Going, Going...

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

                               -- Dylan Thomas

Boy, did the end of this tri sneak up on me. I'm not kidding. I looked up and it was Week 13 and I had to start scrambling to get everything done. Now, here we are in Week 14 and the scrambling continues. It's the end of Tri 8. The End. Of Tri 8. These are the last finals that I have to take for this program. We're all to the point where we're fed up, tired, and so over all of the projects and papers and quizzes and exams and practicals. I've heard talk from a few people about giving up. I really have. It's not out of the realm of comprehension to just throw your hands up in the air, take a different path, and just go quietly into the night. But we won't, because we've come too far and done too much work. We can't quit now. It's just not an option.

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In Doctor-Patient Relationship class today, we were talking about lobbying, the ACA, the ACC, and a few other organizations. We were talking, not just about what we're doing here, but what we're hoping to accomplish -- the bigger picture. We've been tasked with writing down where we want to be in 5 years -- not just what we want to be doing professionally, but personally. I can't imagine what life will be like in 5 years -- where I'll be, what I'll be doing. It seems so far away, and yet I know time will fly (just like this Tri did). I wonder if the face of medicine will change -- whether our scope will change across the board, whether we'll have prescribing rights in more states, or whether we'll continue to be segregated like we have been. A lot can change in 5 years -- 5 years ago my life looked dramatically different. I never thought I'd be where I am now, doing what I'm doing. It's pretty amazing how things can change.

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I know, though, what I'll be doing for the next 9 days: studying. So with that in mind, I'll keep this brief and to the point. Study hard, boys and girls. Get your work done; finish your projects. Check the check boxes and fill in those dots. Share some gratitude and compassion with your classmates and even your instructors. This is the last time we go down this Path.

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As a "going away" for this Tri, I found another little park tucked back somewhere in Gulfport while Grey and I were driving around. Photos in this post courtesy of Grey.

Good luck on exams everyone. Have an amazing and restful break.

Life's Kaleidoscope

The trimester is coming to a close, and I can honestly say it's flown by. We're all scrambling to meet deadlines in the clinic: this many of this, that many of that. It hardly seems that about 12 weeks ago we were terrified we'd be horrible at this. Truth be told, I didn't think anything about deadlines and numbers and paperwork (OK, well I did think about paperwork a little bit). That's probably why I'm scrambling now.

The last couple of weeks have been discussions about who is transitioning to the other clinic, and some talks about where we'll end up. Half of our crew is moving to the other clinic. It's unlikely that I'll see them very often. Perhaps we'll have seminars or training sessions of some sort, or get together outside of school (although we don't do that now). But in a few weeks, there will be another big transition for all of us. Some of us have been together, nearly every day, for about 3 years. This will be something really new.

Newness. It reminds me of my theory about Maslow's Hierarchy from last week. Incidentally, I've been working some more on that, but I'll spare you all the details. I had the pleasure to discuss it with two of my fellow interns today, the concept of new ideas. We were talking about my theory, and about other theories -- things in medicine and science that seem to have been left behind. We were discussing the idea that there are no new ideas.

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Image by http://mladavid.deviantart.com

Mark Twain said:

"There is no such thing as a new idea. It is impossible. We simply take a lot of old ideas and put them into a sort of mental kaleidoscope. We give them a turn and they make new and curious combinations. We keep on turning and making new combinations indefinitely, but they are the same old pieces of colored glass that have been in use through all the ages."

I grew up not far from good ol' Mark Twain's stomping grounds, but between you and me, his writing always made me crazy. No matter how much I tried, I couldn't understand the dialect he wrote. I'm not sure that I agree with Mark; it seems we're discovering new things all the time. From god particles to medicines, we strive and learn how to change, adapt, and understand the world around us.

If the last 12 weeks in the clinic have taught me anything, it's that we have no standard approach to treating anything. We have to be willing to come up with new ideas, or at the very least, new applications for old ideas. For every patient that comes in, even if they have the "same" diagnosis, what works for each one of them is likely to be something completely different.

I'm fairly certain that our discussion today came to the conclusion that there has to be something new. There has to be a pursuit of Science that crosses boundaries into new territories, that bypasses the need for a randomized controlled trial of everything, and simply embraces discovery for the sake of discovery, and implementation for the benefit of the whole. Perhaps we're all idealists. I see no problem with that. Being idealistic just promotes my love of the field and my hope for making a difference.

Neil deGrasse Tyson, in his series "Cosmos" said:

"To make this journey, we'll need imagination, but imagination alone is not enough because the reality of nature is far more wondrous than anything we can imagine."

OK, Neil. I'll take that one to heart. The greatest theories come from crazy idealists.

I wish you all many great new discoveries. May your kaleidoscope always look just a little bit different.

Hierarchy of Needs

I'm back from the mountains of North Carolina, where I spent from last Thursday through Sunday. It was, as it always is, a life-changing event. I learned so much from everything I experienced there, and everyone that I met. My life is forever changed. Coming back from such a life-altering experience is always really hard. I find myself struggling with motivation, coping with what we call the "default world," and dealing with daily obligations. It's funny how being apart from civilization gives a completely different perspective on what civilization actually is.

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On the way up the mountain

I may have mentioned Maslow's Hierarchy of Needs before. Maslow postulated that in order for humans to function, they must have certain needs met. The fields of psychology, sociology and anthropology have embraced Maslow's theory, on some level, and run with it--proposing that everything from the basis of emotional well-being, to the likelihood of success, stems from these needs being met.

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Image source: www.21stcentech.com

When out, away from civilization and the comforts of "home," people tend to do one of two things: they think about how much they miss the comforts of home; or they realize how little those comforts actually comfort them. I tend to be the latter, rather than the former. Don't get me wrong, I would have loved a warm, dry place to sleep, but for the most part, I didn't miss the Internet, television, my cell phone, or even electricity.

Being apart from society and civilization would imply that we're apart from each other. But that's not the case. I've found that when I'm out in the woods, with other people, that that is when society actually begins. We form a tribe, a family. I often wonder why we don't do that, when we're among each other in the default world.

As students, we've been through several years of schooling together. We're nearing the end. Stress is running VERY high among our group. We're finding ourselves more anxious, more short-tempered, more ready to judge, bicker, harass, and goad each other. For those of us that have become close, we're finding it easier to support, empathize, listen, and care for each other. Perhaps some of this is because we know we won't be together for much longer. Perhaps the rest of it is that we're so unsure of what comes next. Perhaps some of us view each other as the member of the family that we really don't want to associate with (because we didn't get to pick this family).

In just under 9 months, we'll all go our separate ways. Some of us will be friends for the rest of our lives. Some of us will never hear from or see each other again. Just like my past weekend, some of us will be friends for the remainder of our lives, and others I'll never see again.

We have the opportunity every day to contribute to someone's hierarchy of needs. We can build each other up, nurture each other, be family (the good kind), and contribute to each other's well-being, not just our patients.

Last, I want to plug some of the upper trimester classmates who've been doing some good community outreach work. My hat's off to you guys. You're making it happen.

Until next week, my friends, I challenge you to think about how your needs are being met, what you really need and want in your lives, and who and how you view "family."

Happy adventures!

Off the Grid

There never seems to be enough time in the day. As I sit here surrounded by boxes and bags and suitcases, and wondering what in the world I'm going to forget, I'm preparing to leave on a trip. Every time I'm going somewhere like this, I'm scrambling around trying to remember what to take, wondering if it's going to fit in the car/bag/whatever, and worrying that I might forget something. It never fails that I say to myself -- "Never again." And here we are at the next round.

The same goes for finals and midterms, which thankfully are winding down for me. The day will soon come when I don't have any more of those. But until that happens, it's always last minute cramming, note reviewing, and wondering whether I'm going to forget something.

There's something beautiful about the concept of being prepared. It's been a long time since I walked into a test most assuredly and thought, "I've got this." More often than not, I don't think about it. I either have it, or I don't (or somewhere in between). That's not unlike other situations either. Sometimes we just know we're ready, and sometimes we're terrified. I find that being terrified is far more detrimental than just generally not being prepared.

In a few--not so short--hours, I'll be in the mountains of North Carolina, surrounded by a lot of people that I know and love. We'll be battling the elements and whatever we come across (including ourselves), just to experience that time together. It never fails that something happens. Situations arise, accidents happen, people get hurt--both emotionally and physically. There are people there to help take care of those instances, including myself.

2014-07-17_shadow _smThis year in particular, we're faced with an event fresh in our minds, of a friend taking their own life. The details of that voyage aren't relevant to this writing, but suffice it to say, he felt like that was the only option. As I look at my mound of boxes and bags and suitcases, I am thinking about what he is missing, what effect his decision is having on all of those around him, and what might have happened to him if he had sought out help.

As physicians, it's our job/privilege to be there for our patients--in whatever capacity they need. As a volunteer, that's my job this weekend. I take it very seriously.

I'm probably not prepared for what might happen this weekend. I never am fully prepared for these things. But I also KNOW, that whatever happens, we'll all make it through together.

If you or someone you know is thinking about or talking about suicide, please seek help. Talk to someone. People are willing to listen.

National Suicide Prevention Lifeline: 1-800-273-8255

The Great Food Debate

I've been embroiled in a debate on different eating habits for a few weeks. It's been a heated debate. Information has been passed back and forth, but the science is a hard sell for those that don't know or understand it. I say, science, because it's not just the facts about Paleo, gluten-free, Mediterranean, or whatever eating patterns/diets, but about nutrition in general. It's about how our bodies handle food and what they need to be healthy.

There are a million and one (and probably more) "diets" out there. Right now, Paleo and gluten-free seem to be trending the most. Celebrities are using them to "get healthy." People are using them for weight loss or to control the symptoms of one disease or another. Some are using them to lower their inflammatory levels. But few seem to know the actual science behind any of it.

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Image source: www.towelmate.com

I'm admittedly biased. I've been a diagnosed Celiac, and gluten free for 16 years. The more information that I learn about grains, etc. -- the more I'm glad that I don't eat gluten. But the general public doesn't have the information that I have. In fact, it seems that most professionals don't either. But that's not the purpose of this posting.

When I started out writing this, I thought about my friend and how vehemently she adheres to her beliefs about "nutrition" and eating. She's a registered dietician. We've argued back and forth about grains, about how she thinks that Paleo/Mediterranean is bad for athletes, about how impossible it is to follow, and about how there's a lot of "false" science/claims about that particular eating pattern. The whole experience has been a major illustration on the adherence to beliefs that people have -- not just for her, but for me. It's also been an exercise in frustration.

I can only "recommend" what science (and anecdotal evidence -- but that's another story) shows to be true. For example, I can explain that zonulin destroys tight junctions in the gut, brain, and reproductive organs, and that the main sources of tight junction destroying proteins are grains and legumes. I can quote studies all day long (and all night long) -- and I have. I can distill the science down to very simple words that anyone could understand by using pictures, analogies, and more broad terms. I can do all of these things, but that doesn't mean it's going to change anyone's mind, and it also doesn't mean that they're going to be willing to put it into practice.

We're very steeped in our beliefs. Usually, those beliefs have absolutely nothing to do with evidence. My friend, for example, focuses on athletes and sports nutrition. The concept of carb-loading with pasta or the use of sports drinks is very much a part of her reality. She's concerned about having energy available for use. She's not concerned about inflammation, overall health and well-being, the prevention of disease, or whether or not someone might develop cancer or an autoimmune disorder. She wants to run marathons, or play 4-hour-long matches. Her reality and mine are very, very different. Chances are, that no matter what I say or provide her with, she will always adhere to her thoughts about nutrition. It will always be about the quick fix. My hope is that she'll come across a difficult case and be forced to broaden her concept of what healthy eating is.

Patients aren't any different. Some may have more or less information than my friend. They may be coming in with a copy of some new fad diet book, or a cookbook of recipes that their Aunt Sally said worked really great to help her lose weight. People may walk into the office carrying a well-worn copy of the all-carrot diet, asking what to do about their increasingly orange skin. They'll be emphatic about drinking their diet coke, eating their bowl of pasta, or consuming 3 Tablespoons of apple cider vinegar before every meal.

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Image source: msmomofosho.wordpress.com

It will be our job to walk them through their questions, hopefully bring some experience and education to the table, and talk them through ideas and possibilities that will help them find some form of healthy, sustainable ground. They may resist with everything that they have in them. As I write this, I'm thinking about how much I struggle with sugar or eating rice, and how hard it has been for me to give them up; I'm not there yet. It's our job to work with them, using their limitations (even if those are beliefs), and our education to help them get to someplace healthier.

My friend and I will probably continue to argue about what we should or shouldn't be eating. The only thing we've been able to agree on so far, I think, is that there's no one single "right" way. There's no perfect way that everyone should be eating. We're all human, and each body is different. The science may figure out that everything we "know" is wrong, and everything must be changed. I may never be able to fully give up sugar or rice. But whatever happens, we'll all hopefully be happier and healthier because of what we learn -- about food, about our relationship with it, and our relationships with each other.

Have a great week, everybody.