Artery Bypass Grafting, or CABG, which had been transected when the man's chest was ripped open.  Apparently this vessel the size of the small end of a chopstick, has a nasty habit of withdrawing into the sternum when cut, which with the poor view afforded by the angle and blood and swelling organs, made controlling it a small nightmare.  It was my job to suction away the blood while retracting the heart as the chief swung an inch long curved needle, almost blindly, toward the spastically hyperdynamic heart.  This required a tiny, frenetic and intricately timed dance, darting the suction tip in front of the needle just as the heart squeezed and the lungs fell with exhalation, lingering just enough to remove the blood without obstructing the brief window of visibility that would allow the vessel to be grasped and oversewn.   After several failed attempts and an ever alarming amount of pressure being applied to man's already overburdened heart, we suceeded in controlling the bleeding just as the cardiothoracic surgeon arrived to transition the operation from damage control to reconstruction.

I stepped out, put my hands on my knees and nearly passed out.  As I stood and began to pace to shrug off the feeling of being deep underwater, my pager went off calling me back to the ER for another trauma...

A wild ride

Since I last posted:

I spent the last day of my medicine clerkship at the Buncke Clinic in San Francisco: home of the late Harry Buncke, the father of microsurgery and the first to reconstruct a thumb by transferring a big toe to a patient's hand. The clinic is now run by his son Greg Buncke who kindly allowed me to tag along for the day and meet his team.



The next day I threw my things into a bag and jumped the red eye flight back to boston. After a bus ride (ie long nap) I arrive in Hanover, retrieved my car which -thankfully- started, and headed to my new address:


27 old etna rd.
Lebanon, NH 03766




The past 10 days have been spent moving in, finishing Medicine, beginning Surgery at the local VA hospital, and generally not sleeping much. Two days ago I finished my second call shift at the Dartmouth ER, which means about 36 straight sleepless hours when it's a busy night (it was). After passing out at 8pm I awoke, drove to Rhode Island, and am now on an island somewhere in the Atlantic Ocean typing in a cafe to 80's music.

An undeniable fact is

...that more than once in 24 years I've woken up to realize that I'm in exactly the place I would choose to be, over any other, and that makes me one of the more fortunate human beings alive. Evidence:





another fact is that this is mostly thanks to the people reading this blog.

A tale of 5 sammiches

I maintain that some of the best meals of my life have been tuna sandwiches, eaten within 1 mile of some coast. In fact I can't eat one at all without thinking of the first I ever voluntarily ate: on the Ground Floor of a Megalithic spanish shopping complex in Alicante Spain 8 years ago to the day for all I know, for one euro. I lovingly ate that sandwich at noon almost every day for a month. More recently I had a tuna sandwich somewhere on long island at the house of the 88 year old mother of my Plastic Surgery mentor. Once too in college, I visited my favorite philosophy prof and his wife at home to drink terrible coffee with wonderful tuna sandwiches. Nikki's mom makes a delicious and simple tuna salad that I usually end up eating cold from the fridge around midnight between 2 slices of airy italian bread. And finally I just had simple meal of baby spinach, olive oil, cracked pepper, some goat cheese, and a basic tuna salad crossed with tarragon vinegar and dried currants- scooped up with an almost stale crusty lemon-basil baguette form the bakery around the corner. All this while watching the sky drip shifting colors into the bay.

The Plank has been walked

Just got board scores back yesterday. One fewer hoop to jump through. Only 281 left to go!

one foot in front of the other until the sea

routes of the city covered in 2 consecutive days' strolls. Blisters are becoming an issue. My first day off is tomorrow and so is the final match of the World Cup 2010. What a coincidence. More to come, but for now I have a date with a local beer and the roof at sunset...

The Ocean's Own Testicles

or "he was a bold man that first ate an oyster" - J. Swift

As of yesterday I finished my first week of six on the Internal Medicine Service at Cal. Pacific Medical Center. Routines are starting to emerge. I wake up at 6:00, eat, make my daily 3 minute 11 second commute from the door of my apartment to the door of the Residents' Lounge where I grab a cup of coffee and look up the day's lab reports on my patients. The next 3 or so hours are spent seeing patients and writing SOAP notes, which are brief reports of the patient's overnight events along with the day's plan for them. At 10 o'clock Rounds begin, where a team of 2+ interns, myself, a senior resident, and an attending doc form a circle in some hallway on the hospital floor, creating a clot that sometimes infarcts the whole corridor. By day five I learned that there is no such thing as a place out of someone's way and have learned to live with it. From 10 to noon we report on our patients and get 'pimped' which is have questions thrown at us by the resident of attending. As was so aptly noted on Scrubs, it's like a game show. Noon to 1 o'clock is a teaching conference, usually a lecture on a topic like sepsis or some specific aspect of hospital life along with FREE CATERED LUNCH- an unheard of luxury. Today I had (4) lamb and beef pita sandwiches with greek salad. When I finish easting I usually pretend to have been paged and sneak out to get a cup of coffee and give Nikki a call while looking out the 5th floor window over the Golden Gate Bridge. After lunch I have more coffee, and finish my chores usually finishing up around 2 depending on which day of the 5 day Admit Cycle my team is on. Yesterday was ' medium call' where we admit patients from the Emergency Dept. from 1pm to 6pm. Today is 'pre-call which means that because tomorrow is the meaty long call evening, my team didn't admit patients and spent the day following up on our current ones. Tomorrow we will be admitting until 8pm, where we will pick up the bulk of our patients for the next week.



I have yet to have a day off, but often escape by 3pm and so have 6+ hours of daylight to play with, though I usually nap 3 of those away. Go to the gym, come home, drink a beer on the roof at sunset, have a light dinner and read until falling asleep.
For the past 2 weeks I've walked a couple of blocks to a local restaurant that serves $1 Washington Oysters all day on Tuesday. Tastes like a thousand thousand years of salt and wind- with horseradish!

1 week down

many liters of saline, grams of antibiotics, dozens of cups of coffee later and I'm still enjoying this job immensely. It's such an incredible arrangement: wake up early to free breakfast, run around saying hi to people high above the city of SF overlooking the golden gate bridge, getting them things that make them feel better, looking at my watch and realizing it's the afternoon and time to go home, right after a free catered lunch. Not bad at all.

I take my barbaric gulp on the rooftops of the world

In what may easily become a daily ritual, I am sitting on the roof of my apartment building in the pacific heights, sipping a stereotypically delicious local San Fran beer, reading up on my patients for tomorrow while the sun sets into the pacific.

I will post more in a bit but right now I'm enjoying myself too much to look at a screen.

evil twin

I realized that my mate' gourd looked like a cartoon bomb, so why not embrace it.

The thought xray

They left an old mind xray in the apartment for us so I figured I'd fire it up on the apt. balcony for my first morning on the job.

41 years beyond the summer of love

I walked to the corner of Haight and Ashbury to have a local beer at a brew pub, passing the corner, a man with one arm gone above the elbow lazily asked "spare change" -"sorry man, all out"- "right on"...the city of San Francisco should pay that man a historical re-enactor's salary.

As I sipped my beer I thought of these words by the late Sir Hunter S. Thompson:

It seems like a lifetime, or at least a Main Era — the kind of peak that never comes again. San Francisco in the middle sixties was a very special time and place to be a part of. Maybe it meant something. Maybe not, in the long run... but no explanation, no mix of words or music or memories can touch that sense of knowing that you were there and alive in that corner of time and the world. Whatever it meant...
History is hard to know, because of all the hired bullshit, but even without being sure of 'history' it seems entirely reasonable to think that every now and then the energy of a whole generation comes to a head in a long fine flash, for reasons that nobody really understands at the time — and which never explain, in retrospect, what actually happened
My central memory of that time seems to hang on one or five or maybe forty nights — or very early mornings — when I left the Fillmore half-crazy and, instead of going home, aimed the big 650 Lightning across the Bay Bridge at a hundred miles an hour... booming through the Treasure Island tunnel at the lights of Oakland and Berkeley and Richmond, not quite sure which turnoff to take when I got to the other end... but being absolutely certain that no matter which way I went I would come to a place where people were just as high and wild as I was: no doubt at all about that...
There was madness in any direction, at any hour. If not across the Bay, then up the Golden Gate or down 101 to Los Altos or La Honda... You could strike sparks anywhere. There was a fantastic universal sense that whatever we were doing was right, that we were winning...
And that, I think, was the handle — that sense of inevitable victory over the forces of Old and Evil. Not in any mean or military sense; we didn't need that. Our energy would simply PREVAIL. There was no point in fighting — on our side or theirs. We had all the momentum; we were riding the crest of a high and beautiful wave...
So now, less than five years later, you can go up on a steep hill in Las Vegas and look West, and with the right kind of eyes you can almost see the high-water mark — that place where the wave finally broke and rolled back.

"The Coldest Winter of my life...

...was the summer I spent in San Francisco"

No, Mark Twain didn't say (or write) this. But since whoever did is unlikely to be as interesting as Twain, I won't go to the trouble of finding out who the quipper actually was.

I'm sitting in the C terminal of Boston's Logan airport waiting on a straight shot Virgin America flight to SFO. Not that the weather is bad, 10 days of cartoon sunshine according to weather.com - which could mean anything.

I spent the last hour in the Legal Seafoods restaurant watching World Cup, drinking a fresh Boston Lager with a bowl of clam chowder and a half dozen fresh east coast oysters completing my culinary farewell to New England. My guess is that the west coast can and will answer in kind. Probably with crab stew in a sourdough bowl with an Anchor Steam. Predictable, but respectable. Should be a good fight.

Oh, I forgot to mention that I am going to be present at the 2014 World Cup in Brazil even if I have to sell a kidney to do it.

On Thursday I had my first day of rotation specific orientation, internal medicine in my case. Luckily when the preliminary pimping began, it was over a medical subject that I happen to excel as compared to my peers, random historical medical trivia - subcategory: illicit drug related.



They showed us this picture, a portrait of 4 founding fathers of medicine painted by John Singer Sargent. After reading us a venerable quote they asked who the speaker was. Not knowing the quote, but realizing I was in the company of Internists, I hazarded "Osler", meaning Sir William Osler the Abe Lincoln, Santa Claus, Dumbledore of Internal Medicine. Then they asked, "Now who is this gentleman lurking in the shadows?" This I knew, "Halsted", referring to William Stewart Halsted, the father of modern american surgery and who incidentally introduced the practice of wearing gloves during surgery not for asepsis but because his assistant (and wife)'s hands were irritated by the insane scrubbing routine which involved something like burning your fingertips off with carbolic acid. "And why is it appropriate that he's back there in the dark?" Anyway, I knew what they wanted to hear, and frankly what I thought was hilarious to say on my first day as fake doctor, and spoke up "because of his raging cocaine addiction"

An auspicious beginning...

The Pager Ceremony

Today we received our pagers, picked from a disappointingly unceremonious fold-out card table covered in bic pens and old school motorolas that weigh 2lbs and probably emit enough radiation to glow in the dark. The kind of pager banned from high schools in the early 90's because only drug dealers carried them, supposedly. They might even be refurbished 90's drug paraphernalia, the telecommunications equivalent of the 'Ghetto Blaster.'

Since the school was heartless enough to so carelessly distribute the millstones to be worn around our necks for the next 40-60 years, I devised a 'Pager Ceremony' for myself and my roommate Kendall. Ideally there would have been a guy with a bull horn, holding a pager over his head shouting "statistically this device will ruin 1/4 of all marriages you as a group undertake, be responsible for 61% of your gray hairs, 88% of your childrens' missed birthday parties, recitals, and graduations, 92% of the weight you will gain, the tums you will swallow, the coffee you will drink, the sleep you will lose. Are you absolutely sure you want to do this?"

Since that person was markedly absent, I stepped in, spoke thusly, and handed Kendall his pager placed inside of an (empty) Spam can, since that's what he'll be eating for the next 8+ years. He in turn asked me the same immortal question "Are you sure you want to do this?" and handed me my Albatross within a can of Espresso, since that will be my fuel for the coming decade.

1st Day of (non) School

1990- 1st day of Kindercare
91' Kindergarden
92' 1st grade
97' middle school
2000 High school
2004 1st day at Rutgers
2008 1st day of med school
2010 1st day of NOT SCHOOL

20 years of standing in lines, being told where to go, to clean up my messes, do my homework, eating lunch in cafeterias, putting my things in cubbies and lockers and now finally, freedom...

... "you have locker number 123, keep the locker room clean, wait in line over there for your id, the cafeteria hours are 6-11, WASH YOUR HANDS after going to the bathroom, share the lounge area, be nice, don't throw things..."

and in that spirit of the great tradition of pedagogy, here is a picture of me on my first day of (not) school, in my brand-new grown-up disguise.



still not as sharp looking as this guy though

Vox Clamantis in Vapidity

So I'm working on some video editing for a study , which requires me to spend time in the Dartmouth undergraduate library's media center. Here's a brief snippet of the gems of insight I'm privy to at this Venerable Ivy League institution.

"So like, that's something that, like, probably our society can't accept yet maybe, ya know..."

"....yeah so I'm graduating, like, tuesday"

"whoa, that's so like..."

"yeah... I'm gonna be like, an Alumni..."

"yeah...."

"Whoa! are they like sewing in that video!?"

"ugh, that's like.... crazy"

My reply:

BLAME CANADA!

It was Quebec all along! I knewed it!

"Smoke from fires burning in southern Quebec has spread south and east across parts of Vermont, New Hampshire and Maine. The Upper Valley has been affected by this smoky condition which is expected to linger for the next 24 to 36 hours when forecasted showers will help clear the atmosphere.

The National Weather Service predicts the acute condition will break up in the next few hours. The following URL provides smoke maps for the current time period and the current conditions: http://www.weather.gov/aq/

We recommend avoiding strenuous exercise outdoors, and to wait until conditions improve"



Take that!



*also
today too is turning out to be kind of weird. So far:

1) Overheard this guy with a cane at the video store asking if his special order "porn video with the midgets" was in yet, and when told no
"But it's been like 3 weeks!"
and then his creepy buddy chimed in " heh heh heeehhhhh...."

2) I saw a girl with Oculocutaneous Albinism doing jumping jacks at the gym. That's the first time I've seen jumping jacks done since 4th grade.

3) Then an 60+ year old man smugly wearing a YALE shirt at the dartmouth gym walked by in a pair of these.

Bizzare Day

Today I awoke in a hammock, after my room mates' dog browned up my bed-sheets with some hideous musty dog goo. I let the her outside and saw that the air was full of smoke for some reason and figured that the neighbors were burning snow tires, or something equally incomprehensible but apparently reasonable to those living their whole lives on a dirt road in Vermont.

When I drove to town I saw that the smoke extended for miles both North and South on the highway, filling the Connecticut river valley, even obscuring the tops of the what passes for mountains in the northeast. Then I remembered Memorial Day and thought MAYBE this was a sign of the greatest Mass Grilling in history. Or maybe graduation related and someone finally torched the Baker Berry Library at Dartmouth. Sadly, neither is the case, and apparently this is, as the local weather people put it "HAZE."

Anyway, as i walked into school I saw this gigantic fuzzy not-moving thing that turned out to be the biggest and most elaborately patterned moth that I've ever seen, just lying near this loading dock behind the med school like it made perfect sense. I brought it inside to take a picture and realized that their was something poetic in the image of a huge, strangely beautiful, dead moth. And being too lazy to write something of my own, I suspected that if any poet had ever mused cleverly over a moth that Emily Dickinson would be that person. 3 seconds on Google and. Oila', poem number 841:
"
A Moth the hue of this
Haunts Candles in Brazil.
Nature's Experience would make
Our Reddest Second pale.

Nature is fond, I sometimes think,
Of Trinkets, as a Girl. "

Exactly what I was thinking. But said with much less profanity. Thanks ED!

And now, somehow, it's 5 pm. Either this strange memorial day in 2010 is coincidently the Haziest, Mothiest, and Fastest Moving day of my life, or something sinister is afoot. The latter is much more interesting an option.

The Neverending Study

I take Step One of the medical licensing boards June 14th, in just under 3 weeks. After about week of downtime sleeping, eating, visiting Nikki, and laundry-doing, I've finally started with my study schedule. It looks like my days will look something like this:

Wake up around 9am

drink a bit of mate'

drive to Hanover, set up shop in the Bone Room (basement room near where the anatomy lab is).

read one of the books I want to have memorized, listening to a symphony for each subject.

Down time for lunch, an hour at the gym.

work on making a model skull in clay while listening to music or boards lectures.

practice questions.

home for dinner

watch a movie.

read again for the next day.

It's actually a lot of fun. Like summer camp designed just for me. The Bone room even looks like the kid's hideout from the Neverending Story, or at least enough like it to amuse me.

I guess 2010 was the cut off for when 'The Future' started...

Creation of first synthetic life form....

Jet Packs cost the price of a luxury SUV

genetic therapy that works

and why not an invisibility cloak?

Furry Justice

http://today.msnbc.msn.com/id/36951696/ns/local_news-plattsburghburlington_nyvt/

Point: 0

CounterPoint: 1

Bounty-ful

found about a billion Morels under the apples trees near the shooting range. Sunny every day, rains every night, napping too much, time passing too quickly.

http://www.theonion.com/articles/deaths-of-550000-confirm-which-mushrooms-are-okay,7014/

Enter the Spring

Shedule for the impending 3rd year of medicine school:

Orientation
June 21-23
Block 1: Internal Medicine @ CPMC in San Francisco
June 24- Aug 11
Block 2: Surgery @ White River Junction VT VA hospital
Aug 12- Sep 29
Block 3: OB/GYN @ dunno where
Sep 30 - Nov 17
Block 4: Pediatrics @ 3 weeks Locally, 3 weeks CPMC
BREAK: NOV 18-19, 24-28
Nov 22- Dec 17
BREAK: DEC 20- JAN 2
Jan 3 - 26
Block 5: Elective
Jan 27 - Mar 16
Block 6: Family medicine locally
Mar 17 - May 4
Block 7: Psychiatry @ WRJ VA hospital
May 5 - June 22

Problem: Timequake!

12 days to final exams...




Problem solved.

Phuc Mai Laif

not really, just too good of a title to pass up. I'm sitting on a tv stand in the NoBai Int'l airport having converted my last few dong into cold beer, stealing electricity to power my beaten-all-to-hell laptop. Just like last year I can't help but imagine the 1975 helicopter evac of the Saigon American embassy:



http://stolenapples1.blogspot.com/2009/10/hunter-s-thompson-interdicted-dispatch.html

and lastly



this is nothing like that of course. But I'm leaving, just the same. On a jet plane. Listening to great music, reading about face transplants, so in actuality: I love my life.

Good Evening, Vietnam.

I have measured out my life in tiny cups of coffee with a bit of sweetened condensed milk

"Now the trip is winding down, and I've foregone the 3 hours bus ride to another provincial hospital. That means I have the next 6 hours or so to gear down and force-feed myself the past 2 weeks of medical school. That isn't as bad as it may sound. After seeing patients and parents, and standing next to the surgeons and nurses that have helped them, I feel like pouncing on this thing with vigor again. Just 2 more months and I'm free of the formal classroom for what will hopefully be the rest of my life. Not that work is pure freedom to learn. But I think that I've come full circle enough that work can be a kind of kindergarden; you have to stay in the building, and you have to get your tasks done so you get a gold star, but in the in between everything is new and colorful and exciting and the in-between is where you really learn most.

below is the classic "all i ever needed to know..." which is called "trite ad saccharine" which I can agree with in a certain light but with the right kind of eyes, there is far more authenticity in this than any medical school Mission Statement.

Most of what I really need to know about how to live, and what to do, and how to be, I learned in Kindergarten. Wisdom was not at the top of the graduate school mountain, but there in the sandbox at nursery school.

These are the things I learned: Share everything. Play fair. Don't hit people. Put things back where you found them. Clean up your own mess. Don't take things that aren't yours. Say you're sorry when you hurt somebody. Wash your hands before you eat. Flush. Warm cookies and cold milk are good for you. Live a balanced life. Learn some and think some and draw and paint and sing and dance and play and work some every day.

Take a nap every afternoon. When you go out into the world, watch for traffic, hold hands, and stick together. Be aware of wonder. Remember the little seed in the plastic cup. The roots go down and the plant goes up and nobody really knows how or why, but we are all like that.

Goldfish and hamsters and white mice and even the little seed in the plastic cup - they all die. So do we.

And then remember the book about Dick and Jane and the first word you learned, the biggest word of all: LOOK"

Ears Lowered

Apparently the humid jungle air here makes my already shaggy mass of hair growth double-quick. I'm contemplating getting a haircut from a barber on the street, in a simple wooden chair with a cracked mirror hung on the low wall along the sidewalk. But all I can think of is this scene from Full Metal Jacket and I'm afraid I'll have the song stuck in my head for the rest of the trip....

bacon in soup form = best brunch ever

great morning, I sat on a little plastic stool by the street with a book seller friend named Quan and his wife, drinking green tea while watching the traffic slink by.

why I love the Onion

http://www.theonion.com/content/opinion/i_didnt_spend_6_weeks_in_a

corollary to below

I remember reading this somewhere, once upon a time. Some guy in Cedar Rapids, IA probably created this and attributed to a sage. But the point is interesting nonetheless.

"There is a Taoist story of an old farmer who had worked his crops for many years. One day his horse ran away. Upon hearing the news, his neighbors came to visit.

"Such bad luck," they said sympathetically.

"We'll see," the farmer replied.

The next morning the horse returned, bringing with it three other wild horses.

"How wonderful," the neighbors exclaimed.

"We'll see," replied the old man.

The following day, his son tried to ride one of the untamed horses, was thrown, and broke his leg. The neighbors again came to offer their sympathy on his misfortune.

"We'll see," answered the farmer.

The day after, military officials came to the village to draft young men into the army. Seeing that the son's leg was broken, they passed him by. The neighbors congratulated the farmer on how well things had turned out.

"We'll see..."

Up, in Hanoi

today like every other day here, leaves me exhausted. This was the final clinical day of the trip, where 20 some odd towering Caucasian strangers turn the surgical ward of the National Pediatrics Hospital into a glorified petting zoo. But as with everything else on this trip, this country, and apparently this world, the darkness is punctuated - but never fully- by tiny filaments of light. Today I saw 20 kids given an opportunity for a better life, maybe. I could look at each child and feel my heart cracking like giant warm egg, but then I'd imagine all the shadows behind their being there and seeing us, the thousands of kids with the same or worse deformities and circumstances, doomed by luck, by birth, by geography, wealth, and maybe fate. For every ear reconstruction done how many remain undone? How many other procedures precluded by the use of finite funds, time, training, will, and political maneuvering? How many of those kids were there because of their parents' connections, positions, or dollars? And why wouldn't I do the same thing given their circumstances?

anyway, the reason for the title of the post is that I'd like to tell a parable by way of a brief reference to the wonderful Pixar movie Up!. Today, as the kids were lined up to see us for the last time, I walked out of the clinic, through the hospital doors, out the gate, and into the little road-side shop selling knickknacks, snacks, and some commonly needed medical supplies. I spent about 10 dollars buying 20 huge balloons: animals, knock-off disney character likenesses, and some of the other unidentifiable blobs of bobbing color that kids enjoy purely up until the age of 9. I carried, and was almost carried by, the balloon animal heard into the wards and gave every kid a choice of balloon. I felt and looked like the house in Up!.

I gave the children balloons knowing that for 5 minutes or so they would enjoy them fully, until losing, popping, trading, losing interest in, or in any number of ways ending them and the moment. I also thought about the staff and parents having to contend with flying unicorns in their way during rounds, being sucked into the ceiling fans, stolen, fought for, cried about. And lastly I thought about myself. Was I buying them for the kids? For the photo op? Maybe for the canned emotional cue of a laughing child to make my and my team's presence a bit more justified with having to agonize over the consequences for even just a few seconds or minutes. Was it worth it, or right, or good? Did it matter? I honestly don't know. But for a moment or three, I tried to forget about myself. Whether the joyful consequences of that abdication outweigh the probable imposition on others, is a question that I'm desperately trying to answer.

So Sorry!

This trip is, has been, and will continue to be, significant beyond words. If there is an English term for whatever the intersection of the meaning of the words inspiring, disenchanting, awakening, enlivening, depressing, joyous, and adventure-boredom is, then that definition should mention the dates of march 3-18 2010. I have learned so much and yet so little about so many and few things, somehow all at the same time. I realize that these statements don't convey anything of what's going on here, but that is more or less the point, which is that neither do I (or anyone that I've yet met for that matter), but somehow I now know more than I did before coming, capisce? There are so many contradictions in this country, and yet, appropriately, they somehow make more sense, and feel less alien to me, than many of absurdities of American life. I've experienced corruption and benevolence, pride and humility, smarmy double-dealing vs. true raw integrity, insight, insipidity, fresh beer, 100 year old eggs, surgery, service, and some really damned good soup. It is such a privilege to be here, such a privilege to be myself here, such an honor to be able, maybe, to one day be here and do some good. And if not that, then at least learn something. I have many adventures and photos, and souvenirs to share. Describing the food alone would take 10 pages. As the Operative aspect of the trip winds down I should hopefully have more time to keep this thing current. I know I've promised that in the past and here I am promising again. But, as they say in the dirty Jerz, hey, whaddaya gonna do?

"my hovercraft is full of Eels"

actually that's the heading for my post on my time in Incheon Korea, which I'll post tonight. But for now, really quickly, here is a picture of exactly where I am as I write this and drink coffee, that is, on a windy roof by the lake in Hanoi. In half an hour we leave for the National Hospital of Pediatrics to hold a clinic for the potential pedi patients for this week. The it's over the Trauma hospital to do the same for the adults. Later the plan is to work out at the Vietnamese gym, get fitted for a "sweet" (suite)" [suit], and maybe buy a monkey at the market.

the past 36 hours by the numbers

268-miles Hanover to JFK Airport
24-buffalo wings and
2-beers waiting to board the
14- hour flight to Korea
10-hours of sweet straight sleep to Seoul
1111- number of Korean Won per US dollar
14-hours to spend in and around the Incheon airport
5-dollars for a breakfast of coffee, water, seaweed and alfalfa sprout broth soup, with oysters, tofu, kimchi, eggs over easy, rice, all while seated on pillows on a heated wooden floor
1- things that tasted like a tobacco leaf that were served with said breakfast
100%- ratio of tobacco-flavored things that went from my mouth to my napkin to be discretely thrown away outside the restaurant...
1- hour that Eddie and I spent riding a bus into the nowhere suburbs of Incheon trying to find the coast, unsuccessfully
20- $'s it cost for unlimited food, drink, air conditioning, internet, cappuccinos and showers in the VIP lounge for the
5-hours before boarding my flight to Hanoi

oh, and this isn't numeric, but there is a brand of sports drink or "ion supply drink" here from Japan called "Pocari Sweat!" that tastes like warm powdered gatorade and is the color of, well, sweat...

Fell asleep in Queens, awoke in South Korea

Eddie and I are the in gargantuan Incheon Intergalactic airport, having landed just a few minutes ago. Between our gate and the free internet lounge, we were too-politely smiled at and bowed to about 47 times, xrayed for shivs and stolen steak knives from the plane, and infrared-scanned for swineflu (negative). Since we have only about 14 hours until our flight to Hanoi, we may decide to hop onto one of these tsunami-tours from the airport to a buddhist temple, over a gigantic bridge and back for only $10 US.

In other news, excepting the funk of 10,000 miles and 14 hours of air travel on disquietingly absorbent cloth seat, I feel pretty good. After take off but before the first lap of the beverage cart , I was unconcious for a dreamless 10 hours until I woke up to about 4 korean octogenarians coughing TB in my face, apparently because the exit row window in front of me afforeded a much better view of the absolutely featureless black sky than the identically sized and oriented window 4 rows behind at their own seats.

It's about 6am Korean time, making it 4 in the afternoon on the east coast. I will try to post again before midnight (US time) tonight. as they say in Korea, ciao for now.

What an amazing morning

Up at 5:00 to toss my junk in a bag to catch the 6 o'clock bus to NYC and Nikki. FIrst mate'
then one of those incredible songs I would have never heard of except that I turned NPR on at 5:30 on a Saturday when they think no one is alive and listening.

1909 Rebecca Clarke, Lullabye for viola

Then as I'm tromping through Hanover I hear this murder of crowing crows in the tree tops on both sides of the street, and suddenly understand why there's always birdshit all over the sidewalks when there aren't any pigeons this far north. So i cawed back at them for fun, and they all dispersed, from tree A to B and B to A, and luckily I didn't receive any warms wet replies to my face while I watched those crows with my neck craned. It looked just like this, and this, pasted together. 2 from right before Vince died in 1890. all 3 with that filthy azure of the thawing sky at dawn.

RIP JDS PBUH

"If you're going to go to war against the system, just do your shooting like a nice, intelligent girl- because the enemy's there and not because you don't like his hairdo or his goddam necktie."

"And I know, sir, that next to scripts that are Tender and Poignant, you love scripts that have Courage and Integrity. This one, sir, as I say, stinks of both. It's full of melting-pot types. It's sentimental. It's violent in the right places. And just when the sensitive subway guard's problems are getting the best of him, destroying his faith in Mankind and the Little People, his nine-year-old niece comes home from school and gives him some nice, pat chauvinistic philosophy handed down to us through posterity and P.S. 564 all the way down from Andrew Jackson's backwoods wife. It can't miss, sir! It's down-to-earth, it's simple, it's untrue, and it's familiar enough and trivial enough to be understood and loved by our greedy, nervous, illiterate sponsors."

Louis+jordan+1942-Caledonia

Louis jordan 1942-Caledonia
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