Used to be cool

Parent's photo albums are incriminating. Disco clothes, tight pants and shoulder pads are enough on their own, but there are the pictures of friends, bystanders. People who you can point to, say,

"Who's that?"

And spark a jog down memory lane with that one couple they always did Jager shots with before hitting the bars. A picture of a beach and Aztec pyramids syncs with a night of doing tequila shots out of the bottle in a limbo line. A picture of Dad and his band.

This stuff is enough for a teen to gather, and in a fit of frustration, scream,

"Gawd -- you used to be cool, Dad."

Door, slam.

Puberty.

Looking back in it, though, everyone gradually makes a transition from someone who is cool, to someone who used to be cool. The transition seems to occur sometime in the late 20s to early 30s, it usually precedes the first child, or happens during the first child's decade. I've never known how it would happen, and never given much thought to it. But today, I think, I started down the path of "used to be cool."

Chances are I'm already pretty far down that path.

Looking back at the past month, I've been going to bed before 11, I tend to fall asleep whenever I'm reclined for more than two and a half minutes, and today, to celebrate finishing the most brutal test I've ever taken, I drowned my sorrows in french fries (two orders) and then went to the library to check out neurology books.

The library.

Stress eating may be more healthy than stress drinking. As some (doctors, peers, women) may call me underweight, stress eating could be a blessing in disguise.

But it just sounds so damn lame. And the library of all places? People are supposed to smoke cigarettes, drink whiskey, fuck and shoot guns.

So, in some future, 25 will be the cut in the photos where my punk ass kid can look back and say, shit, Dad -- you used to be cool.

CH4

Freedom is a gift and a curse.

Each kind of freedom carries different implications. Naturally there are many different kinds of freedoms -- just ask John Locke -- or John Denver (both dead).

The freedom I have been pondering is the freedom of free food.

The hospital where I am doing my surgery rotation feeds its students and residents for free. We are politely asked to keep each meal under $8, but this is not enforced. and more importantly, there is no policy for what constitutes a proper amount of meals.

I'm very close with the cashier who works while I usually sprint to the cafeteria between cases for second breakfast. But all this free food comes at a price. Not the price that it actually costs the hospital, but rather the price of methane.

There is something about the cafeteria food -- it all looks different. Each item has a different flavor, different concentrations of spices and salt, mostly salt. But absolutely every menu item has the fart-inducing power of 10 fat men after an afternoon at the Old Country Buffet.

All-you-can-eat will always be different than all-you-should-eat.

So as we leave a meal full of energy, spunk and farts, we carry those farts everywhere we go. Farts, being gaseous, are light as a feather, but perversely, little is as difficult as carrying a fart for a long time. Rounding on patients leaves numerous stairwells, corners and nursing stations were farts can be rapidly and discretely deposited. But the operating room is a horse of a more trying color.

In the OR there is the attending doctor, me, the resident and the scrub tech. That is only four people in close quarters, and a steady jet of farts will not go unnoticed as operating rooms usually smell like, well, nothing.

Moments to release farts in the OR are few and glorious, and you need to be alert and gaseous to make the most of them. There are the precious few minutes of open bowel when intestines are being hooked back together. It's a ticket to fartville, express train. The other time is for the discerning fartist. The cautery smell of burning hair and fat can neutralize a fart, but the fart must be precisely matched to the duration of cautery. Under-estimation can result in embarrassment, and possibly ejection from the OR.

Med students produce future doctors, and copious methane.

Sewing class.



"Being a surgeon is great," this surgeon was telling me, "you get to joke around, and you don't get to go to the bathroom."

Another surgeon told one of my friends that once living human is cut open, you really can't leave until the job is done. Surgeons have big bladders. They don't get diarrhea. Also, a lot of them watch Fox News, which really, is the only thing that makes me raise an eyebrow when thinking about whether to pursue surgery.

The beginning of med school the baby you. Some lady sends two to three emails a week asking if we're okay, and instructing us to call her the minute we feel sad. We have tutors, professors respond to any emails, and most give us their phone numbers. The idea being, once you're in -- you're in. But with rotations begins the trial by fire. It's still nothing compared to residency, but while hours to study dwindle, the studying itself becomes largely motivated by fear.

Take suturing for instance. Regardless of what happens inside someone during a surgery, assuming everything works how it should, the only lasting memory a patient will have of surgery is the scar. They won't be able to see the incredible rejoining of cut intestines or arterial bypasses, rather they will just see those shriveled ghost lines. Old scalpel entry points.

There is a good chance those scars were made by medical students. During surgery we help hold open incisions, cutting sutures and occasionally tying off this or that and sucking up goop and blood. But in terms of mucking around in a wound, we only close skin, since the actual surgery needs to go well, but nobody ever died of four amateur stitches in the belly.

That said, my first time stitching a human, my glasses started sliding down my sweaty nose. I couldn't see the suture end through my fogging glasses. It was a disaster. I stitched at 1/16 the speed of the resident. So from there we practice. We practice so that we don't give real live humans ugly scars. And we practice on pigs feet, because they are the cheapest thing you can buy that has skin and isn't illegal. So I spend Sundays watching football, making lacerations and sewing up pigs feet so that on Monday I can make tiny scars instead of big scars. Approximate -- don't strangulate!

Today the patient woke up about 5 minutes earlier than one would hope. After two hours of struggling to breath and sweat less (mind over autonomics) I finally had the glasses fogging situation under control when the belly I was suturing started convulsing with coughs.

"Alright, you're just waking up now sir," the nurse anesthetist said in her Minnesota drawl, "your surgery is all done now."

The patient moaned and reached to swat me away.

FUCK. The nurse was full of lies. The surgery was done, but the patient's skin was still open.

Something like this doesn't matter as much as it seems. The patient won't remember anything. The important stuff was already closed, we were only suturing skin. The patient instantly got enough IV happy medicine to calm down a little bit. But being swatted and sewing something wriggly and moaning is fucking stressful. As this was not a situation I had studied for or really had any notion of, I froze and looked to see what the resident was doing. Did he stop sewing? Did he have a look of panic in his eyes? He was suturing like something possessed.

I put my head down and dug my needle in.

It's my squishy, and I love it.

There are certain things we get to do in medical school that would be frowned upon in other fields. Not only frowned upon, but illegal and downright bizarre. In human anatomy you get a tactile feel for the difference between a nerve, tendon and artery. This is a skill that is not applicable unless you're career will carry you inside living breathing humans -- and medicine -- for better or worse -- does this from time to time. Some would argue it does this too often.

Splitting hairs is nothing more than that, and for our exploration of the innervation of the head and neck we had to come in from behind the skull and neck, remove the spinal cord and wedge the skull forard from the vertebral column so we can see the anatomy of the space between the spine and pharynx. The pharynx is great, it lets us swallow, eat, and shoot milk out our nose when taken by surprise.

I had my students get a feel for the spinal cord, the mother of all nerves. It has a texture a lot like a superball. Squishy but firm, and fills the spinal canal like crab meat sitting in a leg.

"It's weird," one student told me, spinal cord between her thumb and index finger, "that something so weird and squishy is so fucking important."

That -- is learning.

Snap crackle scrape.

I'm good for about one major bike wreck per year. I tend to prioritize top speed over general awareness of my surroundings -- and that's gotten me into trouble a few times. It's also one of the reasons I love my helmet -- and one of the reasons I'm down one helmet, lots of skin, a fair amount of blood and a working right shoulder.

A good wreck is instantaneous. Time doesn't slow, rather, there is no time. There is an instant transition from happily spinning through the night to meeting pavement, face on. Someone left a cone where the shouldn't, or rather, Minneapolis set a bicycle trap, and it caught me.

I peeled myself off 3rd avenue, and slunk home, a twisted bloody mess. Handlebars twisted, streams of blood framing my vision. I stuck a paper towel to my face, noticed I couldn't move my arm, checked in the mirror for a blown pupil and fell asleep on the couch. Dealing with these injuries was a job for the Ryan of tomorrow -- Future Ryan!

Not the first time I've dicked over Future Ryan -- it's usually with small stuff like credit card bills or hangovers. This time Future Ryan woke up bleeding from the head, unable to lift his right arm and in crushing pain. I drove to urgent care.

Some X-rays, bandages and stitches to the head later, I started off anatomy lab by making my students diagnose me based on my X-rays (which I brought to class). So it warmed my heart when most of my students nailed the diagnosis. Only 6 weeks into med school, and already radiology whizzes.

Sarah tried to take care of me. I'm momentarily grounded from bike riding. Dependent on the MTC 2 bus -- the slowest and awfullest way between point A and B. The 2's passengers sit there like 400-pound gumdrops, stuck to their seats, muttering. It's full of people like that, and of the angry cripples -- like me.

This morning, I tried to dress myself -- surprisingly difficult when you can't raise one arm. I walked my right hand up the wall, dragging my arm behind it, and wriggled into a shirt, grunting more than Don Draper on a Saturday morning. I can still dress myself -- but this is closer than I'd like to the other side. The side of adult diapers and personal care assistants. That side is no place for me thank you very much.

My stitches itch like hell.

Safety lectures.

Right now I am a teaching assistant for the new medical students' anatomy course. It's one of the elective rotations we can sign up for in medical school, and it is absolutely incredible. It gives us a complete anatomical review when we are actually equipped to understand how the whole body works and does not work. Unlike anataomy the first go-round, we actually have a context for all these various bits and pieces of the body. In addition to being a great review, it allows us to teach, something that is rare for those at the very bottom-most-bottom of the totem pole. And, we have five rooms full of fresh, wide-eyed, impressionable medical students which is priceless. I'm hoping amongst other things that my entire room will trade in their cars for bicycles -- which so far has gone fairly well. I've seen tons of my students biking into campus.

But then one day on a run I saw one of my students biking home with no helmet on. Medical school is a particularly volatile environment for risky behavior. Some risky behaviors are promoted -- such as drinking to excess. But others are viciously shunned -- cigarette smoking and non-helmeted bicycling among these. Perhaps cigarettes are a little more harshly spurned, but as a past non-helmet wearer, I've felt the harsh judgment of my peers many times before. After enough spills in the winter, however, I grew to love my Styrofoam hat, and now the two of us are inseparable.

Medical school is damn expensive, and damn time-consuming. Most everyone is living on loans, and there isn't enough free time to spend the money that you do not have. The sole thing that medical students spend ridiculous amounts of ca$h on, every day, are their big wrinkly brains. So it stands to reason that they ought to protect them. No huffing, no joining the GOP, and most of all -- wear a damn bicycle helmet.

The day following my discovery of my student biking un-helmeted I greeted my class the next day, telling them that I wanted just a few minutes to talk about bike safety.

"I don't want to name any names -- David -- but I saw one of your peers bicycling without a helmet."

Then I told them my spiel about spending money on their precious brains and then threatened them with five extra minutes of additional bike safety lectures for each time I catch a medical student without a helmet. This was a very real threat since lectures run long and dissection time is scarce. It's like threatening a librarian with impending disorder -- it works -- David started wearing a helmet, and I had my lab applaud him for it.

Yesterday morning I saw another of my students, pants rolled up, sweaty, and asked about his bike commute. His guilty face -- but moreso his perfectly gelled hair betrayed his un-helmeted ways. Busted.

I began lab by telling the tables that they may notice the handouts around the room diagramming proper bicycle helmet use. Then we started our first of what could be many bicycle safety lectures. I told them how to style their hair after a bike ride, gave them tips on what to do with a helmet if they're going to da' club. Pulled the recent offending student in front of the class and we demonstrated proper helmet technique. I gave statistics on helmets.

Most cycle fatalities happen to sober males, over 16 years of age, riding in summer, at a busy intersection in an urban area during dusk.

"Mike is all of those things -- except dusk," I told the class. And then Tyler and I, (the other TA) instated a helmet law in our lab. Several states and Australia have them, and now so does room 155.

Tornado'd!

Tornadoes like rural areas. Like the elderly, they hearken back to a simpler time when fabric was rough and life was grainy. Usually you can assume safety living in an urban area, nearly enough to challenge the heavens -- tornado me you cloudy hillbilly!

And then, last Wednesday, the heavens listened and tornado'd the shit out of my apartment and girlfriend. I was in anatomy lab working with one living and nine deceased, while my girlfriend was pounded into the wall by miscreant winds.

The building shook, dust swirled in kitchen, falling from the ceiling as the sky peeled my roof back like a sardine tin, scattering bricks across our deck, moving 100-year-old trees, and giving me a new view of the interchange and metrodome across town.

I got home from lab to see our apartment wrapped in yellow tape. Tape I have broken through each day, and tape that is mysteriously repaired each day. A gutter was wedged against our rear door, and yellow tape was added as an afterthought. Neighbor's milled in the parking lot, sorting through the downed trees and bricks.

We got rubble, yeah you know us.