30th Bday pics

Thank you to everyone who called, emailed and wished me a happy bday. I had a great time yesterday, sleeping in, going to Page, visiting Antelope Canyon (where they filmed Broken Arrow), hanging out on the beach at Lake Powell and eating a nice bday dinner (mexican fried tilapia with octopus and shrimp). No bday cake but Mark got me something even better – bday PIE!

Anyway, here are some pics from my bday. Thanks everyone!

Antelope Canyon, its really just a crack in the ground . . . but its actually pretty durn deep!

30yo . . . but I don’t look one day over 20 do I? I got carded like 10 X in vegas!

Pretty pics of the canyon from inside

Wow, this canyon’s pretty deep!

Yet more pretty pics

Me and the pretty canyon

Its kinda purple colored without direct sunlight

This one looks like a tapestry . . . wow, I used a big word on my bday

They say there is a Navajo face somewhere in the canyon, is this it?

More prettiness

For some reason, this one reminds me of a birth canal

Yin and yang, with sunlight and without

Leaving the canyon

Lone Rock Beach, the water was cold . . . brrrrr

Me and Mark at Fiesta Mexicana after a nice bday dinner

Of course, what’s a birthday without some bday cake . . . I mean pie at the end?!

Vegas and the three musketeers

Whoo hoo, Bellagio with my fellow Dukies, wow, I can’t believe its been 8 years . . . well, at least Darren’s still shorter than me :)

Home visitin’

What an amazing experience it is traveling through the Navajo country with the visiting community health reps . . . I met some wonderful people, helped some, learned a ton about Navajo culture.

The first woman I met was a really lonely 87yo whose husband had died and all she had was her sheep and her prayer meetings to keep her company in her 10’X15′ shack about 10 miles from the 89 highway with probably double that distance between her and the next human being. She was all packed up and ready to move from this, her winter camp to her summer camp down the road. She mixed all her meds up (red, orange, white, yellow, square, round, diamond shaped) all into an old green family-sized motrin bottle because as she said “it was easier to take that way”. The medical student side of me wanted to lecture her about being more “compliant” with her meds, using a pillbox or something more “rational” to take her meds. But another voice told me to listen and try to understand her point of view and most of all not to do harm by confusing her further and ultimately getting nowhere by imposing my view of the world and the human body on hers. As I left her house, I swung by her sheep pen to visit with her family. It was a surreal moment to have about 3 dozen sheep stop what they were doing as I walked up and stare at me. It felt like stumbling into a party where no one knows who you are or what in the heck you’re doing there.

The second person I met was a 78yo guy whose only family for miles around were his six dogs. I’ll never forget pulling up to his one room hogan where he was sitting on his porch chillin while his dogs were curled up in the shade next to him. This elder was also fiercely independent. Despite having a hot frying pan burn a 3X4 patch of skin off his right leg, he was intent on NOT going to the hospital because “they won’t do anything for me”. In addition despite his diabetes and a blood sugar of 226 (nl is around 100), he was dead set on only taking his medications every other day because it made him “feel funny”. Nonetheless, it felt really good making my first medical decison BY MYSELF taking into consideration his vital signs, his wound, his diabetes, his upcoming health maintenance check and deciding not to take him to the hospital and instead putting a dressing on for comfort and instructing the patient to take his medications every day.

The last patient I saw today was a cute lil ole lady who lived with her son who complained that she kept getting gas in her belly after using a nebulizer for residual wheezing from a pneumonia she had a month ago. Although I did not do much more than read the instructions from her prescription label to take the albuterol ONLY AS NEEDED instead of every 4 hours as she was doing, it felt really good explaining the physiology of swallowing vs breathing and reassuring a patient who was motivated to be healthy but just didn’t have access to the right information.

I guess what this day made me realize is that one CAN make a difference one patient at a time and that it DOES feel good to help those who cannot help themselves. All it really takes is listening, staying open minded and caring. I recall Dan telling me one time that he would never practice medicine in this country. Maybe he’d change his mind if he met these three wonderful patients.

Hanover, NH to Tuba City, AZ

Some belated pics of our ridiculous 3000 mile drive out to Arizona from New Hampshire!

Cold Cold Cold West Virginia after a full night of driving through a blizzard in Pennsylvania, maybe it’ll get better after these mountains

After a good night’s sleep at Chateau le Roberts, off to Kentucky . . . Country ham anyone?

St. Louis, gateway to the west, yee ha, crossing the Mississippi

Largest cross in the Western Hemisphere, hmmm maybe this is where Karl Rove lives?

The Big Texan, home of the 72 oz steak in Amarillo TX, mmmm mmm here I come!

cow . . .

to steak . . .

yessirree, get ‘n ma belly . . . I’m gonna eatcha

Ma? I don’t think we’re in Kansas no mo . . .

Epilogue: Anyway, we got in at midnight on the third day after 3 days of driving . . . exhausting but definitely an adventure

Good day in Family med!

I had a great day in family medicine today. Worked with Dr. K in Walk in who is one of the best preceptors I’ve worked with because a) she is patient, never rushes me b) is very observant and opportunistic about areas she can teach me c) lets me do as much as possible (in fact, I think she let me see and manage every one of my patients today by myself and didn’t even bother to come in and “check my work”. She also let me talk to a funny Navajo guy named Dodger who was a real character and extremely open. His father was actually a Code Talker in WWII and he is a vietnam vet who was called a gook by the other soldiers and had several near misses in Nam and even won a purple heart, which he says he doesn’t want because it just reminds him of “not ducking fast enough”. Then in the afternoon, I had a great time working with Dr. M in Peds clinic. Got to remove some sutures, meet a really cute 3yo whose grandma wanted her to see speech therapy because she couldn’t understand a word this girl said, watch a brave 5yr old get a toenail removed, make a 14yo girl with a cough laugh when I joked with her about basketball and talk to a 16yo skater who had sprained his ankle. Again, part of it was the preceptor who really let me do a whole lot including remove the sutures, counsel the kids, set up appts, write orders for medications, write orders for vaccines and agreed with my notes and diagnosis.

Maybe I feel good because its family medicine, I am pretty relaxed and well rested. Maybe I feel good because I ran 4 miles without stopping yesterday, maybe I’m getting more confident with my exam and diagnosis skills and that feels good, or maybe its the friendly people here who are responding to my greetings and jokes. I dunno what it is but I am feeling pretty good about being here right now and being in family medicine. Who knows, I just may work as a family doc for the Indian Health Service someday!

More of Senor Clinton

Interestingly, according to the most recent Bill Clinton interview on CNN, he now says that he did NOT play the race card in South Carolina and that Iowa caused blacks to rally to Obama away from Hillary once people saw that he was electable and credible as a candidate.

He also made the point that the rules of the democratic election is to have a close race due to caucases etc compared to a republican race which he said if adopted the democratic rules would still have four candidates in the game.

One very interesting thing he said is that most democratic voters he talks to likes both candidates which actually goes against Hillary’s argument that she is more electable because she can win the traditionally blue states like New York, CA, etc. According to Bill, Hillary’s states would vote for Obama as the nominee anyway and his strength with independents and moderate republicans would ADD and not handicap his electability in the general election.

Anyway, it makes you wonder: What is this Clinton ‘charisma’ that allows him to convince, influence and suggest to you something that advantages his agenda even when you KNOW otherwise?

Tuba city ramblings and self career advice

Yá’át’ééh y’all! (hello in Navajo, you all in Texan)

Whhhheeeeeewwwwwww, Family medicine is just da bomb. 8-5 clinic, no call, fun patients, beautiful sunshine in Arizona, frybread, instant noodles and cable TV and maid service. Doesn’t get much better than this. Hey, and I actually have time to write on my blog which is always a good sign.

So what am I up to these days? Well, it looks like my summer is all set which is always good. I am going to be in SF May/June for internal medicine to finish out my 3rd year of med school. Then I take step 2 of the US Medical Licensing Exam (three steps total before becoming a physician) in June/July along with doing geriatric medicine. I also set up an away elective in Oakland for emergency medicine at Alameda Highland Hospital which is considered one of the best ER programs in the country which is exciting and daunting at the same time. Then its off to Tuck and possibly a return to the cold hearted business world.

So what’s the “differential diagnosis” for my career these days? A few thoughts that have come up
1) Emergency medicine + startup business – Finishing an ER residency in three years then working part time while starting up a business or helping Dan with one of his medical device ideas
Advantages: high cashflow, low risk, fun and exciting
Disadvantages: Something about just doing residency to work part time (even if it is for $250 bucks an hour) doesn’t seem quite right to me.

2) Organizational Psychoanalysis – I’ve always loved analyzing people and myself, this would allow me to do psychoanalysis and work with organizations, two of my favorite things
Advantages: Can travel, make lots of money, the time flies by when I am talking with or about people, can consult as a psychoanalyst to CEOs
Disadvantages: Long training process (4yrs psychiatry residency + 2 yrs of psychoanalysis) and need to build up credibility, very narrow also, would not feel like a physician w/o some physiology involved

3) Build an industry, help the poor and make money doing it – For profit health care interventions at the base of the pyramid (serving those making less than $1/d)
Advantages: I would be excited and motivated about my job every day
Disadvantages: Although the point of building an industry providing public health through private means requires that one generate profits, I feel like it would be easier to make money doing something where the primary motivation was profits. It would certainly be risky and I am afraid the risks do not balance the rewards.

In the spirit of self-analysis and advice, I have gotten several snippets of truths around selecting a career that I have found very useful.
1) Dr. Coursin has always urged his kids to listen to their “quieter voices” in choosing a career in paths that may not lead to money or fame but could lead to happiness and personal expression.

2) Skip, Mark’s uncle said to me that he thought I was “creative”. Indeed I think I have always had a propensity for creativity whether it is in terms of business models, creative writing or creative analysis of a person or situation. Perhaps my quieter voice is one which resists conforming to a specialized career track and must look at all possibilities to accomplish a task before choosing one.

3) My dad told me that it is best to “widen the road you walk on” in terms of choosing a career such that you explore new possibilities even as you go down a career path and to maximize one’s flexibility. I have always naturally resisted the social pressure to specialize and become an “expert” preferring instead to be a generalist, translator, bridge between disparate groups and knowledge areas. Why not continue to find a career that increases my flexibility rather than diminishes it?

4) Finally my bro told me the importance of cash generation + smart investing in wealth accumulation. In other words its not about maximizing your income so much as having some income and investing it in cash generating activities.