coming up now, out of the blue

A running joke among my fellow interns is that every time I drop a piece of paper from my white coat, it inevitably has a recipe scribbled on it. I don't even know how these end up in my white coat pockets, as it's not like I wander around the hospital collecting recipes. Still, I do tend to scrawl down experiments. Most of the time, there is something about the recipe that does not quite satisfy me, and thus it winds up shoved in random pockets or in the circular file.

There is a little notebook I keep in my kitchen. It looks from outward appearances to resemble a journal, and every once in a while, someone will come upon it and think they are about to discover weird, random musings (when the silly geese could just come here for that!), only to be confused when they open the book.

In the little notebook are the keepers. Recipes I've either used a million times, or ones I've wrangled into submission. If it goes into the book, I know it's the real deal. It may not seem like much, but there are now 21 recipes in there (plus a back page with little random skeletal notes about the proper ratios to make basic ganache and cream cheese frosting). To me, though, that seems like a lot, that many no-brainers, foolproofed solutions.

The 21st recipe was a chocolate ice cream recipe, very close to this one but with a few changes in ratios and techniques. Third time's the charm, and in this case, every time I've made this, it's caused a commotion. It's extremely rich, but anyone who loves chocolate would not view this as detrimental. Ice cream has the added benefit of having cream in it, which is advantageous because I am lactose intolerant, and therefore am rarely tempted when I make it.

Cookies are what I bake when I want to make something, and have a deadline. Cakes I bake for occasions. Cupcakes I bake when I want to make something but feel like fooling around with frosting. Things like ice cream are really more cooking though they involve sweet things. They're a process, the sort which I used to fear and avoid. I've written about this probably a million times, I am nothing if not repetitive. Yet I'm always surprised when things that used to frighten me now actually provide me a sense of comfort. Some people meditate or go to yoga. I've tried those things, but I find learning to temper eggs much more relaxing.

Driving through the Bay Area recently, Young The Giant's Cough Syrup was playing on the radio, and it continues to amuse me how often the lyrics of songs are completely in opposition to the general feel of the music. This seems to be more frequent recently, or maybe I'm just noticing. It worked though, because it lulled me into listening to the lyrics more closely. It gets everything right and wrong, this song, I was thinking. It so perfectly captures how a feeling of hopelessness can lead you to the exact wrong conclusion as evidenced by its opening line:

Life's too short to even care at all

Which is perfectly wrong. The fleeting nature of everything should make us find it all the more precious. But when you're tired and feeling down, I think not so much. And then of course, for those of us who are older, this one's also a sucker punch:

I'd run away to some fortune I should have found by now

There is a weird feeling that you should be free of angst by a certain point in your life. Then you find that the angst is still there. But honestly, in the periods of time when I haven't had angst, I've been suspicious. Was I not paying attention? Was it there and I just didn't notice it? Then I think that some people outgrow it, but some of us never will. Some of us will always have a little inner conflict, a push and pull and insistent questions that nag. I guess I've periodically thought of it as a curse, but maybe the trick is to accept it and befriend this constant companion.

because I never was cool

One of the other interns is also interested in Oncology, and we were talking about how who people are sometimes makes more of a lasting impression on us. She thinks it is because we appreciate how fleeting everything can be. I'm not entirely convinced. I've certainly met plenty of oncologists, I am sad to say, who refer to patients as "the lady with ALK-positive NSCLC that didn't entirely respond to crizotinib" or the like.

Probably it's just a subset of all physicians who process patients as people instead of diagnoses and conditions. I tend to remember a face and a name first, their diagnoses second, which to some, would make me a peculiar and maybe not-very-good physician. To which I respond with a resounding and unapologetic 'oh well.'

When I was a medical student, I was much more quiet and reserved than I am now (not that I am now bursting with fruit flavor). I was acutely aware of being judged and evaluated by everyone around me, and moreover very frustrated with the notion that I was not contributing much to the overall mechanics of the team on which I was supposedly working. My solution was often to give in to the ancillary nature of the role and become invisible. It comes rather easily to me.

So, having stayed at the same institution for residency, I am never much surprised when I am not remembered. It comes in handy, most of the times, because the senior residents and attendings have no recollection of my bumbling incompetence from those previous days. Last week, on a lark, I told one of the senior residents that I remembered very clearly taking my very first board exam, and seeing her at the test center. I remembered because that's how I remember things- people, conversations. I remember because she was taking her third board exam, and had told me not to be nervous. When I had wryly remarked that it seemed these tests never ended, she had bemusedly replied that they didn't end, but that the stakes became lower and you stopped studying for them over time.

She, of course, did not remember any of this, at all, and looked at me as if I was some strange stalker for remembering.

Last month, I was at a conference at one of the hospitals that we rotate through, and an elderly oncologist sat down at the table, engaged in discussion with all of the interns and residents and medical students. I wanted to talk to him afterward but he was surrounded like a rock star after a show. I remembered him too. As a medical student, he used to gather all of us into his office once a week in the early morning. Often, he brought us pastries and coffee. Every week, he went through cases from the New England Journal with us. I was facing a time of great self-doubt during that period, and I remembered that those sessions made me remember to go back to what you cherish when things are rough. I still go back and read cases when I am having a rough day. When I am frustrated with residency, I sometimes sit down with a cancer journal and read those articles, because they're of more interest to me than diabetes and COPD management (no offense intended).

That particular oncologist had always struck me as someone who thought of people as people, not diagnoses, despite his fondness for reading through cases and explaining to us how to think through symptoms to come to a diagnosis. But there he was, surrounded by a swarm of medical students trying to improve their marks undoubtedly and a few interns who had not quite shaken their gunner tendencies. I assumed he didn't remember me anyway.

Last week, I checked my mailbox at the department office, something I only get to do about once a month because of my schedule. In it was a card from the old oncologist. His note read:

Internship is more than 2/3 over. Seems hard to believe it has been that long since you were a medical student here (September 2009). Good to see you doing so well last week.

Now, mind you, he may well send these notes out to every intern who passes through. He may have looked this up in my file. The card may have meant nothing altogether. I get that. It reminds me of a conversation I once had with a friend Y when he was visiting from NY. We were talking about how people were nicer in SF, but were more sincere in NY. He said, "I don't care anymore if they're lying- just be nice to me!" I think, as an intern, that's how you feel after a while. Who cares if it is all an act? It's an act of kindness not malice, so that sort of tomfoolery- well, go right ahead.

It's also one of those things I file away. Because I remember people, and I'm already seeing how much medical students appreciate it when you remember their names, acknowledge them in the hallways, ask them how they're doing. It sounds stupid and like basic social skills, but it's shocking how that sloughs away in many folks during residency. I keep trying to hold onto pieces of me, and this is one of those pieces I want to keep close.

*

On a lighter note, a patient came into the clinic yesterday to have his abscess repacked. He pulled out his iPhone and showed me a day-by-day documentation of the wound. I said appreciatively, "Wow, so you've been keeping a very careful eye on it?"

He waved this off and said, "No, I have a buddy who's squeamish, so I send him a picture every day to gross him out!"

Boys will be boys. Even when they're 40.

Judy sucks a lemon for breakfast

I can't be bothered to take a photograph, because it's been a lazy Saturday today. Not really lazy altogether, but lazy in the sense that I haven't been doing what I'm supposed to be doing. But then, isn't that the story of my life?

Last week, I'd discovered a tree in my backyard pregnant with ripe Meyer lemons, bursting off the branches, begging to be picked. The spring, as much as it is vibrant with life and promise, is not always a happy time. It conjures up some bad memories. It also assaults me with allergies that make my head foggy.

But when life hands you lemons, well. Problem is, I can't really drink a pitcher of lemonade.

I'd bought some ginger root that I'd been planning to grate into soy sauce and simmer with broccoli and water chestnuts. But there it was, taunting me. I took the dare. In the past, every time I'd tried to bake or cook with ginger or lemon zest, I was always annoyed to discover the fibrous little bits interfering with the finished product. I was not about to dive into an adventure of sorbet-making with the same outcome.

When making sorbet (or lemonade for that matter), you have to make a simple syrup, which involves dissolving sugar into water, evaporating a little of the water off in the process. It's the perfect vehicle for infusion. So I sliced up the ginger roughly and threw in lemon peel, added the water, and then the sugar, and heated up the witches' brew. When it had come to a simmer, I set it aside and covered the pot, and let all the ginger and lemon essence seep into the syrup. When it was fully cooled, I strained it into the freshly squeezed lemon juice. At the time, I didn't think it tasted like much, but I thought, well, at its worst, it'll just taste like plain lemon sorbet. Worse things in the world.

When I make fresh sorbet or ice cream, it's rarely a whim that just comes to fruition in an afternoon. It's a stepwise process. It teaches me patience, and also makes me believe in faith, and gives me the capacity to hope. It gives me a future to consider. All in a simple sorbet. I've stumbled in the past with sorbets. When I'd been timid and a purist about them, I'd arrived at frozen blocks that essentially amounted to shaved ice. I'd read a trick about vodka softening the sorbet. And anyone who knows me knows how quickly I'd take to that tip. Indeed, it works if you are going to serve the sorbet in a few hours after making it. And that is seldom the case for me. I tend to make sorbets when I have fresh fruit that is in season and needs to be used.

I'd read a tip some years ago about adding an egg white to the sorbet, as it stabilizes the sorbet and makes it a scoopable consistency. But I don't think I could ever risk making someone sick from raw egg in their sorbet. At the same time, over the past couple of years, I had been developing a relationship with meringue. First baking it, then making homemade royal icing with it, then making buttercream with it, and even making macarons with it. Even then, I stumbled along the way. The first time, I put nearly a 1/4 cup of sugar into an egg white (or two) and beat it frothy in a double boiler, so that it cooked into a meringue. Problem with that was 1) it made the sorbet far too sweet, and 2) it turned out to be too much meringue and the resulting sorbet was a tad too creamy.

That's the nice thing about failing- it opens up an opportunity to get it right. And the nice thing about the kitchen is that the failures can be analyzed. It's relatively simple to figure out what went wrong. If only that could be said about all the other failures in life.

This time, there were no strands of ginger root or bits of zest. This time, there was a mildly sweetened meringue, and just a sparing amount of it folded into the sorbet to give it some structure. A slight splash of Grey Goose for good measure. And as it all had a chance to chill together, the lemon and the ginger combined to pack a strong punch. The result was not too sweet, tart and tangy, with a killer zing of ginger.

It may seem awfully dull. After the letter I'd received earlier this week, that filled my head with confusion and questions with no answers, that had made one particular failure a burning cloak that I could not seem to shed, it was just the dullness I craved. Outpatient urgent care clinic, which sometimes drives me bonkers with its banality, was a welcome opportunity to diagnose a man with a viral respiratory infection, a tired housewife with muscle cramps of her calves caused by chasing her children all day, and a woman with high sugars because she wasn't taking her prescribed insulin. I needed simple problems, codes I could crack. Usually, I revel in the more complicated. But this week, I just needed to fix things.

And the sorbet came out just as I had hoped it would.

if you don't know what to make of it

This song is supposedly played out, because it has been used on various television shows and whatever, but I don't care:



This video is better than a fantasy movie. It makes me imagine there is a world in which you could be hiking along a river and come upon a commune of troubadours who sing you this slice of heaven. The video made me think of home, which I rarely think about, and it made me think of the larger sense of home, and how that word has started to lose its meaning.

Plates keep shifting, everything dynamic, all things transient, nothing permanent. Entropy is the law. Things fall apart, it's scientific. Evolution, inevitable. And even though I write about that all the time, even though I accept it as reality, I don't mind saying (and this seems to be very unhip to admit these days) that I don't care for it one bit.

I got a letter and an email today. The email was from family, said they missed me. The letter was an apology, nearly a year too late. Both were welcome, neither changed how I felt tonight. It seems the only thing constant in life is on the inside, not the outside.

we all walk the long road

The job of the intern on night float is to cover all the patients in the hospital on the Medicine service. This means that, should anything come up, the nurses page the night float intern. But it also means that most of the decisions of treatment and management have been made during the day. There is a slang among us, to do with how well you care for patients during the day: if they are well-managed and treated, they are considered "tucked in" for the night, and you tend to hear little about them over the course of the night.

The "untucked" patient at night, on the other hand, can be traced to one of two causes:

• The team did not properly "tuck" them in during the course of the day.
  
• The patient is very sick and "tucking" is therefore impossible.

It is hard to hold it against anyone if the latter reason is the cause of the various phone calls. But often it is the former that leads to the cacophony of a screeching beeper in the wee hours of the night. Last night, as the night float intern, I wound up having two extensive discussions with patients who had cancer, and it was evident that communication had not been good with the team during the day. One of the patients was an unfortunate 27-year old Punjabi woman who had recently been diagnosed with stomach cancer. Her belly is riddled with tumors. She is getting chemotherapy to keep her symptoms managed, but there is no chance that it will be curative. She asked to speak with me about why her belly continued to hurt. I was surprised to find she had not had much of a discussion about her cancer with the physicians taking care of her during the day. I had a frank conversation with her about the tumors and how she would likely continue to have swelling in her belly, and that our best bet was to manage her pain with medications as best as we could. She was startlingly young.

Looking at her, I was reminded again of why I would never want to do Pediatric Heme/Onc. I know that kiddos bounce back fast, but seeing someone that young face a terminal diagnosis takes a more palpable toll than much else I have seen in the hospital. The next morning, the physician who cares for her during the day, an intern herself, told me that she knew someone needed to have a conversation about the cancer and how bad it looks with the patient, but that she "just couldn't do it." The idealistic, wide-eyed intern I was 9 months ago would have given her the stink eye and yelled at her for being a wimp. Truth be told, it was inappropriate to put off the conversation. I couldn't yell at her today though. I felt like she was recognizing limitations in herself, maturity that she did not yet possess, and it was perhaps too demanding to want her to be as comfortable with the conversation at this stage.

An uncle of mine had a child who was born with a congenital abnormality, which affected the child's development significantly. Sometimes people would ask my uncle how he dealt with it. He never looked at it that way, though. He always said he felt lucky, he felt he had been entrusted this person with extra needs, and it was a privilege, a blessing to be able to take care of this special child.

It's not really the same, but I do sometimes feel that way about oncology. It's not that anyone savors having conversations about death and dying, about bad news and hard fights with poor odds. But it truly is a privilege, it is a blessing. If you're not equal to the opportunity, if you can't see it that way, if you find it daunting to fight the urge to flee from the conversation, perhaps it's best to let someone else do it.

somebody that I used to know

Everyone has been writing that it was inevitable, but it brings a tinge of sadness nonetheless. Sepia Mutiny is coming to a close.

I've been giving a lot of credit to that blog for putting me in touch with some fascinating folks on the web, but if I really trace it back, all the way back, right to the point of its absolute essence, it wasn't actually Sepia Mutiny. Here's the truth. It was blogs. Yes, that dead dinosaur, this format that I can't seem to quit.

Manish and Anna and Abhi had these amazing, lightning-rod blogs that I and many others read voraciously. I thought Sepia Mutiny was pure brilliance when it started; I thought if you combined such forces, nothing could stop it. Maybe that was partially true. But I saw the price that was paid. Each of their blogs dwindled down. With the exception of Anna, when they did blog, their writing became less personal. And frankly, it was those little moments, the little glimpses inside, those were the things that made me so drawn to the community.

I have always contended that I don't share commonality with people who watch Bollywood movies. It's not idli or samosa or sarees which tied me to anyone. What interested me were their voices, the shared experiences. Things we found funny, that we could only appreciate because of our joint experiences. The way Amardeep could dissect an interesting piece of writing. J-money's sassy commentary on food or television or movies or her parents would remind me of some long-lost friend I never knew I had. Or supplesomething's poetic prose. Or maitri's infallible no-bullsh*t breaking-it-down here's-the-way-it-is observations that would make me want to cheer. The little-sisterly feeling tamasha always brought out in me.

Those were the things which caught my interest, made me want to better know these bloggers. In the beginning, in those early days, right before Sepia Mutiny, these bloggers inadvertently encouraged me to blog. And maybe there are too many, and plentiful, and enough voices now. Maybe we don't need Sepia Mutiny, and maybe we don't need blogs. But me, I'm never making any real connections over Twitter. I'll never find myself endeared to someone by discovering their Facebook page. It's the blogs. It's the words. I'm a sucker for words. I'm a sucker for way, way greater than 140 characters. I'm a sucker for more is more. I won't really miss Sepia Mutiny, because I haven't been reading it for years. But I will miss what Sepia Mutiny promised, and the people who brought us Sepia Mutiny. And I already miss all those voices who've grown quiet.

Me, I'll stay in the ancient times, in this echo chamber, with words, words, words. Manish and Abhi and A N N A taught me how, so blame them.

you gave me a lift

Everything takes perspective, I guess. Like how good a bowl of cereal tastes when you haven't been able to tolerate food for 24 hours.

Or, I had to work a night shift last night. I despise them. Not for the actual work, which is actually rather fun. Nights are creepy and cool in the hospital. You learn by doing what you have to do. Nights always provide the biggest contrast as to how the past several months have shaped me- phone calls that used to fill me with panic and dread are now met with gentle reassurance and a short visit to the bedside to confirm suspicions.

What I despise about night shift is the way it pummels your body and turns your circadian rhythm into the Elaine dance. There's no getting around that one.

But it was only for one night. And also, the morning before I left for night shift, I took a listen to The Shins play Simple Song on SNL. I'd heard the song before, but to be honest, the video that had been released for it had been a bit distracting, so I had not really appreciated it until I saw them perform it live.

It wasn't some powerful and rousing rendition necessarily. But it must be said- if you throw a swell of guitars like this into a song, and the lyrics and vocals are equal to it, consider me a goner. And a line like you feel like an ocean being warmed by the sun and love's such a delicate thing that we do with nothing to prove, which I never knew are fairly hard to beat.

The actual video is kind of goofy and distracted me initially, but I do think it has a bit of a point. It's certainly entertaining enough to watch.

But really, I was just pleased at 3 in the morning to have a little guitar and drumbeat to keep me moving through the hospital. Sometimes all it takes is a simple song.

I've got chills, they're multiplying

I couldn't help myself with the title of the post. It's really the only reason I decided to write today. It's pretty impossible to talk about food poisoning in any kind of entertaining way.

When I was in Peru, SP, AL and I all got a nice, nasty episode of food poisoning right before trekking the Inca Trail. SP was the first to recover, and went out in search of Gatorade powder to keep us from dying during our hike the next day. I had been lying on the bed in misery. But I had also not eaten in over 24 hrs. And there was a roll of delicious Peruvian cookies sitting on the night table.

SP came back to the room to find me guiltily eating the cookies. I paid for it shortly thereafter; I was definitely not ready to be ingesting sugar. She shook her head and asked me what was wrong with me. I have no willpower I guess.

I eyed some cookies this evening, and laughed, thinking of what SP would say. I didn't eat them. My stomach's not quite ready for that, and the muscle aches and chills are settling in, so I am going back to bed, after I force down a little ginger ale. Not the best way to spend my one day off, but at least I wasn't at work when all of this happened- that would have been mortifying.

it was dark and I was over

Today at clinic, a patient found out at the front desk that she didn't have insurance anymore. As a result, she no longer qualifies to come to our clinic. She had just been to the Emergency Department yesterday because she had a UTI and she had not been able to see a resident in clinic quickly enough (although, now that we know that she has lost her insurance, she would not have been seen by a resident anyway). She got antibiotics from the Emergency Department, but she wanted to be seen today because she was still having pain.

Also she has HIV.

Last time she was seen for her HIV, her CD4 count was great, which means her immune system was intact. She was on antiretroviral therapy, and it was working well. All we could do for her today was check her vital signs and make sure she wasn't dying in front of our faces, and tell her that she could go to the Emergency Department if she started to feel worse or developing worrisome symptoms.

If you follow this out to its logical conclusion, you have the dizzying, frustrating, enraging headache that is US healthcare. Patients without insurance do not get seen in the primary care setting. Preventative healthcare falls to the side in these patients, the most vulnerable ones, I might point out. As a result, they get sick and they come to the ER. Sometimes they aren't really sick and they come to the ER. But they come to the ER because they don't have a primary care physician to weigh in one way or another. This patient isn't acutely sick right now, so she probably won't get much out of a visit from the ER today. But thanks to losing her insurance, she won't be able to take her HIV meds, and her CD4 count will most likely plummet, and eventually, she will turn up in the ER with an opportunistic infection, having developed full blown AIDS. Good job, America.

As part of my residency, I rotate through the Emergency Department, and it also turns me into a rage monster, because again, a ton of the patients who turn up don't really need Emergency Services. They do not need a CT of their abdomen, seventeen labs and 12-hrs of monitoring, only to be sent away without explanation by a shrugging, tired ER doctor. They need a primary care physician.

But they're not likely to get one any time soon.

I'd like to complain some more, because there's an entire separate rant about how Internal Medicine programs pay pure lip service to encouraging residents towards primary care, while wholly supporting a system that actively kicks out the desire for anyone to do primary care. But I am tired. And frustrated that I contributed to the problem today because the system tied my hands behind my back.

heartbeats

Today one of my patients asked me how long I'd been a doctor. I get that question frequently in resident clinic, because they know we're all in training. Sometimes I want to answer that I'm not one yet. Other times, I want them to stop giving me a hard time. Today, I just told him how long, which is not very long.

The patient asked, "Do you like it?" I said I did, and that I didn't take it for granted, and that I was lucky to get to do something I love. He nodded fervently and said, "Yeah I used to be a computer repairman, and I used to just jump out of bed every morning, I was so excited to go to work every morning."

I thought that was nice, and a nice surprise.

Towards the end of our conversation, he was sort of starting sentences but not finishing them. I said, "Is there anything else going on?"

He asked defensively, "Like what do you mean?"

I shrugged. "I don't know. You just seemed like you had something more you wanted to tell me."

He then told me he was embarrassed. I thought, here we go, and braced myself for some unnecessarily explicit conversation about sexual dysfunction. As usual, I was wrong. He told me he was embarrassed because he'd been clean for a long time, but this past month, he'd been feeling down, and done cocaine a few times. A tiny little detail that changes the entire appointment- the guy has a mechanical heart valve and an underlying condition that makes him prone to cardiac problems. He absolutely can't be smoking cocaine if he wants to stay alive.

Interesting where conversations take a doctor and a patient behind closed doors.

it feels like years since it's been here

Maybe I have just noticed this because I'm finally on a rotation in which I get to see sunlight (and not just by peeking through patients' rooms while I am rounding, which for the record, I have stooped so low to do), but around here apparently spring has sprung. It seems too early, almost unnatural. There was no real big freeze this year, it seemed, although there probably was- I seem to remember a few days during which I raced from the hospital to my house fearing that I was going to freeze to death.

But all of a sudden, there are blooms everywhere, and the sun is warming everything, and I don't really know why the expression "everything's coming up roses" exists, because it seems to me that it should be daffodils. Roses are delicate and fragrant and fancy and romantic, sure. But daffodils are bright, screaming yellow, and they seem to be the first thing that bursts forward in the spring, announcing warmer days ahead. You don't have to wait around for someone to get you daffodils. In fact, they're best encountered growing out of the ground, a chance meeting as you're walking down the street. Or in my case, when I opened the door this morning, I found that my very own front yard was bursting with a little row of daffodils.

When I was young, and living in Boston, and first learning to really love things, the spring would call to me like the Pied Piper, and I would walk out of my room as if in a trance and wander aimlessly further and further away from home. And on those days, it seemed like quite a heady indulgence, to stop at a florist on Newbury Street and buy fresh daffodils, then carry them home and set them in a blue vase and set them by the window, and stare dreamily out on the Charles River. I am not quite at my leisure to do that anymore, but I get to cast a wistful glance at those daffodils without feeling like I'm splurging.

Which makes me quite happy. Simple things do sometimes.

it's hard to dance with the devil on your back

In my last post, I had posted a link to Gotye's Somebody that I used to know. And it is, indeed, a good and haunting song, and a mesmerizing video.

But.

You know, there's a line in the song that I should probably have heeded more carefully- you can be addicted to a certain kind of sadness.

I'm reminded of advice I frequently give 3rd year medical students (I am of the mind that 3rd year is probably the worst year of medical training, and that includes internship). I always tell them- "when you think you're losing your mind, talking to the other inhabitants of the insane asylum is not likely to be helpful." So I always told them to talk to a 4th year medical student (or better yet, someone not even vaguely connected to medicine).

You can't dig your way out of the dark without looking towards the light. I know Florence + The Machine do not qualify technically as all joy and lightness. But baby steps. And this song, no doubt about it, is a step in the right direction. And it's time for those steps, time to stop running to stand still.

But most importantly, there is still time. Time for every one of us who are still here.

put your records on

Medical training can make you seem bipolar, I suppose. Because you can have a totally in-the-toilet day in which everything goes wrong and patients do poorly and you feel overall horrible about everything, and the very next day, you might be doubled over in laughter about something a patient said (or more likely in reaction to some hilarious story told by a fellow intern, which will only seem hilarious to someone else in the trenches).

I'd imagine that is not healthy, but then, not much of residency is healthy. About the best that can be said about it is that I rarely have much of an opportunity to partake of GG&Ts.

Anyway, now that internship has started to allow me a little time for the mind to wander, I have been listening to a little more music lately. I'm still way behind and sadly probably missing out on a lot of good stuff. But, recently, I heard this song, and every lyric was just the perfect encapsulation of a crappy breakup- not crappy because you didn't want the relationship to end, but just insofar as the manner in which it all went down. I love the lyric I don't even need your love, but you treat me like a stranger and that feels so rough. The video is also pretty awesome. Sigh, sigh, sigh, indeed.