Gene's Joint

I PASSED WHOO HOOO!!!

Whoo hoo, just found out I passed all my classes this term which means that . . . I . . . am . . . officially a THIRD YEAR MED STUDENT

(yea lame, I know, but seriously, its finally done with the basic science crap and onto to the really interesting stuff, taking care of patients, clinical medicine and B-school)

Now hopefully my exuberance can translate into work ethic for boards studying

Anesthesia, the best balance

I just shadowed Dr. H in Anesthesia. Saw some pedi anesthesia, got to watch pre-op, post-op prep and even some NORA (Non OR Anesthesia where for example they anesthetized a 2yo girl before her MRI).

Overall I think its a GREAT balanced specialty where you get to DO a lot of stuff (put a patient under, bring them back, control all of their vital functions for them, make them pain free, even palliate or offer them a “good” death a la Dr. Byock, the guy who started our palliative care group), the cases are open and shut, you get to go in, do your stuff, achieve an outcome and get out, GO HOME. Or go on vacation, or travel around the world and give talks. Dr. H does 0.8 which means she takes 1 day completely off per week which is easy to do 1) because its shift work 2) Anesthesia is a MONEY MAKER not money loser in the hospital so you are pretty well protected and supported within the healthcare organization. Its exciting when stuff DOES happen (a la the day I saw a neurosurgery go awry) but when stuff slows down your co-workers are usually nice enough to take over for you so you can take a break for 30 mins (AND you can even rationalize it since as a resident told me, you need to sometimes clear your head instead of stare at the monitors in order to spot red flags). For example, I went in at 8am, left at 4pm and had time for two lunches and some long fun conversations with the attending and residents while I was there. Oh another plus is VERY FEW NOTES and less paperwork than other internal med specialties.

Some downsides: no patient continuity and not much patient contact (although I don’t really care that much about it, just seeing your patients right before you put em down and right after they wake up groggy isn’t super appealing), also not being able to really interact with patients, gather information and make a differential dx kind of takes a lot of fun out of being a doc (although being in scrubs and DOing a lot makes up for quite a bit) and also you are kind of tied to a machine in a hospital without which you are kind of a glorified EMT. Dr H also cited the fact that it is true what they say 30hrs of boredom and 3 minutes of SHEER terror since a patient can crash and crash quickly on you and you can get so used to being in total control over a patient’s life that losing a patient can be really traumatic.

In the end the key will likely be personality fit and culture where I can safely say Dartmouth’s Anesthesia folks rank among the coolest people I have met so far here. They are pleasant without being superficial or ditzy (like Derm), determined and strong willed without being total control freaks. Overall Anesthesia gets an ‘A’ for lifestyle and ‘B-‘ for interesting work (by comparison Hospital medicine would be an ‘A-‘ for interesting work and B for lifestyle and C for pay). Anyway, note to self, schedule a clerkship EARLY (not necessary to do a Sub I and Dr. H recommends against it)

Transition Ceremony Pics!

Finally, done with the first two years of “sit-on-your-ass-all-day-and-listen-to-lectures” part of med school and onto the “never-get-to-sleep-but-at-least-I’m-in-the-hospital-doing-something” part of med school

Here are some pics from our little mini celebration

Dr. Pfefferkorn, one of our favorite profs telling us all about William Pickles who made a contribution to medical science by simply being an astute observant general practitioner in the British countryside

Our teachers those luvable old white guys

Departing Brownies, we’ll miss you guys!

Hangin in Hanover after the ceremony

Ako and Jane getting ready to chow down on sum Indian food (this is before the cheap bastards refused to give us the standard 10% student discount)

Jared and Eugene, skeptical about the service at the Jewel (I mean) the Crap of India

Everyone looking happy and smiley . . . except Abby who is spacing out as usual :)

Rachel loves Florence . . . ewwww

Getting some well deserved ice cream (and Champagne!) at the Hood Museum after the ceremony

Abby, Jared and Jane starting a new modern dance troupe at Dartmouth . . . Pilobi-LUST

Freedom and Belonging

Just got back from a Sonny Rollins concert. Seriously, one of the best parts of being here are the $5 concerts with legends like this man.

Its special. I want to be doing something I love at 77.

Anyway, its amazing how good music can really help you let go of the day to day stresses and worries and remind you of the real good stuff. For me, it really comes down to freedom and belonging. Freedom, like walking along Ocean Beach from the bottom of the alphabet up toward the tip of Golden Gate park and going along PCH to the Sutro baths to watch the sunset. Belonging that feeling of camraderie of being out with the guys driving on the highway with the windows down on a cool summer day. Damn I love the ocean.

Note to self: figure out how to get closer to the ocean! :)

Consultant’s Guide to Dating

For all you single consultants out there

R-O-A-D to success or boredom?

I shadowed an Ophthalmologist today. Fun experience, lots of cool gadgets, get to “see” a lot, patients are a little sicker than in Derm but not sure if its for me. I guess to some extent, I am now thinking of more managerial or business-like functions within medicine like Hospital medicine where I get to do a lot of negotiating with doctors, communicating with patients and get to meet a lot of different people (and walk 6 miles a day!). I DO understand why people go into ophthalmology though, really great hours (we stopped seeing patients at 4), infrequent call schedules, not a lot of patients will die on you, nor do you really have too many emergencies. Plus there are some lucrative procedures with Lasik and Cataract surgery. Btw, I finally figured out why some people do not qualify for Lasik. Apparently, the procedure works by adjusting the CORNEA (not the lens) by making it more concave thus pushing the image focal point which falls in front of the retina in myopic patients to lie on top of the retina. However, some people are just born with thin corneas which are too thin for the procedure which would subject the cornea to perforation (which is REALLY bad). Also, I learned that myopia is actually due to the eyeball flattening out rather than a lens dysfunction and that presbyopia (far sightedness) is more due to the lens. Cool stuff, easy to do, can bill a lot for it, and the patients always live. And apparently there are subspecialties in ophtho like Neuroophthalmology where you get the harder and sicker cases but I guess not nearly as tough as neurology. Anyway, if I change my mind, I can probably do a nice 2 week rotation in ophtho during my Tuck year but for now, I think I’m leaning away from it.

So ruling out Radiology (no patient contact, don’t like anatomy that much), Ophthalmology (patients are that sick, not exciting or managerial enough, not that psyched about the eye itself), Anesthesia (gonna shadow in a couple of weeks but my pain clinic experience wasn’t that fun) and Derm (great for making money but the people aren’t super sick, I think I might get bored). Anyway we shall see, if Jack Wennberg is right and what we need to lower the cost and waste in health care is LESS procedures and acute care NOT more, primary care might just be the place to be in 10 years.

Being opportunistic, going with the flow

I feel like I’m in such a rut lately. The second year of med school is finally winding down but I feel like I’ve been so bored, boxed in, confined for the last two years that I’ve become downright boring . . . and really bored

So much so that the only things that seem to offer me some kind of escape tend to be thinking about the future, about my career, about taking care of patients, etc etc etc

Its at times like these that its good to get some perspective. Dr. Payson, the “godfather” of the MD/MBA program here at Dartmouth had some great advice. He said that in the end, allow yourself to be opportunistic and take what comes to you. In other words, though we may all think that we can plan and plan our careers to maximize our productivity, time, happiness, Norm’s message is quite the contrary: don’t plan

He’s the second person (along with Prof Michael Chu, another person who I want to emulate) who has had great societal and personal success in life, a happy home life, successful career, does philanthropic work, etc. Like Prof Chu, Dr. Payson’s career as turnaround guru in the insurance industry and a big time private equity zonk was not something he mapped out but rather stumbled into and became good at because he liked it. In fact, he started his career as a family doc in the Indian Health Service in Arizona before joining the first group practice which he later became CEO of and sold before starting a successful HMO and then turning around a major insurance company in Oxford health and selling that. Its interesting to hear him say now that despite all of his success in business and all the impact that he has had to insurance companies, doctors and patients that he doesn’t think there is anything one could do that has the same emotional impact as helping a patient especially one from a vulnerable population. So as to the questions of what do I want to do with my career, my degree, my life (questions I get asked and ask myself all the time), in the end, I think I’m gonna just do what I feel like.

As Norm says, no matter how much you plan, its very unlikely that you’ll map your way into being uber-rich but if you follow your passions, you have a good chance of living a happier life.

What makes the time fly by?

Lately, I’ve been talking with Jane and others about the idea of being simply satisfied with your life vs being truly happy. The latter obviously more important one always seems so elusive and as I think about what I really enjoy doing I think it really all comes back to talking with people in a time of need. For example, I recently I had a long talk with a friend about a major career change. It was a difficult decision that had major consequences on his personal and professional direction and somehow counseling him, establishing the relationship, listening and offering good advice all was really fun for me. So much so that the two hours we spent together literally “flew by” and I found myself having to run to my next meeting and almost getting late.

Anyway, this all makes me think that perhaps counseling and mentoring folks is my “happy place”. Developing a relationship, working toward a goal with someone. The problem is that somehow this all sounds a lot like psychiatry, resolving unresolved conflicts, listening to people, cognitive behavioral therapy and the like. The only problem there is that psychiatry is the antithesis of all the symbols of prestige and power that I have surrounded myself with my whole life even if it would fulfill the side of me that wants to help people. So maybe I should just be a psychiatrist after I have had a successful business career and satisfied my business ego? Counseling and motivating CEOs as my patients, hmmmm . . .

Restaurant list in Montreal

Here is the list of great restaurants we actually went to or really want to go to next time (in order of recommendation)

La Croissanterie Figaro
(514) 278 6567 open til 1am
5200 Rue Hitchison
-kind of in the outskirts so you have to drive but parking is good
-Almond Croissant is friggin amazing, the best almond dessert I have ever had

L’Express
(514) 845 5333
3927 St Denis
-French bistro, quite expensive but very good an foo foo
-NEED RESERVATIONS

Isakaya
(514) 845 8226
3469 Avenue du Parc
-Not bad but disappointing in that I was expecting a real isakaya complete with benches a good sake list and lots of Japanese tapas, this was more of a family sit down and eat restaurant but the food wasn’t bad

L’Academie
(514) 849 2249
St. Denis and Duluth right next to SAQ the wine store
-bring your own wine French place

Jardin Nelson
407 Place Jacques Cartier
(514) 861 5731
-seasonal only open in the spring, they were closed when we went there
-good for Crepes and breakfast in the Old Port

Bishoku
1184 Bishop St
-apparently it is mostly a sushi place, the Sushi pizza is supposed to be pretty good

Magic Idea
1675 de Maissoneuve Bloulevard
Good Bubble tea place

Chains you can find anywhere
-Dagwood’s
-Amir’s for middle eastern
-Basha for lebanese

Monreal is AWESOME

Man, they aren’t kidding when they say that Montreal is like a little bit of Europe in North America. It definitely was in many ways very much like France except WITHOUT the snobbery. The people in Montreal were really friendly. I was there for our break after exams for just two days and had at least three encounters with the friendly French Canadians. For example, one guy across from us on the train platform signalled to Jane that she had dropped her hat even as he boarded the train going the other direction. In addition, we ran into a family sitting next to us at L’Express (a really good french bistro btw) who talked to us for sometime (The grandpa even spoke to me in Japanese). Even right before we left, the gas station attendant was teaching me how to say how are you in French! It was really great.

The city itself is really awesome! Lots of amazing food of all kinds (they are like a Hub for immigrants from Francophone countries, North Africa, Vietnam, Middle East). In two days, we at the following menu:

Lunch at L’Express (french bistro) of Foie Gras, Steak Tartare with fries, Fish soup (which was amazing) and Goat cheese salad

Dinner at Isakaya (Japanese Izakaya) of Amaebi (not that great), Miso ramen (not bad), Gobo tempura (very good), okonomiyaki, Isakaya salad (very good)

Brunch at a Creperie at the Old Port in Old Montreal
Snack Pho in Chinatown

Dinner at Le Croissanterie Figaro (THE french bistro, highly recommended) – THEY HAVE THE BEST ALMOND CROISSANT YOU’VE EVER HAD and awesome very very fresh salads (I got the avocado salad myself) and great coffee. Definitely a great place to sit and chat and drink a coffee and have a snooty french meal. Great service too

The best part of all is that its really accessible from here, only 2h 40min by car . . . and seriously, I feel totally rejuvenated after this weekend and eating a chocolate croissant from Figaro and middle eastern lunch from Amir’s that we brought back.