RIP Heinlein early 1990s to July 31, 2006

My family and I have had dogs and cats as pets since I was 7 or 8 years old. Over the years I've lost many four-legged family members. Although intellectually I know that they have a shorter life span than my bipedal family members and that they are "just" animals, losing them hurts. Aside from young children, how many people love you unconditionally and look to you as their sole provider. I've cried for every single one (and if you have a problem with that I'll painfully remove you from the gene pool for the good of the species).
When I first moved into my condo the first thing I noticed was how big it was, and I thought that perhaps a cat could make good use of this space since I'm away for many hours during the day. I went to the Champaign Country Humane Society. In the cat room I looked at the kitties where a small coral, grey, and tan cat with pretty green eyes who reached through the bars of her cage, hooked my hand with her paw, and began to berate me. They took her out of her cage and we sat in one of the side rooms to get acquainted. She hissed and growled vehemently at the dogs barking in the background but curled up comfortably in my lap...still sounding like a pissed off bag pipe. She had me at that and I adopted her. I brought her home and told her if she ever stopped using the litter box I'd kick her out.
I named her Heinlein after one of my favorite science fiction author's Robert A. Heinlein. He liked cats a great deal and they play occasional cameos in his books. She quickly proved to be a scintillating conversationalist, greeting me when I came home with a long series of yowls, purrs, and meows. She'd hop up where I was working or eating, or join me on the couch to get her petting time. She loved attention on her terms: petting was great but being picked up was cause for plaintive cries of displeasure. Mostly she liked to lay around near enough to keep an eye on me but in a strategically cozy spot. She used her right to deliver quick jabs and wicked hooks to both prod me to pet or feed her and in her cunning attacks on anything that moved oddly (to cat). She could work herself into a frenzy with the birds in the backyard yowling and stalking them on one floor before sprinting to the other.
On one occasion Heinlein met my folks' nearly 200 pound mastiff. As the gentle giant came forward to inspect the feline, so like the cats she shared a house with she was rudely stopped by Heinlein gently putting her fully extended clawed paw directly on her nose, the needle sharp points delicately dimpling the skin. The mastiff turned and fled in terror at such behavior as Heinlein realizing her bluff had yielded maximum benefit bolted in the other direction.
For the last few years Heinlein shared her domain with my second cat, Tolkien. Although she expressed great displeasure and disdain at this upstart, she seemed to enjoy his company. I would catch them sleeping close together but as soon as I witnessed this alliance they would rapidly separate as to convince me that they thought less of one another. They would often ambush one another either by running up and delivering a "drive-by" swat before bee-lining out of range or by stalking the other (typically asleep) feline and delivering a full tackle.
One of the funniest things I ever saw the two of them do followed a near feline calamity. I was working on my computer and I heard the most plaintive Heinlein cries I'd ever heard. I walked to the bedroom and saw the screen had vanished from the second story window and Heinlein was standing with her head out the window, posterior high in the air as if to jump. Springing into action I rushed to the window ready to snatch her away only to pause as I noticed Tolkien on the patio 15-feet below, slightly shell-shocked looking up trying to figure his way back through the window. They were like two teenage siblings yelling at each other trying to undo totaling dad's sports car. I shut the window and ran down to open the patio door, Tolkien streaked inside, got a once over from Heinlein, as he shot to the litter box to relieve himself.

Knowing What You Are Not

I know what I am and what I am not. One of the "nots" being graceful. Me and Miz Grace have a distant and rather chilly relationship. I tried dancing again last night, entirely sober which is bad because although EtOH does not make me more graceful it does nullify my already low inhibitions. My pretty partner almost died of hilarity-induced abdominal spasm, that is, she almost bust a gut laughing. The management called an ambulance and a priest since they weren't sure if this was seizure activity or possession.
My problems with grace are not because I'm that uncoordinated, I can knock a glass off the shelf and catch it before it hits the countertop. On other occasions I can hit a wall and then miss the person I'm about to trample due to my altered trajectory. In other words in action I'm a klutz and in reaction I'm frigging Neo. In grade school I was the god of dodge ball, I couldn't hit anyone worth a damn but I could move like mercury on a hot skillet. The only time I could hit anyone is in other sports when I was throwing the ball back and I'd catch the one guy who wasn't looking -- in the head. When I first started sport jiu-jitsu one of my friends noted, "Your instructor wrestles like cat, your more like dog." To this day I'm like a Great Dane worrying a chew toy on the mat. Limbs everywhere, head down. I'll come out a competition feeling great and then watch the video, it's supposed to be a coordinated game of kinetic chess, instead its slightly nauseating.

Hail Satan?

Given the superstitious auspiciousness of today's date, I had to repost this. I'm not religious except for being a devote procrastinator, but this poll fitting you to the most appropriate religion caught my eye. Guess what I scored as...

You scored as Satanism. Your beliefs most closely resemble those of Satanism! Before you scream, do a bit of research on it. To be a Satanist, you don't actually have to believe in Satan. Satanism generally focuses upon the spiritual advancement of the self, rather than upon submission to a deity or a set of moral codes. Do some research if you immediately think of the satanic cult stereotype. Your beliefs may also resemble those of earth-based religions such as paganism.

Satanism		100%
atheism		88%
Buddhism		33%
agnosticism		33%
Paganism		29%
Islam		17%
Judaism		17%
Hinduism		8%
Christianity		0%

Which religion is the right one for you? (new version)
created with QuizFarm.com

Hunh...go figure.

The ULTIMATE Doctor's Bag

I've decided to construct the ultimate doctor's bag, so as to never be short the materials necessary to perform the diagnostic physical exam. I have some of these materials but I thought I'd show the whole shopping list:

Stethoscope

I really like my Classic II S.E. from 3M Littman Stethoscope. It's resilient but I've been able to perform decent auscultation of the abdominal, breath, and heart sounds. The decent is probably more a failing on my part then this fine instrument. Plus it makes me look "doctorly".

Pulse Oximeter

The O₂ saturation has become part of standard vital signs. Pulse oximeters have become smaller and more compact, providing both the heart rate and O₂ sat. The Invacare Digit Finger Pulse Oximeter is one of those available.

Sphygmomanometer

Blood pressure measurement requires a stethoscope and sphygmomanometer (blood pressure cuff and gauge). There are many types of sphygmomanometers available at AllHeart.

Peak Flow Meter

There is a new hand held Peak Flow Meter for Spirometry with FEV1 from MicroLife which enables both measurement of peak expiratory flow (PEF) and forced expiratory volume in 1-second (FEV₁), allowing a quick bedside evaluation of pulmonary function.

Opthalmoscope/Otoscope

Two years ago I purchased a Welch Allyn 3.5v Diagnostic Set due to the size constraints and needs of a medical student. However, in a doctor's bag the 5x magnification and ease of a PanOptic opthalmoscope might well be worth it.

Neurological Instruments

A Baseline Taylor Hammer with Tuning Fork has all the tools necessary to test fine touch, pain, vibration, and deep tendon reflexes. Auditory testing including Weber and Rhinne test requires a 512 Hz tuning fork. Two-point discrimination can be done with a Baseline Aesthesiometer. Finally a pen light would also be necessary. A Snellen eye chart would also fall in this category.

Glucometer

With the increasing prevalence of diabetes this makes a valuable addition to a doctor's bag. Glucometers are available at Diabetes Store.

EKG Calipers and Ruler

Make use of a drug rep, usually the ones in cardiology will have some.

CPR Mask

Cardiopumonary resuscitation can be performed more efficiently and safely with a CPR mask. Checkout The Lunatick's Fire and EMS Store.

Trauma Shears

Its amazing how handy trauma shears can be, try The Lunatick's Fire and EMS Store.

Tape Measure

I have not included disposal items such as hand sanitizer, gloves, Hemoccult cards, lubricants, etc. This British article also has some excellent suggestions, with the addition of medications.

Fear the Joker

This weekend I went on a bar crawl with the nominal "theme" of pirates versus clowns. As girls and pretty boys generally pull off the sexy pirate routine (a lot) better than me, I went with the clown motif. Since I'm already menacing and creepy I decided I might as well maximize this by going as my nicknamesake, the Joker. Therefore, I appropriately arrayed myself with green hair and eyebrows, white face paint, and red lipstick. Little did I realize what a study in fears this would be.
First, on a personal level. I had to drive several miles during the daylight hours to make the bar crawl. Thus my fellow motorists had ample time to gawk and stare. Fortunately the circus was in town so maybe they thought I was a refuge from there. But as I drove it dawned on me that their attention shouldn't bother me. I wasn't hurting anyone and their judgment was entirely irrelevant. If they thought I was weird, creepy, "light in the loafers", or whatever I was doing something fun, legal, and they could all largely bite me if they didn't like it. Although as I was entering the bar I hoped wholeheartedly that other people would be dressed up, otherwise it would make for a long night, I certainly wasn't going to backdown if they weren't, but clown reinforcements were appreciated. I did spend part of the evening alone in my regalia at one bar and had to walk the length of campus town to get my wheels. Although I provoked quite a few stares I received a bunch of compliments ranging from, "great job" to "you look fantastic" to my favorite "holee...". Apparently you can't mess with a classic and a little bit of theatrical balls is appreciated.
My appearance must have been terrifying. People from a poor guy with a phobia of clowns to several shocked young ladies gave me wide berth. I made one of our party scream when I snuck into her field of view. I defeated a whole table of attractive pirate-ettes when I brandished a plastic scimitar and cackled maniacally, their weapons hit the table with a concerted polymer clatter. It was interesting to see them not only shy away but to avoid eye contact as if the ostrich defense would work. In their minds not seeing me, I would not see them and hence wouldn't do anything. What this says about people not facing their everyday or global fears is probably illuminating. Do we as a species hide or avoid that which scares us? Definitely and its self-destructive. Rather than seeing me as a silly guy with a bad paint job they saw something else which played on fears inlaid by popular culture.
It was interesting to see how much "bravery" my grease paint skin afforded me. I climbed on furniture and stole a tray from a waitress without anyone saying anything. My normally low level of self-control eroded with the safety of my disguise. I would talk to anyone just to see the reaction I could provoke, especially folks trying their desperate to appear cool as a gaunt, menacing clown invaded their libations. Although normally sociable this is extreme even for me.
I might just have to get some more make-up.

MMA WTF...and I don't mean World Tae Kwon Do Federation

I was flipping through the trade journal MASuccess and came across this ad for Century's XMA (Xtreme Martial Arts) line of teaching/training materials. The ad highlights a school using XMA products. Based on the ad, I have come to the conclusion that I have not, am not, and will not ever train Mixed Martial Arts. To do so you have to wear a surplus NASA jumper, carry glowstick weapons, and act or be approximately 7 years old. Your teacher may also just be a highly confused member of both the Black Panthers and the Aryan Nation. Furthermore I'm doing this whole martial arts teaching thing wrong. I currently train in my garage or a surplus University warehouse and lose money each year being an instructor. I have one tenth (or less) the students and operating budget of XMAGrrl. *sob* (blows prodigous nose) This has to be a sign of the end of the world as we know it. Buy guns and Twizzlers...lots and lots of Twizzlers.

Black Sheep

As I was passing through the Medical Sciences Building Friday I glanced at the announcements board and saw a map of the United States with the graduating medical students' pictures pinned at the location of their matches.

All of them.

Except me.

My exalted rank of black sheep remains unchallenged. Now I'm generally opposed to other people announcing my personal events. I can but you cannot. I did not attend the Match Day dinner, primarily because I thought it was juvenile and I wanted to celebrate with my friends in my fashion. I also didn't really see the point in celebrating. It is nearly impossible to fail out of medical school, matching was like everyone winning first place in a competition with one person brackets. I have no doubt that my entire class will be successful wherever they match, so we seem to be celebrating the irrelevant. I was also having a ball doing primary care in my Family Practice clerkship and working actually seemed more fun. By the time I got home Thursday, everyone's match results were announced. Again my business, my call, But that choice was made for me. The fact it happened is not important, the fact that it was done without my consent is.

Based on the above, why am I annoyed that my picture wasn't posted? I'm not really, it was a minor oversight. However if the results are announced they should be done so universally. Perhaps I feel like pariah because I was resoundingly informed that I had been demoted to a repeat third year even though I figured out that I could graduate with my original class of fourth years. Subsequently retooled my schedule to be a good M3 but was then able to match as third year and be suddenly promoted back into my M4 class. I did no away clerkships and applied to one program a week before the match closed. If you haven't noticed the black sheep has large horns and a thick neck, we can pretend to do things your way, but eventually I'll batter my way through the barricades of bureaucratic confusion and do things my way. It's as inevitable as death, taxes, and hypertension.

And yes I'm skipping graduation. I'm a BAAAAHstard.

Kill Inn

I'm not a huge fan of horror movies (although I love movies about the inevitable zombiepocalypse) for two reasons: (1) stuff is always jumping out at the soon to be gruesomely eviscerated main characters and (2) the aforementioned protagonists always do really stupid things that then get them killed in really stupid ways. Horror movie stupidity is funny until you do it.
This week I had to take my second set of boards (Step 2 CK) the nearest test center is in Peoria. After getting directions to the test facility I had to find a hotel. After being mysteriously rejected from making reservations on Hotels.com, I finally managed to secure a hotel three or so miles from where I needed to be Friday morning via Orbitz. It was rated at two stars and was reasonably priced at about $60. It was called Kill Inn.
Just kidding, but it did start with a K! Anyway I drove to Peoria and after missing a turn finally found my hotel. It was right across from a shiny Marriot Suites. You know in the old cartoons where they show the "good" house and the "bad" one. Well Kill Inn was the one with the big clouds, lightening striking it, and bats flying out of it. There were two beaters in the lot and all the lights were out except for the office. It was several shades darker here than across the street at the Marriot Suites. Behind my chosen hotel the night swallowed some sort of bombed out industrial area. As I approached the front door a disheveled black man smoking a cigarette opened the door and flicked ash out. He muttered a greeting and held the door open, so I followed him past the numerous posted "NO SMOKING SIGNS". He shuffled up to the desk and gave the night manager a TV remote.
The night manager was a diminutive, pale fellow with Coke bottle glasses askew on his head. A new band-aid was precariously attached above his right eyebrow. As the myopic manager fiddled with the remote, I was able to inspect my fellow guest, the illiterate smoker. He was covered in names tattooed on his neck and arms, all done in the same dark blue shade of prison ink. With new batteries in the remote he shuffled off and I was able to check in. I was the first Orbitz customer to visit Kill Inn. As I left another guest, an obese Hispanic man with an entire novel in Gothic script permanently inscribed on his skin came to the desk. With at least two minority guests and a night manager I knew I would buy it no sooner than fourth, which reassured me greatly.
I drove around to the back of Kill Inn and proceeded upstairs to my room, there were at least three other guests by the number of heaps parked in the back lot. As I opened the door, I smelt the sour odor of drying paint. A chill brushed across my face and the curtains flickered, so I crossed the room and closed the window. The room was quite clean, mostly I suspect from the fact that it'd been remodeled quite recently to cover up a triple homicide of semi-nude prostitutes or something equally morbid. The clock radio was analog and looked like it was heavy enough to be the murder weapon. After watching some television (sterilely bagging the remote) and snacking, I called it a night. I hoped to either get enough sleep for my exam or to present an easy target for Norman Bates' nearsighted little brother downstairs so that I wouldn't have to take it.
I dragged the luggage rack in front of the door, since I could probably floss with the chain lock. As I was drifting off to sleep, a voice spoke to me, uttering some guttural gibberish. I was prying my fingers and toes out of the ceiling when I realized the noise of the television had masked that the sound proofing of the balsa wood walls only made people sound demonic rather than blocking them out. Satisfied that I did not need to perform an exorcism, I settled myself comfortably and sleep began to crawl upon me.
I drifted off and was rudely brought to consciousness by loud if good rap suddenly emanating throughout the room. I started to shrug off the covers and get ready to get up, hit snooze and drop off again. Which would be a little difficult as I hadn't set a radio alarm. After a little confused banging and tugging on the murderous clock it shut up. Presumably sometime after that I woke to cars pealing out of the lot, most likely my fellow guests escaping an axe murderer. Maybe my imminent demise had jumped up a few notches from slot number four.
When the alarm on my cell phone awoke me, I struggled to get ready then staggered out to my car. I drove to the front desk, where an amazed day manager accepted my room key. Apparently he had not expected anyone to be alive enough to checkout. And then the real horror began, I sat for a 9 hour Step exam.

Five Phrases That Make Graduate Students Cringe

"Let's set up a meeting"

Translation: I'm either bored, trying to justify my salary, or going to deliver some really bad news. In any case I'm going to waste your time and accomplish nothing.

"This is an opportunity for you."

Translation: I don't want to do this scut work.

"You should know this."

Translation: You are an undereducated fool. Being highly insecure and worried that you are smarter than me I chose to be flippant rather than helpful. To me mentoring means use a mistake to belittle you rather than teach you.

"This is an easy experiment."

Translation: I was sitting in my office and had a spontaneous delivery of oxygen and caffeine to my brain which then mated with some inherent lunacy producing this "hypothesis". Unfortunately, I spent less than five minutes thinking this out, have not actually physically performed a successful bench work experiment in over a decade, and will promptly forget about this idea after my next meal. In the meantime work yourself to the bone as I complain about how long it takes you to finish this "simple" project and present me with the results of an experiment whose hypothesis I will then disregard as utter madness.

"This is a quick paper."

Translation: My tenure is in jeopardy, I need publications now despite the lack of funding, data, laboratory manpower, or a literate grasp of the English language. That and the fact that my turn around time for editing your manuscripts is 6 to 12 months.

2006 Goals

Happy New Year! I think (and many motivational speakers, management consultants, and the like agree) that setting goals is great way to develop one's fullest potential. The new year seems to be a fitting time to do it (and procrastinate from studying). Here it goes:

This year

• 1/4/06 -- Pass the USMLE Step 2 CS.
  
• 1/27/06 -- Bang out an astronomically sensational score on the USMLE Step 2 CK. I'm shooting for a minimum score of 102.5%
  
• Spring 2006 -- Earning outstandings in my remaining rotations: family medicine, emergency medicine (surgery elective), and pediatrics. Not going to do them for a living (most likely) so I might as well take advantage of the experience and give it my all.
  
• June/July 2006 -- Perform amazingly during my visiting student clerkships in interventional radiology and neuroradiology. Convince programs that I can handle their residency program while saving Universe.
  
• August 2006 -- Start my (off-cycle) residency training as part the University of Illinois College of Medicine at Urbana-Champaign Residency Program in Internal Medicine. My first "real" job (aside from saving Universe)!
  
• Fall 2006 -- Apply/interview for Vascular and Interventional Radiology DIRECT Pathway programs. Given the miracles I will have to have performed up until this point, the application process will be a cinch.
  
• Publish work done with my students Josh and Amir.

In 5 years

• Be approximately a year and a half into my Vascular and Interventional Radiology DIRECT Pathway program residency training.

In 10 years

• Completed residency and fellowship training, working at an academic medical center.

And of course also meet my martial arts / combat sports goals.