The End

Here we are. It's the end. So, the thoughts I'm leaving you all with, are what I deem, my "commencement speech." I wasn't asked to give the commencement speech (I don't even know if we have students give one at all), but if I had been -- this is what it might be like.

In the immortal words of Diane Court, from one of the seminal movies of MY generation (Say Anything):

"We're all about to enter 'The Real World.' That's what everybody says. But most of us have been in the real world for a long time. But I have something to tell everybody. I glimpsed our future, and all I can say is... 'Go Back'."

Well, Diane, I don't have the same advice.


Yes, we're about to go out into the "Real World," and some of us have been out there all along, and long before, but it's different now for us. Some people have their whole lives and careers ahead of them. They have families to create and fortunes to make -- names for themselves. Others have different goals entirely -- coming to this as a steppingstone, or a second career, or both. These are exciting, and scary times for all of us. Because after we walk across this stage, after the fanfare and the parties and the dinners and whatever else, we'll simply be -- Doctors.

It's a title -- sure. But it doesn't mean anything unless we MAKE it mean something. If I've learned anything at all over the course of my professional and academic lives (and there have been a few), it doesn't mean anything at all, if we don't do something with it.

We're called to be leaders and teachers. We're called to make a difference in the lives of our patients and communities. And if we so choose, we're called to be revolutionaries.

When people ask me (nowadays) what I want to be when I grow up, I often use the following quote (also from Say Anything -- in the voice of the illustrious Lloyd Dobbler):

"You mean like career? Uh, I don't know. I've, I've thought about this quite a bit, Sir, and I'd have to say considering what's waiting out there for me, I don't want to sell anything, buy anything or process anything as a career. I don't want to sell anything bought or processed, or buy anything sold or processed, or... process anything sold, bought or processed, or repair anything sold, bought or processed, you know, as a career I don't want to do that."

And I might add.... So, I'm becoming a Doctor.


For those of you contemplating a career as a physician, know that it is one of the hardest choices you could ever make. The school is grueling, the hours are long, and the thanks may not be plentiful. If you can choose ANYTHING else that you believe you'd be happy with, do it. If you want to be a lifelong student, challenged every single day, and called to be more than you ever thought you could possibly be, it's the perfect place for you. What are you waiting for?

As for me, the first part (Yes, I said first part) of my education is over. There may be more studies. There may be research projects. There may be additional degrees. But I'm far from being finished. I'm just getting started. And so are my classmates.

It's been a ridiculously long, hard road. We've been through a lot together. There were times we hated each other -- and times we couldn't hug each other hard enough. I have watched my classmates grow as people and as practitioners -- into things they never thought they could be. From the first day of dissection when people didn't know if they could handle it, to the last days of clinic when some of us knew we'd never see each other again after graduation -- we are family.

For those just getting started, don't give up. No matter what -- whenever you're struggling or Life hands you a speed bump... DO. NOT. GIVE. UP. Persevere! Keep studying. Keep moving. Keep trying. Keep learning. I have faith in You... just like You've had faith in me.

Look out world. Here I come.

The Beginning of the End

This is the beginning of the end -- second to the last entry. I know I've said this before -- but time really does fly. I've been writing with you over 2 years. We've been together through a lot. This almost feels like a break-up.

It really is me this time -- I promise.

We're practically family -- you and I. Don't take my departure too hard. (It'll be hard for me, though). I'll miss you guys -- just like I'll miss all of my family here. We've been together for 3-½ years. I honestly don't know what I'm going to do when we're all apart -- probably cry. We've already talked about harassing each other from afar -- texting each other at godawful hours of the night (since I'll be 3 hours behind here), and flying back and forth to see each other (since we'll finally have the money to do so). I've already started recruiting them to move out to Oregon. (The power of inception is a beautiful thing).

You all have been "listening" to me talk, for the last 2+ years, about these people. So, I thought I'd introduce you -- to the people that have kept me going. These people are my family.


Here is Julia. Julia has honestly been the glue that has held me together for the last 3-½ years. If we were off from school, she and I still emailed and texted back and forth at least once a day. We stayed, and studied together during boards. Anyone that can deal with me when I'm that neurotic deserves sainthood. We've laughed together. We've cried together. We've dissected together. She's my sister and my best friend. I'm going to miss her most of all. She's my rock and I can't imagine having done any of this without her.


Joe has been my work/school brother since right after we met. He actually reminds me of my brother (except he's cool and I actually like him). He's given me way too many pep talks, helped me out with all kinds of business-type stuff, and has the most hilarious brotherly advice.


This is Leslie. Leslie came late in the game. She started here (transferred from Lombard) after 8th Tri -- but it feels like she's been a part of the "family" forever. From her pet lizard Roger, to her brand new baby Emma, she's always been amazing -- plus she cracks me up! She's probably glad I'm leaving Florida, because I keep teasing that I'll run off with her baby. Crazy Auntie Andrea will always be around Leslie... don't worry.


This guy probably has the biggest heart I've ever seen. Well, I haven't ACTUALLY seen it -- but I've listened to it. This is Ricky. Let me tell you, that he has been through hell and back, and always has a smile on his face, some new tune for me to listen to, or a REALLY corny joke. He joined our motley crew from an upper Tri -- but he never missed a beat. He's the only other intern that has stayed until late into the night (or so it felt) with me, working on paperwork. He's always been a dedicated guy.


Dave is the quiet guy sitting in the corner -- who, when he does decide to share something -- usually blows my mind. We've both, not so secretly at times, plotted to overthrow the powers that be (on more than 2 occasions). I honestly can't wait to see what he does in the future. He may be president someday. (I'll vote for you, Dave).


Last, but certainly not least, is Antoinette. Antoinette is the epitome of sassy, and she gives great hugs. She's another strong, quiet force sitting in the corner. But, she has a lot to say. She's great with her patients, and I know she'll be amazing. I can't wait to see where she goes.

There have been other people in my family here. Some are over at the other clinic, like Alid, who was so sweet that he even helped me move. (He's a smart guy -- look out for him in the future too!) But, our group here -- we're the close ones. I'm going to miss them terribly -- and all of you.


Next week -- the grande finale. Have a great one, Everybody.

A Comically Absurd Exam

Does it feel like spring at your house? We had a brief moment of chilly over last weekend -- and then it started getting warm again. Since there's no real spring here, we're definitely in the early stages of summer.

Well, today's blog is going to be more of a community service announcement -- and a testament to how (much better) we do things here. Today, I went to the neurologist. Given my history, and the fact that I've put this off FAR too long -- it seemed like a good idea. I'll leave all of the names out of the picture, but I will say that the person that I saw was an MD -- and the student that I saw was a DO student. So, I arrived at the neurologist's office, stack of MRIs and CTs in my hand -- to see if they'd do a follow-up MRI on my head and neck.

In case I haven't filled you all in on this (or you don't want to go through the archives) -- I was diagnosed with a Chiari Malformation in 2005 and had surgery to "correct" it shortly thereafter. The student walked me into the room, introduced herself, and was supposed to take my history. She asked me a couple of questions -- brief thoughts on why I was here with very little about my history. I watched as she wrote down about 5 lines with 2-3 words on each line. In her defense, I have no idea what the words said, but after hearing her give her summary to the doc, she missed a lot of what I said.

Image of comic

So, the doctor came in, asked me a few more questions -- a few more about how my condition presented itself, why I was there, and what I hoped to gain from the visit. She made a number of assumptions about me based on her perception without questions. All of them were wrong. When I questioned her back, she had no idea how to handle me or what to say. My favorite question that she asked me was, "When was the last time you felt normal?" To which I replied, "I've never felt normal -- what a strange question to ask me."

It's easy, as a physician, to make assumptions about people because of the way they look, how they're dressed, their age, their background, or a million other characteristics. Know that many times you will be wrong when this happens. This was a great reminder for me to not fall prey to this. I will admit that between the poor history taking and the lack of bedside manner, it didn't set the tone or instill much faith.

Then she did her "exam." Now, if you've ever had a neurological exam, you know that it takes a while. There's sensory testing for light touch and pain, strength testing, cranial nerves (if you're going to be thorough), reflexes, and cerebellar testing (and a few random other things thrown in). Going through this exam, even quickly, takes 10-15 minutes. This doesn't include any advanced testing -- it's just a screen. The exam performed on me involved the patellar reflexes only (normally biceps, triceps, brachioradialis, patellar, Achilles, and pathological reflexes as the basics), 3 of the strength tests (I do 16), NO sensory testing, and 1 cerebellar test (and not the best one at that). I kept waiting for her to do the rest of the exam. It never happened. No cranial nerves were tested. Now, given how severe my condition was originally (my brainstem was herniated to the second vertebrae) and all of the fallout from that, wouldn't you have done at least the basic exam?

After waiting for 30+ minutes, talking to the student for maybe 3 minutes, dealing with the doc for a max of 10, and sitting through that pathetic exam, I can't possibly imagine how she could have learned anything about my current condition. Before I even walked in the room she had a prescription for an MRI written out. Maybe she'd already decided that the exam was extraneous. I have no idea. But I'm STILL baffled. After offering me a prescription for Valium (for the MRI -- assuming I'd be claustrophobic -- which I'm not), she excused herself and walked out.

I shouldn't complain. I wanted the MRI -- in fact that was the main reason that I scheduled the appointment. But I also expected that I would be seen by a "real" doctor who would offer some level of expertise -- beyond what I already have. I wasn't.

Through all of my educational forays, and now at the end of my time here at National, I can tell you that there's no excuse for a pathetic exam. We're taught better than that. We're taught to be thorough -- to evaluate the tracts, the function. We're taught to listen, watch, and test. We're taught to ask questions -- LOTS of them. We're taught, and have the opportunity, to be good.

I don't know that I'll go back. I have my MRI scheduled. I plan on taking the films with me when I leave and evaluating them myself. I never anticipated having the skills to do that. Between my own personal studies and my exposure here, I definitely trust my own evaluation more than I trust hers.

Here's hoping that all the docs you meet are good ones, and that if you're studying -- that you'll become one of the good ones too.

Have a great week, everybody! Work hard.

Things Are Moving Forward

"I should be asleep." This is what I say to myself at hours like this -- around O-dark-thirty when I'm still up working on something. "I should be sawing logs or whatever people are supposed to be doing at this hour... instead I'm here."

This last week has been a week for the record. I finished my master's degree. I don't know how I did it -- but I did it. I honestly don't know how I worked, had any part in my kids' lives, was full-time here at National, and full-time at Western States. But I did. And now it's over. I haven't quite come down from it all just yet -- but the moment I realized I didn't have anything left to do, my head kind of dropped. While most people would be ecstatic, I was sullen. What do I do now? Now, granted -- I have absolutely no shortage of things to do, read, study, learn, attend, aspire to, whatever. But no one is making me -- but me.

On Friday of last week, I also sent in my paperwork for my Oregon license. And all last week, when I wasn't studying for or taking master's finals, I was working on the bridge course to be able to sit for the licensing exam, which takes place the day after graduation. In all of my "down" time, all I could think to myself was -- what am I going to do now? Where am I going to go? What am I going to do? I have to find a job. I have to move. I have to...

Sometimes we get so busy that all we do -- is do. And as those old parts of my mind started to wander back in, you know, the parts that think about stuff -- I started to get more and more scared. This is it. Things are happening. Things are actually happening.

Grey came back from Orlando, where he was competing in the FBLA (Future Business Leaders of America) state competition (He won 5th in his category -- which is kinda a big deal). He told me a story that made me cry -- in the middle of the grocery store. He told me about this guy -- Alex Sheen, who spoke at the FBLA ceremony with thousands of high school kids from all over the state. Grey said that there was barely a dry eye in the place. And I can see why. Alex started the organization "because I said I would." Here's his story:

It made me think about what promises I might make at this point in my life. I'm at such a point of transition -- finishing school, Grey going to college, moving across the country, starting a new profession...

In the quiet moments, at the clinic, we talk about what life will be like when we're not around each other anymore. We've spent nearly every day together for the last three and a half years. Even when we still had breaks in between trimesters we would often text or email each other, or sometimes hang out. I'd like to make a promise to my close classmates that I won't lose touch and completely disappear, as I'm apt to do.

Things are moving forward. Even though we might not all be in the same place, I hope that we move forward together. After all, we've been together so long that we're family.

Have a great week, everyone!

Gone in a Flash!

I *blinked*... and then it was gone. I couldn't even begin to tell you what's happened over the last week. I took a comprehensive final over a year and half's material, volunteered at an event, did a bunch more master's work, and I don't even remember what else.

Work in the clinic was a little slow last week due to SPC students being on spring break. We squeezed in a few patient visits, though, and I had some interesting cases. There was one in particular, a woman with a pretty complex history of stroke among other things. I love the variety. You absolutely never know what you're going to see each day.


We had a pretty good-sized crew to go down to Sarasota last Saturday. We worked alongside Dr. Arick at the Sarasota-Bradenton ITU Triathlon. We had several hundred 16- to 19-year-old triathletes participating in swim-bike-run at Nathan Benderson Park.


Joe Hicks, Julia Harter, Leslie Jacobi, Dave Aiello, and I did a ton of soft tissue work on several injured, non-rehabbed athletes. There were several that had continued training through some pretty tough injuries. It seems like many of these teenagers have coaches that push them really hard, but don't attend to their injuries once it happens.


Julia Harter participated in the Seminole City Fire Truck pull for the Kiwanas. They raise money for vocational school scholarships for kids. Dr. Jaya Prakash heads up a lot of events with them. Dr. Carlo Gaudagno was also at event. Our team won first place for "mixed adults" and garnered a trophy!

(L-R) Julia Harter, Alex Gubco, Brandon Alexander, Fan Yang, and Dr. Guadagno

That's about it from me. I finish the master's program this week. Everything should be done on Friday. I honestly can't quite grasp it. Here's hoping that this week goes by quickly - but not too quickly.

Have a great week, everybody!!!!