Antiochian Village, Part II

Sorry. Med school has this tendency to get busy. Especially with all the other fun stuff I'm trying to do. Anyhow, Part Deux...

So from the zipline we moved over to a high element called "Ship's Crossing." This one is moderately ridiculous. Basically, there's a thin cable strung between two large trees. Maybe ten or fifteen feet above is another cable that has two long ropes hanging down, one near each tree. The only way to complete this challenge is two at a time. Both people have to use their ropes to get out near the middle of the cable -- which is about as far as those ropes will stretch -- and switch ropes, simultaneously crossing past one another to continue on to the other end of the cable. Of course, the cable you're standing on isn't taut, and with two people on it at once...well, it bounces around a fair bit. Also, it helps if the two people trying this thing are wildly different sizes...makes the whole "crossing over" bit a tad less awkward. I'll let the photos tell the rest of this story...



























That one didn't go quite as planned...the reason there's no picture of me up there is that I wiped out within a minute or two of stepping on the cable. Bah. Oh well, still fun!


The last "high element" of the day has two names. Officially, it's called the "Leap of Faith"; the name most often used to refer to it is the "Pamper Pole" (diapers optional but often recommended). Basically, it's about a 30 foot telephone pole with hand/footholds for climbing that has a trapeze hanging several feet out from the top of the pole. The idea is simple: climb the pole, stand on top of it (diameter is probably about 12 inches), and jump off the pole grabbing the trapeze in the process. I went up the thing last time I was at the course and my nerve totally failed me. It was all I could do to sit on top of the pole for a few minutes without puking all over everyone standing below encouraging me. Memories of that experience flooded back as I sat looking up at that pole. Despite relatively warm weather, I was freezing -- mostly because I was terrified. But I knew that the others weren't going to let me escape without even trying (for which, by the way, I'm incredibly grateful -- I would have been really upset with myself had I wimped out). So I found myself on belay, with my helmet perched on my epinephrine-addled head, staring up at my old nemesis. Small steps, I decided -- my goal would be to get a foot on top of the pole. With that in mind, I started to climb up the ladder to the handholds above. I got up onto the metal staples, climbed a little further, and froze. My body simply refused to keep going. I might have given up at that point but for the friends who surrounded me. They each had their own ways of encouraging me. Steve called for me to pretend that a certain person was there watching ("You're not helping!"). Jen wanted to know if I just wanted everyone to shut up so that I could concentrate on beating the pole into submission ("I don't have a competitive bone in my body...keep talking!"). Beth Ann, of course, reverted to her camp counselor role, constantly suggesting new approaches and intermediate goals, and simply wouldn't let me give up ("I think I'm done." "Come on, if you're going to fall off, don't you at least want to fall off trying?") Everyone chimed in, everyone offered support, and I clung to that chorus of friendly voices as if my life depended on it. And while I did fall off in the end (gravity and I aren't friends), I did so after having planted a foot on top of the pole and while struggling to get the second foot up there. So, thanks to the support of my friends and the grace of God (and no, I don't think the two are actually separate...) I did what I set out to do. When I came down, I was thoroughly exhilarated. I was also shaking uncontrollably and in moderately severe sinus tachycardia -- my heart rate, as near as Natalie, Steve, and BA could tell, was somewhere between 160 and 170. My extremities were freezing and the tips of my fingers were blue but I had (and have) no regrets. I gave it my best, and next time, I'll make it to the top. Anyhow, pictures...

Anyway, that's all I've got time for tonight. The saga will conclude with a wrap-up and random pictures from the day in my next post, and then we'll return you to your regularly scheduled blog.

Peace and God bless!

Antiochian Village, Part I

Finally, as promised, the long-delayed review of the day at the ropes course! Antiochian Village is a wonderful place that reminds me a great deal of the Benedictine abbey at Still River. It has the same sense of peace about it, but it also inspires a certain awe.
At the start of the day, we did some nice team-building activities to get everyone warmed up. Of these, the favorite had to be what the experienced counselors call "Turning Over a New Leaf." This involves standing on a tarp that's been folded to the size of maybe 12 square feet (3x4). We had to do two things. First, we had to get everyone -- all nine of us -- onto that tarp. That's the easy part. Then, with all of us standing on it, we had to flip the tarp over. Those of us who had been to the course before had tried this on a prior visit, but despite our best efforts, we hadn't managed to figure it out. This time, thanks mostly to Jen, we emerged victorious. However, there aren't any photos of it and the movie is currently too big to upload...I'll work on that.

From there, it was a short walk through the woods to the next element. Except that the short walk had a twist: half of us had to close our eyes and be guided through the woods by a partner. And this wasn't a nice, wide, flat path. It was narrow, rocky, and had plenty of ups and downs. It also had a plank, probably 18 inches wide and 8 or 10 feet long serving as a bridge across a small creek. Needless to say, this was quite a challenge. Unfortunately, we were all a little too focused on making sure no one went for an unplanned swim to take any pictures, so you'll just have to use your imagination here.

The walk through the woods led us to the zipline. Basically, you climb a ladder up to a series of staples (they look kind of like small horseshoes) and up the staples to a platform that's about 30 feet off the ground. From there, you're hooked up to the line itself which runs a couple hundred feet through the forest. Then you take a deep breath and either scoot, walk, or jump off the platform and go on an awesome ride through the trees. The scenery is amazing and the rush is incredible. Getting down requires some assistance: a couple of volunteers haul a ladder over to a wooden platform, unhook you from the line, and run the rope back to the platform for the next crazy, amped-up individual to grab it. Also, someone occasionally needs a little help stopping. If you end up in the position of having to do this, allow me to give you a piece of advice: F = ma. Thus, even if you're trying to stop a relatively small person, you're stopping them cold from probably 10 or 15 mph. It's a little harder than you'd think... Anyway, the pictures...

All right, that's about all the room I have for this installment. I'll work on the next one and get that up as soon as possible.

Peace and God bless!

At long last!

I finally have [most of] the pictures from the ropes course!! ...Unfortunately, I still have to sort through them, but hopefully within a day or two there'll be a complete retelling of the events of that wonderful, wonderful day:-)

Here's a preview...

Quick update

Spent the day at the ropes course. AMAZING. More details tomorrow; for tonight I'm falling asleep at my computer.

Peace and God bless!

(EDIT: Details will be forthcoming once the photos are available. Much easier to explain with pictures.)

Deep breath

Well, cardio is done. Hopefully. I'll know for sure in a couple of days. Really good class, an incredible amount of knowledge crammed into my poor little brain...and then a test that made the proverbial ton of bricks seem like a friendly pat on the back. Ouch. Anyway...let's focus on the positive.

Finished up with my pediatric mini-rotation today. Summary: I love pediatrics. Although that may change when the kids don't want anything to do with me and the parents decide to make my life miserable. I'll deal with that when it happens. The kids I've gotten a chance to see over the last couple of weeks (sorry, no stories...HIPAA, you know) have been phenomenal and it's been a true blessing to be able to work with each of them. The preceptor was tough, very tough, but a terrific teacher who really cared about making all of us better clinicians. Small hit to the ego, big boost to everything that really matters (clinical skills, approach to peds patients, interacting with parents, presenting patients, writing H&P / A&P, etc.). Couldn't have asked for a better experience. Another blessing, no question. Bonus: more clinical time on Friday, this time in Infectious Disease. That promises to be a whole new experience. I should review the adult exam though, huh...probably don't need to ask them about their birth history.

Anyway, there's plenty of other blessings in my life right now, and one of them is the fact that I can go to bed now and not worry too much about getting up at any specific time tomorrow -- I just need to make sure I get to the student lounge before the first-years get out of their exam. Hence, I am going to take full advantage of this particular blessing and get to sleep before I fall over. For any of you who read this, prayers for a couple of special intentions would be very much appreciated.

Peace and God bless!

A couple of really good songs...

Both from the musical Rent.


You can find the lyrics for Seasons of Love here.



And for finale B (Another Day reprise), the lyrics are here. Enjoy!

Peace and God bless!

Stress reduction

With the cardiology exam rapidly approaching (Saturday morning), I've been swamped and a little stressed lately (hence the lack of new posts). Thus, I'm going to steal another idea from Sara (I, uh, may need to start paying her royalties or something...) and spend a little time mentioning some of the people and things I'm really grateful for.

Two and a half days with nothing to worry about but studying -- and incidentally being able to avoid the scary crowds of protesters swamping the city on the eve of the G-20.

Incredibly cute newborns in the neonatology unit and NICU with excellent prognoses.

A PalPittations rehearsal without any disruptive influences...singing is fun:-)

Those little "sneaky God thangs" (tip of the hat to Fr. John Paul) that make me realize 1) God's watching, 2) He cares, and 3) He has a sense of humor.

Friends who continue to encourage me to give things a try despite my lack of confidence.

A trip to the ropes course next Saturday. As much as anything else, it's knowing that this much-anticipated day is approaching that's giving me the motivation to keep studying and get through cardio.

Family and friends that recognize my need to take care of people and let me do that without complaining.

Study sessions with Steve and BA. Part productivity, part comedy act, pure genius.

Notre Dame alums. Constant reminders of why it's good not to take sports seriously.

Phone conversations with my parents keeping me up to date on their lives and what's happening with my siblings. Don't know what I'd do without those.

Knowing that I've got my plane tickets home for Thanksgiving:-D


Yep, I definitely have lots to be thankful for. Back to studying now, but with a little less tension than before:-)

Peace and God bless!

Sola gratia

Some interesting readings at Mass today. The second reading was from the Letter of James and is one that has occasioned much comment.

Jas 2:14-18
What good is it, my brothers and sisters,if someone says he has faith but does not have works? Can that faith save him? If a brother or sister has nothing to wear and has no food for the day,and one of you says to them, “Go in peace, keep warm, and eat well,” but you do not give them the necessities of the body,what good is it? So also faith of itself, if it does not have works, is dead.
Indeed someone might say,“You have faith and I have works.” Demonstrate your faith to me without works,and I will demonstrate my faith to you from my works.

The Gospel for the day (Mk 8:27-35, too long to reproduce here) drives this point home. Christ asks His disciples what other people think of Him before inquiring "But who do you say that I am?" Peter demonstrates his faith by saying "You are the Christ." The best known part of the passage has Him later rebuking Peter ("Get behind me, Satan") for "...thinking not as God does but as men do." This, though, is not the crucial part of the passage. Rather, the critical line is Christ's admonition for one who would serve Him to "...deny himself, take up his cross, and follow me." Belief is not enough; we are called to live the faith we profess.

But what it all comes back to in the end is grace. Faith itself is a gift that we do not, cannot deserve. Not sola fide as some theologians have suggested, but sola gratia. Salvation, by any measure, is not rooted in us but in the benevolence, the grace of a God who love His creation enough to offer that salvation to us. Faith and works are both the products, first and foremost of grace. How great indeed is our God who offers us this gift.

Peace and God bless!

A&P + randomosity = this blog post

Spent most of today trying to craft an actual assessment and plan for a patient I saw yesterday, the first of my young medical career. It's, uh...harder than it looks (especially since it was a patient in the hospital with GI problems -- we haven't done the GI block yet). I spent just about 5 hours reading and researching and putting this thing together...a grand total of less than a page. And yet I don't begrudge a single minute of the time I spent on it, especially since it's probably something I'm going to be doing a LOT of over the next several years, so it behooves me to gain some experience and get better (and faster) at doing them. It was also more fun than I should probably publicly admit...but anyone who reads this already knows that I'm a nerd.

Non-medical thoughts for the day:

I'm really looking forward to Monday. That's when all of the Notre Dame alums in my class will go through their weekly ritual of making excuses for their football team. Former Wolverines, go to town.

Really great, Serena. Look, losing a tennis match is excusable. Losing your cool like that is not. Once again, you're just setting such a TERRIFIC example for budding tennis players everywhere. Get over yourself.

The SEC takes a narrow lead in the "second best conference in college football" standings by virtue of not having any of its teams choke on one of their cupcakes. Lemme give you a hint, Oklahoma State...if you want people to take you seriously, losing by 10 at home to a team that barely qualifies as having a pulse is NOT a good way to go about it.

'Bama needs to start playing with more discipline.

I can't wait to see what Florida does to Lane Kiffin's Vols next week. Better hide the kids.

Gotta love Ohio State. They're always good for at least one major gack a year.

Wow. What a round by Tiger. Was he playing the same course as everyone else...?

Still running into the person I mentioned last time. Hopefully that continues. More time and more conversation are the next goals.

You know, if you want to fix the health care system, we're going to have to spend money. Hope and change aren't free.

Of course, where we GET that money is another issue altogether.

In memory of the events of September 11, 2001, please say a prayer for our soldiers abroad and our first responders at home in thanksgiving for their service and in supplication for their protection.

Peace and God bless!

Random thoughts

When I say "random," I mean "having no rhyme or reason." These are merely comments that I'm typing as they pop into my head. If you're looking for a coherent read, better wait till next time...

Last time I saw my cousin, she was a 10 year old kid. Now she's a married mother with a second kid on the way. Apparently people change over 17 years...

And her husband is quite a chef. Learned rather a lot about grilling / cooking tonight.

Brownies are better when made with dark chocolate. This is not an opinion.

Inpatient pediatrics is not my cup of tea. Much more fun to get them better and send them home than to watch as the kids go through hell and then slowly convalesce. Peds EM all the way.

What a match by Melanie Oudin! I haven't pulled for an athlete this hard since Dara Torres in the Beijing Olympics.

...even though it's slightly depressing to realize that she's a decade younger than I am.

Yeah, the -8 was great, Tiger...classic case of "too little, too late." Something about a barn door and a horse...

In the Hoodie Master we trust...but Seymour to the Raiders? Really?

Yeah, the final score was 34-24, but it was only that close because the Tide were undisciplined, played atrociously on special teams, and only told the quarterback that there was more than one eligible receiver on the field sometime after halftime. It coulda been ugly.

Very impressive, Notre Dame. You beat Nevada. (<-- sarcasm) Then again...

It's better than losing to Appalachian State. Right, Wolverines?

Congrats to Boise and BYU. Maybe 2 BCS busters this year??

That said, the Boise player should have been suspended too.

I keep running into this one person (seemingly) all over the place now.

And each time I find myself increasingly impressed and thinking that I'm not running into this individual enough.

...is that creepy?

Pressure-volume curves are the current bane of my existence. At least the adrenergic drugs make sense, even if I don't remember all of them.

EKGs, on the other hand, make me feel like a kid in a candy store.

Or perhaps more accurately, like a chemist with a shiny new NMR.

Amazing how much peace can be derived by just sitting quietly in the chapel.

Even more so in front of the Blessed Sacrament.

Is there a reason people keep assuming I'm married? It's happened several times already this year, and I can't figure out why.

Gray hair is worth its weight in gold on the wards...patients' (and parents') willingness to accept what you're telling them seems to be directly proportional to the number of gray hairs on one's head.

I'm thinking research study.

White coats can be another variable.

Ok, that's enough randomosity for tonight...class early tomorrow.

Peace and God bless!

Research and journalism

There's an article in last week's issue of Annals of Internal Medicine that compares retail health clinics to primary care physicians, urgent care centers, and hospital emergency departments. It arrives at the conclusion that these retail care clinics provide care statistically equivalent to that given by PCPs and urgent care centers and superior to that given by emergency departments in cases of otitis media (middle ear infection), pharyngitis (sore throat), and urinary tract infection (UTI). This article was reported on today by MSNBC; you can see that story here. There are, to my mind, enormous problems with both of these pieces, and I want to address some of them here.

I'll start with the MSNBC article. The egregious error lies in the author's assertion that "To track the quality of care, the researchers studied outcomes for three routine illnesses..." This is incorrect. The study does not (and does not claim to) measure outcomes. Rather, it uses quality metrics based on standardized instruments and professional guidelines. Outcome has absolutely nothing to do with it. The reason that this is such a serious lapse is that "outcome" is, essentially, the bottom line for any patient encounter. When all is said and done, how did the patient do? By carelessly using this term, the author effectively creates an illusion that patients "do better" in one setting than another. In this case, yes, one word makes THAT much of a difference.

For the Annals article (written, ironically enough, by an UPSOM professor and his colleagues), I also take issue with a number of things. Most of these issues stem from a single gripe: the emergency department is not a good choice for a comparison group in the study. EDs, unlike retail clinics, PCPs, and urgent care centers, must by law accept all comers. They tend to have higher average acuity (EMERGENCY, people!). They tend to be starting from scratch rather than from an established diagnosis. They don't generally do follow-up visits or chronic care; they have you follow up with your PCP. Many times, in non-emergent situations, after ascertaining the lack of immediate danger the emergency physicians will get in touch with the primary care docs and allow them to manage the course of treatment. And most of all, they are not designed or intended to deal with minor issues. Translation: THE ED IS NOT THE PLACE FOR DIAGNOSING AND TREATING OTITIS, PHARYNGITIS, OR UTIs (or vaccinations, Pap smears, colonoscopies, mammography, or really any preventive health interventions -- all metrics used in this paper). Also, the article does not make it clear what kind(s) of EDs provided data for this research. Were they large academic centers? Children's hospitals? Small community hospitals? It makes a difference. Another point: the study compares the costs of care at the different health care centers, and the ED is by far the most expensive. Why? Because if you have insurance, you're basically paying for all the people who come into the emergency department without it. I wonder how much the numbers would change if they factored in the patients who received full ED services gratis. Anyway, the long and the short of it is that the emergency department was a poor choice for a comparison group.

Of course, the point of the article is that the quality of health care (as defined by the metrics, and in these three particular illnesses -- the latter is a rather severe limitation) is no worse at retail clinics than in other settings and that the retail clinic costs less. Great. Maybe they can start taking all of the patients that don't belong in the ED. But the numbers (and the conclusions) must be taken with a good-sized grain of salt, especially in the comparisons between health care providers. Anyway, read the article (by Mehrotra et al) and tell me what you think.

Peace and God bless!

All I can say is "try it."

My original intent was to post something about prayer. I actually got pretty deep into two different versions, both variations considering a line about prayer from C.S. Lewis's The Screwtape Letters. Both were heavily academic, and you'll notice that neither one appears here. Why? Because they just seemed inadequate while I was writing them. Prayer isn't an academic thing, and it's not something that I'm capable of elucidating right now. To understand prayer, you need to...pray. So instead of wasting copious amounts of virtual ink on something I can't yet hope to explain adequately, I'm going to go pray Compline...and then sleep, since 6:30 will get here mighty early tomorrow. Oh well.

God, come to my assistance!
Lord, make haste to help me!

Peace and God bless!

Perspective

It's awfully easy to stress out about life. Sometimes it seems like there's an endless parade of obstacles and problems, each attempting to make life as infernally difficult as possible. There are classes to study for, abstracts to write, posters to assemble, FAST gatherings to plan, clinical sessions to attend...and of course, the pink elephant that no medical student wants to talk about -- post-graduation debt. There are millions of things to do and not nearly enough time to do them all. And so we (and by "we" I mean "I") worry about all of these things that seem so important.

And then I see something like this. I found a link to it in a blog written by another medical student, and it puts into shockingly clear perspective just how monumentally unimportant most of my worries are. Perhaps more significantly, it reminds me of just how little I've done, just how little I've sacrificed, to make the world a little better for the rest of God's children. It reminds me of why I've chosen this path, and of why it's important for me to shut up with the complaining and work to learn as much as I can. I've been blessed beyond all belief; thus, my vocation for the rest of my life will be to be a blessing to others by the grace of God. Maybe, just maybe, it's time for me to stop being a wallflower and start making a difference.

On a not-totally-unrelated note, I also found an article that some people might find interesting. Take a second to check it out.

Peace and God bless!

Sing a little song...

PalPITTations is back and (after knocking some of the rust off) better than ever! If there's a better way to improve an already satisfactory day than by spending some time singing with friends, I have yet to discover it. It really is more fun than you might think, given the discipline and practice that are required even for our laid-back little group. Just being able to sing is a release and a joy in itself, and to hear a song coming together, the voices blending in a vibrant harmony...it's really its own reward. It's especially gratifying after a day spent doing virtually nothing but studying cardiology. It's the playtime that helps to refresh the mind after hours of intense work, and while it can seem like it's wasted time ("I NEED TO BE STUDYING!!!"), I know it helps me be better prepared for the tasks that still lay ahead. After all, burning out now sure won't do me any good.

Anyway, life right now is surely good, which is a blessing for which I'm very thankful. It stands to get even better (albeit infinitely crazier) next week when we get to go start playing doctor again. I'm absolutely looking forward to it! In the meantime, could I ask those of you who read this to keep a special intention in your prayers? Thanks, it's always appreciated!

Peace and God bless!

Decisions

It's late and I'm exhausted, so I offer a single thought to ponder for tonight. Which is preferable: to do the right thing for the wrong reasons or to refrain from doing the right thing because you know your motivations are poor? Let me know what you think and why.

Peace and God bless!

Reflections

So the first class of second year is over. In some ways it was a great way to begin: interesting material, short duration, and for all intents and purposes impossible to fail -- low stress = happy students. Next up, starting tomorrow morning, will be cardiology. The syllabus is enormous, easily several hundred pages long, but this will be one of the most interesting and useful courses we've had so far. It'll be a huge volume of material, so some other things may end up sliding a bit.

On another note, since it's Sunday, I just want to take a moment to consider the reading from St. Paul's letter to the Ephesians today. It's probably one of the most uncomfortable readings in Scripture from our modern perspective. I'll be honest, I've never understood it particularly well myself, so I'm probably not the best one the explain it, but something struck me while listening to the reading today, so I figured I'd write it down and see if it made sense.

"Wives, be subordinate to your husbands." The statement offends modern sensibilities. It appears to oppose everything that we're supposed to stand for. It's a statement that few homilists will dare to approach in any detail. However, one Dominican priest of my acquaintance bravely attempted to explain once that the husband's relationship with his wife is to mirror that of Christ with the Church. There was a lot more to it than that, but that was the central point. Until now, I haven't really been able to come up with a sufficient explanation of what that meant.

Today, as I was contemplating the reading, I realized that Christ not only gave His life for His Church, but that He has joined Himself to the Church, that He lives for the Church. It is her life for which He is primarily concerned; He cares more for His Church than for His own life. He sacrificed everything that His bride might live. And it is this that a husband must do in his own life. He is to place his wife before himself in all things, to be her shield and her sounding board, her friend, her shoulder to cry on, and her partner. It is his job to care for her when she can't care for herself. I should probably explain this before getting myself yelled at: a wife's first concern is not for herself either, particularly when she becomes a mother. And when you live for another, you tend to neglect yourself, or have unrealistic expectations of yourself. Often, we can push ourselves too far, and even when someone else points this out, we don't want to hear it. And so, it is the part of the husband to look out for his wife's well-being in all things, even if it means sacrificing himself. Thus, if the husband is doing his job, his wife would be smart to pay attention to what he says. Since she isn't concerned with herself, she should be guided by the one who is concerned for her.

Anyway, I don't know if any of that made any sense. Probably not. Either way, those are my thoughts for the evening. More in the near future.

Peace and God bless!

The joys of simulation

I've said it before (although not in this space) and I'll say it again: medical simulation is one of the most powerful teaching techniques I've ever experienced. And it's not just good for manual skills either. Pharmacology overall has not been a poorly taught class (with one or two exceptions), but I learned more about cholinergic and anticholinergic toxicity in two hours today than in all of the lectures on the subject (some 6 or 7 hours) combined. For example, in explaining why it was a horrible idea to give a patient with myasthenia gravis either succinylcholine (it won't work) or pancuronium (the patient will be paralyzed for an extended period of time), the anesthesiologist presenting the case clarified the entire mechanism of activity of both drugs. He also included a bonus lesson in clinical management of patients so affected; while his advice may be of little help on the test, it was of immense practical value.

So why aren't we doing more to employ this particular modality? Even here at Pittsburgh, where we have a massive simulation center and the medical students make regular use of it, we're only experiencing a small fraction of its full potential. In other places, students aren't even permitted to use the mannequins; they're only used to train MDs. It seems to me that we're wasting valuable opportunities by not making the fullest possible use of this technology -- or at least spending some effort on validating it.

Anyhow, those are my thoughts for the night. Tomorrow's a study day; next entry will probably be after the test on Saturday. Till then, take care.

Peace and God bless!

Mad as a hatter...

Those among you who are medical students or physicians may recognize the title as being part of an old mnemonic for an atropine overdose -- i.e. a muscarinic antagonist overload. Color me overloaded. (Well, no, not really, but I am nuts...just ask anyone.) Anyhow, in the last three days we've covered basic pharmacokinetics (including handfuls of equations and instruction on how to design a dosing regimen) and all things (ok, maybe not all per se) cholinergic. Muscarinic, nicotinic, ACh, AChE, succinylcholine, rocuronium, organophosphate toxicity, sugammadex activity, agonists, antagonists, etc. Tomorrow we deal with cholinergic activity in the eye, then we have another conference (this one on, shockingly, cholinergic activity), and we finish off the new material in pharm with a simulation session. It's all very exciting. (I told you already, I'm crazy.) Then, of course, the test is Saturday, and even my nerdy self can't find much enthusiasm about that. Oh well. Anyhow, I should probably cap this here and get going, as there are still muscarinic antagonists to learn, mechanisms of neuromuscular blockading drugs to wrap my mind around, and...oh, yeah, dinners to eat. Hm, should probably get on that.

Oh, and if any of you are just DYING for the rest of the mnemonic:
"Red as a beet, dry as a bone, blind as a bat, mad as a hatter." Ask any med student (who's had pharm) or physician; they can explain it to you...although I can't for the life of me understand why you'd want to know.

Peace and God bless!

First day of MS-2

So it begins. And we're not talking "dip a toe in the water"; this is full-immersion baptism by fire. Today: four pharmacology lectures (moderately interesting, believe it or not), a two and a half hour research meeting (that completely transformed my project -- most productive 2.5 hours of research I've ever experienced), and an advising dinner for the new first years (two points here: a) the class of 2013 is awesome; and b) my FAST group is even awesomer. Yes, that's a word now. Because I said so. No, you can't argue.) This is followed tomorrow by more pharm lectures in the morning, an hour-long orientation to second year from 12-1 (I'm thinking there'll be pizza involved), and then a re-orientation to the IPC (Intro to Patient Care) block that's scheduled for 3 1/2 hours. Yikes. Then, after that, I have to meet with my small group to put together the pharm presentations due Wednesday (Rational Use of Drugs) and Thursday (Cholinergic Medications); that'll keep us busy for a while. Of course, there are more lectures to go along with those presentations on both Wednesday and Thursday, and then Thursday closes with a simulation session run by my research advisor (looking forward to that like you would not believe!). Friday is a review day and then the pharm test is on Saturday morning. Deep breath. *Whew!* So yeah, that's the week. More updates to come as things happen.

Peace and God bless!

Health care rant

All right, all of you lame-brained, lily-livered, greedy, grasping, partisan, worthless politicians, LISTEN UP. I don't know about the rest of the country, but at least one American is SICK and TIRED of your petty partisan bickering, your incessant lying and exaggerations, and most of all your persistent choices to sacrifice the good of the American people for political and / or personal gain. And don't ANY of you try to tell me that you're just the innocent victim here, that those big, bad Republicans or those Lilliputian Democrats are out to get you. This utter FIASCO that is the current "debate" on health care reform has made one thing very clear. Neither of you are the LEAST bit concerned with anything but making the other guys look bad. Republicans, you've made this very clear with your asinine assertions regarding coverage for millions of illegal immigrants and the elderly undergoing what would amount to (by your arguments) mandatory suicide counseling. Your best arguments (you know, the ones about fiscal responsibility and the fact that we have no way to pay for all this as well as the central role of the oh-so-efficient American government in the administration of this new structure) apparently aren't sensational enough; instead, you'd rather stick with the off-the-wall crap ("DEMOCRATS ARE SOCIALISTS!") that you know will get you air time. Despicable. And Democrats, you're no better. You're flat-out LYING about the "saving money" thing ($2500 per family, Mr. Obama? Really?); this bill is going to cost an incredible amount of money that the country just doesn't have. You have no solid plan about how to pay for it. And your rhetoric demonstrates that the biggest reason you're so hot to pass this measure is to stick it to the Republicans. Once again, you're virtually omitting your strongest arguments (that this could potentially provide coverage to millions of additional Americans which, by the way, benefits both patients from a health perspective and health care workers from a fiscal perspective; then of course there's the little tiny fact that THE SYSTEM WE HAVE AIN'T WORKING!) in favor of "The Republicans are trying to screw you over!" and "We're going to save you money!" Which is true if you're...oh wait, no, it's not going to save you money AT ALL because while this may make coverage more available it does NOTHING to combat the underlying issues that have caused the price of health care to balloon *coughdefensivemedicinecough*. So, in summary, despite the glaring need for honest-to-goodness health care reform, all of you in both parties (and the nominal independents) are fighting over half measures to make political gains. Shame on you. The American people deserve better. Get off the donkeys and elephants and start taking your jobs seriously.

*Ahem* sorry about that. Unless you're one of the aforementioned politicians, in which case I'm not sorry at all. I'm just sick of all of the pointless political crap surrounding an issue that so desperately needs to be addressed in a timely and decisive fashion. Anyhow, last day of summer break tomorrow, and then MS-2 year begins in earnest. I'm actually looking forward to it. Yes, I'm a nerd. 'Nuff said.

Peace and God bless!

It's all in the way you look at it...

Traveling back to Pittsburgh from home is, as I believe I've mentioned before, always a struggle. It's always tough to leave Providence again, and to deal with the nagging feeling that I'm journeying in the wrong direction. The hardest part, without fail, is saying goodbye...saying goodbye to my parents, my brothers, my sisters, knowing that I'm not going to see them for months. These were the thoughts running through my head as I brooded on my return to the Steel City.

One of the most depressing thoughts that occurred to me was that every "hello" is merely the prelude to an inevitable "goodbye." No matter the circumstances, every human relationship ends up in parting. As you can imagine, this did little to improve my state of mind.

But as I thought about it a little more, I realized that my original impulse couldn't be more wrong, that in fact I had everything backwards. It is not that goodbyes are the unavoidable product of hellos, but that the partings are preludes to reunion. This is, in my opinion, one of the greatest comforts of the Catholic faith: the realization that even death is merely a temporary separation. So tonight, I won't think of the goodbyes that are behind me, but of the hellos that are yet to come.

"Consequently, friendship is, as it were, concomitant with perfect happiness." --St. Thomas Aquinas, Summa Theologiae Ia IIae Q4 a8 ad 3

Peace and God bless!

Back from Phoenix

Well, we're back. I would have posted before this, but the internet has been kinda screwy for the last couple of days. Anyway, it's late, so here's a quick summary: Arizona rocked. It was a little hot for me (average high was near 110 while we were in Phoenix), but thanks to the swimming pools and the scenery, that mattered little. I'm not going to go on and on about the trip; for the very few of you who look at this blog, if you want to know more, just ask me. Here are a few pictures from the experience:

Peace and God bless!

Prayer request and travel plans

This seems to be happening all too often these days, but for anyone who's reading this, I'd really appreciate your prayers for one of my good friends from college and her family. Her mom is really sick, and not for the first time; it gets harder and harder on my friend and her entire family each time her mom ends up back in the hospital. If anyone could use prayers right now, it'd be them.

Second and less importantly, tomorrow morning I'll be off to Phoenix for a little over a week, followed by a week in Providence. I still don't have a camera so I can't promise pictures of the trip, but I'll try. I'll be back in da 'Burgh on August 10, just in time to help out with orientation for the new 1st years. I'm not sure what kind of internet access I'll have in Phoenix, so I may not receive emails till I'm back in Providence.

Anyhow, I'm signing off for now. Gotta eat, finish packing, and then get to bed...early flight tomorrow.

Peace and God bless!

Health care reform, part I

I've spent some time over the last couple of days looking at the House of Representatives proposal regarding health care reform. Of course, the bill is over 1,000 pages long, so I've only seen a very small part of it. Thus, this will probably be an ongoing (and sporadic) series of posts as I read more. I should say at the outset that I am wary of this plan, but I'm not about to dismiss it out of hand. I plan to frame this as a series of questions, and I will attempt to point out both the good and the bad in the plan. As always, [polite] commentary is appreciated.

One of the overarching questions that I think needs to be addressed: who is eligible for health insurance under this plan? Will, for example, illegal immigrants be able to receive health care under the so-called public option? (I think it's important to note here that I don't think this is necessarily a good or a bad thing; it's all in the context).

Another thing that needs to be addressed: part of the reason that health care reform is necessary in the first place is because of the ballooning costs to which Mr. Obama alluded in his remarks this evening. An enormous part of this cost is derived from the fact that physicians are virtually required to practice defensive medicine rather than being permitted to rely on their best judgment. If you take a blow on the head, unless the doc is 100% certain that there is NO risk whatsoever, you're likely to get a CT, over 99.9% of which will be negative. Why? Because of the threat of lawsuits for enormous amounts of money. Of course, not even doing everything right eliminates the risk. One woman threatened to sue any physician who 'let her father die.' The man was over 80 years old, everything in his body was falling apart, and he was kept alive and coded multiple times (very expensive and horrid quality of life) because the physicians were laboring under the threat of a lawsuit. Of course, they couldn't keep him alive indefinitely, and when at last he died, his daughter did in fact sue. The kicker? The insurance company settled for thousands of dollars rather than undertaking the "nuisance" of defending the physician's reputation and actions in court. We are a litigation-happy society, and that inflates malpractice insurance, requires physicians to order expensive and unnecessary tests and procedures, and drives health care costs through the roof.

A brief interlude here: Mr. Obama is certainly well-intentioned, but in terms of actual health care, he clearly knows not of what he speaks. He's right that we need better communication, but he seems to be laboring under the delusion that there's a single "correct" diagnosis or test for every patient, and that docs should always be able to arrive at the right conclusions. While I appreciate the confidence, that's not the way it works. There's a reason we have different kinds of specialists and different kinds of tests. He's also very deft at playing politics while appearing to take the high road. I know that's ubiquitous in Washington, but it's kind of disappointing in someone who's been portrayed as being above that. I will reiterate, however, that I DO believe that Mr. Obama is genuinely doing his best for the American people, and I agree with his assessment that he was given an absolute mess to begin with.

Another thing I want to comment on is the concept of exclusions for pre-existing conditions. In some ways, these are reasonable protections for insurance companies against fraud. That said, they can easily be abused, and the exclusion periods seem excessive. Certainly they do not appear tenable in their current form; however, is it financially feasible to eliminate the exclusion altogether? It seems like that's the kind of thing that unscrupulous people (and there's no shortage of those in America) could easily take advantage of. How can this be crafted to strike an appropriate balance?

Another interlude: props to Mr. Obama for this one. I completely agree that it should be the physician rather than the insurance company deciding what care is appropriate. Of course, the question of reimbursement becomes a sticky one, but still, the thought is right on the money.

Ok, that's it for now. I'm going to finish listening to this press conference and maybe do some more reading. Any thoughts or commentary would be most welcome!

Peace and God bless!

On Ordinary Time

Some brief thoughts on the season of Ordinary Time:

Despite the fact that there's no big holiday associated with it, there's nothing "ordinary" about it. Nor is it merely marking time while we wait for Advent to begin or Easter to arrive or some such. Ordinary Time is a remarkable and beautiful season in its own right, and in some ways it is perhaps the most sublime liturgical season of all.

During Advent and Lent we prepare ourselves for the celebrations of Christmas and Easter. We celebrate the great mysteries that define our faith: the Incarnation, the Crucifixion, and the Resurrection. We celebrate the greatness of God as it is made manifest in those mysteries. But in Ordinary Time, we celebrate the greatness of God because He is God. We need no other reason.

It is indeed a time to focus on the ordinary, on things to which we would normally not give a second thought. When we begin to contemplate the ordinary, we quickly arrive at the realization that there is nothing "ordinary" about it. The simplest things -- a daisy, a robin, the smile of a person that you see every day -- they are all, in their way, exquisite. They are all ordinary, yet they are all extraordinary. They are all the gifts of God's wisdom and grace. They can all be powerful and awe-inspiring reminders of the majesty and the unbounded love of Father, Son and Holy Spirit.

So take a moment today to think about something ordinary. On closer inspection, you may just find that it's not so commonplace after all. For sometimes the most routine things -- like Ordinary Time -- may just be the most extraordinary.

Peace and God bless!

Working with kids

A few things for today:

First, please continue to keep my friend and her family in your prayers.

Second, I wanted to say a few words about the tenth and eleventh graders that I worked with this past Wednesday. I have to say, it sounded like a pretty tough schedule. Many of them were coming from an hour or two away and so were only getting four or five hours of sleep. Needless to say, these teenagers weren't too excited about having what amounted to a series of 20-minute lectures first thing in the morning. I was assigned, along with one of my fellow MS-2's, to present a synopsis of the neurological exam. Fair enough, we figured, we'd do brief presentations on cranial nerves, cerebellar testing, and then demonstrate reflexes and let them practice on each other. Well, never having done it before, the first group was a pretty fair disaster. I'm pretty sure at least two of the kids fell asleep. So we picked it up for the second group, had plenty of time to do our "fun" activity (reflex testing)...and found out that they had already learned how to do this the previous day. Oops. Sooo, we started improvising. We starting doing things like demonstrating Weber and Rinne testing, pupillary reflexes, and the Babinski sign. (After much debate, we decided to skip actually showing them how to test a gag reflex...) It ended up going ok, although it was pretty evident the kids had had about enough after three or four stations (I think there were seven total).

The afternoon got everyone much more engaged. They were presented with a public health crisis - they had to come up with a plan for dealing with an H1N1 / H5N1 flu outbreak in Pittsburgh. The discussion was very spirited and HIGHLY entertaining. As the scenario got more complicated (oh, it seems that the disease has spread to DC) and the kids had more and more to deal with, they became more and more desperate...and increasingly hilarious. I didn't know whether to be amused or disturbed by the frequent references to "I Am Legend" and when we suggested that there were really no wrong answers, we had to retract almost immediately thanks to a "cut your losses...nuke the city" suggestion. In the end, the kids decided to quarantine a radius of 40 miles around the city, make all the citizens remain in their houses under guard (military and police who would be supplied with protective gear), to set up triage stations at Mellon Arena, and to supply the city by airdrop (all supplies would be dropped into Heinz Field). We tried to indicate that this would require far more in the way of manpower, money, and supplies than we would have available, but to no avail. Still, it was certainly not a terrible plan and it was very interesting to see how they prioritized -- they emphasized the good of the community over individual freedom and suggested eminently pragmatic and unsentimental measures. There was even some suggestion that the media should be asked to lie to prevent panic, although this was eventually voted down on the theory that offering misinformation would cause greater panic than truth ever could. The group dynamic was also interesting -- one girl established herself as the clear leader, while the others each had at least one substantive commentary on some issue about which they felt strongly. It was fascinating and truly entertaining, although I almost died when they presented the "nuclear option" and the "day of the dead" option (kill all of the infected) before getting to their actual proposal in the big group setting. I'm kind of shocked that Dr. Gonzalez didn't ban us from all future related events...

Anyhow, that was a truly fun and rewarding experience. I don't know if I'll get any photos from that event, but if I do, I'll post them here.

Third, I do have some pictures from the Health Scholar's Academy that I and a handful of other PittMed students helped out with last week, so I figured I'd post those.

That's all for tonight; on tap for tomorrow (circumstances permitting): reflections on Ordinary Time. Till then, take care!

Peace and God bless!

A prayer answered; a prayer asked

To anyone who prayed for my aunt, thank you; she delivered a healthy baby boy by C-section this morning (5 lb 7 oz, 19 in). They'll be in the hospital till at least Monday, but they both seem to be in terrific shape. Unfortunately, no pictures yet...maybe next week?

In other news, I was hoping today to spin some tales about my experiences teaching 10th and 11th graders yesterday at Scaife. Unfortunately, it appears that what you get instead is another prayer request. From the little information I have, all I can say for certain is that one of my friends here at school apparently suffered a family tragedy today. I don't know for sure what happened; all I know is that something bad happened. So please keep her and her family in your prayers.


Psalm 130 - De Profundis (From the depths)

Out of the depths I cry to You, O Lord
Lord, hear my voice!
Let Your ears be attentive to my voice in supplication.
If You, O Lord, should mark our guilt,
Lord, who would survive?
But with You is found forgiveness,
For this we revere You.

My soul is waiting on the Lord;
I count on His word.
My soul is longing for the Lord
More than the watchman for daybreak.
Let the watchman count on daybreak
And Israel on the Lord.
For with the Lord there is mercy,
And fullness of redemption.
Israel indeed He will redeem
From all its iniquity.

Eternal rest grant unto them, O Lord, and let perpetual light shine upon them.

Peace and God bless...

Prayer request

My aunt, who's about 35 weeks pregnant, is currently in the hospital with bleeding problems that apparently have the docs there baffled. She and my uncle have been bouncing back and forth between house and hospital for a week now without answers or any kind of solution to the problem, so I'd really appreciate any prayers you could offer for them and their child at this point. Thanks, all.

Peace and God bless!

The eternal "now" of the love of Christ

This was the topic for Fr. David's homily today, and I thought it was worth some virtual ink. One of the easiest things in the world, as he mentioned, is to get caught up in the past, or to spend one's life "looking away to the future, to the horizon" (bonus points for identifying the movie quote -- it's a seriously easy one). When I think about it, it's really easy to see how true this is in my own life. How many times each day do I catch myself brooding about things that have already happened, wondering if maybe I shouldn't have said something or should have done something differently? How often do I relive old moments, fretting over that which I no longer have the least ability to change? And it's even easier to spend too much time looking forward in any of a number of ways. This is perhaps understandable -- the future is unknown to us, and so we come up with plans to make it seem less frightening, less overwhelming. So instead of accepting that we don't know, we design something of a fantasy life and try to convince ourselves that our vision reflects a future reality. But both of these things remove our focus from the present, from where we are now. (Side note - in his book The Screwtape Letters C.S. Lewis makes a very interesting argument regarding why concentrating on the future is an especially dangerous thing. I highly recommend it.)

But hold on a minute. This whole "living in the present" thing, isn't that what most people do nowadays? Isn't it the "Do what you want today because tomorrow may never come" mindset? Well, no. I think it's particularly important to make a distinction between "living in the present" vs. "living for the present." When we do the former, we are trying to allow the presence and love of Christ to affect us where we are. We recognize the day for the gift it is, and we open ourselves to the grace that God offers us. The latter is something entirely different. When we live for the present, we neglect God's grace entirely. This is the mentality so common today, the idea that it's perfectly acceptable to do whatever we feel like because today is the only thing that matters. In living for the day, the eternal is deemed to be of no consequence; indeed, the very concept of eternity is alien. It offers no recognition of past or future, which (it must be emphasized) is NOT true for one living in the present.

It's getting late and I'm becoming incoherent, but I want to take a moment to offer a quick summary of what I think it means to be living truly in the present. It means that, on some level, we have come to terms with the unalterable nature of the past and the uncertainty of the future, and that we are willing to commend the past to His mercy and the future to His grace and providence. It means that we open ourselves to His love now, that we seek Him where we are, and even when we can't seem to see Him, we still choose to open our hearts and obey His commands. It means acknowledging our own limitations and shortcomings, and placing ourselves in the hands of the One who has promised to be our shepherd. ...um, yeah, I can't do all that either. I'm not even close. What makes it so tough? Because as with so many things in life, the hardest part is letting go.

That sounds like a nice dramatic ending, and I don't have the energy to go into detail for the purposes of explanation just now, so we'll leave it there for the night.

Peace and God bless!

Today

I had the chance today to work with some high school seniors who are in a high-intensity summer program. It was a lot of fun for me; I got to answer their questions and teach them how to throw sutures in pigs' feet. They seemed like they were having a good time, but there was something that really stood out to me. More than any other high schoolers I've ever met, they were tense, worried about the future, not convinced of their own adequacy. There were so many questions about what they needed to do, what they should study, how they were going to get into medical school. They were already filling their resumes with volunteering activities, with high-powered classes, and with all sorts of things designed specifically to get them into medical school. Even this program they're in, while the part that I participated in was fun, is an incredibly intense, demanding, difficult academic exercise. They have virtually no free time during the program, and it involves heavy classwork, at least one research paper, and the design and execution of a service project. Don't get me wrong, I think the program is a very worthwhile one; it's just that there is NO way you could have convinced me to spend my last summer in high school doing something like that.

Maybe I'm not the best person to judge; after all, the desire to become a physician is something that I've only come to relatively lately. It hasn't been a lifelong dream of mine to be a doctor, and for many of these guys, I think that going to medical school (PA school, nursing school. pharmacy school) has been their only dream all their lives. Still, it seems to me that as kids going into their last year of high school, they should be getting excited about college rather than fretting about medical school. As I said more than once today, you only get to do college once, and in my experience, there will always be part of you that wants to go back. Sure, it's important to work hard while you're there; after all, only a very small proportion of the population gets the opportunity in the first place. But college is also meant to be fun, a time to learn about yourself and to make the most of life. I feel like it's such a waste to make the college experience nothing but a springboard to medical school. They're all talking about what activities they need to participate in, what they need to major in, how much they need to study for the MCATs. In a lot of ways, that saddened me. My four years as an undergrad at PC (Providence College, just in case there's someone reading this that doesn't recognize the abbreviation) were perhaps the best of my life, and my experiences there played an enormous part in making me who I am now. But a big part of that change was that I became far less prone to sweating the small stuff. I began to focus on what was good in life and doing what I enjoyed, even while I was working hard on my studies in chemistry. I really don't think it would have been the same if I had been worrying about all the things these kids were worrying about. If they're stressing out this much now, before they even hit college, what's going to happen a couple of years from now when the work is much harder and lives may be riding on it?

Maybe I'm wrong, but it seems to me that there's enough stress in life to begin with. Is it really necessary to create more of it? Anyhow, those are my thoughts for the evening. Stay tuned...

Peace and God bless!

Home

Being home with my family allows many more opportunities for activities and ways in which to keep myself occupied than does living alone in Pittsburgh. Hence, since I've been doing other things, I haven't been updating this blog as frequently.

As awesome as Pittsburgh has been, there's simply nothing that beats being at home. I know that I'm never going to look back and wish that I'd spent less time with my family, only the reverse. So I'm going to enjoy it while I'm here. And as much as anything else, it's the little things that still give this a sense of being "home": grocery shopping with Mom (it's a little different shopping for a family of 7 -- effectively 8 -- than just buying what I need to get through the week), putting the air conditioners in and playing Rock Band with my siblings, and hanging out in the Hasbro ER with Dad. It's an experience that bears absolutely no relationship to my solitary living arrangements in Pittsburgh, and for that reason, it's always tough heading back to da 'Burgh after being at home. Everything seems quiet, monotonous even. When I get on the airplane, I always feel like I'm traveling in the wrong direction. But I always know that, God willing, I'll be here again with my family and all will be right with the world.

That's not to say I don't love you guys in Pittsburgh, but I have the sneaking suspicion that any of you who read this blog (all two of you) know exactly what I mean. Catch yinz back in da 'Burgh.

Peace and God bless!

There's a reason it's called the EMERGENCY ROOM...

As an aspiring emergency medicine physician, one of the things that frustrates me most is the intentional misuse or abuse of the resources of the emergency department. It is not a place to be used as a primary care facility, nor is it a dispensary of your favorite narcotic. Anyway, this being one of my pet peeves, it shouldn't be terribly difficult to see why this article really irritates me. Look, I understand that it's natural to be worried about a loved one whom you've had to bring to the ER. But threatening to call the hospital president or CEO is not merely an obnoxious tactic but one that demonstrates extreme disregard for the emergency department staff as well as the other patients. What someone is essentially saying by doing this (or any of the myriad variations on this theme) is that he is more important than anyone else in that emergency department, and that he knows better than the trained (and presumably objective) physicians, nurses, and other staff who needs to be seen urgently. If you get bitten by a tick and are worried about an acute allergic reaction (Type I hypersensitivity, for those of you who are keeping score at home), fine. But if you don't have any of the signs of anaphylaxis, it's really not necessary for you to be seen before the guy experiencing chest pain or the woman complaining of an intense sudden-onset headache. But of course, if your egotism requires you to be seen before anyone else and you manage to pull the doc away from the other patients who have been designated by triage as more emergent, you won't be the one to suffer if someone else dies, will you? It'll be the physician's fault, the hospital's fault, for not doing enough.

I've had the privilege of working with some truly outstanding emergency physicians, and I hope to be able to number myself among them someday. But when they're dealing with a waiting room jam-packed with people convinced they have swine flu, when they're dealing with full trauma bays, when they're dealing with large and uncooperative patients, abrasive family members, patients exhibiting drug-seeking behavior, and with the ever-present threat of lawsuits should the smallest thing go awry with the wrong person, can you blame them if they're a little harried, maybe slightly stressed out or on edge? And now someone wants to insist on making life MORE difficult for them and the even busier nurses and ancillary staff? I'm sorry, that just doesn't sit well with me. If you're truly in an emergency situation (the hypothetical the author poses to the physicians in the article postulates a spouse in a life-threatening state), they'll recognize it and get you where you need to go. If not, they'll still keep an eye on you; it's not like they're just going to let you die in the waiting room if suddenly your immune system DOES decide to send you into anaphylaxis. Please, give the emergency nurses and physicians the credit they deserve -- they know what they're doing. If you honestly feel that you (or the person you're with) is getting worse, let the triage nurse know - politely - and you'll likely get a prompt re-evaluation. Otherwise, wait your turn and count your blessings -- you could be one of the patients in those trauma bays. Or in ICU. Or in the morgue.

Ok, that's my rant for the day. You can see a video associated with the story below; believe it or not, the video version is actually much more tolerable than the written article. She makes it a point to indicate the kinds of problems the ER staff faces on a regular basis, and makes generally more reasonable recommendations regarding how to alert ER personnel if you really think things are going south. Once again, any questions, comments, concerns, opinions, etc. would be greatly appreciated (from all two of you who read this blog...oh well...). Hopefully we'll return to happier topics tomorrow.

Peace and God bless!