Being the highly unique individual that I was, R.E.M. was my favorite band in high school. My appreciation faded in college after New Adventures in Hi-Fi (inexplicably, because I love New Adventures...) and for some reason I've never bought another of their albums. Maybe it just ran its course, but the more likely reason is that their music became weighed down by memories & associations that I needed to get away from and I threw out the proverbial baby with the proverbial bathwater.

I never got to see them in concert. In college one of my film professors got her students passes to the premiere of the Scorsese Tibet movie (blech), Kundun. Michael Stipe was there. After the screening I planted myself at a payphone, pretending to be on an important call. Meanwhile I was spying on Stipe as he hugged Joaquin Phoenix and Philip Glass. As he walked past the bank of payphones, he looked into my eyes. I thought my head was going to explode. Michael Stipe's eyes looked into my eyes. Afterwards, I ran all the way from Times Square to 72nd Street to get rid of all the adrenaline.

"Tongue" has always been a special favorite. The first guy I loved, Jeremy, was really into this album around the time we met and he thought "Tongue" was a beautiful track. I agreed because I agreed with everything Jeremy said. I remember tucking him into my bed one night after he had had too much to drink and putting this song on repeat in my Wal-Mart 3-disc changer.

This song always makes me think of the Midwest, secret love affairs and a cute, sexually-confused drunk boy in my bed.

 

Drew says it's white trash to use paper towels instead of napkins.

Is that true????

I told him that at my grandmother's house you weren't allowed to use an entire sheet of paper towel at once. That's considered wasteful.

Maybe that is white trash.

Am I seriously supposed to keep us stocked in napkins? Wow. That actually seemed ridiculous in my head, but now that I've typed it....

 

While we were packing Drew went through the birthday cards and holiday cards he's collected over the two years we've lived in this apartment. At dinner he told me he found several handmade cards from me and then we talked about what a weak, wretched little stream my creative output has become. Or, rather, how weak it's always been.

Last week while I was talking on the phone I doodled a smiley face and Drew tried to save it. It was so ridiculous, though. When I found it on his desk I threw it away. At dinner last night he said he thought that smiley face revealed something about my unconscious or something. It revealed something about something, although at the moment I'm having trouble remembering what it was. But listening to him I started thinking maybe I should try to do some kind of free-form fine arts project (painting or drawing or something -- I don't know if those are considered "free-form" and "fine arts", but you get my point) --

OH JESUS A FLEA JUST JUMPED ON THE KEYBOARD.

Oh, Madeline. Goddammit.

-- anyway, I think doing something that isn't so rigid (I'm also trying to start knitting, but that's the opposite of free-form) would be good for me during med school. Drew wants to get back to painting when we move to Philadelphia, so maybe I can use his scraps.

Ugh. Fleas.

Addendum: Drew would like you all to know that (a) he loved all the handmade cards and (b) he never actually used the words "wretched little stream" and (c) that he's a much more loving, kind boyfriend than he may appear to be in this and other entries.

 

We've started packing for Philadelphia. I had to go through my little library and decide what to get rid of and what to keep. It's stressful getting rid of books.

There's not enough time in life to read all the books you would like to read, so there comes a time when we have to prioritize. I could get through more books in a month if I'd give up the 45 minutes I spend reading the newspaper every day, but I'm not willing to do that. I'm still not good at reading in the evenings. Mostly because Drew's not a reader. Plus, reading is such a solitary thing and I like to spend time with him when he gets home from work. I've given up some tv time, but that's a relaxing/passive thing that serves a very real need in my life. I won't be cutting too deeply in that department (especially not once school starts). This morning in the shower I told myself that I'm going to try to read a book a month while I'm in school.

A book a month. It actually sounds like a challenge at the moment. Realizing that I'm approaching a 12-books/month period in my life, I'm frantically trying to read as much as I can before August 6th (the first day of classes).

My booklist:
1. Rabbit at Rest by John Updike
2. White Noise by Don Delillo
3. How to be Alone: Essays by Jonathan Franzen
4. Humboldt's Gift by Saul Bellow
5. JR by William Gaddis

There's a maddening crush to cram a lot of stuff into these next two months. But then again I think I probably need to make room in my pre-Philadelphia life for a lot of "fucking around" and a bunch of "accomplishing nothing."

 

Exhausted. I've noticed other yawners as I've gone about my day. There are a lot more tired-looking people out there than I normally realize.

Dear Mr. ________:

Thank you for contacting me about the war in Iraq . I appreciate hearing from you on the most important issue facing our nation today.

... On May 24, I voted against an emergency spending bill that allows the President to continue his one-man show in Iraq. I voted no because I believe that Congress must make it clear to the President that our commitment in Iraq cannot be open-ended and that it is time to start working to bring our troops home. We need to redeploy our troops out of Iraq as part of a sorely needed new policy, one that emphasizes diplomatic and political methods - not military strategies - as the best way of bringing stability to Iraq.

Since American forces went into Iraq in March 2003, more than 3,400 of our troops have been killed. Of those, 21 percent have been from California or based in California . Over 25,000 more have been wounded. Countless numbers of Iraqis have been killed, victims of an intensifying civil war. Furthermore, the first half of 2007 has already been deadlier than any six-month period since the war began more than four years ago.

Please be assured that I will continue doing all I can to see that Congress acts boldly to bring this tragic and ill-fated war to an end. Once again, thank you for your letter and for caring deeply about this critical matter.

Barbara Boxer
United States Senator

 

I can't sleep.

So much coffee yesterday I made myself sick. Nausea.

Changing everything = Stress. Stress + 5 cups of coffee = 3 hours of sleep.

I have a mock exam tomorrow. Today, I mean.

There's an article in The New Yorker magazine from last week about L.A.'s mayor, Antonio Villaraigosa. He talks about self actualization, about picturing yourself being successful and letting that image show you the way from A to B. It's not really his name (Villaraigosa); he was born Antonio Villar. He combined his last name and his wife's last name to create Villaraigosa. An invention.

I picture myself in a white coat but the image is fuzzy. Where am I headed?

Fuck. I wish I were headed to four more hours of sleep.

 

I hate it when the ACLU or Moveon.org or DFA sends me an email asking me to call my representatives. I'm sure that can be effective, but I feel so manipulated by that kind of mass-phoning campaign. Plus, they must see right through it when suddenly hundreds of people are calling about the same issue; it must make it easier to dismiss the idea when it seems to be coming from one particular group, right?

Plus I'm totally intimidated to call those numbers. My old boss used to make me do that. Lots of times I'd lie and tell her I called. I prefer to send emails. Emails which I'm sure no one ever reads. Emails such as this one:

"I am writing to offer my support for Senator Feinstein as Congress attempts to hold the President accountable for the war in Iraq.

I do not favor funding that is not connected to a thoughtful plan for drawing down our troop levels.

In most matters I have come to trust Senator Feinstein's judgment. On this issue, however, she needs to listen to her constituents. A war that we the people do not support hurts our relationship with our own government, our government's relationships around the world, and most of all it hurts our men and women in uniform."

I should probably go back to my old plan to send Becerra, Boxer and Feinstein actual mail that can't be so easily deleted. Crap, why didn't I do that???

 

Yesterday I was with Drew's mom. We went to Starbucks, and as I was getting out of the car I saw a Parliament box on the ground. I bent down and flipped open the lid to see if there was anything inside. There wasn't. I picked it up and threw it away, pretending that my intentions were honorable all along.

This isn't a new thing. I've been having cigarette cravings for a few months. It's been years since I've smoked and I honestly thought I was over it. Especially now with all the running and exercise I've been doing. But lately I'll be running and I'll go past someone smoking a cigarette and think it actually smells awfully fucking delicious.

When Drew and I were in Philadelphia last month I saw a girl get into a car smoking a cigarette. She was probably twenty years old. I envied her for her youthful idiocy. It seems impossible that I actually used to smoke cigarettes in my car.

I'm a little uncomfortable with some of the anti-smoking proposals out there these days. I wouldn't vote for a huge increase on cigarettes taxes, for instance. It's a little too paternalistic for me to control behavior through taxation. I think that's creepy.

And I also thinks it's disgusting that there's basically no funding for lung cancer research in this country. According to the American Lung Association's 2006 data, lung cancer is the number one deadly cancer for both men and women (accounting for 29% of all cancer-related deaths). Yet the research funding still lags far behind that for breast cancer and prostate cancer. And if you think that people who smoke deserve what they get, then what about all the people (including my mom's best friend) who die of mesothelioma every year who never smoked one cigarette in their life?

While I was looking up those statistics, I saw that the ALA says that former smokers remain a high-risk group regardless of how long it's been since they've stopped smoking. God, I must have smoked for ten years. 16-26? Something like that. That's craziness. Shit I'm old.

 

Today at homeless outreach the doctor had to cap the list at ten patients. He had an important meeting and couldn't let the clinic run long (which it often does). Which means that I had to turn people away. Which sucks.

One patient I've known for over a year said "I should be on that list. I was here early but the list wasn't out and then I had to leave."

"I'm sorry, but he can't take more than ten patients today. How are you doing?"

"Not good." Tears. "I wish somebody'd just drive up and shoot me."

This patient has a long history of depression along with a chronic medical condition. Her husband died over a decade ago (murdered, I believe). She's got addiction issues. She looked miserable this morning. And so I decided to say exactly the wrong thing, although it felt honest and true when it came out of my mouth.

"I know how you feel."

I meant I know depression, I know suicidal feelings. I know how lonely it feels. But of course I don't know how it feels to be her (or anyone else, for that matter). So maybe that wasn't the best choice of words. The worst part, though, was realizing that what I'd said had the unintended consequence of appearing to minimize her situation.

"No you don't. You're young. You don't know how I feel." By this point she was bawling and kept repeating her death wish as she walked away. Some people overheard her and started laughing at her as she walked by. (She's been around for years and they've all heard it before, although I still wanted to tell them to leave her the fuck alone.)

However, I was too busy feeling like a total ass.

There's not much the doctor could do for her, honestly. She has all her prescriptions and she was in the clinic last week. I think she just wanted to be around him. He's a very warm, caring, spiritual person and a lot of patients just like talking to him. He makes them feel good.

I feel like I'm going to be good at that part of medicine someday. But what this interaction made me realize was that I have to make more of an effort to understand how the patients see me (as opposed to how I see myself). She looked at me this morning and saw that I was well-dressed and healthy and young and on the path to becoming a physician. I see myself as scared and unsure of myself and as someone who continues to deal with depression and anxiety. But even if I could get her to see me as I see myself, that's not really helpful to her. Or not nearly as helpful as being someone who can be a constant, reassuring presence in her life (like the doctor).

Basically, she doesn't need me to feel her pain. The doctor has a great line for patients who have overwhelming personal histories: "What can I do for you today?" I've heard him say that dozens of times, and it's usually at the point that I'm starting to tear up while listening to the patient's story. And tearing up isn't exactly helpful. The doctor knows he can only do so much, though, and so he tries to keep the patients focused on specific things that can be done to improve their situations.

He seems to have a pretty good grip on the role he can play in these peoples' lives. It's something I'll have to grow into slowly. Right now I still feel so much closer to the role of victimized patient than caring physician.

 

From Bob Herbert's editorial in today's NYT:

"Three months ago a homeless seventh grader in Prince George’s County, Maryland, died because his mother could not find a dentist who would do an $80 tooth extraction. Deamonte Driver, 12, eventually was given medicine at a hospital emergency room for headaches, sinusitis and a dental abscess.

The child was sent home, but his distress only grew. It turned out that bacteria from the abscessed tooth had spread to his brain. A pair of operations and eight subsequent weeks of treatment, which cost more than a quarter of a million dollars, could not save him. He died on Feb. 25.

There’s a presidential election under way and one of the key issues should be how to provide comprehensive health coverage for all of the nation’s children, which would be the logical next step on the road to coverage for everyone.

That an American child could die because his mother couldn’t afford to have a diseased tooth extracted sounds like a horror story from some rural outpost in the Great Depression. It’s the kind of gruesomely tragic absurdity you’d expect from Faulkner. But these things are happening now.

[...] Medicaid and the State Children’s Health Insurance Program provide crucially important coverage, but the eligibility requirements can be daunting, budget constraints in many jurisdictions have led to tragic reductions in coverage, and millions of youngsters simply fall through the cracks in the system, receiving no coverage at all.

It is time for all that to end. American children should be guaranteed nothing less than comprehensive health coverage from birth through age 18. This can be achieved if an effort is mounted that is comparable to that which led to the first moon shot, or the Marshall Plan, or the postwar G.I. bill.

Keeping American children alive and healthy should be at least as important as any of those worthy projects."

 

I have a free day today. No school, no health clinic, no exercising. So I'm going to make a record of what I'm doing every couple hours so I don't waste my day watching bad television.

7:15
I made breakfast for Drew (oatmeal, coffee, fruit). We discussed tonight's dinner plans with our friend K.D. and who we want to invite to our Goodbye-L.A. picnic in June.

8:04
I started this blog entry.

9:23
I washed the breakfast dishes and read some of the newspaper. Wolfowitz is in trouble, and I'm not sure how I feel about that. The guy's clearly a tool and I'd love to see him thrown in Guantanamo for lying and deceiving re: the war. But I'm not totally convinced that he acted so badly when he got his partner a raise. He was having her moved to a different part of the bank so that he wouldn't be her supervisor anymore -- trying to avoid a clear ethics violation. So he got her a nice raise in exchange for disrupting her career. Maybe I'm wrong about those details, but if I'm not then I'm thinking they should just leave the guy alone.

I read part of The Orchard Keeper. I'm not sure about it anymore. It's starting to feel like a Faulkner knockoff; baroque, Southern morality tale. I should read more Faulkner. The Sound and the Fury is the only one I've managed to get through. Plus some short stories in high school. I need to finish this book today and start the bookclub book.

10:52
Bathed. Started the laundry. Picked up the bedroom. Watched 3 minutes of Charlie Rose and 20 minutes of The View. Read "Talk of the Town" in this week's New Yorker. Circled the words I need to look up.

11:50
Read more of the newspaper. Our landlord brought someone by to check out our apartment. My med school sent me an email inviting me to join a blog they just created for the first-year students; I had a moment of panic when I realized that by accepting the invitation, blogspot automatically linked my blog to the med school blog. I quickly made sure no one could get from there to here.

1:10
I talked to my little sister on the phone. I tried to play with Madeline, but she would have nothing to do with me. I read through some medicine-related blogs.

4:04
I took a nap. I talked to my mother on the phone. I finished the newspaper.

I finished The Orchard Keeper. I didn't enjoy it, I must say. I thought his writing was flowery and florid writing puts me to sleep. Example (I'm going to flip to a random page and give you a taste): "They go on--steps soft now in the rank humus earth or where carapaced with lichens the texture of old green velvet, or wet and spongy earth tenoned with roots, the lecherous ganglia of things growing--coming down, pursuing the shadowline into the smoking river valley." Yeah. You know, I really don't want that. Don't need it. When I read a novel I want to be in a character's head. I want to hear his thoughts and watch him make decisions and see him acting with and against his instincts. I want to finish a book and feel like I've had a deep connection with some character or some idea or even just one particular moment in the story. I don't want these long descriptive passages that serve no other purpose than to make everyone think Cormac McCarthy has an impressive vocabulary.

 

I'm taking a break from the Weekly Dolly Videos (I'm guessing only one of you actually cares) because I feel like I've run out of really good Youtube Dolly clips. Maybe if I wait a few weeks someone will upload something interesting.

My sixth grade girlfriend (someone I've known since I was about 4 years old) came to stay with me and Drew this past weekend. It was great -- we got out of our regular weekend routine and I got to spend time with someone I rarely get to see. Also, Drew really likes her but hasn't gotten to spend a good amount of time with her up until now. One of the best parts was that we got to play L.A. tour guides, which was a great way for us to start saying goodbye to the city. My friend is starting law school the same month I'm starting medical school. Too bad our relationship only lasted a few weeks; we could be like the Huxtables.

Drew and I bought tickets to fly to Philadelphia June 4-9 to look for apartments. I'm getting excited.

In other random news, I just did six consecutive miles that were all under 8 minutes. The last five miles were all right around 7-1/2 minutes. That's pretty exciting, considering that only a few months ago my miles all averaged over 9-1/2 minutes.

 

From Atul Gawande's editorial in the NYT today, in which he discusses the possibility of a major overhaul of the healthcare system:

"There is a second option, a fallback: we could guarantee coverage for today’s children — for their lifetime. It could be through private insurance or through a Medicare plan that families must enroll them in. Either way, the subsidies required are very much within our means.

We might even pass the fallback plan first. Then, while we are stymied fighting about how to fix the rest, there’d be at least one generation that could count on something more."

I've gotten to the point where I'm counting on that fallback plan; over the past six months it's started to heavily influence my interest in pediatrics. I don't want to get stuck treating only patients who have money, but I also don't want to spend my career trying to plug holes in a broken system by having a career where I'm treating only underserved communities.

I realize that sounds harsh, but I'm saying it because I know myself and I know that after a while I would become demoralized and bitter because in a way I would essentially be an enabler. If you work on behalf of the underserved as a politician or a civil rights lawyer you're working towards a goal of some kind of justice for that group. Towards a day when the fight will be won. I find it hard to think that way about medicine, because treating individual uninsured patients doesn't really have the larger effect of one day creating a system where everyone is covered. Again, I know it sounds harsh and maybe I'm wrong there (factually and morally). I guess what it boils down to is that given a choice, I'd rather work within a system that's fair and includes everyone. If that's not possible, then yes, I'd rather work the broken system in a way that allows me to treat the underserved populations. In third place is working as a dermatologist for upper middle class people with PPO's and driving a BMW; that option is tied with returning to Hollywood and working as a personal assistant.

I want to work with a diverse population in a practice that's accessible to anyone, and I'm betting that policymakers can convince voters that every child in the U.S. should be able to see a doctor regardless of their family's income. I've got three years to make that decision, and I'm guessing that the midterm elections in Clinton's first term in office will pretty much tell us if reform is possible. Hehe.

 

I posted that Dolly video days ago. I don't know why it took this long for Youtube to publish it. I'm sure there's only one person out there who really gives a crap, but I'm just saying....

Drew and I watched a hilarious episode of Dick Cavett last night. 1973. Katharine Hepburn. They showed all the footage, including her entrance to the stage, her chastising of the crew, her disgust at the show's set ("Who picked this carpet?!"), and her abrupt exit once the interview was finished. For anyone with TiVO, I highly recommend adding a "Katharine Hepburn" wishlist; you catch all kinds of great stuff.

We found a dog on the street two nights ago.



We're trying to find a home for him today. He and Madeline get along pretty well when he's not humping her, but I cannot handle expanding the family right now. It's just too much. Drew would love to keep him. It just makes things too crazy around here, and I'm trying to simplify simplify simplify.

Mentally I'm all over the place lately. Lots of reading about lots of things, nothing very focused.

I've done some cursory research on student loans, because I'm sure I'll have to get a private loan on top of the federal loans I've already been approved for. And I'm totally disgusted with all the student loan scandals and refuse to just blindly borrow thousands and thousands of dollars without knowing who I'm going to be indebted to. It's a lot of work, though. I need to call my med school today to make sure I'm not supposed to be doing something about that stuff. I need to make sure my undergrad loans are still on hold.

I don't want to do any of that.

I'm on the verge of supporting the anti-Olympics campaign because of the China-Darfur connection, but I can't get myself to really commit to it. I still haven't gotten around to writing to my elected representatives about the war funding. I haven't made any headway on selling my car. I haven't planned our last Philly trip yet.

I'm seeing Nicholas today. It's his birthday. I need to come up with something special to do with him before 2:15. He's turning 10, I believe. Or 11.

If any of you are in the L.A. area and would like a very well-behaved, recently-bathed Jack Russell terrier (mix?) please post a comment.

 

 

I'm reading and loving The Orchard Keeper by Cormac McCarthy.

I'm trying to make plans to visit Philadelphia once more before we move there.

I'm trying to make plans to move to Philadelphia.

I'm working up the courage to call Nicholas, whom I haven't spoken to in four weeks.

I'm doing five loads of laundry.

I'm sweating. It's 92 degrees here right now.

 

We're moving to Philadelphia.

I didn't get into the New York school. I just heard yesterday. I was disappointed, but also relieved to know for sure where we're going. And we both love Philadelphia. I did prefer the NY school to the Philly school after my interview, but considering how competitive it is to get into medical school I am not allowing myself to complain. The Philadelphia school is a great school, and if I can't be thankful for my admission there then I'm probably going to be unhappy anywhere. There comes a point where you have to nix the pouting, because there's always going to be another school or another program that looks better.

Drew is working for four more weeks. Then we're going on a camping trip. Then we're packing up and moving. Seven or eight weeks from today.

We went out for dinner and margaritas last night to celebrate. There's a very small margin of error since I haven't heard from UC-Irvine. But they haven't even offered me an interview yet, so at this point the best I could hope for was a spot on their waiting list. Which means we'd be in Pennsylvania before I'd get an offer, at which point the lower tuition at UCI would be weighed against our excitement about our new city. I don't see UCI coming out the winner in that scenario.

It's over. Thank fucking god, because I couldn't take much more of this process.