Diagnosis -- diarrhea.

Days off become very precious. I worked 100 hours over the last week, and come hell or highwater, I am going to wring every last drop of freedom from my days off. During my last day off I had a migraine that started while I was on a run. At the end of the run I noticed a blurry shimmering rainbow blotting out some of my vision. I recognize that old friend -- he comes to tell me:

You're head is going to be a vice soon, enjoy not seeing!

I soldiered through. Finished the run, a handful of ibuprofen and a beer later I was on my way to a movie. I was not going to miss the X-Men for a weeny headache.

So yesterday began as a great Ry-Day. Some coffee, some wife time, some guitar time, a long run, and even frosted mini-wheats. Then the pooping started. My belly gurgled a warning and I headed off to pee out my butt. There is a medical term for this, but honestly this best captures what I spent all of yesterday doing.

I ran out of poop really quickly, but my intestines had an endless supply of water that they were determined to get rid of. Through my butt. I would try to stand, and be doubled over with cramps, then off for more butt-diuresis.

The wife was good. She saved my life, brought gatorade and gingerale, both of which made me feel like my insides were being torn out. She pointed out that this was probably more than my mild inability to digest milk (damn you mini-wheats) since that milk was long-gone by now. She suggested I go over my diet to see if there were any likely offenders.

1) end of day sushi.

For our rotations at the Veterans hospital, we get stacks of 7$ meal card tickets. I have about 50 of these right now. They look like monopoly money, and I eat most of my meals at the hospital since it's free. I usually get done after dinner time, and the hospital cafeteria has OK sushi. And there is never a line for the stuff in the refrigerated section. So, often I get sushi at the end of the day for dinner. Probably not the best time to eat raw fish.

2) old roast beef sandwiches.

There are lots of conferences that have free food. Occasionally the amount of free food supasses the desire for the free food. That was how we wound up with a heap of free sandwiches that were at least an unknown amount of hours old, and made our work room smell like old sandwiches. Not one to pass up a good deal, I ate three of them.

3) coffee and energy drinks.

110 hours at work over the week = 5 or so hours of sleep per night = more coffee and red bull than water. It's sort of sad.

After going over this, sweating and in fetal position, I realized two things: it was probably the roast beef sandwiches, and it's surprising I don't always have diarrhea.

It has been too long. I've been doing a lot of writing lately, but most -- really all -- is legal documentation. My best piece is:

"Pt slept through the night, denies fevers, chills, nausea, vomiting, diarrhea, chest pain or shortness of breath. Hoping to go home tomorrow. Mentioned that he has not been eating well over the past several months due to losing teeth when he eats solids. States "wife usually mixes up 2-3 quarts of koolaide" this is his main form of nutrition.

-Plan to consult nutrition&dietary"

I've been spending long days and longer nights at the VA hospital. Vets of all ages attend, but our biggest patient population is men who fought in Vietnam and Korea and are in severe decline. Hard living mixed with minimal education, less money and more mental illness make for a hard life, and these vets have it all. They avoid the doctors until a critical breaking point and then they seem to become professional patients. In and out of the hospital, multiple visits per season.

Not by choice.

I love working with these guys. They got drafted and then shunned, and it's nice to be a part of their safety net. They are also tough and nails and have huge balls -- not just from anasarca. They'll limp in gangrenous. Drive in from the country in a deadly heart rhythm, passing out on the freeway.

There are so many small victories and losses that it's hard to keep track of the score. But one take away I've had is that if I see someone stopped in the middle of the highway ever, I'll go and check if that person has a pulse.

Poor caliente - que una vida preciosa.

Workin'

In just over two month a bunch of insanity is going down.

-I'm getting married
-I'll be a doctors
-I'll be getting paid for being a doctor.

Over the past two years I have been paying to work an average of 60 - 80 hours per week at the hospital. It's been incredible. I love what I'm doing, I love seeing patients. Even an afternoon of pelvic exams doesn't destroy me when I put it into monetary terms:

Wait -- I'm paying to do what?

At the end of a long day I have enough spiritual energy to work out, make dinner and still be a person. Looking at the variety of things humans do for money, truly loving your job seems rare. There are thousands of obscure jobs that can essentially be termed "accounting," though most workers in said jobs would balk at the title. There are many more jobs where the works sit in front of a computer, trying to not get noticed. And then you can be medical support staff, in the army or work at a restaurant.

I think this covers about 100% of jobs leaving out artists and athletes.

The university just hired me along with most of my cronies to help transition to a new electronic charting system. It's a system used by most of the hospitals in the metro, so we all know how to use it. The only reason that any of us are doing this is to make it rain. The university did not adequately gauge how desperate and poor students are, so starting wages were set at $75/hr.

That's right -- $75 per hour!

I would've done it for $25 -- which would still be more than I've ever made per hour ever. Also several tactless med students shared this information with nurses and others around the hospital so are now universally resented.

Nonetheless, now I am showing up at the university daily, donning a green fleece vest sized made for big people and standing around the hospital as a "green-vest" meaning one who helps physicians use the new computer program.

Most smart people can navigate easily through a system, and questions come the first time, are answered and don't come again. So most of what I do is play words with friends and angry birds -- for 12 hours. The contracting company is aware of the diminishing need for legions of tech support, and understandable doesn't feel that it is a good use of resources to pay me $900 daily to play scrabble. They have been circulating around the hospital trying to find areas to cut employees from. Naturally this is a cat and mouse game with two strategies. Primarily I try to look busy. I walk around with the care teams on rounds, shoot the shit with nurses if they are standing near a computer and sit in heavily populated areas so that at first glance it may look like I am doing something.

Next -- they can't send you home if they can't find you. I scoot around the hospital, talking to other people sitting at computers, giving the impression that I am engaging in larger-scale tech support.

There is a tremendous toll on my spirit, however. I have never had zero investment in my work. Even working as a server, I liked (most) my patrons and loved my fellow staff. Landscaping I wanted the landscape to look landscaped. But here my goal is to be there for 12 hours so I can get paid for 12 hours. My secondary goal is for the time to pass quickly, but I couldn't give two shits how or why. It's a terrible feeling. I begin each day tired and exit each day empty -- fully knowing that I have accomplished nothing.

This is how people get fat, I think. They have jobs that don't matter, and they are aware of this, and unable to change it. It's a fatness that equates to powerlessness. I do nothing all day except try to avoid being sent home, and then am too tired to do anything other than eat and sleep. I feel like a depressed panda bear.

And I fucking hate polar fleece. Probably the worst thing about being white is the association with polar fleece.

Popsicles and a doctorate.

After four years of medical school -- and two years of essentially paying a lot to work 60-80 hours per week -- it's over. I graduate in May, but have no more tests, no more hospital time, no more clinic visits. Last day. Completely done. And I didn't even lose my stethoscope!

There were a few close calls, prompting me to shop online for new 'scopes -- it turns out they're expensive.

I've been doing hematology and oncology for the past month -- which is incredible and difficult. The hard part is the introduction. Whenever I meet a patient for the first time I need to explain what hematology and oncology is:

"We're the blood and cancer docs"

Which means that whenever I introduce myself I have generally broken either bad news or raised the imminent possibility of bad news. It's akin to having a normal name, terrible title, like,

"Nice to meet you, I'm Ryan -- I'm the angel of death."

It has a lot of weight, enough so that I make sure I have my entire story perfectly straight before each new patient. Nonetheless I like it. Each encounter is very charged. Each time I bring bad news -- that's the most important thing I'll do that day. Keeping that in the back of my mind is a powerful organizational tool, and the rest just falls in line.

But now I'm done. I won't see another patient for nearly 3 months -- and the next time I do -- I'll be Doc. Clay. Terrifying and exciting. To celebrate my staff bought me a popsicle at the VA cafeteria -- "The Canteen."

We toasted orange deamsicles and talked about the future.

Hello god? It's me ... claybert.

It's been a while -- but if REM can do it, so can I. This won't be an exciting blog post -- mostly it will just be a blog post. I've loved writing, and when I look over the past two years the majority of my writing has been summaries of individual's bodily functions. Not that I don't love being a poop and pee journalist -- it's more that I can't add a creative flair for fear of legal action. It would not compromise patient care to document,

"Mr. S was complaining of fevers, chills and peeing out his butt,"

But I can see how that would look poorly to another doc doing a chart review. I can also see how that would look even poorly-er in a legal-type setting if Mr. S had a bad outcome and his family got angry. Nonetheless I don't feel stifled, I mostly just feel tired of typing, and after each long day of logging hours on my butt, I feel like off my butt is the place to be while at home.

Turning to a few housekeeping issues, this blog has a lot of baggage. It carries around almost 8 years of gunk. More than once I've had to go back and delete posts that would've made me sound cool to other 19-year-olds but much less cool to possible medical schools and employers. In that sense this blog is a bit of a burden. Automatically it carries around embarrassing pictures of me. I've done my best to mute it by ignoring it and filling it with dead links and outdated formatting, but it still persists.

But writing makes me feel better, akin to sad bastard music. All writers are sad bastards under their dust jackets anyhow.

Lastly, blogger's interface just sucks. Wordpress is so much better, cleaner and simpler. But it doesn't link to my google account. And for that I think I'll keep this blog. Stay tuned for a new background and culling broken links!

<3

RC

Computer repairman.

My computer is getting on its days. For no reason it will heat up and think way too hard. Just opening the google stresses the little guy out. But for as much of whir and whoosh as my macbook can whip up it still works. And having an old computer is free, that's something that you just can't put a price on.

I was riling up the dog, feeling both guilty and elated because I promised my roommate I'd stop riling up the dog -- even though I love it. Constant riling had started wearing away the dog's training, and he was sliding toward becoming 70 pounds of fuzzy, unbridled public embarrassment. On the couch, wrestling with the dog, someone -- I won't say who -- knocked my laptop from the table I had delicately balanced it on the edge of.

Fuck.

I picked up my computer and opened it -- it froze. I turned it on -- only a white screen and lots of whirring. I assumed this could by related to it falling on the floor, and that likely this was a bad thing. Thinking quickly over everything I ever knew about computers I turned it on and off again six times and punched it twice. I turned it back on -- white screen.

Time to ask the internet, I thought. I googled my problem, "White screen of death," came up several times. I was hosed. Then there were some suggestions. Apparently holding down random combinations of keys while booting a computer up somehow communicates to it on a deeper level. Like saying, "OK -- I know you were acting broken, but now for real turn on because I don't want to go to the Apple store and spend over $1000 because I don't know what I'm doing."

On combination involved mashing 4-6 keys. The computer restarted 5 times. I let go of the keys, and it turned off. I turned it on again.

White screen -- of doom.

I shook it once, and slammed it gently on the table. The internet also suggested holding "C" while restarting the computer, presumably because "c" is for computer.

I held c, held my breath and restarted -- fixed.

The whole scenario makes complete sense. The computer broke because I knocked it off a table, and all I had to do was punch it, turn it off and on 20 times and hold "c" while turning it on.

Computer genius.