Decisions, decisions

Another milestone will be soon upon me, another marker on the trail to all the things never dreamt of under sheets of Crayola colored locomotives. Nostalgia has a way of permeating these days, a washed out backdrop to all significant biographical events. The sense of excitement and mystery brought about by the next stage is offset by lofty expectations and tired promises of progress. A survey of my life would hopefully indicate that the best is yet to come, but one never knows about such things.

Eighteen, twenty-two, twenty-seven, thirty, a job, a wife, kids, IRAs, graduations, grandkids, cancer, remission, Florida, cancer, revelation. You could put it on a poster and tack it to the door of a guidance counselor.

This is not to say that I am not looking forward to the rest of my life. I always do, but it's the leaving behind that always gets me, all the things to which you're forced to say goodbye. I find it the most difficult part of life - the burying of the years. Memories serve well for a quick revisit, but one can never relive the tales. And when the memories start to fade, it's as if they never happened. It's as if you were born into the present with no recollection of how you got there. The past, it seems, belongs to someone else - albeit someone familiar, a childhood friend or one-time enemy. It's all so blurry now.

Surgeons get all the girls

Just finished watching the latest episode of Boston Med. In case no one knows what this show is about, it follows physicians at MGH, the Brigham, and Boston Children's and the cases that they handle. Pretty much a hospital documentary that has been edited for maximum entertainment value, complete with tear-jerking, sun-setting-over-horizon, lonely tear drop type of theme music. All in all, it's a decent show with good stories. And to top it off, two of the CT surgery residents on the show actually trained at BCM. The show however, does suffer from a surgery heavy bias. The majority of the patients are surgery patients. Transplant surgery especially, is heavily featured. Surgeons are framed as the selfless heroes of our day and just all around nice guys with the exception of one surgical intern who's name is "Bar-douche". No explanation required there. The only two nonsurgical physicians featured are an emergency physician and a neonatologist, both procedure heavy specialties.

This very apparent slant of the show's content begs the question "Why is surgery so much more entertaining than medicine?" But of course, we all know the answer to that question. Surgery yields quick and unmistakable results. There is no uncertainty in whether or not a gallbladder or an appendix was removed. When surgeons see their patients, they think "I will fix you." Something is wrong, they make it right. This is comforting to most people, knowing that in a world so full of uncertainties, there is someone who can give you a definitive answer. Surgeons are paid for results.

Surgery also translates well into stories because there is a clear problem, climax, and resolution. The protagonists and antagonists are clearly defined in every situation. Could you imagine if they tried to weave a story out of a medicine patient's disease course? There would be more twists and turns than the last 10 chapters of a Dan Brown novel. It is my general opinion that the personal lives of internists make for much more entertaining television than the patients they treat. Take Scrubs for instance, the patients were always a subplot.

Medicine will never receive the fame and glamor of high-profile surgery and therefore will always command a lower income and less respect among the public. Because the majority of an internists work is accomplished in his mind and yields no concrete results, people are unable to recognize the extraordinary value he creates. 

Medicine does not pride itself as much on inventing the right solutions as it does on asking the right questions. 90% of sentences that arise from mouths of internists begin with "I wonder..." whereas 99% of surgeons begin their sentences with the words "I can...". Therein lies the fundamental dichotomy of the healing arts. 

Just as questions beg answers, medicine feeds surgery. Rare is the contrary.

High Tide

If there's one thing that most physicians are guilty of, it is being secluded in their own little world of doctoring. Your mind becomes consumed with details of diseases and diagnosis. Even your sense of humor, the last remaining sanctum of your former self, becomes infiltrated by the legions of trivial medical factoids that for four years have relentlessly sieged upon that last castle of sanity. I am a victim of this. But what defenses have I against these perennial waves of niche facts and kitchen-corner details, these elements that wear away daily any formation of original identity? After all, I chose this. To stand steadfast against a welcomed onslaught, bare-chested, spread eagle and looking towards the heavens. This was of my own volition.

"Sacrifices must be made for promises of the future". It would be easy to submit to an ideal so poignant, but what is the future if I cannot be in it.

A City of Stone

It has been 8 hours since I landed in Guadalajara. The altitude is a few thousand meters higher than Houston so needless to say, my body is working to adjust. I noticed that I'm a bit tachycardic.

Weather

I remember I use to think that Houston was the hottest place on earth, but as of today, Guadalajara during midday has taken that throne. It's a good 95 degrees here during the day but it lacks the humidity so it's not stuffy. The sun out here, however, is no joke. If you stand out under the sun for an extended period of time - like 15 minutes - it will literally begin to hurt. Luckily, the town cools down drastically during the evening time. It was low 70's when I went swimming around 8:30 PM and drops down to the 50's during the night. Weird weather, but at least it's predictable. They say the daily afternoon summer rains are due in about a week. Hot showers. Fantastic.

People

As you no doubt have guessed, the people here are predominantly Mexican. Some are whities and some are darkies - is it still acceptable to use those words in a nonmalicious manner? The thing I noticed right away though, is the phenomenon of unabashed staring here. Perhaps it's the lack of Asian people around this area. I don't mind it most of the time, but when I get it from men with cutoff shirts and tattoos of the virgin on their jugular, well, let's just say that I'd have quite a career as a Soprano opera singer if I ever had to run from them down a dark alley. With that said, the majority of the people are incredibly nice. You can still detect that faint hint of small town neighborliness in the people that work here.

Food

I went to a Mexican Restaurant called La Tequila for dinner. The place has a contraption in front that looks like it could have, at one point, been used to distill the drink. Seeing the condition of it now, hopefully, that is no longer the case. The food, as you might have guessed, is fantastic. The servers make fresh salsa from a mortar and pestle right at your table and the chips are freshly fried. The bread had a ball of butter baked right into it, but somehow the ball of butter still held its shape? Some sort of Mexican culinary magic, no doubt. I ordered the Chicken Pablano Mole and the it was D-licious. The tortillas were freshly made from blue corn. Hands down the best Mexican food I have had in my life so far. Hopefully it only gets better from here. On a side note, we walked an hour back to the hotel so at least I'm getting plenty of exercise here - no accounting for the health of my lungs though, as our stroll was mostly through areas of active construction.

Floating on my back in the pool tonight, I noticed that the skies here are filled with stars. You can literally see hundreds if you stare long enough. I'm certain they're the same ones that we have back home - the constellations are the same, anyways - but I suppose it's been a while since I've taken the time to notice these beautiful things that are of little practical matter.

The Smaller Side of Me

People are conflicted. I say this, of course, so as to not feel alone. I didn't want to start off with a sentence so presumptuous as "Since the dawn of time, men have...yada yada yada" since I'm sure that levels of male self-conflictedness have skyrocketed to unprecedented levels in the last century, mostly, I would guess, after the turning point in history when men began having to make choices between contraptions known as cars and well, everything else. But I speak here not of the conflict that plagues an indecisive shopper, but more so of the type that plays to the life goals, inner values, and all the things that line up in our forever rolling queue of insatiable wants. A classic example of this is Family vs. Career. Reasonable arguments can be made for favoring either one. Conventional wisdom holds that you must choose only one, as limited worldly resources, namely time, will prohibit a successful endeavor in both. Of course, one must then take into account the threshold of success and it's variability for different folks. And, let's be honest, if success is different for everyone then any distinctions or thresholds made by an individual would be arbitrary and meaningless. All that matters is how high you set the bar for yourself. Which brings me to my point. Set the bar low.

The older I get, the more I realize that happiness lies in ignorance. That, and there is an inverse correlation between intellectual and social capacity. The trick to happiness is - I think I've got it - to surround yourself with people like you and never ever talk to new people or try new things. Don't even watch new TV shows unless your whole crew decides that it's a good program. The idea is to mentally isolate yourself from anything unfamiliar that may cause confusion and panic. I have seen my grandparents do it all my life and they are now both in their 80s with their health intact. They may still be watching reruns from 30 years ago, but there's a certain comfort in knowing every line.

Also, smiling is the key. You have to smile at everything and everyone. If you smile often enough and long enough your mind will mistake it for happiness.

Random Thoughts

Step 1 Done

Finally finished with that beast of an exam. I have no idea why a profession would want to torture its disciples in such a cruel and inhumane manner. It must stem from some sort of instinctive bestial urge to herd along the tides of natural selection, weeding out the intellectually weak. There are challenges to the attainment of every goal, I suppose. A wise man name Randy Pausch once said "Walls are there to separate the people who really want something from the people who just kind of want it." Sledgehammer. Check.

Advancements in Computing Technology

You know what's funny? I've noticed over the last 2 years that as computing and software technology has advanced at a seemingly unstoppable pace, my dinky little Dell 700m bought for a then-respectable $900 6 years ago has paradoxically been GAINING SPEED. That's right. My computer was top of the line when I first purchased it, but began showing it's age at about 2-3 years. What I've noticed in the last two years, however, is that newly developed software has been increasingly light on the processor load. No more stumbling behemoths of code like Office XP or Windows Vista, rather, software developers of today are focusing on lightweight and nimble pieces of code that are responsive and efficient. So many years after the death of my beloved 386, I believe we have finally reached a reasonable plateau of processing power in the realm of home computing. What we're seeing now is a phasing out of the old megatron-like monoliths of CPU and the increasing adoption of more sleek and svelte slates of a minimalist persuasion. After all, who really needs a 4.0 GHz Quad Core trimmed with a 1TB SSD, parallel 1Gb Nvidia Geforce Video Cards and a fine ass mobo studded with 32 Gb of RAM? (I need a moment...)

It's amazing to think that just 15 years ago I was still trying to stave off dysentery on a DOS home screen.

Skynet is lurking, folks.

This is John Connor. If you're reading this, you are the resistance.

Words to Live By

In making the difficult decision of choosing my career path, I find myself repeatedly reminded of these words. They hover over my shoulders like the withering echoes from long gone sages of yesteryear.

Or perhaps, being the masochist that I am, they're just the words I've always longed to hear.

"In your career, if you're ever presented with the options of choosing something hard versus choosing something easy, Choose what is Hard, because if you choose what is easy, chances are it's going to be hard anyways. That's just life."

--Dr. O.H. "Bud" Frazier