A few words on medicine

Needless to say, this last month or so has been an experience. Another step in a series of life-altering events that, when the dust clears, will leave me with my head spinning and the tools of a physician at the tips of my fingers. How does such a thing happen? I actually wasn't sure it would, or at least didn't see how. But things are becoming clearer... one patient at a time.

For all the books, lectures and clever mnemonics, nothing compares with a living, breathing, feeling illustration of disease. And while that may sound like a morbid perspective of a human life, it is the stark truth that there are many names that may fade from my memory, but processes of illness that are indelibly etched in my mind for having known the face bearing the disease.

Another morbid truth I have come to accept is that intimacy with death highlights certain people in my mind. I could spend days upon days getting to know a patient, but my recollection of them is now dim in comparison with the vividness of one known briefly who is no longer among us. A code called last night found me in a line of people waiting to be the next to pump a heart that had stopped beating. As I compressed his chest, I briefly closed my eyes to connect with our Father, the one who made and knows intimately both me and the dying man beneath me, asking for His protection over both of us. Moments later, a pulse returned on the monitors and the resuscitation continued. In short, success, at least temporarily.

I don't mean for this all to come across as dark, it's just that the most profound moments are the ones that leave a lasting impression. Overall I've had an absolute blast on this rotation. My team has been wonderful and I will miss them when I come back to Alaska. I have less than two weeks left now and intend to make the most of them. While I don't anticipate a future in internal medicine, what I am doing right now is a joy.

Refreshment

I started this a while ago and never finished it, so now I'm finishing it.

After spending 10 days out on the Alaska Peninsula trying to gun down a moose or a caribou, I'm back in the civilized world counting down the days 'til I leave for Seattle to start my Internal Medicine rotation. I wasn't sure I would be able to say this with confidence when I reached this point, but after recent events, I'm ready to go back to work.

I think the reality of beginning a real profession was hard for me to adjust to at first and taking some time off allowed me to come to terms with the fact that my free time was becoming scarce as a rule. I'm actually pretty okay with the idea of not having a vacation for a while and buckling down to get some real learning done. A quick rundown of my 6 weeks of freedom:

Seattle: a few days to see friends, revisit some of my favorite places, do a little climbing and tie up a few loose ends before heading to Alaska. I quickly realized that hanging around Seattle with all my friends there busy with rotations would not be profitable.

Anchorage: (see: "Seattle" addend "and work and school" to "rotations") I also got to see some great live music courtesy of Marijke and Paul.

being back in both places was excellent, but it's not quite the same being there with nothing to do.

Kenai: Stacey needed some attention, so I spent several days in Kenai attending to her needs, several days basking in the glory of doing nothing and some time preparing for the hunting trips. It was great being back at church and seeing everyone. I heard some great truth that helped realign me with the fact that life isn't always about just basking in the love of God, but that there are times of that, and times where we endure and times where we must seek.

West Forelands: I grew up duck hunting with my dad, it was one of those father-son things that was really special for me. I hadn't been since possibly high school and possibly middle school, and getting back out on the duck flats was a high priority for my time in Alaska. My shooting wasn't what you would call stellar, but I managed to bring a few birds home. That wasn't really the point anyway, but if you've never had wild duck, you're missing out. It was a beautiful trip and an awesome time.

Alaska Peninsula: The big moose/caribou/black bear hunt. My dad has friends who live on Lake Clark in the middle of the Alaska Range and run a flight charter service. They picked us up and dropped us off on a lake out about 40-50 miles from the proposed Pebble Mine. It's rolling hills and spruce forests with willow thickets in the low places. Blueberries galore. Our hunt turned into a camping trip where we spent a good bit of time waiting out storms under shelter. We had steaks, burgers and blueberry pancakes to help us pass the time and I think I finished more novels that the previous 4 years combined. Despite not getting anything, it was great hanging out with my dad and brothers-in-law.


Port Alsworth: As we were unloading the float plane and preparing to hop the plane home, Glen Alsworth Jr. mentioned that if I had time, they could drop me off at a bear camp where they were picking up hunters and try to get a caribou. I jumped at the opportunity obviously and got to spend some great time in Port Alsworth, one of the most beautiful places in the world. The highlight was probably hanging out with the ground crew, an awesome group of 20-somethings who were tons of fun, but more importantly, really encouraged me in my faith and attitude toward God.

Alaska Peninsula: Two days of drenching rains, howling winds and rugged country. No trees out here. One of the ground crew guys, Micah, came out with me to do some small game hunting. Despite the weather, we got out and hiked quite a bit, but only glimpsed a caribou herd from across the valley. By the time we had stalked them and made it to where they had been, they were long gone. It was nice to see something though. I had a lot of time for reflection and prayer out there in the open country and started feeling more like myself than I had in a while. The morning the plane was coming, I got within 400 yards of a lone caribou, but we were on an open plain together and as soon as I began edging closer for a reasonable shot, he sensed danger and was long gone. They're usually not so skittish, but there had been wolves in the area.
Kenai/Anchorage: A few goodbyes and some more awesome truth from the home church and I was ready for Seattle. Truly ready.

I should probably write something

Back in Alaska. In between rotations. Six weeks of pursuits designed to provide pleasure, good company and all that. As we would say in our progress notes for "interim history": no major events. Spent some good time with family, made some vehicle improvements, climbed a mountain, saw friends perform some killer music... good times.

You know, deep thoughts are nice and they have to be confronted at times, but sometimes, it's just pretty nice to enjoy life.

Two Rights Don't Make A Right

I see my life as a series of seasons, each with its own themes, decorations, sounds and thoughts. Entering this season, I prayed that I would truly come to learn, understand and embrace humility. Now part of that is learning to look at myself in an honest light, thinking neither too highly or too lowly of me. In fact, I think it's more about learning to think of me less.

Learning humility takes on many forms, but in my case, it has involved realizing that my own talents and efforts are not always sufficient. Sometimes, no matter how hard I try and how well-equipped I may be, I fail. I think I tend to withhold effort in most of my endeavors so that I always have the mental excuse that I could have avoided failure "if I'd REALLY tried." Sad to say, I have discovered that I can REALLY try, and still come up short.

Along this road, I have begun to take joy in being content in my weakness. If I allowed myself reign to condemn and punish myself for every shortcoming, I would quickly become miserable, yet through failure, I am learning to base my joy in things other than strictly defined "success."

Part of being a third-year medical student is acquiring new skills and knowledge through experience. Clearly, some experiences present themselves frequently while others are more rare and difficult to obtain. It is normal to desire fairness and equality in the distribution of these experiences. In fact, many would say that they have the right to experience the same procedures as every other medical student, and if some one else gets to do something they don't, it is unfair and justifiably unjust.

And just as I'm experiencing this, the voice of God breaks through (in the form of a book called The Shack) and announces to me the ridiculosity of this concept we have of "rights."

We have essentially taken things that we should receive out of love and fashioned rules that we can collapse upon in the event that we are not loved. What a tragedy that such efforts have been made in the past to simply claim what should be freely given. Rights to freedom, rights to a voice, rights to peace. And yet these rules do not and cannot replace what was missing in the first place, instead imposing a rigid framework devoid of warmth with only a token nod affirming that yes, you probably should get this.

How bold and daring we may be should we willingly give up this frantic pursuit of love for ourselves, in both big and small ways, in exchange for the knowledge and security that we are loved already and that the one who loves us is already working for our good. Humility is choosing to stop demanding love and start accepting love on its own terms.

Defervescing

Not only is defervescing one of my new favorite words, but it's actually pretty descriptive for my life right now. Since my last post, things have settled down a little here in Pocatello. I'm starting to catch on to the rotation and getting more comfortable operating as a 3rd year medical student. I still screw up on a daily basis, you know, the kinda thing where as soon as you open your mouth, you realize the words coming out of it don't actually make sense. But all in all, things are feeling just a little less feverish.

I'm a little more settled into a routine and getting used to 6-7 hours of sleep. This was a slower week, which wasn't great for learning, but allowed me a chance to get my feet back under me after a long run of not being really settled. Hey, I even went rock climbing!

In the neonatal intensive care unit (NICU), we have a status for babies who are in the clear and developing as they should be. They're called "Feeder/Growers" and that's a good thing. It means all their systems are working right, and the only thing they have to do is keep eating, digesting and storing away energy as they develop. Yep, that sounds familiar. Lovin' it.

Laying Down My Life

On the receding end of one of the most intense weeks of my life, I, needless to say, have a few things I've been thinking that I'd like to get into words. The last few months have felt a little like sitting in a sauna where some one kept turning the heat up a little bit at a time, culminating with taking boards.

Hitting the hospital/clinic this week was my analogous experience to jumping into a huge pile of snow after sweating in the sauna for a few hours.

It was exhilarating. It was unexpected. It was really freakin' hard. I kind of want to do it again.

I'm not much of a morning person, but we start our day around 7, which might not sound THAT early, but it is. I actually got up at 5:30am one day this week for the first time that didn't involve fun in I don't know how long. I'm used to getting lots of sleep and on my 2 call days this week I didn't get home from work until 11 or 12. You do the math. I actually did pretty okay with the sleepiness cause everything was new and exciting and REAL.

Talking about patients specifically is not ok, but I do want to share a cross-section of the kind of stuff I'm seeing. I'm working on a pediatrics rotation, so none of the patients I've seen have been 18 or older, so it's little kids and young teens I've been seeing. I've seen cases of possible pregnant teens having to weigh the moral consequences of the morning-after pill against the possibility of having a child before graduating high school. I've seen children hearing that they have a life-threatening illness and won't get to be normal kids for years to come. I've seen brand new babies with life-threatening illness that I can't confidently say whether they still live as I write this.

There's more, but it's hard to share without giving too many details. As I finally caught my breath this weekend, I started to ask myself the natural questions, like "What am I doing?" "Am I even competent to do this?" "Do I really want to spend the majority of my life indoors?" "Do I really want to live like this?"

The answer came to me on my knees in the shower this morning. As I contrasted the life that I could pursue of adventure, recreation, travel and self-indulgence with a life of a physician, I realized that the one is focused on self, while the latter is focused on others. When I was called to this profession, it was not because it would bring me fulfillment, but because it would ease the suffering of others. And through that, I would find fulfillment and peace with God.

We studied the story of the rich young ruler (Matthew 19) on a Wednesday night when I was home in Kenai. He asked what he must do to be perfect and Jesus told him to sell everything and give to the poor. While we can never life up to perfection, walking with God involves taking steps toward him, and at this point in my life, I've realized that laying down myself and trusting God is the step. I'm not doing this because it makes the most sense or because I think right now it will make my life the easiest. But I know without a doubt that I will be burdened in this life and the burden that I am going to choose will be the light one that Christ offers rather than the unbearable weight of attempting to hang on to my life and wring the last drops of joy out of every experience. I will be content in what is before me and be full because I am allowing God to fill me by walking with Him rather than attempting to forge my own road.

When I truly submit to Him, there is no room for jealousy or cynicism or regret and all the room in the world for love and joy.

Friday night found me at my cousin's house in Blackfoot, a 30 minute drive from Pocatello, watching Pierce Pettis soulfully hypnotize the audience and myself with songs of honesty as he and his guitar spoke the truth about what they have seen and heard in this life. It was one of those moments that transcends our daily experience and reminds us of those other connected times that dance on the periphery of our memory waiting to be recalled. For me, those times have been centered on and surrounded by and saturated with the presence of God and reflecting His glory back to Him with the knowledge that you are exactly in the right place, doing exactly what you've always known you were meant for. So now, I can't wait for Monday.

Independence

Quite fitting that on July 4th, I finally feel like I am yet again independent... kind of.

Quick summary of what my last month has consisted of:

Early June: cramming parts together in some semblance of a vegetable oil burning conversion for Stacey, trying to pack up, get everything NOT being packed disposed of and trying to be a decent human being at the same time.

Less-early June: leaving a few things behind, JR and I jumped in Stacey and began the trek through Canada to the homeland. The link is JR's account of the adventure w/pictures.


Junish: There were rumors of my presence in Anchorage and Girdwood for a few days, then I disappeared from society for two weeks. Some surmise that I was inventing a toaster oven that never burns toast, but in reality I was cramming information into my head at alarming rates. I took a brief break when I realized that my graduating class had reinvaded Kenai for the weekend:

Early July: D-Day. Both the day of Step 1 of the United States Medical Licensing Exam and the 1 year anniversay of Daniel getting shot in Ecuador. A wry irony. The next day, I packed my bag in Kenai, tied up a few loose ends and headed out for Seattle and Idaho.

I'm now in Seattle, finally relaxing. Ahhhhh.

Being back in Alaska was AWESOME. And I love it a ton. I always forget how great it is being there until I get back. No place like it.

Since being alone and back home, I've been doing a lot of remembering. Remembering who I am, who I have been and who I've wanted to grow into. It involved some checking in with myself to see if I'm living up to the man that I was hoping to be at this point. In some ways, yes, in some ways, no. I believe that God is steering me down the right paths right now and that His grace is enough to get me through the rough patches. I felt his presense with me strongly taking my giant test and was reminded that the only thing keeping me from that assurance all the time is my own attentiveness. So I'm ready to enter the wards of 3rd year with full confidence in the God who has brough me this far. He has been faithful and kept His promises and I LOVE Him for it.

Before signing off, I would be no kind of uncle if I didn't show off a couple pictures of my NEW NEPHEWS!!! I present to you: Carson Richard Hawes

and Jeffrey Dane Hultberg:
They're WAY cuter in real life, but these were the only shots I had handy. I am incredibly blessed.

Catching up: A Birthday Extravaganza

I'm sitting in a hotel room in Fort Nelson, Canada and have no restraints on my time right now because Stacey is across the street waiting to get her exhaust leak fixed. Ahh, the joys of owning an old vehicle. At least the ride from here on out should be quieter. I've been meaning to write about my birthday since... my birthday... because it was awesome.

I woke up to a soft knock followed by a soft voice and a slow opening of my bedroom door. Attached to that knock was a hand now carrying a tray full of morning goodness. Scrambled eggs with onions, bacon, fresh tomato and avocado cut over the top, sourdough french toast with real maple syrup, bacon and a whole grapefruit just for me. A quiet happy birthday singing greeted me, some couple-y words and I was left to eat my breakfast in bed. Truly royal treatment. Apparently, it's tradition in her family's household that the birthday recipient gets mandatory breakfast in bed. That's a good tradition.

So I got to spend part of my morning with an amazing girl, a treat in and of itself. She took off about her day and I got down to business. I had a mission. Stacey waited patiently in the driveway and I set to her with a fury known to few men, those who undertake working on their own vehicles in a time crunch. By lunchtime, I was ready for a break, and was pleasantly picked up by my friend Teja. She brought me over to Sage Cottage, a home I have come to dearly love, where Xavi awaited me with an amazing chocolate cake baked with Fair Trade chocolate. Sarah Reed, I salute you and simultaneously get flying-hugged (I owe you one or six for the cake).

They graciously took me by the auto parts store as I was rideless before going to lunch at Nana's and getting some more deliciousness in the form of grilled sandwiches (we ate cake before lunch cause it was MY BIRTHDAY). They dropped me off and I was back at it, with plans to look nice and meet up with the Alaska crew by 7pm. Well, 7pm rolled around and I was still grubbing around in the car with Greta looking exceptionally cute and ready to go. I ran inside, scrubbed up real quick and made it out to Chandler's Crabshack on Lake Union just late enough to be annoying, but not so late that everyone left. We had a spectacular dinner overlooking Lake Union as the sun was going down. The windows in the room opened up the whole view to me from my seat. I again got my hands grubby, but this time breaking apart crab and mussels and all kinds of good things. Dinner was great and the company was better. Capped off with a glass of Cote du Rhone syrah and a chocolatey, gooey birthday cake.

We made a final stop at the Duchess to grab after-party drinks and meet up with a couple more friends... and have cake one more time. What a day. Driving home, I couldn't remember a better birthday... everything that I had wanted and more. Good friends, good food and time for doing exactly what I wanted to. Thank you, God, for an amazing birthday.

Exploding Little Men

There's a little man in our backyard right now, and I'm a little worried that he's going to blow up any minute now. This isn't some kind of euphemism or anything like that. He's mowing our yard. And I have two open gas tanks sitting back there.

I don't really know where he came from or WHY he's mowing our yard in particular... maybe he works for the realtor? He's wearing one of those bucket hats that were all so popular in late middle school/early high school. I kind of wonder how he got to be where he is and all that, but I'm mostly just concerned that he doesn't blow up. I also recently (aka this morning before he started mowing back there) dumped gasoline on some weeds to kill them. Just thought I'd share.

Back to studying/working on Stacey.

Hurdles

Just finished my OCP... that's Oral Case Presentation to the layman. I'm sitting in an art-deco meets preschool 5th floor lounge set aside for the few, the proud, the classroom-bound medical students. I should be reworking my pharm cases, but I wanted to blog.

Hurdles. Hurdles define this year for me. I only actually tried running hurdles once or twice in middle school, but from what I remember, it goes something like this:

1. start running as fast as you can
2. realized there is a big metal thing in your way
3. awkwardly jump over it and try not to wipe out on the landing
4. realize you're still alive, upright and still propelling forward
5. repeat

As much as anyone enjoys running hurdles, everyone has a breaking point where they wear out. You have to stop, catch your breath, reflect, refresh and possibly regurgitate, before starting the next race. I mostly have felt this year that I was in the middle of the race: sprint, leap, land, repeat without much of a chance to catch my breath. Some of the hurdles were great: Spring Break skiing, a plethora of live musical performances, dinner with friends, parties, church... all good things... still hurdles.

I cherish the moments when I can lose myself in the moment and embrace the vigor of the race as lively and intense. Hanging from a rock wall, exploding a pocket of powder, absorbing full auditory and visual stimulation, savoring an exquisite taste... Flashes of full engagement. But even more do I enjoy the moments when I can look the next hurdle in the face with nonsensical peace and calmly engage in this path that has been chosen. I lost that feeling for a while this year, but was then reminded of the incredible power I have when I fall to the ground with my hands lifted up to my most gracious Father. Thank you.

The Gospel of the Birdcall of 9

Let me introduce this post in the most appropriate of post-introducing ways:

KA-REEEEER!!!!!

If you have no idea what that means, I'm sorry, for I feel that I have failed both you and those who have gone before me in the way of the Gospel of the Birdcall of 9. Please forgive me. For those who know EXACTLY what that means and all that it entails, I beg your forgiveness as well, for I have forgotten my past and that which has molded me.

I was riding my bike along the Burke-Gilman trail as I was on my way to class this morning. I spied, on the other side of Sand Point Way, a parallel friend strolling on her way to class. I wanted to get her attention and simultaneously tell her that I appreciated her as a friend and that seeing her makes me happy. The noise of the cars on the road, the fleeting nature of the moment and my own hesitation prevented the interaction, thus nipping in the bud the joy that could have been added to the day.

And that's when I remembered. I remembered how life used to be.

Flash back to Texas. It's a beautiful day, the sun is shining, the college students are swarming out of Chapel. And all of a sudden, it comes cracking through the din like a bolt slung by Thor: KA-REEER!!! and you turn, ka-reering in return, before your eyes even make contact, and then they do, and you smile, laugh and go on your way if you're busy, or perhaps stroll over and share the latest on the way to the Bean (school cafeteria).

Coming to a new place, leaving behind friends near and dear, the Way of the Birdcall has faded. But today, today I made a new commitment to share with others the Gospel of the Way of the Birdcall. I've told others of the joy of the Birdcall, I've convinced them of its beauty and authenticity at times. At other times, they've merely blown me off, not believing that something so noble could exist, or perhaps twisting the message in their minds and dismissing it as something childish and irrelevant in today's culture.

No longer will I settle for merely speaking of the Birdcall. No longer will I withhold a due birdcall in shame. I must show others the joy of living with the Birdcall. So today, as I crossed over the pedestrian overpass and looked up the street to see the picketers blowing their whistles and waving their signs, I encouraged them with a hearty sound. The man on his cell phone looked at me askance, but I detected a hint of smile in his eyes and knew that his day was better for having been a part of that moment.

I guess you could take this as a spiritual metaphor or whatever. To that, all I have to say is:

KAAAAAAAAA-REEEEEEEERRRRRRRRRR!!!!!!

Chasing Cars

Mom - you might, cancel that, you definitely, won't enjoy reading this one and will have a happier life if you just close the window now.

That warning also goes for the rest of you who don't believe that I am actually James Bond in disguise.

With that said, man, sometimes my life explodes in momentary bursts of awesomeness. Usually, not intentionally. Wednesday was just a typical day... met some random guy on the street in the U district to buy car speakers (woo hoo!), went to my tropical medicine class, sat through repro and path... blah blah blah... attended a training class so we can give free sports physicals to low-income middle-school kids, then hit up the climbing gym for a little while. It was when I realized that I had a 30 minute bike ride to complete and only 15 minutes before I had to be at Bethany Community Church that the trouble started.

I booked it up the Ave on my bike, snagged a left on Ravenna and was making good time. As I cruised up to the various stop signs, I would time myself so that I wouldn't have to actually stop, but could just ride in the shadow of a car that happened to be crossing the intersection at the same time as me. Make sense? I cross at the same time as a car, rather than trying to compete with everyone else for my turn at the stop sign.

So I was cruising up to the 5-way stop at Green-Lake that has lots of diagonals and weird turning patterns. It's confusing as heck. So I was more than happy to jump on the tail of a car in my lane that was just ahead of me. It was probably a little too far ahead of me in retrospect, but it seemed like a great idea at the time. So I was pedaling hard, trying to catch up to that car when my eyes got big and I saw the oncoming car turning right behind the car ahead of me... and accelerating.

I kept waiting for him to brake, to show some sign that he was acknowledging my presence on the road, but no, he was intent on getting through that hellish intersection at top speed. Neither slowing down nor speeding up was an option for me, so I elevated my center of gravity and prepared for impact.

It was spectacular. A brilliant crash swept my bike out from under me and threw me onto the hood of the speeding car, rolling me over before depositing me on the ground with a few more departing rolls for good measure. After taking a quick self-survey, I assessed that I was indeed still alive, and confirmed that my health had not rapidly deteriorated, information which I relayed to the concerned driver of the vehicle. Ensuring that all of my bodily parts were still intact, I straightened the handlebars on my bike, which had been thrown all out of whack, briefly looked for any debilitating deformations and hopped back on, determined not to miss my deadline.

I was stopped by a horde (two or three) of concerned passersby. They demanded that I must be injured after such an explosive interaction, but I assured them I was fine, wearing a helmet and that my training as a soccer goalie has indwelled me with sufficient falling skills to land on all the right parts.

I made it to my final destination on time and safely transported my passengers from downtown to their evening abode. Mission accomplished.

Piety

When it comes to life, I've got it more than pretty good. I don't need to sit here and tell you how great everything is for me, but suffice it to say that my idea of a rough week is one where I don't get to do something exceedingly fun with exceptional people. A life lived in such a fashion has notable potential to produce a whole lot of guilt regarding the people whose rough week is one where they don't eat.

This is not a new struggle, but one that has haunted me since I first really started engaging God and seeking to understand His purpose in my life and more generally, the world. I've definitely felt the tug to sell everything, give my money away and go squat under a bridge. At least then I wouldn't feel guilty. That's a lie. I would have replaced the previous guilt with the guilt of having squandered irreplaceable resources.

This year has been somewhat of an experiment. I've honestly felt the call to put aside piety and just enjoy what was before me. And it's great! Seattle has a ton to offer!! Skiing, climbing, hiking, famous musicians, rising stars, plays, professional sports, exotic food, more varieties of beer than I could taste in a lifetime. All these things at my fingertips. And yet, handing over a 20 dollar bill for a night of entertainment, I sometimes cringe realizing what that money could buy in Cambodia. Literally, it could feed a family for a week.

This Sunday, my preacher clarified the confusion with a simple admonition: "Don't attempt to be more pious than God."

In short, it is not our work to deprive ourselves of everything in a reckless attempt to fix the world. Neither is it our place to live lives of endless pleasure-seeking that never satisfies. It is our place to enjoy the work that God has put before us, and the fruit of that work and in doing so, loving ourselves. It is only with that framework that we can begin to love our neighbors in the same way we love ourselves. There's a whole lot I could say about that, but the final piece for me was realizing who my neighbor is.

The Good Samaritan is the quintessential example of being a good neighbor. He wasn't out there feeding the homeless or starting new charities. He had some business to attend to. Then something interrupted his life, but rather than seeing it as an interruption, he saw it as an opportunity to alleviate suffering, so he laid down his desires and plans temporarily, and loved some one as he would have loved himself in the same circumstances, then continued about his business. No huge missions, no crusades, nothing worth waving banners around, just simple life, seeing the needs in the proximal context and using the available resources to patch something together.

I don't need to, in fact shouldn't, make my life hell so that people halfway across the world can eat. The number of people who are going to die is too overwhelming for me to start counting pennies... or twenties. But I would be hugely remiss to think that nothing is required of me either. I intend to more forward in alleviating the suffering around me while enjoying the heck out of life and my work, with a huge smile on my face.

That's a good start.

Studying

I'm in my tropical medicine elective, which is rad, but I'm studying for my midterm in systemic pathology. I keep forgetting these diseases, so I'm just going to write them down. Thought you'd be interested. Ha.

Wegener's granulomatosis - vasculitis affecting lungs, kidneys & others; ANCA positive -> causes neutrophil degranulation; small-medium size vessels; can lead to lots of H&E symptoms, glomerulonephritis, skin nodules, lung "coin" lesions, cavitations & hemoptysis. Thanks Wiki.

Primary Biliary Cirrhosis (PBC) - progressive destruction of interlobular bile ducts w/florid duct lesions; most common in middle-aged women; eventual cirrhosis

Primary Sclerosing Cholangitis (PSC) - fibroinflammatory destruction of bile ducts w/"onion skin" lesions; most common in young men; eventual cirrhosis

Wilson's Disease - accumulation of copper in organs, esp. liver, brain & eye; autosomal recessive disorder of copper metabolism; Kayser-Fleisher rings; presents w/acute hepatitis & nonspecific findings (i.e. mallory bodies - purple blobs)

Time just ran out... gotta go take a test. Why are there so many weird liver things?? And all this on the coat tails of a post about using this blog for more noble purposes. I repeat: sheesh.

Refocusing

Lately this web-writing thing has been kind of scattered. I started this so that people who love me would know what was going on in my life. Rather than sending out mass emails about my summer travels, I thought, "Hey, why not just broadcast what I'm about for the world to see? Maybe I'll inspire some one!" That's what I want this to be about. I want people to laugh more and be more intentional about living. Living actively rather than responsively. I want to share the best things, the most admirable things, the worthy things that I contact because this world does not shed light on such things enough. I started this so that God would be glorified. Lately though, I've been doing some thinking about how to take the next step into being a part of what is admirable. It start with a healthy understanding of

Stupidity…

…is often associated with impaired reasoning, lack of knowledge or misperception of the outside world. Yet none of those need be present for stupidity to rear its head. In what context then? In the context of relationship. In the context of forcibly placing your own wishes and perspectives and interpretations in the path of some one else, leaving them no alternative but to dive through your twisted web of past experience, beliefs and preferences. Why would we do such things? Why impose? I have no reasonable response; reason has little to do with it. Yet we persist in casting forth our webs to trap and hold those around us in the patterns that we create for them. Can satisfaction be taken in such actions? I can imagine so, but only with relentless self-confidence spurred on by a paternalistic mindset and an individual dedicated to the idea that their own vision for the world rings with absolute clarity and goodness.

It hurts every time.

Why stupidity? Pride.

When, oh when, will I exchange this stupidity for humility?

I must become less that Christ may increase.

A few good bands

I've been to more live shows this year than in the rest of my life combined. It would be a travesty to forget these. So in an attempt to add an element of usefulness to the reader while selfishly immortalizing the good times I've had, I present to you:

The Stratified Subjective Subjugation of Sweet Seattle Sounds

Lame

Project 86
Wyclef Jean - lame because I DIDN'T GO. Sheesh, what the crap was I THINKING??
Talbot Tagora
Cold War Kids

Tolerable

Jesse Sykes
Presidents of the United States of America

Enjoyable

Moneta
Soljibe (New Year's at Schweitzer)
Metro Station
PWRFL Power
Maritime
Mae

Sweet

The Everybodyfields
Tristan Prettyman
Whitley
Sherwood
Motion City Soundtrack
Ted Leo & the Pharmacists (Neumos <>Totally SweetThe Cave Singers
Throw Me the Statue
Death Cab for Cutie (Sasquatch)
The Cure
Mates of State
The Classic Crime (plugged)
Jimmy Eat World
Justice

The Best Day of My Life

Michael Franti & Spearhead
The Classic Crime (unplugged)
Death Cab for Cutie (Bremerton)
Steve Earle
Ghostland Observatory
Anberlin
Hell's Belles

I'd recommend checking out anything at the Sweet level or below. It's been a good year. (these are all the BANDS I've seen, not individual shows)

A True Beauty

This week's episode is brought to you by Solstice Cafe, a favorite venue for long study sessions, some good brew of the stimulant or depressant varieties, or just a quick stop in to catch up with the current trends in edge music. To start off an evening of studying, grab yourself a cup of coffee and a peaches and cream scone, or to wind down after a long day, tap into their rotating selections from Elysian Brewing. You're can't go wrong at Solstice! Now, back to our (ir)regularly scheduled broadcast...

Confident that nothing else could go awry, our heroes spent a pleasant half hour en route to the quaint little town of Surrey.

Rossulous Maximus: "Gosh Davius Awesomnis, it feels great to have all those foul knaves behind us. Surely our luck is about to change for the better!"
Davius Awesomnis: "I concur my esteemed compatriot. Tis a grand day for fine fortune."
Rossulous Maximus: "Ahhh... how pleasant a half hour this has been... but Davius, does not your... umm... toyota pickup... normally make that ticking sound?"
Davius Awesomnis: "By Jupiter, it surely does not! Quick! Crawl under this rapidly moving transit and give a differential diagnosis of its ailment!"

Braving the extremely-nearby, rapidly-moving countryside Rossulous lowered himself into the undercarriage much like the renowned warrior, James Bond. With extreme horror, his eyes came to rest upon a bomb firmly affixed to the frame with a bright, flashing 30:00, 29:59, 29:58 light staring him coldly in the face. After futile attempts at deactivating it, he returned to the cab in a smooth, 70 mph tuck-flip through the window.

By consensus, he and Davius agreed that the only reasonable option was a race against the clock to their awaiting destination. Failure was not an option. A tense 25 minutes passed.

Devoid of the resources needed to zero in on their destination, they circled the area where they knew the beauty to reside, but the clock was ticking. With only minutes left, they elected to abandon their trusty steed to the streets of Surrey and take off on foot. As they sprinted down the byways, through the trees, over bridges and through groomed yards, they could feel the ticking of the clock as a weight upon their souls, a pacemaker on their emotions and a fine example of sinus bradycardia.

Bursting through a hedge, guided by pure instinct (and conveniently-placed street numbers), all thought and emotion vaporized, replaced by a radiant glow encompassing them in its brilliant light and goodness.

KJ the Keeper: "You have arrived, with only seconds to spare."
Rossulous Maximus: "Seconds to spare?? You knew of the bomb?"
KJ the Keeper: "Yes. It was necessary to insure your prompt arrival. Fear not, for I have deactivated it."
Rossulous Maximus: "You are most... uh... kind. Now, you must know my purpose in being here, yet you look not dressed for combat?"
KJ the Keeper: "Combat we shall not engage, but ritual rather. Join with me in the most ancient dance of The Sale and The Title."

What happened next must not be spoken, for it is a sacred ritual passed down through the ages...

-- Break of character --

Okay, I thought I was going to finish this thing and talk about the registered importer meeting me for vehicle inspection and the border crossing that took 4 hours because the computers broke down and the triumphant return to Seattle, but this has dragged on long enough (despite it being really fun to write), so without further ado, I present to you the fruit of our adventures, a rare feast for your eyes, a most noble vehicle: the diesel, the 4 speed, the 1988 Toyota Land Cruiser!!!!!


And there was peace throughout the land.

Battling the Giant

We left our heroes with their sights on the horizon, speeding off into the great unknown, enemies in hot pursuit. However, thanks to the speediness of their trusty steed and the skillful driving of Dashing Dave, they arrived at their destination without a challenge. Little did they know that the monster awaiting them sufficed to set even the boldest adventurer aquiver.

As they pulled into the small town of Chilliwack, everything seemed peaceful and quiet on the surface. Coming to a halt at a neighborhood curbside, they could scarce believe their eyes as they spied the object of their affections seated pleasantly across the street. Emerging from their transport, they started toward their coveted prize with eagerness, only to be met by a rumbling, "WHO GOES THERE??"

Chivalross: "Tis I, Chivalross, here to sweep fair maiden off her feet and return her to the pedestal that she belongs upon."
Jeff the Giant: "Jeff see... well... you come at good time. She many beautifuls and run like deer. You speak her. You give Jeff monies."
Chivalross: "This seems easy... a little tooooo easy. I was expecting a fight. What do you have up your sleeve?"
Jeff the Giant: "One arm. Each side. What you mean?"
Chivalross: "Never you mind. But know this, giant, I'll be keeping my eyes on you."

The excitement built as Chivalross approached the maiden. Yet as she turned around, he was overcome by horror!! This was not the ravishing beauty praised by the muses in song, but a hideous, rusty, old witch!! Her flesh was tainted, scoured and giving way to bone and hollow recesses the sight of which chilled our hero to the bone. Unlikely as it may seem, our hero and Dashing Dave had let their guards down at the shock of the sight before them just long enough for Jeff the Giant to sneak up behind them. They were whisked off their feet, hanging from their collars in the hands of the giant before they even had a chance to bust out some reflex break-dance fighting moves. "Now we all go nice walk. You like girl. You give money Jeff."

Admittedly, the witch had a soothing voice and kept pleasant enough company, but the enchantment she had cast over the giant was a constant reminder of her true treachery. Given no other alternatives, Chivalross made conversation, enough to learn that the witch had spent much of her time in the corrosive Saltlands of Vancouver. But even as he pretended conversation, he was plotting their escape and thinking to himself, "It's a good thing we keep changing our names, or these bad guys might track us down!!"

Without loosening the strength of his grip one newton, Jeff the Giant demanded his bounty of 9,000 pieces of eight... err... dollars. And that's when Chivalross sprung into action. Blinding Jeff with an outrageously small offering of cash, he stunned the giant, rendering him speechless and causing him to swoon in delirium. As the witch sat patiently in the driveway, waiting for her minion to carry out her dirty work, Dashing Dave and Chivalross dashed across the road, into their waiting autocarriage... really great pirate landship... Batmobile... toyota pickup... And picking up speed, they blazed away from Chilliwack, never looking back.

(...except for the stop they made at this really good pub. Chivalross would recommend the buffalo chicken wrap with delicious steak fries. Canadians sure know how to do fries.)

And so they set off again, with their eyes to the road and discouragement at their backs with only the promise of a brighter this-afternoon to beckon them on...

To be continued...

Fleeing from the Mounties!

This weekend saw your hero (in case you forgot, that's me... at least on this blog) face-to-face with the Royal Canadian Mounted Police. As they brutally interrogated him, he responded coolly, without hesitation and with great confidence in his voice.

Evil Max the Border Guard: "Why are you coming to Canada?"
Ross the Avenger: "To liberate a damsel in distress!"
Evil Max the Border Guard: "How much currency are you transporting?"
Ross the Avenger: "Enough to free said damsel, 85 hundred U.S.! Now, HAVE AT YE!!!"

Your protagonist then proceeded to slay the villain with a swift ninja-kick to the trachea, delivering him into the next life with a painless farewell and a stunned expression on his face.
As the dust settled, the hero hearkened back (heroes hearken frequently) to earlier in the day, when he held up a bank...

Savage Scott the Bank Teller of Bellingham: "You need this much cash... why??"
Masked Man: "My reasons are my own, but know that you will be serving a most noble purpose!"
Savage Scott the Bank Teller of Bellingham: "Uh... we usually don't just hand out cash. Do you have an account here?"
Masked Man: "I have not the time for your pithy responses. Your lack of chivalry overwhelms me. You leave me no choice."

As you have distilled by now, the Masked Man in question was indeed our would-be rescuer forced into the realm of crookery by the sheer magnitude of his quest and the exorbitant costs of medical education. Minutes after the above exchange, the smoke began to dissipate, leaving only a few scattered bills softly drifting to the ground still and a smattering of bank clerks hog-tied and gagged with various currencies, deposit slips and advertisements for loans that would make the whole family happy.

As our famed avenger un-hearkened, he thought to himself, "I have no time for daydreaming. My fate awaits me miles ahead."

The storyteller would be remiss to neglect an important character in this tale. You may be wondering... how could one man dispense with multiple bank tellers in the brief span of a giant smoke bomb? Indeed, he was not alone, and as our hero sequentially incapacitated each unsuspecting worker, Daring Dave the Diligent was busy entangling them in his devious webs and stuffing paper in their mouths. And if not for the brilliant distractions of Daring Dave, Evil Max may well have seen coming the ninja kick from Ross the Avenger in time to avert his trachea.

As Daring Dave and Ross the Avenger sped down the highway, leaving a wake of destruction and children holding flowers behind them, they gazed ahead with grim expressions, knowing the Mounties would be hot on their tail.

To be continued...

What We Crave

Last winter I had a transcendent experience in the Wrangell-St. Elias mountains that reminded me of a freedom I had thought lost upon moving to Texas. I can't explain the nature of that freedom or how it felt different from any other unburdening my soul had experienced previously. Two snapshots ebb and flow into each other with the same energy and emotion:

My last night in Alaska. As a farewell to our childhood home and in a sense, to childhood itself, 3 friends and I set off north along the coast at the end of the North Road in late summer. Firecrackers, hot dogs, marshmallows, and some pure sodium metal (which is REALLY cool in water) in our packs. We road our bikes until civilization was long gone and commenced with our evening entertainment. As the sun set and the stars came out, we folded out our sleeping bags on the beach and watched the meteors rain down in a salute to a childhood well-lived.

My return to Alaska. "...the great white silence, not a snow-gemmed twig aquiver/ eternal truths that shame our soothing lies..." A line from Robert Service that bubbled up as I trudged along the frozen river at 20 below. I knew a warm fire awaited me, but in the moment, the air sparkled, the trees shone and the mountains rose up to meet the sky all around me. A time spent away had only heightened my longing for the pure tranquility of absolute focus on and unity with beauty.

This week I made a declaration, to myself at least, that I officially do not like Seattle. And yet as I sit outside Chocolati with the face of a robustly blooming cherry tree beckoning me to appreciate the landscape: the lake, the evening colors, the industrious exercisers, I am reminded of the same sense of freedom. And I realize that my surroundings do not dictate my joy, nor my tranquility, nor my sense of place in the universe. It is rather my acceptance of life and the willingness to fully engage all that it persistently and patiently offers.

It is in these moments that I find peace, purpose and the gentle, loving touch of my Creator.

Going out in a blaze of glory

My last post was written in response to an assignment on death and dying. We were supposed to reflect and write about our role as a physician in the face of death. I realized that my perspective on death was shaped dramatically by my experience with Grandma. In some ways, I'm still processing her passing. Unlike others who I have known and are no longer here, it feels like I could still go visit her. It doesn't feel like she's really gone.

Yet writing that still chokes me up and brings tears to my eyes in the midst of a crowded coffee shop.

I had another moment of self-realization today in our clinical medicine class. Our professors invited a lady with metastatic breast cancer to be a patient in front of the entire class. A psychiatrist interviewed her, demonstrating for us a proper psychiatric evaluation. She seemed perfectly healthy, but death loomed in her eminent future. It made me think of my own mortality and how I would respond to terminal illness.

My dad used to say if he ever knew he was on his way out, he'd just fly his airplane into the side of a mountain out in the wilderness. I tried to talk him out of it... no reason to waste a perfectly good airplane. He said I had a good point.

He did too, though. I don't want to languish. Faced with terminal illness, I would not want my last years/months/weeks spent in a hospital scraping for life. There are stories of terminal patients smuggling Bibles into closed countries, risking execution to bring good news to the oppressed. That's how I'd want to go out. I don't necessarily want to smuggle Bibles, but something along those lines would be sweet. Our ambitions for greatness aren't always out of pure motives, but somehow, there is a certain romance about giving your all, even if your all will soon be taken anyway.

I suppose it has something to do with this:

"Greater love has no one than this, that one lay down his life for his friends." - John 15:13

Grandma

I got the call late one night as thoughts of video games, quantum mechanics and the intricacies of the college-aged feminine mind were dancing through my head. A contented existence devoid of major preoccupations suddenly exploded into a myriad of questions, unknowns and uncertainties. My cousin and her boyfriend picked me up and we were off on an after-midnight outing, destination known, but dreaded.

We didn't know what to expect when we got there, but we needed to be there. I dozed restlessly as the miles passed, waking to cold bursts of air when the truck door would open long enough for Heath to jump out. After a few sprints up and down the highway shoulder, he would jump back in car with a little more adrenaline and drive the next stretch until sleep began to overtake him again.

My Grandad was in surprisingly optimistic spirits considering that his wife was lying in a comatose state just yards away. You could tell our arrival there was a relief however. He seemed tired, yet vigilant, a worn-out wolf guarding over his wounded mate. Grandma looked like death and I had to take another breath before fully stepping into the room. A lively, spunky, pie-making, laundry-doing lady with a heart of gold was transformed into this gray wraith sparsely covered by sheets that served only to accentuate her weakened state.

"Brain stem stroke" "wait and See" "We Don't Know" "We'll Know More..."

Words that meant nothing to me flashed in my head and bounced off the walls shattering in brilliant displays of frustration. And then we gathered around the bed. As we joined together as family to lift up our loved one before our Lord, a sense of peace and healing settled over the sterility of the room that smelled of Purgatory.

And through the calm and unspoken uncertainty, a toe moved.

The next few years were absolute gifts. Grandma never really recovered, but we ate Mexican food together. Grandad cooked for the woman who had prepared his meals for over 50 years, nursing her, helping her fight on, loving her.

She passed one night, moving into the next life with ease and grace. My aunt, who had been a stronghold for Grandma and Grandad in their battle, awoke to a voice at her ear, "I'm free Judy-babe." She got the call an hour later.

The funeral was a celebration. All those who attended remembered not the mourning, but the laughter and the tears, sadness mixed with joy. We do not weep for her. We weep for us, because we miss her and will not see her until we too rise to new life.

Death is not a bleak occasion for me. It is the graceful transition from pain to the final testing grounds where we all will answer for the choices we've made. I anticipate the day when I can look back on my life and look forward to death as a step into freedom.

3rd Year Schedule

And the moment we've all been waiting for...

Pocatello, ID: Pediatrics, July 7th - Aug 15th
Free time!! Aug 16th - Sep 28th
Seattle: Internal Med, Sep 29th - Nov 7th
Anchorage: Internal Med, Nov 10th - Dec 19th
Christmas!! Dec 20th - Jan 4th
Anchorage: Psychiatry, Jan 5th - Feb 13th
Fairbanks: Surgery, Feb 16th - Mar 27th
Anchorage: Ob/gyn, Mar 30th - May 8th
Wrangall: Family Medicine, May 11th - June 19th

That's all for now!

What the Easter Bunny isn't telling you

My favorite Puerta Rican recently made me aware of a problem with Easter. While I fully support egg-hunting, bunnies, bright colors, fake grass, jelly beans and Jesus rising from the dead to bring life to the world, there is one aspect of this joyful holiday I can no longer endorse with a clear conscience.

I'm warning you right now, if you are female or under the age of 13 and want to fully enjoy the holiday, go read about the latest invention that should be in every Easter basket.

Just so that you're fully informed, this will definitely put on smudge on your festivities.

Last chance.

Ok.

For real.

...

It's the chocolate. (you still have a chance to stop reading!!) I can no longer endorse most chocolate for Easter or any other application for that matter. If there was an official website where you could endorse things officially, I would heretofore withdraw my endorsement of chocolate in most forms.

Here's the scoop. Most cocoa or cacao or whatever you want to call it is grown in Ivory Coast, roughly 40% comes from there. Now while there are many family farms that pass from generation to generation, there are also farms that employ forced labor, offering lucrative jobs to children and then completely enslaving the workers once they arrive on site. They often recruit from other countries in order to completely subjugate their workers and leave them no recourse to protest their conditions. Mali has been especially hard-hit by slave traders. There are countless stories online detail the practice of cocoa slave traders. One boy way promised a bicycle to come work, then inhumanely abused as a worker. Needless to say, no bicycle ever appeared.

What can we do about it? Not a whole lot right now, but the idea of buying a Snickers doesn't seem quite as sweet now thinking that I would be enjoying on the backs of abused children. It actually bothers me a lot that I could still eat chocolate and probably not flinch. I've become dulled to oppressing others by my purchasing and indulging habits. Is it ridiculous to cut out chocolate completely? Probably. But that's the kind of life I have committed myself to when I signed on with Christ. Ridiculous. oh well.

Who's guilty??? Almost all cocoa not specified as "Fair Trade" is bought by purchasers at cocoa markets where cocoa from all over the world mixes. In these markets, there is no differentiation between chocolate produced by just practices and that produced by oppression. This almost guarantees that slave cocoa makes it into the mix of most major brands. Specifically, Nestle, Hershey's, Mars and yes, even Cadbury all purchase "blood cocoa."

There is a spark of hope for chocolate lovers: Fair Trade chocolate. I wouldn't suggest that every single person stop eating all chocolate, but I would request that you would support an alternative to slavery. Start mixing some Fair Trade chocolate into your purchases.

Every purchase you make supports either fair practices or unjust practices.




P.S. I concede that not all children can realistically jump and dance all day in fields of green with butterflies and bubbles, and realize that working is actually a pretty good choice for children in poor countries given the current social conditions. Read up on what's going on in the slave trade and realize that we are supporting unnecessary slavery and abuse with our $13 billion of chocolate purchases every year.

Whoa.

I just read my cousin's latest blog. And it's rad. You've got to check it out. Seriously.

http://shellywillbanks.blogspot.com/

The Clean-up Hitter

Love. It's about love.

There's a series of videos called NOOMA with a guy named Rob Bell talking about all kinds of weird stuff. In one, he poses the following questions:

We'll tell somebody we love them and in the same breath, we'll talk about how much we love a new car, or a certain pair of pants. I mean, I love my wife, and I also love... tacos?

Do you think the word love loses its meaning when we use it for so many things?

Does it affect our understanding of what real love is?

I was talking about the ideas in the blog below (judging and stuff) with a friend and the subject of love weaseled its way into the conversation. You know, the usual stuff like, "What is love? How is it perceived? How do we describe it?" It then hit me like a speeding semi-truck: We (as a society) get so worked up about "judging" because we have redefined love as something conditional.

Western Love When I talk about loving almost anything, I'm talking about how it makes me feel. I love skiing because of the sweet sensation I get in a (mostly) controlled fall. I love fajitas because they set off a brilliant array of delectable explosions in my mouth. I love mountains because of the soaring feeling I get standing on top of one and the sheer awe that surrounds me when I see them rise up to meet the sky.

If all those things lost their sweetness, my love for them would vanish. And so it is that we have defined our love for each other. Words have power and the associations we form with them have power as well. When I say "I love you" to a friend or relative, I could essentially replace that sentiment with "You bring me joy/happiness/entertainment." Still complimentary, but less so. There is no word that means I love you unconditionally because of who you are, not because of the choices you make or what you do for me. Some would argue that our choices define us, but that assumes that we have no deeper identity which lends us greater worth.

Do You Love Me? If loving some one is simply an effect of how they make us feel, then it is easy to see why it could be so upsetting to lose some one's approval. If some one stops pleasing me, I stop loving them. Me not liking your shoes because they're not hipster enough isn't a huge deal. Me not "loving" you anymore because your look clashes could cause some significant emotional pain.

Back to the Basics Back when love was invented, it wasn't based on a "give-and-take" system. It was more of a "give" system. A reputable source claims that the greatest display of love is to give up your life for another. Hardly a pleasurable activity. That kind of love doesn't say "You please me," but rather, "Your worth to me is immeasurable, infinite." It is that kind of love that is unconditional, seeking the betterment of the other and not the pleasing of self.

There is no word in our language to express unconditional love which is rooted in loving some one because of their innate value. In fact, many times we don't assign value based on the right stuff. Everyone reflects the image of God. We all have a chunk of perfection that we can uniquely illuminate to the world. We are all sons and daughters of the King. THAT'S worth loving. And if we start loving people because of the worth of their deepest identity, I have a feeling they wouldn't feel quite so rejected when we tell them their shoes are ugly. They might even smile. 'Cause they know they have our love, regardless.

No one is into all kinds of music

But everyone says they are. Is it an unwillingness to admit our own personal preferences that drives this phenomenon? Perhaps just social laziness? When I ask some one what kind of music they like, and they say, "I'm into all kinds of stuff," I immediately judge them as being noncommittal. I don't want to, it just happens.

There's a lot of talk these days about judging and not judging people. It's the social equivalent of painting yourself with honey and going bear-slapping to bust out a particularly judgmental phrase. And no, I'm not going to give examples. And here it comes, the elephant in the room...

Everyone judges. But that doesn't mean they hate you.

Having opinions and expressing yourself in various ways is intrinsically a form of judgment. By making one choice over another, you're evaluating that option as more valuable, thus naturally demonstrating your preferences. I'm about to order a mocha, NOT a latte, because a mocha is a better choice for me right now. When Ted just ordered his iced mocha, I judged that choice. I actually thought, "Wow, that looks really good, I wish I was more like Ted right now."

Now if he'd made what I would consider a bad choice, like ordering a cappuccino, I would have thought, "Dang, that looks like drinking bitter foam." And been quite content with my own choices.

Neither one of those hypotheticals would diminish the friendship or respect that I have for him, and this is the point I'm trying to make. It's okay to disagree with, or even disapprove of the choices other people make. It's okay to express that. It's honesty. I think what people are really adamantly opposed to are the judgments that say, "Because you made this choice, you're a terrible person." Yeah, not cool.

So here's my goal, to keep our preferences apart from our acceptance of people, but on the same token, not insult each other by pretending we don't actually have any preferences.

I almost didn't post this because it's kind of abrasive, but it's a topic that seems important to me, so feel free to call me out if I'm in left field on this one.

Meeting amongst friends

He described the first sensation as a warm buzz that he immediately wanted to experience again. He did experience that buzz, many times over and many times stronger over the years to come, but that one experiment, that 11-year-old curiosity, that open bottle of wine was the spark that ignited a blaze of alcoholism culminating in a 25-year-old high school graduate dragging himself, drunk as a skunk, into his first AA meeting.

My first AA meeting was a class requirement. I went to observe what it's like to admit you're totally out of control and cannot change yourself. Actually, it's a lot like me. Actually, it's a lot like you.

It's smiling faces,
It's raucous laughter,
It's taking a big bite of chocolate cupcake and almost snorting frosting up your nose at a buddy's joke.
Sitting tiredly waiting for the one to finish,
Secretly wondering if, when your time comes, you'll spill the beans
The whole can of beans
Not just the top that looks nice and tasty,
The dark bottom where the squished beans reside,
Where it's cold and agglutinated.

But smiling face after smiling face
Urges you on,
You sip some ground-filled coffee and remember all the times you spilled the beans
And the relief and the joy
And the freedom
It's curtains for your fears
As the words pour out
Acceptance, pure acceptance

They don't even break stride when you tell them you did coke
Are they paying attention?
Sure, they've just heard it all
They walk on the razor edges
Another round
With cream and sugar to boot

This is real
Real, shaky, life
With all its uncertainties exposed, no one is a stranger
Drifting in, drifting out
Week after week
Month after month
Decade after decade
It's like finding an old restaurant with a crabby waitress. The food's not great. The coffee always tastes burnt. And don't get started on the smell. The table wobbles, but you keep coming back. Even though the table wobbles, you keep coming back.

It must be something in the coffee. Or maybe the cup. But probably the hand the pours it for you. It's 'cause that hand's attached to some one who understands you. 'Cause, really, they're a lot like you. A lot like me.

Sometimes I do stupid stuff

As a brilliantly ironic contrast to the post directly below, I was riding my bike yesterday to go pick up my truck, when I suddenly felt my back tire lose traction and begin to skid this way and that. I was already pulling off to the side, but had little control and subsequently hit a curb and went flying off. No injuries were incurred.

I was going so fast because I was racing against the clock to get to the transmission shop before they closed. The transmission shop is about 5 miles from my house, and I had no intention of walking all the way home empty-handed, so I started running... to the wrong address. Breathless, I called the shop and asked for directions. A mere 10 blocks to the north they were, so I started running again. Fortunately, the guy on the other end of the line said he would wait for me to get there. Clary's Transmission: I salute you.

To add to the further irony, it took a $2 part to fix my transmission, but the total bill for diagnostics, shop time and replacing the fluids was well in the 3 digit range. It's moments like these that make the moments below that much sweeter.

Sometimes I do cool stuff

For the full walkthrough of the trip, please see Dave Brown's account of the Kaleetan Peak summit. In brief, it was an awesome trip, although the snow was less-than-desirable at times. The picture is from the descent from Kaleetan Peak (close to the Alpental ski resort) as we passed through Malakwa Pass. I was really freakin' sore the next day, but moments like this make it all worthwhile:

My To-Do List of Blogdom

My blog (who I will henceforth refer to as "Harvey") has underlying goals to which it aspires and meets to varying degrees depending on the author's energy level and creativity:

• P - Provoke thought
• I - Inspire
  
• B - Be funny
• I - Illuminate my world to the masses

Harvey does a better job of this when there are interesting things going on in my life. Unfortunately, many of the interesting things are not suitable for publication because they may evoke unintended reactions in those who observe Harvey. To achieve PIBI today, Harvey will wax upon the subject of "What Ross Did Today."

Still being tired, from getting up at hours suitable only for roosters and yuppies, and sore, from putting 2,500 feet of elevation on my legs, I slept in. My truck has been having reversing difficulties. The mechanic informed me that the problem could be two things which differ mostly by a decimal place or two in the bill. Upon PIBI analysis: Not challenging, inspiring, maybe slightly funny, but mostly illuminatory.

Most of my day, I spent at The Blue Dog Kitchen, attempting to study, but I ended up planning Spring Break and buying 3 books:

• Rod Machado's Private Pilot Handbook: The Ultimate Private Pilot Book
• Gleim's 2008 Private Pilot Written Exam Guide
• The Hipster Handbook

I'm getting excited about Spring Break, but will not allow Harvey to speak of such plans until they are official. Hopefully, part of it will entail studying for ground school and then starting my flight training this summer. P-, I-, B-, I+

This blog is failing to do little more than tell you about my day and plans.

And actually, I'm going to be late meeting Ted at the rock gym if I try to add anything inspirational or provocative. I am henceforth abandoning the PIBI system and will now stop referring to my blog as "Harvey."

What a random entry.

Priorities

We had an interesting discussion in class today revolving around the idea of a system of financial compensation for excellence in providing health care. We had a lengthy discourse on the "fight for justice" paradigm, this idea that if I've EARNED something, I'd better get what I've earned. Everyone was squabbling about how to insure that no one who didn't deserve their reward got it.

In one of my more abrasive moments, I challenged our class to aspire to more than merely working for the payday, but to be motivated by altruism and sacrificial giving. We must renew our minds now so that when confronted with a choice, we naturally react by nature of our virtue. I got a mixed response, varying between those demanding that a lucrative salary was a great reason to be a physician and those who were visibly stirred to think that there is something more to life than "getting their just desserts."

It really made me reflect on authenticity and honesty with one's self. It's a question I've asked myself before and will ask many times again: If I really believe what I say I believe, what practical choices will I make?

If I say I care most about loving my patients, I won't care about how well I'm compensated so long as I earn enough to continue to love my patients.

If I say I care most about getting what I deserve, I will do everything I can to protect and promote myself and do nothing that hinders me getting mine.

Just expressing the first of those dichotomous viewpoints brings over me a rush of peace and Godly wisdom, the principle of freely giving because I have freely received. The second reeks of futility, greed and frustration, characterized by a life lived surrounded by others, but alone.

It took some encouragement from one of my dear friends to get the ball rolling in class today, further confirming the importance of community in my life. I wasn't sure it would go over too well, and with some, it didn't. However, as class ended, several of my classmates approached me with gratitude for expressing what needed a voice.

We are surrounded by a great number of allies, no matter what our position, who will encourage and support us if only we will rise to the occasion.

Reminiscing

I've spent the last 30 minutes or so reading over some of my old posts. I could almost taste the curry in Siem Riep, feel the bites of the bed bugs in Phnom Penh and see the smiles of my friends as we lounged at Amok. A long night of laying on a wooden mat contrasts sharply with the luxurious bed that I will sleep in tonight. Dreams of 50 cent noodle plates and glasses of Angkor beer give way to $10 burgers and $4 pints.

A 90 dollar CT for a dying child and a 180 dollar coat for an outdoor enthusiast.

A day of mending deformed faces and a day of listening to the mechanisms of the intrinsic clotting pathway.

A 3 hour bus ride to a fishing village to work in a clinic and a morning listening to a patient tell her story.

An endless day by the bedside of my best friend and an endless night absorbing pages upon pages.

Life measured by constant surprises and unknown horizons and life predictable, yet imposing.

Undecipherable foreign jabber and complex guarded conversation.

The green, the stone, the sea and the green, the clouds, the buildings.

Dust blown in my face by the countless sea of motos and wind blown in my face as I navigate the city.

Poverty at every turn and the homeless with their empty stares.

Clambering orphans with incessant chatter and the people of cell phones, oblivious to the world.

A seat on a bus, bound for the horizon and a seat on a bus, bound for downtown.

A borrowed computer, barely responsive and borrowed internet, efficient and impatient.

Captures of a life lived. Parades of the past and possibilities for the future.

Sentiments of sacrifice. Joy at the return to haphazard paradise.

A Trip to the ER

I realized today that I've told this story multiple times in person, but have neglected to inform the world at large of my exploits, so here goes.

It all started in our PBL group (that is, Problem Based Learning) when we got a case centering around a "curbside" consult which is medicalese for professional courtesy, or more simply put, free health care because you happen to be in the club. The issue was raised: is this case centered in reality, or is it merely pop fiction that docs can get free care from other docs. I took that issue home as a "learning objective."

My learning objective took me to Smallville Hospital ER [names have been changed to protect the victims]. I cased the joint. Up front was an administrative assistant, who are usually pretty sharp and able to keep the riffraff from getting to the docs. I almost knocked on the back entrance so a janitor I had spied would let me in, but figured she might sound the alarm. Then it came to me: the security guard. A venerable spot in the defenses.

"Excuse me sir, I'm a second year medical student and I need to speak with an ER doc. Is there any way you could let me in?"

After a little finagling, I was past the first obstacle.

A complication! The security guard didn't just let me into the ER to wander about aimlessly, but escorted me to the physicians' desk. As I stood there awkwardly, he explained that I had a question for one of the ER docs. I willed him to go away, but he was impervious to my mind control. So I suspiciously leaned down with my back to the guard, only to be met with a startling,
"Is this a personal health question?"

from the ER doc of choice. Yikes! I wasn't the first with this idea. Not one to be perturbed, I pressed on.

"Kind of. I've actually been fasting for several days and I'm worried about my ketone levels causing kidney damage. Is there any way I could get a urine dipstick."

Here's the shocking part. Without a pause:

"Can you do it yourself?"

Not a "Get out of here kid." No hint of "Your behavior is completely out of line." And definitely no nod toward security to dispose of me properly.

My response: "Sure!" And the doc: "Let's get you a dipstick."

Now my assignment was to find out if a medical professional could actually get lab tests done without being an official patient, so my work was done. I sheepishly explained that I didn't actually need the test and mumbled something about it being an assignment for a class before I took my nervous, sweaty self off the premises. I don't think the doc was too impressed with my covert op skills, but neither seemed too put off at my imposition on his time (for which I expressed my gratitude).

Is this a sad commentary on our medical system? Nah, I think it's pretty cool that we haven't become so bureaucratic as to totally abandon professional courtesy. Medicine seems like a pretty tight-knit group at times.

I'm so in.

A Tribute to Tributes

In honor of my 99th post, before I spring into the triple-digit blogging world, I feel compelled to reflect.

This all started one morning when I poured myself a bowl of Captain Crunch with Crunchberries cereal (it was on sale, I'm not usually a sugar cereal fiend... really) and a lone blue Crunchberry went skittering away from my bowl upon application of milk. I reached to retrieve it only to find it well-fortified under the microwave. I bent down to see a collection of various items, mostly bread-tabbie-like things and set to pondering the location of various by-gone possessions to which this post is dedicated.

[Interruption]

This post had genius written all over it, I had a great mental list of things gone by. Then life happened. Mostly I couldn't find a picture of my old Ford Ranger which was going to be the first thing on my list. Oh how I miss her... Unfortunately, at this point in my life, I've realized I have little time for putting together creative little projects, and so what you get instead is a brief apology for not writing a creative post and scattered thoughts. Enjoy.

But gosh I love tributes and I think it's great to remember the good that once was while being thankful for the good that still is.

On a larger scale, I think that pattern speaks a lot to my current situation... Life was so good in Girdwood and Anchorage, but that doesn't negate the good that I'm finding in Seattle. I declare this post, my 99th, a tribute to good ...everything... gone by: possessions, friends, seasons of life, sports, cities, relationships, dwellings, adventures... the list goes on.

In that spirit, I am now free to write about whatever pops into my head. Who knows, maybe post 100 will be totally mundane.

Mistakes

That feeling where your stomach drops out from under you, indicating that melting into the ground and out of existence would be preferable to exerting the strength to remain standing... yeah, I get that. Vivid images flash through my mind... snapshots of my past forever mentally preserved by the sheer impact of their arrivals. Time is a great analgesic, but despite the transition from sharp to dull, the pain remains.

Envisioning the next shot of sorrow directly dependent on my choices could paralyze me. Indeed, the aftermath of a single incident is near crippling. However, accumulating the combined weight of my future failures in the present borders on insanity. To achieve peace in the face of such opposition, I become mindful of the words of my Master.

Your heavenly Father already knows all your needs, and he will give you all you need from day to day if you live for him and make the Kingdom of God your primary concern. So don't worry about tomorrow, for tomorrow will bring its own worries. Today's trouble is enough for today.

I don't understand how to manage my impending mistakes, but the one who made me understands life much more deeply than I do. When I accept the reality that He offers, I lose the motivations of guilt and fear and can confidently move forward in love and thankfulness. This is not a ploy to shirk responsibility, but to embrace my own limitations as a necessary state of my dependence on the unlimited one. In Him I find mercy for my mistakes and stern admonition to be His hands and feet to those in a broken world.

I share in the sorrow of those I hurt. And I will hurt many in my life. As my character grows more and more like that of God, and my medical knowledge increases in depth and breadth, and my judgment and wisdom gain firm holds on my heart, I will learn to do less damage and do more good. But in this life, I will always be limited.

By the grace of God, I have the blessing to recognize my own weakness and fallibility. By the love of God, I am forgiven because He he taken the burden of guilt upon Himself.

Now all that I have to do is really believe that.

Closing Thoughts on Physicianhood (part 3)

Seeing as this series of reflections is due tomorrow, I thought I'd better wrap it up.

I know who I am at my core and want to paint a picture of how that could possibly play out in my role as a physician 10 years from now.

The wind blusters at my back as I reach out to unlock the door, spawning snow swirls and depositing a few more crystals into the drift at my feet that has built up overnight. Before wrenching the door open, I look over my shoulder to admire the fresh ski tracks the full moon is illuminating on the mountain face rising behind me. Another good weekend.

My office is cozy at this hour of the day, more resembling a private study than a place of business, but if an outsider were to peer in, they might think the coziness had won over, exiling me again to the lands of sleep. This is not the case. My thoughts fill with anticipation of the day to come and prayerful presentation of my concerns to my Lord. In a few minutes, I will be dashing about talking, testing, evaluating and diagnosing. But for a few minutes, I am still and quiet before my God, seeking His strength and wisdom for the day to come.

I know the answer to my first case before I even walk in the door. Ellen was one of the first people to welcome me here and despite her warm tone, already had concerns about her heart that she wanted addressed on my first day of business. Her heart is perfectly healthy, but she's convinced that no one can make it 91 years without heart trouble. I'll of course do a thorough exam and refill her hypertension meds in hopes of encountering nothing more than a little pleasant banter with a feisty old lady.

As lunch time rolls around, I look forward to seeing my wife and kids as I step back out into the cool Alaskan midday. Clearly a highlight of my day. My wife and oldest always have stories to share about their days at school and the little guy is just starting to form full sentences. The other teachers now know that I'm a regular in the lounge and always try to update me on the latest gossip, which leaves me feeling a little awkward, but accepted.

We talk about our plans for the evening and how we'd all like to get outside and do something, just not sure what. In the back of my mind, I'm making allowances for tomorrow when I'll, weather-permitting, take my Cub out to the closest village. It's been a while since I've checked on them and the PA should be able to handle anything urgent that comes through the doors at the office. I tune back in just in time to hear a lingering question about "Are we really all going to Africa this year?" from my daughter. I smile and say "Lord willing," which gets me a frustrated look. She doesn't quite grasp that our lives are not our own and wishes her parents were a little less kooky sometimes. I really think she is starting to grasp the freedom and joy that come from walking with God though. In small ways.

As I walk back toward the clinic, I lift my eyes up to the mountains and begin to sing a song of praise. Joy overflows, and I thank God for the life I have been given.

Grace

I cannot even begin to explain how refreshing Christmas Break was for me. I've expressed frustration with words like "awesome," "amazing," and "incredible" before and this is no exception. In light of their insufficiency, I will resort to expressions such as life-giving. restorative. nostalgic. heart-warming. spiritually filling. enlightening. and emotionally fusing. In short, being surrounded by people who know me deeply and understand and share the things most important to me reminded me of who I am.

I can't describe each facet of this restoration, but a different need of mine was met in Anchorage, in Girdwood and in Kenai. If you'd like the details, I guess you'll just have to ask. I'd be more than happy to share but I anticipate an inverse relationships between the length of a blog and the number of people who finish reading it.

The heart of what I want to say and what I experienced.

You cannot choose your actions independently of outside influence. We make choices daily that demonstrate what is in our heart. Sometimes we love what we do, sometimes we don't. How is it that we do things we dislike? It's counterintuitive. It is the core of who we are, our heart, that dictates the choices we make, despite our thick rationalization and heavy brooding.

How then do we have any amount of say into what happens to us? How can a man choose his course in life? Or even in one day?

By grace alone.

Most of what I'm saying was revealed to my dear brother Adam after intense study and prayer and seeking after wisdom from God. Through revelation, he challenged my understanding of grace and what it meant before we Hallmarked* it. I did a quick search just now and found a website with an awesome description: In most of the passages, however, in which the word "charis" [grace] is used in the New Testament, it signifies the unmerited operation of God in the heart of man, affected through the agency of the Holy Spirit.

Simply, grace is the direct influence of God upon our hearts.

We may not be able to control our decisions as much as we would like to, but we have a great deal of control over what we allow to influence our hearts. Our hearts may remain wild and untamed, subject to whim and circumstance, but they will be shaped into the image of that which influences them.

For those who don't yet know God, this still leaves an important principle dictating that we pour into our hearts that which we wish to become. What source is worthy of emulating? Who can we look to in perfect admiration?

To truly shine, we only need ask for grace to become more like the Holy One. He is faithful and eagerly awaiting those who desire to know Him.

An unlikely source to leave a lingering thought, but fitting nonetheless, Bloc Party's "The Prayer:"

Lord give me grace and dancing feet...





*the act of Hallmarking is where you take something beautiful and mysterious and reduce it to warm platitudes often expressed on cheesy cards that cost six dollars.