The Culprit Life

Dutch Bells

I tracked some percussion with my friend Emily today for that folk song I mentioned. Emily is really remarkable. As a consequence of being a grade “A” classical violinist, she can keep time like nobody’s business. And so, I recorded almost none of the percussion myself and instead let Emily pound away at the kick drum and snare. She also brought these little Dutch bells she’s “borrowing” from another violinist who’s abroad. I’m not sure how much of them will make it into the track once mixing is done but they were fun to record. There’s a lot of janglin’ involved.

The Wash

Today I kind of feel like I’m slipping through the cracks of the American medical education system.

Study, Study, Study

I took a little break tonight to record with some friends. It’s a folk song I wrote a while back and doesn’t have anything to do with The Culprit Life. I’m hoping to finish it up next week and post it somewhere.

I got a lot of good studying done today.
But you don’t care about that.
What you care about is good music. I do too.
So on that note, tonight I finished up some photos I took at the Tycho show last month.

You can see the full black and white set here

You can see the full color set here

The Fifth Floor

Every American man should have a novel by Michael Harvey on his shelf.
I finished his second, The Fifth Floor, today and loved it just about as much as his first. It’s bare bones, masculine, detective, noir writing at its best complete with a protagonist who’s rough around the edges but has a heart of gold.
Some artists are groundbreaking and experimental. Others make pieces that seem more traditional but are the absolute best at what they do. Harvey would fall into that latter group. But all you really need to know is that it’s brilliant and immensely enjoyable all at the same time.

I forgot but we do have a spring break in the third year of med school. It starts next week. Although, because of my current state of limbo, next week will be just the same as this week for me, chock full of studying. I’m happy for my classmates though.

Study, Study, Study

Hoops

I saw a quite different film tonight: “50/50”. I thought it was generally a pretty good look at the life of a young person who is diagnosed with cancer. I wasn’t crazy about it but I did really enjoy it. The only thing I really had a qualm with was that they made almost the entire medical community look like heartless jerks, especially the physicians. There’s no way if you went to a cancer center like that that people would be so harsh and indifferent. It really bothered me. I mean, I know not all medical communities are as nice and humanistic as the one I’m currently training in but it was just ridiculous how they had no respect for the family and acted like robots when explaining things. Luckily, Joseph Gordon Levitt did a commendable job acting and the supporting cast was pretty good too.

So I know I’m the last person on earth to see Fight Club but I watched it for the first time tonight. It was crazy. I mean, really. Chuck Palahniuk is a sick genius. David Fincher is a mastermind. The casting was perfect. I don’t think I’ve ever liked Norton more. The cinematography was fantastic. The only real flaw I saw in the whole film was how the final scene (the last couple minutes) was incredible medically inaccurate. It’s unfortunate because the rest of the film was so believable. I will say though, I really don’t like watching human beings beat each other up like that. It made me uncomfortable. I don’t mind violence in my movies, in fact love quite a few that are loaded with it but I don’t know, the way it was displayed in fight club was grotesque and disgusting and almost pointless but then again maybe that was the point. Anywho, fantastic film all around. Can’t say I would want to watch it again though for the reasons stated above.

I also got this earlier in the day for a buck.
Good stuff.

Well it wasn’t easy but it was a lot clearer to understand and think through than I remember. Still there was a load of random stuff in there that I don’t think I would have known even if I had memorized every word in the three study guides and three questions banks I used to study for this exam. I had a month! A whole month! Plenty of time to study for those 100 questions and it still didn’t come easily or even semi-easily. I keep feeling like there’s a switch I forgot to turn on or something that’s so obvious to everyone else and the reason why the vast majority of people don’t have a problem passing these NBME exams. Like “Oh, it’s in English! I was reading it as German this whole time!” or “Oh, you’re supposed to bubble in the letters not put an “x” through them??”. But I think those moments will never come. I need to somehow come to grips with my staggering inability to do well in any written exam no matter how hard I try. Maybe there are some mountains that are impossible to climb. Or maybe I’m just trying to climb the wrong ones.
Other than all that, it was a great day.

Alright. The big day is tomorrow. Insert giant cliche phrase about how important this is here. I don’t know if I feel prepared or not prepared or what. I feel like I’ve looked at almost everything five times. If I fail tomorrow, I have to retake an entire year of medical school. If I pass, I have to take a series of exams that are extremely difficult, any of which could result in a retake of the year as well if I fail them. The pen is in God’s hands and I’m trusting in him to write a great story with my life no matter what happens tomorrow. Or the next day. Or the day after that. Or… you get the idea.

I’m a Patient Patient

Weakness, muscle aches all over my body, chills, fever. Last night was pretty awful, especially for something no one will officially call the flu. I went to the doctor’s but because I didn’t have a fever at the exact moment I was in the office, she couldn’t write me a document saying she recommended against me getting the flu shot. The medical health office at the med school heard me complain to them so many times that they told me I could pass on any further flu shots mandated by the school. So that was a win. The doctor ended up calling me back in to do an ECG on me since I complained of chest pain. The whole day I pretty much felt like someone had punched me in the ribs 20 times. I don’t see how this qualifies as being a reasonable set of “side effects” of a vaccine for a relatively mild illness. I’d rather take my chances with the real flu. It’s not that much worse.

The Shot

So I’m just going to come out and say it: I hate the flu shot.
Every year, our med school tells us we have to get the flu shot but I’ve been able to avoid it until now because they threatened to send a letter to the student affairs office saying we are non-compliant if we don’t get it.
My reasons for not wanting to get it are both personal and public in nature. First, every time I’ve gotten the flu shot in the past I’ve gotten sick for three or four days with “flu like symptoms” (and really, can we just say it was the flu already? Enough with this “symptoms” crap, you injected the influenza virus straight into my arm. I have the effing flu.). I’m talking fever, muscle aches, the whole bonanza. It’s happened about three times to me and a couple times to my sister as well so my mom finally stopped getting it for us when we were growing up. I can actually only remember one time when I got the flu and it wasn’t because of the flu shot.
Second, I think you have to look at the policy of flu shot administration as a whole with a critical eye. So every year, some scientists get together and come up with this new vaccine to save America from different strains of the influenza virus. Every year, it’s pretty much a new vaccine. No, it doesn’t get any long term or extensive research done on it. How do they test it? Look in the mirror. You are the guinea pig. How safe does that sound? Other vaccines? Hepatitis, yellow fever, chicken pox, shingles: all pretty much the same from year to year so we have tons of data on them. The flu shot? Nope.
Now, I’m not saying the flu shot doesn’t save lives. It does. I honestly recommend the flu shot for young children and the elderly. But everyone in between? I wouldn’t discourage anyone from getting it but I also wouldn’t recommend it. Do I bring it up with every patient and offer the option to them? Yes. But I would never press anyone to get it.
Now, I’ve never had any bad experiences with any other vaccination. I consider myself “pro-vaccination” even. Especially for children. I just don’t understand why, after time and time again I’ve shown my body doesn’t handle the flu shot very well, I am still mandated to get one. Yes, I’m not completely ignorant, I know the official reason is that it “protects the patients you come in contact with” but technically my immune system is still doing the protecting, not the vaccine. And if my immune system has been protecting me for years (it’s literally been almost a decade since I’ve gotten the flu) without the vaccine, what’s the point of getting it? Now, if I start showing symptoms then yes, I should immediately pull myself out of the hospital and recover before I see any more patients. But what’s the point of crippling an immune system that’s already shown it can handle a multitude of viruses (given they’re not injected directly into the body with a needle)?
Case and point: I got the flu shot at around 2pm today and for an hour now I’ve been feeling muscle aches and noticeable weakness.

Tunnel

Study, Study, Study

Everything is a Test

I met with my adviser again today. I expressed my worry that I’m a week out from this major exam and I feel like I’m clueless when it comes to proper fluid resuscitation for ICU patients. We went through a few problems together and I felt better about it but I still could use a lot of work. It’s just one of those things I never got in the first two years and now I’m paying for it.
I’m really not sure I can write a check that big.

Crank and Pedal

Study, Study, Study

Appropriately Good Typography

Walking toward the hospital this morning for trauma team rounds, I noticed an elderly lady ahead of me being helped along by another woman. I felt something was wrong and when I came up along side of them I noticed the elderly woman’s face was covered in bright red blood. Apparently she had taken a terrible fall on the sidewalk. The woman with her cried out asking if I worked in the hospital and if I could help. I had nothing of any use on me so I made sure the woman was still breathing alright and that the blood wasn’t gushing out of her head and I instructed her to sit down on a nearby slab of concrete while I booked it as fast as I could to the emergency room to get help. Luckily, the nurses and security in the ER were able to get a paramedic on the scene within a few minutes. Later, on my way out I saw the lady who had helped the woman who fell. She thanked me and expressed considerable relief that the woman was going to be okay.

Rounds was a lot different since I’m not really connected to the team or any of the patients. It’s like picking up a novel and reading half of chapter five and then putting it back down. Not really a fulfilling experience but I guess I got a little taste of something. For our last patient, we all walked down to the trauma bay in the back of the ER. As soon as I passed through the double doors I noticed a team working on a patient behind a pulled curtain. Almost immediately, I heard a voice say “Call it.” and another respond, “Time of death: 12:13.”. Someone thanked the other members of the team for working hard. I joined my own team who was four beds down with another patient. Nobody even flinched. Six feet to the right of me, someone just died. They might as well have been typing up a spreadsheet in the cubicle next to us.

Here is what I take away. When I saw the woman with blood covering her face this morning, my heart didn’t beat any faster, I didn’t panic or even sweat. There was no adrenaline pumping. I was calm, almost methodical. Like sorting through my mail or pumping gas. Just another part of my day. I did express compassion but I never felt out of control or my comfort zone even. It feels a little dehumanizing maybe. That blood and people in pain don’t jolt me anymore. That someone on the other side of a thin piece of fabric can die a horrible death and I can act like nothing happened. But I realize that society has asked us and shaped us to be this way. The world needs people to stand at the intersection of tragedy and hope and be unshakable. Today, I have to say, even in light of the cost, the act of shedding some of these things that make me human, I feel privileged and humbled to be one of those people.

After church today, for the first time in my life, I wrote a straightforward worship song. Parts of some other songs I’ve written have been worshipful but it was largely unintentional. So anyway, I might share that here or I might not. Haven’t decided. It’s definitely not a song from The Culprit Life catalog. On second thought, I think I’ll just post the lyrics here and not the recording. I feel that worship songs should be handled a lot differently than any other songs that are written for maybe obvious reasons. I think your heart has to be in the right place when you write and share them. I think posting an actual recording of it on this blog in particular might violate the sacredness of this form of communication between human beings and God. That said, I don’t have any problem with people posting worship songs or listening to previews on itunes or whatever (I would do those things myself), I’m just speaking about their place in this specific blog.

“Confounding”

In doubt, I stretched out my hand to steal what love I could from earth
And found I’d forsaken the grace that only comes through second birth
And though you’ve placed many miles between myself and what I’ve done
I still find I stumble toward all those things you’ve saved me from.

‘Cuz I’m the chief of that nomadic tribe,
Of the people who stray;
A descendant of the ones who worshiped clay.
And your love is so confounding.
I know I don’t deserve a single piece,
But your grace is such that you give me the whole thing.

In light of all of my terrible inconsistencies
You reveal how great it is, this thing that you have done for me.

‘Cuz I’m the chief of that nomadic tribe,
Of the people who stray;
A descendant of the ones who worshiped clay.
And your love is so confounding.
I know I don’t deserve a single piece,
But your grace is such that you give me the whole thing.
Yeah, your grace is so unsettling!

And I can’t comprehend why it is that you would choose to still provide
For a whore like me who’s repeatedly refused to be your bride.
And I don’t understand how you can mix your water with my oil every time.
And it’s beyond me how your grace continues to reshape my life.

‘Cuz I’m the chief of that nomadic tribe,
Of the people who stray;
A descendant of the ones who worshiped clay.
And your love is so confounding.
I know I don’t deserve a single piece,
But your grace is such that you give me the whole thing.
Yeah, your grace is so unsettling.
And your love is so confounding to me.

Micheal Harvey Speaks Truth

Things I Used To Know About

For the second time in a little over a week, I was on the other side of the chart. I’ve been feeling really run down physically for a few days so I decided to go to the student health clinic for kicks (it’s free). I’m proud to say, I was correct in my self-diagnosis and treatment. I just have really bad allergies due to my super human immune system (thanks God, I’m being sincere) and hot tea helps more than any medication. The physician was funny. She suspected that I was a medical student from my precise account of the history of present illness and solidified her suspicion when I used the term “mucosal lining”.

I also met with both the dean of student affairs and dean of education today. It was non-mandatory which is a good change. Both were great and super encouraging as always. I can’t say enough good things about them. I shared the results of my neuropsych testing with them and neither were surprised that I was generally on level with people who have doctorates. The dean of education asked frankly if I’m just bored out of my mind when I read a book about medicine. I answered, “pretty much”. That seemed to make a lot of sense to him and to me as well.

It’s funny, after all the scientific testing, after the literally dozens of PhDs and MDs who have attempted to analyze me and my difficulty learning, after seeking advice from all the experts, the conclusive answer science has given me is that I’m bored to death. I have carried the belief for many years now that science does not have the power to answer a staggering number of life’s important questions and so it is beautifully fitting that this truth has been made so evident in my personal existence. I am my own living proof.

I got up at 5:45am to attend the trauma service’s morning report where the night team passes off the patients to whoever is working that day. It felt weird to be in scrubs walking down the halls of the hospital again. Later in the morning, I went to my friend Kenny’s house to record some guitar. We only finished one song, “White Mass”, but it was a really good experience. I tracked the main gist of the song and Kenny tracked a good solo at the end that we co-wrote. I love it. For a while there, this record was sounding solely electronic. I think throwing in a bit of guitar makes for good contrast. Hopefully Luke and I can strike a good balance when we mix everything.

After almost a full day of studying at school, I came home to organize the music my friend Kenny and I will be recording tomorrow at his house. I know we’re not going to get everything done but I’m praying and hopeful that what we do record actually sounds good in his big living room. As far as guitars go, the size of the room is the one variable I have yet to test.
Cross your fingers.

I’ve been somewhat discouraged in keeping up this daily journal of my life in art and medicine. Part of the reason comes from the fact that I’ve been doing poorly in the medicine portion. Well, actually only on standardized tests if you want to be specific. But still. I’ve been struggling to keep track of every single day like I used to. I have been writing behind the scenes but the problem with this is there is no accountability. If I miss a day or five or ten, no one says, “hey man, you haven’t posted in a while”. And I really need that accountability because, typically, I have a good many things to say but at the end of the day I feel to drained to type them all out, especially if I’m the only one who’s going to be reading them for the next couple years. And I really do want this thing to continue. I plan on publishing it in a different format one day as I believe it is the most complete record of the medical school experience from a student’s perspective to be created thus far. Wow, that sounds incredibly ambitious/egotistical/Ron Burgandy level of conceited. I know. I know.
You might know, if you’ve read this blog before, that I strive to be completely honest about myself, about the school I attend, about the situations I come across, and about the interactions I have with people. And that kind of thing (I’m talking about the honesty) runs the risk of getting you in trouble with all sorts of people when you’re inside this machine (er.. institution) called medical education. That’s why I’ve kept “silent” for so long and that’s also why if I start posting publicly again things are going to have to be a little bit different.
If you decide to read this from now on, you’re going to be reading a disjointed narrative. Not everything is going to stack up. Pages will be missing, characters will be left out, and it’s probably gonna sound like I’ve gotten pretty darn soft. But let me assure you, I will be writing the whole honest to goodness truth of this story as it happens whether I post it here or not. And one day, if you care to, you will be able to read the entire thing, worms and all, unedited (except for maybe my terrible spelling).

Alright, well, if you’re on board, here are a few facts to get you up to speed:
1. I passed the USMLE Step 1, successfully putting the nail in the coffin of my first two years of medical school.
2. I had a very exciting six or so months of third year in which I completed my Neuro/psych clerkship and my surgical clearkship except…
3. Half-way through my Primary Care clerkship I was asked by a review board to take a couple months off to study and retake the surgical and psychiatric NBME standardized exams which are the only parts of the previously mentioned clerkships that I did not pass.
4. All of those setbacks combined with the extra time I took to study for the Step 1 exam put me at risk for not graduating on time with my beloved class of 2013. It is even less likely (yet still remotely possible) that I will be able to start residency at the same time as my fellow classmates (then, my fellow physicians (crazy!)).

Alrighty, I think that is more than enough for now. If you’re still reading, you deserve a taco and/or a cookie. Thank you (all two of you) for allowing me to once again fill your computer screens with photos and words about my often mundane (but occasionally exciting or at least interesting!) life.

sincerely,
the Culprit