Forgetful.

There is angry dementia and cute dementia. It's an awful disease -- progressive with no cure and no way to slow its progression. Dementia takes a tremendous emotional toll on the afflicted person's caregivers.

It marches on inexorably, and people can live on their own with cognitive decline for a long time until they fall below a threshold -- and that brings them into the hospital. The threshold seems sudden, but really it's a a marker of longstanding cumulative damage. There are warning signs. Spoiled veggies in the fridge. Poor hygiene. Bizarre phone calls. Previously controlled medical conditions spiral out of control with forgotten pills.

One of my patient's was in the hospital for just that reason -- he was just a pinch short on having enough functioning brain to care for himself -- other than that, he was okay, we just needed to hold him until his family figured out a safe place for him to live. In the mean time he developed really bothersome diarrhea. Diarrhea is bad enough, but when you're always confused, a little dizzy and very slow on your feet, that's when diarrhea is the worst. A quick peak at the guy's chart showed that he is lactose intolerant. An open box of frosted flakes and two empty milk cartons sat on his hospital tray.

"Sir," I said, "Do you have a hard time digesting milk maybe?"

"I suppose," my patient told me.

"Have you been drinking a lot of milk here?" I asked.

"I have," he said. "I've had more diarrhea than I have ever had in my life."

That was the first medical mystery I solved. I told his nurse, phoned nutrition, and wrote an additional note in his chart instructing providers to read his chart and not give him any more milk.

The next day I rounded before breakfast and intercepted two more milks before my patient had a change to give himself diarrhea.

One of his doctors ordered a screening test for an intestinal infection.

I asked his nurse to block any dairy from entering his room. And then I felt like I accomplished something.

Batman gloves.

Minnesota has more of a "pre-winter" season than a fall proper -- but pre-winter is still mild compared with the real thing. Winter requires windproof lobster gloves, alpine mittens and gear that looks like it was made with technology. During pre-winter you can still wear clothing that looks relatively normal and not freeze your important parts off from exposure.

My favorite gloves for pre winter are the thin stretchy gloves for robbers and kindergartners at the bus stop. They aren't really made for adults anymore at target, but the ones in the kids aisle stretch to fit all hands. Being in the kids aisle, I had my choice between girl colors, Dora the Explorer, Batman, some other superheros and a few Japanese cartoon things. I picked Batman.

Yesterday I was ungloving at the coop to bag and buy a pound of sweet precious coffee. After checking out I realized I down one batman woolly.

"Whoever lost their batman glove, please come pick it up at customer service," the PA chirped. "Again, whoever lost their batman glove -- we have it at customer service.

I trotted over to customer service, wearing one batman glove.

Greenway'd

Minneapolis developed a bike highway some years back, paving over an old rail line to make a direct East-West cut across the metro for bikers, they called it the Greenway, and the deemed it good.

It was sort of good -- it's also sort of bad -- really bad. It turns out when you make a 5.5 mile corridor of unpoliced poorly-lit public land, you get 5.5 miles of assault and mugging. Worthless fucks have been toppling late night commuters off their bikes for the past few years, and in a state where the sun rises at 8AM and sets promptly at 4PM, it's pretty fucking difficult to avoid riding in the dark, and because the city is too incompetent to do anything, bike commuters take the hit. On the road we're already worrying about every Joe Cholesterol behind the wheel gunning for us, and now there are idiot kids with nothing to lose trying to mug bike commuters. Ridiculous.

The city put in some lights, the police urged cyclists to avoid using the highway made specifically for bicycles. That's it, call it a day. Policing enough to deter crime is too costly because it technically isn't a road. Lack of motor vehicle access sites makes rapid police response nearly impossible from a number of areas, and the design and lighting of the bikeway has a few natural hideouts for would-be assailants.

Last week this kid died trying to mug someone who stabbed the kid in self defense and fled to the greenway. It's horrible. I'm not rooting for the bad guy here -- I just don't think he ought to die. When people are packing weapons in self-defense, the public works have failed. Minneapolis needs to pull its head out of its ass and do something.

So fast forward to yesterday when a group of idiots release a video of themselves assaulting bikers on the Greenway. It's a group of kids who identify themselves by face and name in the video on youtube, and then taped themselves pushing strangers off bikes and loaded it on to the internet. It's one of those things where you figure that natural selection will deal with idiots like this deftly and justly, but it's still absolutely maddening. These are the fuckers who come into the hospitals for acute help because they did something idiotic, and these are the same assholes fucking with me on my ride home from work.

I feel like I need some sort of medic badge, don't mug me, I'm a friendly, something to identify that taking me down is in bad taste since I'm one of the people who will eventually prop them back up.

Anyways, here's the video -- youtube keeps taking it down because of evidence, or investigation or some shit, and probably to protect the identities of the kids who put it up since now a group of them are in custody and being investigated. Mercifully, a lot of those fuckers are over 18, so if this does go to trial, they can get justly and properly fucked over. So watch the video. Feel angry. Feel invaded, and show it to all of your friends. If anyone deserves to have their identities spread and smeared, it's these assholes. When you have people with minor drug charges and cleaned up alcoholics stuck in unemployment because of ridiculous criminal background protocol, these kids deserve every roadblock and hurdle to happiness that our fucked country can through at them. They are taking glee in directly causing others misery. Fucked.

The real yeast of the matter is that Minneapolis is too much of a pussy to do a fucking thing about it without a victim coming forward. Police state that possible victims do not have visual ID of the assailants. Minneapolis doesn't have the balls to prosecute clearly identified men committing crimes on public land for the sake of public safety and basic human rights. They still haven't done a thing to clean up the situation around the Greenway, yet they've dumped money into redesigning large stretches of down town to make them less safe for bikers and pedestrians. It's not fair. Statistics show that most people will die from heart attack or stroke, but my biggest risk factor is getting creamed by one of those fat fucks in their car.

This whole situation makes me so fucking mad I just devolve into expletives and gibberish.

All I want is to not get mugged on my way home from work. I hate feeling paranoid on the way home. There's a lot of really boring studies in psychiatry that say that constant paranoia is not healthy.

God. Fuck. Damn. Shit. Cunt.

I'm so mad, I'm c-word mad.

Pains of pooping.

General surgery taught me one poignant message -- trouble-free pooping is never something be taken lightly. The tortuous gooey journey food takes from the mouth to the anus is fraught with peril. The human alimentary canal (also known as the poop factory) can be up to 30 feet long in a normal human. Within that 30 feet anything goes. It can bunch up, pinch off, knot up, swell, shrivel, burst, bleed, telescope in on itself, detach, reattach, and erode.

A lot of these problems warrant surgery. If someone starts pissing air (pneumaturia) it means a hole has worn through their colon and bladder. Same goes for someone pissing poo (fecaluria -- you get the idea). Some of these problems happen because of a reckless lifestyle, but often people's bowels just turn against them. In a squishy revolt a colon will start wearing holes in itself and bleeding. The answer can be to remove it, connect the small intestine to the butt, bunching it up at the end with staples to make a new rectum. This new answer works OK, but it can get infected, and even if everything goes according to plan it leaves the patient with 6 - 8 poops per day that are the consistency of oatmeal on a good day.

So this is why we pester our patients about poop from post-op day one. Every morning I wake my patients and asked if they've pooped yet, or farted. Farting is a harbinger of poo, and is a good sign.

"Gas is music to our ears," we tell our patients.

When one of my patients had his first poop with his newly revamped colon post-op day 4, I stopped by and said,

"I've heard the good news sir -- two poops, amazing."

Poop means we can start a patient on solid food, it means that they are one step closer to getting out of the hospital. I've always thought pooping is hilarious and awesome, and now it is my professional duty (heh) to hassle patients about their movements. Surgery is the best.

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.