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Saturday, December 19, 2009

Cab Ride of the Year... In the Hamra Traffic

Over heard or made to hear...

On the way to pick up my car from the workshop where it had been for some maintenance...

Cab driver picks up phone, dials a number, and puts it to his ear. The short of a one and a half minute conversation: "Eh hayete yalla khallaset liom, jeye 3al beit la nodhar ma3 el wled" Translation "Hello honey I'm almost done for the day. I'll be home soon and we can take the kids out."

Cab driver hangs up.

*5 seconds pass*

Cab driver picks up phone, dials [what is obviously] a different number, and puts it to his ear. The short of a 3-minute conversation: "Eh hayete. Layke ma rah e2dar shoufik liom mdahhar marte w wlede. Wlek *Interrupted* Wlek shou bou rasik ma 3am tefhame ya mara?!! Ana ma3 marte ou3a tehkine ente. ANA behkike shou fhemte>!!>? Bshoufik boukra khalas boukra fhame ba2a!!"
Translation "Hello honey. Listen I can't see you today, I have to take out the wife and kids. I hav...*interrupted*... I ... What the hell is wrong with you woman?? Can't you understand?? I'm with my wife and kids tonight. Whatever you do don't call me. I will call YOU, understand!!? I'll see you tomorrow!"

Cab driver hangs up, looks at me with an arrogant smile, and says "Kif baddak tlahhi2 neswen? kif? Wehde w tnen w tlete, w ba3dein??
Translation "How can I keep up with the women? how? One, two, three women, and then what??

Help me decide whether this is funny, or outrageous, disgusting, and sleazy.
I could not believe my ears.

Saturday, December 12, 2009

Wondering

I find myself wondering if it's normal that I felt so much like kissing you that my heart is still pounding. I find myself wondering if you felt the same.

For M.

Saturday, November 21, 2009

...I'd still be on my feet...

A beautiful Joni Mitchell cover by Diana Krall. Great voice, great artist.



Lyrics

Just before our love got lost you said,
"I am as constant as a northern star."
And I said, "Constantly in the darkness.
Where's that at? If you want me I'll be in the bar."

On the back of a cartoon coaster
In the blue TV screen light
I drew a map of Canada, oh Canada
With your face sketched on it twice

Chorus:
Oh, you are in my blood like holy wine
You taste so bitter and you taste so sweet
Oh, I could drink a case of you, darling
And I'd still be on my feet
I'd still be on my feet

Oh, I am a lonely painter
I live in a box of paints
I'm frightened by the devil
And I'm drawn to those ones that ain't afraid
I remember that time you told me
"Love is touching souls"
Well surely you touched mine
'Cause part of you pours out of me
In these lines from time to time

Oh, you're in my blood like holy wine
You taste so bitter and so sweet
Oh I could drink a case of you
I could drink a case of you, darling
And I'd still be on my feet
I'd still be on my feet

I met a woman
She had a mouth like yours
She knew your life
She knew your devils and your deeds
And she said, "Go to him, stay with him if you can
But be prepared to bleed"

Oh, you are in my blood like holy wine
You taste so bitter and you taste so sweet
Oh, I could drink a case of you, darling
And I'd still be on my feet
I'd still be on my feet.

Monday, November 2, 2009

It's back...

I just realized I had missed the winter! There's nothing better than holding a boiling hot cup of tea in front of the chimney in my room watching that insane november rain slither down the glass.
Ok so I don't really have a chimney in my room, but I definitely have a glass window! And a reasonably warm cup of tea. But hey, I can dream can't I??

Off to work now. We have a new team of residents/interns coming in today so I'm afraid It's gonna be a long one... Can't even start to imagine what traffic's gonna be like in this insane weather!
Have a good winter everyone!

Thursday, October 22, 2009

No Comment...


No comment, because I can't say how it feels to connect with someone like you do when that someone is your patient. And even less when you spend hours in that room talking and talking and end up wondering if you'd ever meet someone as interesting, as insightful as them, and with a story as captivating as theirs...
There's no describing it. Much like there's no describing what it felt like when I got this note after saying goodbye to Mel, who was leaving the country for good. It felt like saying goodbye to an old friend.

Goodbye Mel, All the best.

Saturday, September 26, 2009

Cinema Paradiso, a Blast from the Past

There is nothing better than that feeling you get when you come across something from the past. I don't know, I guess this may be the appeal, the incentive, or maybe the lure, that makes people dwell in it so often, and sometimes indefinitely. Ranging from that once-in-a-while sweet, harmless nostalgia to downright pathological, disabling failure to progress, this feeling of familiarity and comfort found in one's past is probably, and to my experience, the reason why so many people struggle or fail to move on to new pastures.

The other day I tagged along with M. for a short DVD shopping trip. We were both flipping
through the monumental stacks of DVDs, and were ready to go home, nothing of note having been caught in our respective nets, when I heard the clerk making a recommendation to a girl (and a nice looking one at that!). I overheard: "you should try Cinema Paradiso..."

Instant flashback to 1990. I was eight years old, and we had just moved to a new place in Beirut. A brand new TV set, a brand new VCR and a nice VHS to christen it with.
Cinema Paradiso, an award-winning film by Italian filmmaker
Giuseppe Tornatore. I remember it so vividly; it was late, one of the first quiet nights in the post civil war era. The living room engrossed in the somber yet elucidating light provided by a solitary candle placed on top of a run down coffee table, I waited, anxiously observing the clock's every move, in anticipation because at midnight, we get to enjoy the luxury of electricity again.
I fell asleep on the couch, to be woken up at midnight by my mother, who was just as anxious as I was to watch that new movie.

Perhaps ironically, the theme of the movie circles around letting go of one's roots, of one's past and all that it entails, as it so powerfully follows the life of Salvatore di Vita, affectionately called Toto, as he morphs from that 5 year-old kid with so little on his mind, through a hormone-laden teenager, and into a grown man with aspirations to a career and success.
Always the sucker for blasts from the past, I jumped on that thing like there was no tomorrow; I drove back home in a daze, and the mere sound of the two words "Cinema Paradiso" brought my mom to tears. To say that watching this movie 20 years down this long road was an emotional experience would be a masterpiece of understatement. So many powerful scenes, and a theme and topic that remind me so poignantly of my own childhood, my own journey through life, proved to be nearly too much to handle. I guess that my having been through the experience of leaving home and loved ones behind meant that I identified with Toto in the movie.
Ironically, a movie riddled with nostalgia, departures, and separation from the past, has reunited me with mine in a way my clumsy words will never be able to describe.

Why so afraid of the past?

Monday, September 7, 2009

First LVAD implant in Lebanon - The misconceptions surrounding a highly successful operation

"A team of AUH surgeons has successfully carried out the first artificial heart implant operation in Lebanon, saving the life of a 37 year-old man and father of four".

That is the claim of many renowned media sources in Lebanon. Click here to read the official AUB article by Maha al-Azar.

I'm currently, and incidentally, on the Cardiothoracic surgery rotation at AUH. Yey me. I was surprised by a phone call on Thursday night and a friend screaming at me for not telling them that the first "Heart Transplant" in Lebanon was performed at AUH. Shocked, I thought to myself, there's no way I didn't hear about that one!! Then came another call, another newspaper article, another overheard conversation... All with one, or two, or three things in common... The misconceptions, the misconceptions, and the misconceptions. I just thought there were too many scientific blunders on the part of the media and their reports have been massively misleading at best. The following is a roundup of the misconceptions I thought people should be aware of...

Misconception 1 - This is NOT a Heart Transplant...

...And even if it were, it would not be the first one in Lebanon. The first heart transplant in Lebanon (a real heart transplant) was performed at the Hammoud hospital in 1999. Click here to read about that.
This is an LVAD, or Left Ventricular Assist Device (more on that later) implant. The original heart is still in place!

Misconception 2 - This is NOT and Artificial Heart Implant...

This is an LVAD (Click here), NOT an artificial heart. Let me explain. An LVAD, as its name implies, is a pump that merely assists the biologic heart in its function. It neither takes over its function nor does it replace it or completely take over its role. It ONLY assists it in its function by taking some of the work off its back... The biologic heart is still in place, functioning properly with the help of an assistant, if you will.
The implanted LVAD.
An Artificial heart, the Jarvik.

In contrast, an "Artificial Heart" is... well... an artificial heart! It is a complete heart-like pump that replaces the biologic heart, which is taken out of the patient on the OR table. It is still an experimental technology with only limited success in the United States.

Misconception 3 - This is NOT a life-saving device...

The AUB article also states that the operation saved the life of the 37 year-old patient. I am sad to point out that this is not the case. An LVAD implantation is what we call a "bridge to recovery" or "bridge to transplantation" procedure. This device is designed to help keep cardiac performance at an acceptable level for a limited amount of time pending one of two events:

- The recovery of a mildly diseased heart as a result of decreased workload afforded by the LVAD: Bridge to Recovery.
Or:
- The availability of a matching donor heart for transplantation: Bridge to Transplantation.

The LVAD used in this case was the Heartmate II by the Thoratec corporation and is claimed by Thoratec themselves to be able to provide circulatory support for only up to ten years. Now keeping in mind that these ten years are the result of the most optimistic and optimized calculations, it is clear that we should be expecting 5 to 10 years, more realistically, before there is a need for a new intervention. And we would still be optimistic in that we are neglecting all the possible complications that the poor guy could face.

I am not trying to rain on anyone's parade, and least of all the patient himself or the thousands of others with heart problems. I just think it's a shame how the media are having a field day with his story and modeling it, be it willingly or unknowingly out of lack of scientific knowledge, to fit the textbook picture of a world-class achievement in medicine, or that of the wonderful doctor or hospital saving lives by the millions. That this life has been saved is simply not true, and while I am truly ecstatic that this operation took place where I work, and even more ecstatic to see its success and the time it gave our 37 year-old father of four, I cannot emphasize enough how much of a temporary solution this is for our patient, who is, at the end of the day, whom we should think about before anyone or anything else. I can only hope he and his family know what the future holds for them.

This is a milestone in the practice of Cardiothoracic surgery in Lebanon, one that I am proud to witness during my young career. I just can't stand it being taken out of context in this manner. The authors of these articles and their sources shoud be reviewed.

Monday, August 31, 2009

Espen Lind Fuentes Holm Sing Halleluia...

One of my all time favorite songs...
I Came across this version a few weeks ago. I've been meaning to post this here but i never got around to it.
I think These guys sound amazing. They interpreted many other classics including David Gray's Sail Away, Seal's Kiss From a Rose and songs by U2. They also have a few songs of their own. Great music.



Saturday, August 29, 2009

Dear Sarah...

I came in and you were there. I sat at the table and you were around.
With your fresh looks, you stood out from the crowd. With your enticing smile, you caught my eye. There is something about you that played with my mind all night. Is it that smile? is it your hair? Or is it just as simple as your being at such odds with all of our dearly held ideals, self-ordained stereotypes and mundane ideas and clichés of the laws of attraction, that I just couldn't let it go?
So I told you. And from that moment, you knew my secret. You blushed and smiled. I did the same.
I was struck, and I knew so little. At an unfair disadvantage. But I will brave it.
I told you, and it wasn't that simple. He has your heart.
It's not to be. Not for now, maybe not ever. Or maybe...

Thank you for a pleasant night.

Saturday, August 15, 2009

Yesterday, the day it all went wrong...

Have you ever felt like a stone surrounded by glass? Like you couldn't make a move without something or everything shattering and crumbling down in a deafening rumble and screaming racket? Minutes or seconds later, you look back: nothing more than a hole in the ground, where once all the great plans you had just built up seconds -or years- ago stood tall. Nothing left... Be it an hour, a day, or an entire lifetime, actions and their consequences are the same. Well at least they act the same. With a little hindsight on things that have happened in my life as far back as 15 years ago, or as recently as yesterday, I realize how strong and steady of a truth it is that when you make decisions, life starts moving so fast that it's not like you're moving through it anymore. It just starts happening to you.
It's strange to realize that this holds true at all scales... Whether it's your career choice, or that crush you decide to finaly do something about after so much hesitation. You just make the slightest move and it puts in motion some restless unstoppable mechanism, like thousands of cogwheels all spinning, each at its own speed, but all equally inexorable in their relentless thundering stride toward that common end point, like an army marching to the Valkyrie.

Here we go. I didn't know I was on one of my late night ramblings again... I didn't get the memo! I'm rambling again. It must be the melancholy found in the resignation to a few concequences of a choice made in the past, no matter how distant, with a certain goal in the future, no matter how remote.

Sunday, August 9, 2009

The Emergency Room... Oh the Anarchy!

If I had one word to sum up the ER and what comes through there in a day, it would be Chaos. But it's amazing. Challenging in a way I could never have imagined. It took me 2 days to realize that what you can learn in one day of an ER clerkship really amounts to more than you will learn in 2 weeks of patient care and follow up on the ward floors. There is no comparison. You can see, examine, process, and discharge 10, 15 patients a day with ranges of problems so varied it'll make your head spin!
On any typical day you can see:

-The prissy church choir girl (girl being a serious misnomer here, seeing as how she was 74, but hey...) who "burnt" her hand trying to put out a blanket, placed a bit too close to a candle, caught on fire near the church store room. She had two of her fingers covered with melted nylon which stuck after cooling down. She came to the ER not because she had a burn, but because she had no idea how to remove this thing of DEATH that had entrapped her silly fingers!!!

And then minutes later...
-The poor 24 year-old construction worker (A.) who had a 6-kg rock fall over his head from the top of a 9-storey building while he was out for a walk on his break. He sustained multiple fractures of the skull, and was brought to the ER with his mashed brains pouring out the top of his head. Scientifically speaking, and to put things in perspective for my med readers, the brain CT report was significant for multiple skull fractures reaching the base of the skull, severe depression of a part of the calvarium deep into the brain causing midline shift, trans-tentorial herniation, and severely increased intracranial pressure with all of its sequelae.
We stabilized his vitals after 3h of fighting and 4 L of I.V. fluids.
The poor guy died in the ER exactly 48 hours later.

This is a small idea of the spectrum of sights and colors we see on a day at the ER. But what struck me the most is surprisingly not the patients. It was not the drama, the excitement, the rush of dealing with life and death. It was the patients' families. Why? It became apparent to me how everyone saw nothing but themselves, nothing but their own, and just dismissed everything and everyone else in complete and utter disregard.
As poor A. was expiring in Trauma 1., we were also handling a patient (in S2) with mild head trauma. He had been hit by a car at low speed and hit his head against the windshield. He was awake and oriented, and his studies all came back negative, so basically he was fine. All he had left was a small laceration on his forearm that we had to suture before we could send him home. Naturally when the alarms went off on A.'s monitor screaming that he was going into severe tachycardia and O2 desaturation, we all left S2 to go check on A. and see if there was anything that could be done. Obviously there wasn't.
Now imagine this. Coming out of Trauma 1, heavy with heartache and shaken to your core by your first ever encounter with death and a patient who slowly died in your hands, you and your resident take a tough walk out to the ER waiting room and make sure the parents know that their worst nightmares have come true; "we are truly sorry to have to tell you that your son passed away 2 minutes ago. There was nothing more we could have done."
Now imagine walking back into the ER, in that state of mind, to find an obnoxious old lady, S2's grandmother, in a panic, screaming at you and yelling all sorts of nonsense asking you how it was possible for "doctors" to leave his wound uncleaned, knowing that she was coming to see him. She hates the sight of blood apparently.
How could we? how could we have such disregard for her great presence and not have wrapped him up before we tried to help a truly dying person? I don't have an answer to that.
This was even more destabilizing to me when I thought back at A.'s parents' reaction when we told them what had happened. Actually it was not in any way worse than the old lady's panic. No. Even less dramatic in my opinion.

So is worrying about a loved one an all-or-none sentiment? Can anyone worry, but at the same time have as little as an ounce of consideration? Can anyone worry, but realize that there are priorities and that there are always people who are worse off??
The answer is, YES, worrying is an all-or-none sentiment. From the stupid prissy choir girl who came for a hand-cleaning session, to the exceedingly unfortunate A., rest his soul, brought in by the Red Cross with only a few breaths of life left in him, and to the mind-twistingly annoying and naggy fat boy who twisted his ankle and had no signs of injury remotely indicating even as much as an X-Ray, you will be surprised to see that the parents all act in the same craze, the same insanity, and the same "treat-my child-first" attitude. You will be surprised to know that sometimes it is even reversed, that families of patients in dire emergencies will seem more composed and cohesive than families of patients with petty scratches not even worthy of a band aid. And for now, this is what makes the ER stand out.

Tuesday, July 21, 2009

Patient Insanities on 10 North... Have a Laugh

Well I figured it was about time I shared some more stories about our dear patients on the surgery rotation. Here are the three cases that spring to mind... Actually there's a fourth one, but she deserves a post of her own so come back soon ;)

The crazed grumpy old man on 10 North.
K.H. has been driving all the floor insane for about a week now. Anxiety attacks, flamboyant claims and accusations that make me wanna scream out in anger... To put things in perspective, one of his latest complaints was having a nurse that smiled too [damn] much!! He even told her that to her face! Hilarious and sad... The poor guy has been one of the most complicated medical cases we've seen so far, with several operations, intestinal leaks and what not... Understandable? Granted. But it is still annoying, and yet funny in a marginally twisted sense, if you see what I mean, to hear him complain about things the world of medicine has never known, like diarrhea caused by walking!!

[Note]: "Patient is not doing very well, complaining of general anxiety and unable to tolerate hospital stay. He is pain free and is refusing to take his anti-hypertensives and anxiolytics by mouth. He refuses to ambulate for fear of diarrhea." Making sense are we? LOL
[Plan]: "Start I.V. Lexotanil"

The nice and healthy middle aged Man on 9 South.
M.D. is A previously very healthy, strong man. After extensive surgery, he seems to be recovering nicely, and is happy to see me every time I walk into his room. Always a good sign to see a patient greet you with a smile. It is so rewarding and puts an inexperienced mini-physician such as yours truly at ease and makes the job that much easier. I walk into the room, M. smiles and brags about how well he's doing, is always anxious to show me how good his breathing is getting, or how comfortable his lazy-boy chair is, with its fancy electric recline and foot support functions. Me, smiling "I wish I had one of those at home, Mr. D!!" It has been a pleasure following this one up. He's staying till the end of the week.
[Note]: "Patient is doing very well, tolerating regular diet, passing stools and flatus, ambulating freely and using incentive spirometer as instructed. Bowel movements normal, no pain or discomfort reported upon defecation. Patient is pain free and has no new complaints. Plan for discharge soon."

The distant old lady on 10 North.
S.D. was a 70-something-year old lady we followed up for about a week, some few weeks ago. I had completely forgotten about her, until I met K.H.
She had her own set of problems, like being too good to look at us med students, or letting us examine her without her attitude, or having not one, but two of her private nurses in her room taking care of her and making our lives miserable... Case in point: M. my colleague was about to draw blood from S.D.'s arm. It was her first time doing that, and she was looking for the vein, taking her time to locate it with some degree of certainty. After all, you don't want to poke her majesty for nothing! Some odd 20 seconds later, S. just lost her patience (bear in mind that M. hadn't even picked up a syringe yet!) and with her face turned away from M., called her nurse and said: "ta3e shoufe hayde shou 3am ta3mel sarla se3a!!" Translation "come here and see what this one is doing, it's been an hour!" Priceless!!
[Note 1 ]: "Patient is pain free as confirmed by private nurse. She is non compliant and refused to be examined, claiming that the nurses already gave her a physical."
[Note 2 ]: "Patient is pain free as confirmed by private nurse. Physical exam not done because patient is sleeping"

And for the record, all that the nurses do is take temperature and blood pressure and stuff like that so...
Difficult patients are a real challenge! I still need to work on that area! Something about them shakes my confidence! But they're funny to tell your friends about!

S.D. and K.H. ? a match made in heaven! We couldn't help but try and imagine what these two would be like living together! Imagine the children!!!
Those of you calling out outrage, relax. We're not making fun of our patients. It's not like that. It's just that these few cases are too entertaining to forget. So we document them! See? it's a noble cause! But seriously, they all get the same respect and standard of care... Rightfully so!


Monday, July 20, 2009

A Sunday From Hell

I had been dreading this day for a while. Sunday, July 19, 2009. Bidding farewell to loved ones, saying goodbye to friends. All on one day seemed like torture. And it turned out to be even worse.

This just in: friend and fellow blogger wondering: "Is it true that Lebanon is now nothing more than a pit stop?" This is a question to ask indeed...
I live here, I grew up here, and even for me this is just a pitstop.
For everyone who woke up one day and decided they wanted more from their lives than this place had to offer; For everyone who is contemplating the thought of leaving; nothing more than a pitstop. That Sunday, I said my goodbyes to my aunt in the evening, and to one of my best friends from childhood later that night... Very eloquently, this sucks.

Flashback to Sunday, late afternoon:

It was a long drive to Ballouneh, where my auntie N. lives. LiveD. Mixed emotions flying in the air. There was a distinct feeling, or taste, to that trip. Everytime we went on that noisy drive singing silly music and hopeless songs, there were great times. Barbecues, nargileh, and that sweet feeling of a family reunion every few weeks. Not this time though. This time round, this warm familiar feeling was overshadowed by foreseen grief and heartache. N. is going to Canada. She's taking her incommensurately adorable kids -this from a hardened official kid hater, remember?- and she's going to start a life somewhere else.

Somewhere where she won't have to worry about making ends meet every month, somewhere where people are actually people, somewhere... Don't worry, I'm not gonna start another tirade about our dearly cherished country, if one can call it that. No, I've done that before (read). What matters now is where she's going, and who she's leaving behind. This is the second time that this country has done this to my family. And what's worse is that it's about to do it again. I'm going to have to leave, again, for my residency. And that Sunday, this was always on my mind and I felt like I was suffocating.
My grandmother worse for wear, my grandfather's voice choked out of him as he desperately tried to hold back his tears, my uncles and other aunts in no better shape, and my tears clouding my last sights of N. and her kids, we left Ballouneh for a silent trip back to an insipid Beirut.

Goodbye N. We love you so much. We miss you already.

Saturday, June 27, 2009

Patients: for a change...

I am happy to report that the long awaited feelings of gratification, satisfaction, and sweet fulfillment have come through during these two past weeks of hospital clerkship (the first two weeks in Med III). This is it. What I have been waiting for since I graduated from high school, and even a few years before that, if you will deem meaningful the idealism of a foolish teenager and his noble aspirations to save the world one patient at a time. This quest, this mission, now surely tarnished by disillusionment and eroded by its relentless and savage conflict with the grit of reality, this enthusiasm, and idealism, or what's left of them, is what I am trying to salvage at this time in my life and career. The fact is, I can proudly say that at last, at long last, I have the power to do something about it. I, your dedicated and enthusiastic medical student, now have enough to work with to impact people's lives, no matter how limited that impact may be. Flashback 3 weeks ago: I was just another student in a classroom counting the seconds before it was time to head back home or to the pub for a few drinks. Now, for a fast change, things are different. Let me tell you the story of a patient who made me realize that.

N. is a sweet old lady patient I was following up. She was one sick lady, with heart problems, kidney problems, and diabetes. One of the many, many long term complications of diabetes is peripheral vascular disease. simply put, this means that diabetics have problems in their blood circulation and as a result, there is impaired blood supply to the lower extremities. Impaired blood flow means impaired oxygenation, impaired eventual wound healing, and impaired immunity in the affected area. This is why you see 'informed' diabetics and think that they're anal about foot hygiene. It's simply because they've been informed that even the smallest abrasion or cut to the skin of their feet could result in devastatingly painful ulcerations and invasive infections that could ultimately warrant the amputation of a toe, or even the entire foot or leg in severe cases. What makes it worse is Diabetic Neuropathy, another complication of Diabetes that impairs sensation in the lower extremities, meaning that any wound, abrasion, or developing infection in a hidden area could go undiscovered for months, without the patient feeling so much as a tingle. Read more about The Diabetic Foot and Diabetic Foot Care.

N. had had diabetes for many years, and after an ulcer between her toes failed to heal and got infected, she lost her little toe, which was amputated to prevent the infection from spreading further up her leg with dire consequences. The first time I examined N., she immediately reminded me of my grandmother (Read); an exceedingly sweet, but obviously worried old lady, more open to suggestion than anyone could imagine. Even long years of fighting with chronic disease, life saving operations, and medications, along with a roughed up body both inside and out, had failed to embitter this inspiring character. The best of it all is that all she had to do was smile.

After this introduction it's time I got back to the point I was trying to make. People like N., with limited resources, bad or no insurance, are usually treated and let go as soon as possible. This is the sad reality of health care today, and is something that I'll be sure to write about when time and inspiration permit. The bottom line is that after a successful operation, N. was about to be sent home with her foot well on its way to a full recovery. Sadly, no one really took the time to sit down with N. for a few minutes and explain to her what steps needed to be taken to avoid another visit to the operating room. My group and I (Myself, M, and G.) felt that we could do it. Why not? It is now our duty to care for our patients, examine them, and help in their treatment and convalescence. Why would we not be responsible of raising some awareness and help them also by preventive measures? We went to N.'s room and gave her a talk with a few crucial instructions on how to care for her feet. And yes, this is the essence of what I've been rambling about for the past 3,000 words or so. We did that, and I like to think that we DID make a difference in N's life. Only time will tell, but things are looking up.

M. told me a similar story about one of her patients. She felt the same as I did, but the feeling is a bit new to us. It's something that, deep down, you know is right and that you are 100% sure that you're doing the right thing, but that still feels awkward, for some reason, and you're always worried that it's not your place. Well, I think it is. And I'm sure that if we don't do it, no one will. If we somehow lose this enthusiasm, this 'flame' that sadly has burned itself out in all but the newest blood in the health care system, we can be sure that no one, especially not the hardened veterans with their cynicism, will kindle it back to life. And it is the patients that will ultimately pay the price. Who else?

I said goodbye to N. with a few last minute instructions and reminders, and she told me how grateful she was, and the last words she said before I left will stay with me for a long time.

"Ra7 a3mel metel ma eltelle ya 7akim!"(I will do exactly what you told me to, Doctor!) - said a proud and emotional N. ...

Sunday, June 21, 2009

And So It Begins...

One week into Med III and I've been wondering how it would be possible to sum up a whole week in one post. And not just any week. The first Med III week,the first week in med school remotely resembling anything that even comes close to being a physician.
Well in fact, sometimes when I think about it I feel that I haven't done anything quite so significant yet. But at other times, I also feel that every small step, be it the patient you so much as greet in the hallway, or the first EKG you set up, or every Once-In-A-Lifetime Choledochal Cyst (1 case per 2,000,000 Live Births in the U.S) Roux en Y Hepatico-Jejunostomy (Yeah never mind... Just something fancy ) you witness in the OR is now a decent step forward, a landmark, a mini checkpoint, if you will, along the way to becoming a fully developed physician. It's really hard to describe, but what I can say is that it's a whole new world, that's for sure, and there is absolutely no way of comparing it to the previous two years of classes and bookworm-ism so I'm not even going to try.

Getting ready for tomorrow, the 8th day into Med III and the General Surgery rotation we incidentally started out with, and already, I'm (and when I say "I" I mean "we") already feeling more familiar with the system. There's a certain satisfaction to it, to becoming one of the microscopic cogs on one of the tiny wheels in the at-best marginally well-oiled, Willy-Wonka-esque machine that is our hospital. We meet with and examine patients, write admission notes, follow up on patients after their operations, write progress notes, and suggest management plans that will be a new point of reference in the patient's chart. And the new in it all, I mean besides the contact and all, is that it feels useful. What I'm doing with what I've learned and what I'm learning is actually being used by my peers and superiors, to benefit someone in the end. I think that's the best way of describing what it feels like. In one word: just grandiose. And it's only when you realize just how much more there is to learn, how much more there is to accomplish, that your head starts spinning and you let it spin back down to earth and get on with what you're doing.

I just paused for a second, and thought about all the stuff I want to write here. There is no way this could all fit into one post. So if somehow I've managed to grasp your attention and interest, come back soon for more...

Sunday, June 14, 2009

Our Humble Beginnings... Who Are We?

It is a the end of this one-month vacation that I realize that we are at a new checkpoint. For those of you who remember, I was rambling about time and how we seem to be pissing it away by the years and decades without even wondering where it went. But today, I stand before you a changed man *grin*. Changed by the beneficial effects of that exquisitely inculpating farniente month that just seemed to rain down from the heavens. And is difference a beauty or what?

Here, we're contemplating the onset of a new, 2-year era, a new setting and a new context in our lives, as we peer through that door, ajar, on the threshold between books + exams on the one hand, and the patients + associated responsibilities + real medical practice on the other. On Monday, tomorrow, we begin our 2 clinical years, as well as the beginning of the second half -and end- of our medical training.
It is at this opportune time that I started thinking back 2 years ago. When Le and La Colleague were nothing but strangers to one another, and I thought I'd catch us up on how it started... For simplicity, I will be Le Colleague, and La colleague will be the "She".

Some time around the end of August, 2007, the first day of med school for 83 students from AUB, adding 2 from universities abroad. She was one of these two. The first time I laid eyes on her, I knew that our love story had begun. REALLY??? Wait it's that glass of whiskey talking. Let me rephrase. Hmm... let's see. She was hanging out with the wrong crowd -as wrong as it gets if you ask me-, she dressed funny but I've never told her, hair looked funny but I've never told her... -need I say more?- we were casually introduced, and I looked away and made no note of it, just another med student in the sea...
The next few days didn't get any better, as we had our first meaningful encounter at the Saab Medical Library. If memory serves right, someone was on the phone *cough* and another someone was all pissy and "please can you keep it down?" with a serious frown and "woe is me" (La Colleague 2007). It was all downhill until we had one crucial conversation at main gate during that skipped class (what was it again?); that conversation was to prove a landmark, a milestone without which no further contact would have been made. That made me realize back then: hmmm... we may be on to something there...

Here's to you...

Keeping the story short, we sure have come a long way since then, La Colleague became La Friend, and perhaps La Baby Sister (although there's nothing baby about her, so don't get me wrong on this) and now as we look ahead for even better times, I can't imagine how everything would have turned out if she hadn't been so interesting to talk to on that fateful day at the gate. Ups, downs, crazy days, relaxed times, easy sailing and rough seas, we've seen it all, and I don't see why anything would change.
I don't know about you, but it's just sinking in right now; the day before the beginning, before we start getting the feel of real medicine, and I couldn't be more excited if I tried. So here's to another 2-year batch of heaven and hell, and many many more to come.

Sunday, June 7, 2009

Elections, Lebanon, What do we really need?

For many months now, but mostly in the few days leading up to today, election day, we've all heard and seen countless ads, slogans, rebuttals, petty claims of corruption and some of the best and worst publicity we'd ever seen. I've hung out with people from all parties, listened to them discuss the elections, and what the other clan was up to. What they meant with this or that phrase, and what the hell they were thinking. Then I realized the disparity between what was at stake, and the level at which the discussions, verbal clashes, and even thinking were taking place. In fact, there was a distinct lack of mention of Lebanon in all these discussions. What the future held, what the REAL plans were for this country of ours that we're losing piece by piece. Instead, everyone was ecstatic when their clan rebutted the other clan's allegedly failed or misplaced ad. Everyone couldn't stop laughing and smiling when they heard their chief's distinct horn pattern. Keep in mind, that in arguing about the ads, and from a truly objective standpoint, both were right and wrong at the same time, but let's not go into that right now, because I think the arguments given by these people are too stupid to be a part of this post.

This brings me to the point I'd like to make. A point I and very few around me have been trying to get through. Also, I've been meaning to write about this here, but I have to admit that my lack of a respectable knowledge of politics has prevented it. I've often wanted to discuss and critique many key points that would come up on the news here and there, things my friends and I have talked about, but I never got around to it, because I never thought I'd be able to do it with enough substance. All I know is that the country's still being led by the same political leaders, thieves, murderers, and warlords that made it the shit hole that it is today. All I know is that their devoted followers are so goddamn blind that all they care about is how catchy their new slogan is or how humiliating that new advert is to the other clan. All I know is that this country is losing its youth, losing all its intellectual resources, and all I know, me, and my limited and stupid brain, is that there must be a reason behind this. There must be something that's being done that's preventing improvement, and leaving our problems like an open wound on an arm, gathering all kinds of infections, dirt, and parasites, to the point where amputation becomes the only viable option. All I know, is that very few people, if any, -and I am most definitely NOT a part of this few- can rightfully claim to have even the slightest idea on how to heal our country.

I came across something the other day that would do all this much better than I'd ever be able to. B. (My Marmite Guy) pointed out a video to me, a compilation of opinions and rants, denunciations and regrets expressed by a few prominent Lebanese personalities.
I will only post the trailer here, but please visit the link below and watch the whole thing. This is NOT some loser video with nothing but complaints and rants. It is a documentary and it starts and ends on a positive note, emphasizing hope rather than despair. I watched all three parts and each shook me to my core.

For the love of Lebanon, for the love of our future, please wake up.


TRAILER


Thursday, June 4, 2009

Adultery... Punishable by Death?

"At least eight women and one man are reported to have been sentenced to death by stoning in Iran.The group, convicted of adultery and sex offences, could be executed at any time, lawyers defending them say."

See the BBC article.

I heard about this on the drive to Beirut this morning. Not much was said, and I barely caught it on the radio so I wasn't sure what I had heard.
Now I'm reading about it and the more I read the more disgusted I am. I find it so difficult to believe that in the 21st century, we still hear about these sorts of things. Here are a few things I came across here and there while trying to satisfy my curiosity.

Monday, June 1, 2009

Air France: Missing plane probably crashed into Atlantic

Read more here.
Thoughts with families of victims.

Wondering how people deal with such horrific news about loved ones. Among the victims, reportedly, are 5 Lebanese passengers. 

Awful news.

Friday, May 29, 2009

A Rude Awakening...

Sitting on a bench on campus, doing some reading in the morning, and someone comes along to share wisdom. Happens every day? Not like this.
That someone was K., one of the AUB campus cleaning troops -I call them troops because the thought of how monumental the task of cleaning a university campus this large just baffles me.
So how to describe K.? The best way I can put it is to say that he reminded me of Abou Kamal from a while back. A bit younger, but the same expression, on a weary, yet friendly face that has seen so much, so many students, doctors, and professors passing by, most surely too proud to make eye contact, but a welcome few nodding in acknowledgment. The roughed up skin and the snow-white hair again spoke volumes on his behalf, like they did for Abou Kamal.
So as K. walked up to me, and after a friendly "Saba7o estez" ("Good morning sir") asked me it was OK for him to pick up a few spent paper cups left around my bench. "Of course" I replied, and with a few swift picker upper moves worthy of the seasoned veteran that he is, he had cleaned up the area. When he was done, he looked at me and went on a long tirade. He opened with: "oh yes, son, education will give you your life". And from there he went on to tell me his story. Here's what I can manage to translate for you.

I've seen K. around campus many many times, as -apparently- he's worked at AUB since years before I even graduated from high school. He comes from a poor family of 9 children (if I remember correctly), and he talked about how his father could barely afford their everyday expenses, let alone provide them with a proper education. K. was out of school at a very young age, and had gone away against his dad's will to try as he could to get decent jobs here and there. Cleaning, construction, he had done it all by the time he was 18. He had started out at a construction site near the Golf club at Ouzai. 
After a quick biography, K. ended his speech with words that I will not ruin in translation. I was looking at him, and I was lost for words. What do you say to something like that? For a split second, I imagined myself saying how much it sucked to still be a student at my age, or how bad we medical students had it, but this was a brief moment of imagination. Very brief. How inappropriate! I don't remember what I ended up saying, but it was nothing too meaningful, as I blathered out  some insipid philosophical statement about life and how there's always worse off people.
So there I was, thinking about how I (and we all do) had been taking everything for granted. All I ever did was whine about how hard it was to grow up, how bad it was that we had to study for our stupid exams, and it suddenly hit me that I had never really stopped to think about what a blessing it was to actually be learning. I mean I have always loved learning, and wouldn't have it any other way, but I had never thought about it under this light. The difference in perspectives between myself and poor K. at that moment struck me silly (I do NOT mean to say that I felt pity for K. or that I felt superior in any way so please don't misunderstand me). 
This conversation reminded me immediately how quickly and deeply we get cocooned in our entourage, our environment, our everyday silly worries, whatever these may be, in such a way to somehow completely forget about the more unfortunate, the less fortunate, and about what real problems other people may be worrying about, and how disproportionate, if that's a right word to use, these two worlds are. 

This has been a learning experience by itself. Talking to K. felt like a shot of wisdom and perspective on life from the least likely source, and I'm going to keep it, even if I know for a fact that next year (which starts in 2 weeks), I'm going to be whining about the difficulties of medical training, about how people drive like cattle in this country, or how I can't seem to find time to go out for drinks and dinner. But one thing's for certain, K. will be on my mind when I do and I'm sure the thought of it will slap some sense back into me.

This could not have happened at a more appropriate time, for reasons that I will not discuss, and this has made me think about the whole "it's a sign" or "it's meant to be" philosophy, which as I've commented on Posh's post (read it and you'll understand), I am completely against. Nothing has changed in that department, but it got me thinking.

Saturday, May 23, 2009

The Most Expensive Shawerma in Lebanon...

S. Told me about this place, and for hours before we even got close to that little corner of heaven, I was anticipating what it would be like. I know this is not new and that I haven't made a world-altering discovery, but it is the first time I've heard of it. 
It's called Shawerma 3al Fahem (Chargrilled Shawerma), and the name says it all... To the shawerma lovers who have not tried it yet, pack up and go right now I tell you!
It is right next to falafel Sahyoun on the street leading from Sodeco Square to Downtown beirut. 
So how was that sandwich? It was a costly one to say the least. This little taste of shawerma heaven, is gonna run you anywhere between 4,000 LBP and 80,000 LBP, plus a confiscated driver's licence... How?? 
Choose from the following items:

Item 1 -  The 50,000 LBP traffic ticket, if you're unfortunate enough (like I was) to be U-turning from the parallel street going the opposite way, and you somehow choose to make that illegal U-turn to save a few meters on your odometer, and a few precious moments of anticipation before you get there. Make sure you call that over-zealous cop, with his newly found preoccupation with our dear traffic system's proper functioning, greater good kind of stuff, and have him amicably fill out the paperwork and confiscate your driver's licence. He's sure to be there, in some wickedly strategic position, hunting for wrong-way outlaws!

Item 2 -  The 20,000 (is it more?) illegal LEGAL PARKING ticket: Now that you're done fighting with the officer that gave you the 50,000 LBP ticket, confiscated your licence, you have to find a parking spot. All you have to do is park right in front of the shawerma place. Now you have two options. Option A: to obtain item 2, all you have to do is park your car, shut your windows, lock your doors, and enjoy a happy shawerma meal. You will come back to find the item delivered. Option B: to avoid item two park your car, leave your windows open, and your blinkers on otherwise you will be smitten by the long arm of the law.

So ... for me it was item 1, plus 2 sandwiches (4,000 each, too small for just one to be enough!). Do the math. That's one expensive Shawerma place if you ask me! 

Worth every penny, but if you're not willing to pay this much, take the longer road, or don't drive there, and take care while parking! Cheers.

Thursday, May 21, 2009

Overheard

Two guys in the gym...

Guy 1, with the heaviest Lebanese Americanized accent- "Yeah yeah man, I studied really well for this exam" so it's like.... akhou ekhta ya3ne!!!!
Guy 2 - "Jnoun"

hahaha gotta love it!

Wednesday, May 20, 2009

The End of Med II - A Rough Start...

There could not have been a worse start to a summer vacation. Especially this one, supposedly a godsend toward the beginning of the end of the 7-year medical curriculum, a turning point in the way evertyhing is done. No more classes or stupid exams, only hospital clerkships and real healthcare work -if we can call it healthcare in this country, not really,  but I digress... A month's vacation after a year of hell. If I were to find a way to relate to you what this feels like, I'd tell you to imagine being held captive and tortured with electricity, razor blades, and dripping water for a whole year (because that's all that Med II turned out to be), and then instantly and with absolutely no idea of what's going on, being released on a sandy beach on an insanely sunny day, favorite drink in hand, and then somehow having all the relief, the abatement of torture, and the solace one should find in overcoming such an enormous obstacle, somehow wane and wither in your disbelief-stricken face. Somehow, and quicker than I could realize, something got lost, something just didn't feel right, a few things happened that were not supposed to, more than one thing, actually, and that turned the whole experience inside out. I don't feel it anymore, and I feel that all the hype, the expectations, the hope and anticipation that led up to that Friday when it all ended, have all been turned inside out and their bad parts exposed. Much less excitement now, much less expected.
If I have learned one thing from all this, it's that some realizations stop you in your tracks, like when you realize that you have a bad case of the stockholm syndrome, while others seem to get you going, if only for a little while before they atrociously live up to their time-proven tendency to turn back and bite your hand when least expected, so be ready. 

Be ready... It's time I learned that, but this hit me like a truck going 1000 miles an hour.

Monday, May 4, 2009

"Quelque chose de pas très propre" . . .

"Quelque chose de pas très propre" -translation: "something that's not so clean"- said A. with a trembling, worried voice over the phone. It took me a few seconds to realize what on earth she was talking about. And I still had to ask her, I wanted to hear it.  "You know what I'm talking about", she uttered in a shy, now reserved voice. 
So that's what they're calling it now? She caught me off guard, I have to admit. I had heard all kinds of nicknames, from the shiest "haideke" (the other one) to the boldest "el marad" (the disease), but never had I heard about cancer being called "something not so clean". It came as a shock; I have known A. all my life. In fact I grew up under her watchful eyes, ate her wonderful cooking, and she tucked me in countless times, I watched her get sicker and sicker over the last 15 years of my life. Fighting asthma, diabetes, repeated hernias, age that's getting older and older, A. looks weary, as she barely stands, 70 years old, and a mere few steps away from giving up on living in a body so spent. We talked many times of her diseases, and I reassured her as much as I could, listened to her complaints and resignation to a disease-laden life, but I had never heard her talk about that 'unclean bastard' before in my life. An awakening? Fine, call it that. It hit me like a truck, that's all I know. 
Lately A. has been calling me regularly to report what her doctors have been  telling her. She has more faith in her grandson and future doctor, I guess. All the tests she'd been getting done, the results and what they meant. Her recent worry has been a chronic anemia, her hematocrit having dropped to the low 20's. She and her doctors have not been able to treat it effectively despite supplements and diet considerations. This means that there has to be a loss of blood somewhere. Gastro intestinal tract bleeding is a prime suspect in these cases, and the doctors ordered an endoscopy.
-A: "I am scared, R., really scared of the results"
-R. "What results ya A.? what are you talking about? You haven't done anything yet!" 
-A: "That there may be something not so clean in there my boy"
-[...]
-A: "You know what I'm talking about"

A. is on more medications than I could count on 2 hands and 2 feet, I don't even know what conditions they're supposed to treat and control. The first time she talked to me about her intractable anemia, I thought "bleeding ulcer"; all these meds can't be doing her stomache or intestines any good. I have to say I never even thought about cancer. Denial? I don't think so. But may be... No, surely not... 


Wednesday, April 29, 2009

One Gets to Thinking...

Hey it's been a while! Been a long couple of weeks in the fast lane. That's the worst when you realize that all this time was supposed to be cooling off time... Things are a bit calmer in academic life, ergo you have more time for yourself, your blog, you know, the usual free time stuff... But no, I don't know why, but things have been different lately. I don't mean to sound like a broken record, but time is just flying away, and I've been realizing that more and more acutely lately... And, apparently, it's not because of studies and workloads. I don't like this...
So I've been trying to muster some stuff to blather about on here a couple of times over the past few days... Struggled with a bad case of blogger's block I guess. That is, until I found myself alone in a borrowed apartment, and there's nothing like that to get the ideas flowing...
So it's a cool small flat in Hamra, and it belongs to a very close family friend, C., who is away on vacation. C., knowing how much I struggle with the daily commute, the daily parking hassle/expenses, kindly and generously offered to lend me her place for a few days. Much appreciated. Previously a skeptic, I now know and understand the blessing that it is to have a place close to where one works/studies. You can wake up an hour later than usual and come home an hour earlier. You can come home for lunch, for a midday shower if you feel too sticky in the summer heat, it's just amazing how different and easier everything seems to be.
The first time I walked into C.'s apartment, I loved the colors, the black leather couches, the rugs, and the mixture of European and Middle Eastern influence in the choice of furniture and wall decoration. Look at one wall, you see an artisan mirror with Arabic calligraphy. On another, a beautiful Cézanne. In the living room, beautiful copper ware on a traditional wooden table seems to match perfectly with the modern tiling.
C. is a French immigrant, working in Lebanon as a French teacher in a prominant school. Her culture and background are vividly depicted in her choice of furniture, books, and art. When I asked M., she said it was obvious that whoever lived here was a foreigner. So many Eastern articles just screams it I guess... But C. has found the perfect balance between these and leather couches, modern flooring and colorful curtains and lighting. I love this place. C., Merci Beaucoup de ta générosité :)

So here I am, wasting more of my time, typing away on a soft couch, soft rock playing in the background, as I ponder what tomorrow and the days after that hold. The studies, the family's finances, the lovelife and whatnot, one watered-down glass of whine at a time... I need to live alone again.

Get off the streets....!!! Another plea that no one will hear...

To all you ladies out there that cannot seem to find any time in your busy schedule to apply makeup that is more convenient and safe than while you're driving. To the beauties with freshly issued driver's licenses and brand new cars, and the less blessed and less fortunate Venuses driving your asses off into beautiful sunsets (or walls). Please, I implore you, TAKE A F!@#$%G CAB for the love of God!!!

I know that:
- 100% of feminists among you (women or men, weirdly enough; hey, you never know!)...
- 80-90% of women among you (see the remaining 10-20% below)...
- 1% of all men among you...
... will think I'm a sexist bastard who does not know what he's talking about. Well you would wouldn't you? Yeah...

But I also know that:
-10-20% of women among you...
-99% of all men among you...
... will think this is something everyone knows and that proper action needs to be taken to ensure everyone's (and that includes you ladies) safety.

Why? I don't know why. How come? I don't know how come. I don't know how, why, when, and with what twisted, insane, moronic agenda, nature simply decided that women would not get the driving genes. What matters is that She did. We've seen it all! The ones screaming into cell phones, those (classic) looking into the purposefully-readjusted rear-view mirror, thinking "Oh why is it that when I look into that thing, I see cars behind mine and not my beautiful face??" *tires screeching in background* Well they've dealt with that one!

Check out this video. Watch every second. It's just too funny, and says everything better than I can :D

Thursday, April 16, 2009

Today Is Mine, All Mine!

I woke up about a half hour ago. Today is the last day of classes before a our long ‘vacation’; another word for Friday and Monday off, prolonged weekend if you will. Med II is almost over. Most will tell you that it’s all downhill from there. 4 exams left in the countdown, that’s four more weeks of hell and it’s over. We made it. I can feel it, I can smell the clinical years coming! I’m too tired to get up. Yes, way too tired to get up, take my daily morning shower, get in my car, let the engine warm up for 4-6 minutes, drive 20 Km, 15-20 minutes, park in that extravagantly overpriced underground parking lot, get the [first of my two daily] poisonous double espresso[s] from Fadi’s (coming soon), waste 30-45 minutes either with M. when she’s here on time, or in the computer lab, and go to class from 8:00 to 12:00 am, have lunch, and go to class again from 1:00 to about 4:00 pm depending on what day of the week it is. What more can I expect from just another day in college? What else? what, other than the relentless tide of expected events and incidents, usual occurrences and pleasantries, hypocritical moments, complaints, and whining? Not much.

DSC04647

You know what? I’m not going. Screw this. As you can probably see I spent the better half of yesterday snapping pictures in class with utter disregard to our lovely professors and their feelings. There’s no point in going today. I need a break. A long one, we all do. When the end is so close, you just feel like letting go. I want to let go. Today, I’m getting in my car, and taking a different road, because I can, because I want to. I don’t care what happens, or how the day unfolds, it’s all on the table. I’m buying DVDs, seeing an old friend, driving senselessly, I don’t care, today is mine and I’ll do anything with it that I see fit.

DSC04654

Pictures taken: April 15, 2009, 9:03 PM.

Can you tell what I’m writing? That’s it. I’m going for it. It’s done. Going outside to check what’s the weather like…




No. I don’t like the weather… Pretty bad-looking clouds threaten… But it doesn’t matter. It’s all in the mood. M., oh colleague, sorry I ditched you. This reminds me of that day we don’t speak of! :)

Tuesday, April 7, 2009

Written by Jason Wade and dedicated to lives lost to traffic accidents... Drive Safely




Lyrics

So far away from where you are
These miles have torn us worlds apart
And I miss you
Yeah, I miss you

So far away from where you are
I'm standing underneath the stars
And I wish you were here

I miss the years that were erased
I miss the way the sunshine would light up your face
I miss all the little things
I never thought that they'd mean everything to me

Yeah I miss you
And I wish you were here

I feel the beating of your heart
I see the shadows of your face
Just know that wherever you are
Yeah, I miss you
And I wish you were here

I miss the years that were erased
I miss the way the sunshine would light up your face
I miss all the little things
I never thought that they'd mean everything to me

Yeah, I miss you
And I wish you were here

So far away from where you are
These miles have torn us world's apart
And I miss you
Yeah, I miss you
And I wish you were here

Monday, April 6, 2009

Another Sunday Night, Monday Morning?

Yes... here we go again. And no, I'm not whining this time. Wow! Is it numbness to stress? Learned helplessness to the runaway clock? No, not really. Just feeling indifferent and disinterested this time around I guess. When I stay up late in my room, I feel like I'm getting hints of what's going on outside during the late hours of the night. These samples come in the form of distracting but interesting noises ranging from the rumble of an 18-wheeler driving by Southbound, to the engine screams and tire shrieks courtesy of that maniacal neighbor in his "watwat (Arabic for 'bat')" Beemer (Lebanese Jargon for the late 80's model BMW 3 Series Coupé) driving donuts round the conveniently empty intersection a couple hundred meters from my home, to the essentially worrisome, reassuringly distant, but worryingly nomadic sound of machine gun fire disturbing the peaceful moonlit night (YES, true story!). Did I mention it was past 3:00 am? Quite interesting, really! Most days of the week I'm fast asleep, clenched fists, and completely oblivious to everything that might be going on outside! I should do this more often!
For the curious among you, here's what my desk looks like tonight. Quite the way to spend the better part of the night, huh? I want to be about 20 Km away, drink in hand.

Ok enough with the night-time daydreaming. The noise has subsided. Screw this week's exam I'm going to bed!

Wednesday, March 25, 2009

I Got Marmite!!

DSC04508About fifteen years ago I was introduced to Marmite, a pungent-tasting spread that can be had with just about anything from cheese, vegetables, to peanut butter on butter toast. It’ll spice up anything you can throw at it! The first time I tried it I was in Cyprus as a guest at a friend’s place. Breakfast was cereals and milk, fried eggs, grilled toast, and there was this funny looking little jar with a funky yellow cap. “This is marmite, the mom said, it’s a bit strong, but it goes well with peanut butter and toast!” I’ve always liked strong tastes so I took her advice. The chemistry was amazing, and It’s been a love story ever since! I came back to Lebanon and slowly forgot all about Marmite until it came up in a microbiology class a couple years ago; I was astonished and fascinated to learn that Marmite was actually a yeast extract and a by-product of beer brewing. Flash forward 2 years, one of my expatriated friends, B., who's living in London flew in for a 2-week vacation. Wouldn’t you know it, I – and a couple of my friends who got infatuated with the idea of Marmite before even tasting it – were begging him to get us a couple of jars 10 days before his flight. It was a thing of mystery for them. I had built it up so much!

I got an email from B. describing the reactions of the people around him back in London. A couple fought over it for a while as he stood and laughed, listening to their eloquence in describing their love/hate of Marmite.

-Girlfriend: “Is that Marmite in your hand?”

-B.: “Yes why?”

-Girlfriend: “and you do know it tastes like sticky shit right?”

-Boyfriend: “Oh no no don’t listen to her! I think it’s great!!”

-Girlfriend: “Oh my God it’s shit! It’s a complete waste of toast!” […]

-B.: Laughing.

Marmite1So there’s no question about it. Marmite is definitely something you either love or hate. And during our little degustation session at a local eat-in, the reactions to the pungent taste and dodgy smell made that all too apparent. Some hated me for raising their expectations so much (yes, they took it personally haha), others were more pleased… And then we realized that the company had a website, we visited and its love or hate turned out to be a worldwide dispute. Strong feelings either way:

Found under the “Squeeze Me” section: “Eat Marmite? You don't just want to eat it, you want to bathe in it, wallow in it like a hippo in mud, slather yourself from head to toe and wrap yourself in bread and butter... And you know what? That's fine. Just fine. Completely normal in fact...”

Found under the “Squash Me” section:Eat Marmite? You'd rather rip the wings off live chickens. You'd rather be stripped naked in public. You'd rather swallow rat's tails and snail shells... Enough already! We get the picture. And yes, you're in the right place...”

So the next time you’re in London, Cyprus or wherever, or have someone flying in from there, make sure you ask for a jar of that little mixture of heaven and hell. You owe it to yourself to try it, and decide if you have the guts and taste buds for it. And who knows, maybe we’ll be importing it soon. Just make sure you research the recipes, their website is hilarious.

Just be careful with the dosage, it’s some strong sticky shit you’re dealing with!

Tuesday, March 24, 2009

Overheard

Overheard at the AUB cafeteria:
-Guy: "Hii! Kifik? Ca va?
-Girl (Huge Smile): "Salut toi! I'm good, enta?"

I'm confused !

Monday, March 23, 2009

Now Two Different Persons...

I remember the hype right before the Christmas break last December. I remember how I felt, on our last day of classes before our 14-day (or so) break. (Needless to say that a 14-day break in Med School is nothing short of a trip to heaven).
I felt light. Relieved. Granted, It was not my first time looking forward to a long awaited, much needed break, and yet, the feeling was unique in a way that I cannot put to words. December 24, 2008, we went out for lunch, a bunch of close friends/select classmates, meeting with expatriated childhood friends who had just flown in from respective countries, and the atmosphere was just fantastic. I felt light. relieved. I felt different, and silently baffled at how good it felt to feel different, and how long it had been since my last similar moment. A glass of wine helped. Later on it took a bunch of my friends, who noticed the difference, a few minutes to describe to me how they saw me from the outside. They said I was a different person when I was taken out of the academic atmosphere. The atmosphere of constant stress, constant information binging, and constant evaluation and scrutiny. Apparently there are more smiles, pleasantness, jokes, and less worrying. That made me a different person. So what's unique about that? Everyone is different under stress right? The problem is, this was the perception that I had of my personality, and it was supposed to be the case no matter what the context. My affect in this atmosphere was supposed to be unchanged no matter what. I made sure of it, and was complimented on it by many friends. I am now different. Apparently I cannot maintain my laid back character anymore. Things get to me more easily now.
When did I change? How and when did I change so much? And could I have changed so much without even noticing? Not the slightest clue! I don't know... It's hard to sum up, and hard to pinpoint exactly when or how this change occurred. That's Med School for you. I guess the last 2 years of my life have gone by in a flash. And a flash may even be too long... that's how fast, yes. I can't help but carry this thought further back into the dark alleyways of my memory and try to remember the last 'checkpoint' in my life that feels genuinely distant in time. I can't find one. I could wind up all of the 26, soon to be 27 years of my life in a heartbeat, and It's a frightening feeling.
So here I am, on another one of my late-night musings, typing away with a Gastro-Enterology book obstructing my reach, thinking that oddly enough, it is now Monday morning, rather than Sunday night, rather than Saturday afternoon... Where did my weekend go? Might as well have been last Monday, the one before that or the one before... Same difference... Yes, here I am, Monday, March 23, 2009, at 1:35 AM, with a lost track of time, anticipating (for a change) the change that I'm about to exhibit "tomorrow": Friends have flown in, exams will have let off for a little while (Upcoming exam in exactly 6 hours and 25 minutes).
I wonder what's in store this time...

Saturday, March 21, 2009

On n'est jamais trop grand pour chuchoter "Maman"

... Les trois petits cochons
Reconnaissent la saison
Où les fleurs poussent sur le gazon
Alors ils sortent de la maison
En chantant une chanson
Qui dit: "Nous t'aimons"
A la Maman de la fille et des deux garçons.

Ils lui offrent des bisous
Qui s'en vont partout partout
Pour qu'elle n'oublie pas surtout...

...Qu'on n'est jamais trop grand
pour chuchoter "Maman".


From sister to mother...

Happy Mother's day.

Friday, March 20, 2009

Rien Ne S'arrête.

Here it is March 20, a long way from March 20, 2008...

And as I struggle to relive those carefree days, I sit and wonder, when did I stop having time? The one thing we are sure to have, the one thing we take for granted. I lost it. I lost Time. I lost the absolute concept of it.

Medical students are so consumed by their lifestyle and their studies, they forget that unfortunately the world is still evolving. Until it hits you. Until you get that phone call that your friend died, or that A. needs to go to the hospital because his cancer metastasized. What do you do next? How do you explain to your teacher that you couldn't study, or that you cannot attend said lecture or exam because A. could only see his physician at that particular time. How do you manage? How many times will you curse that garbage truck you're stuck behind because it is stealing precious minutes of your once insignificant time. Minutes you started counting and regretting once it was too late, once you realized they were gone.

Rien ne s'arrête
D'autres vies continuent
D'autres parler sans taire
Pour ceux qui se sont tus
Rien ne s'arrête

--Patricia Kaas, Rien Ne S'arrête.

Thursday, March 19, 2009

A reminder of what is perhaps an ongoing childhood...




I came across this song and it sent me back 20 years... To our old house, our old Lebanon... A childhood well-lived, and it's all coming back...
Aznavour is just amazing.

Lyrics

Je n'aurais jamais cru qu'on se rencontrerait
Le hasard est curieux, il provoque les choses
Et le destin pressé un instant prend la pause
Non je n'ai rien oublié

Je souris malgré moi, rien qu'à te regarder
Si les mois, les années marquent souvent les êtres
Toi, tu n'as pas changé, la coiffure peut-être
Non je n'ai rien oublié

Marié, moi ? allons donc, je n'en ai nulle envie
J'aime ma liberté, et puis, de toi à moi
Je n'ai pas rencontré la femme de ma vie
Mais allons prendre un verre, et parle-moi de toi

Qu'as-tu fait de tes jours ? es-tu riche et comblée ?
Tu vis seule à Paris? mais alors ce mariage ?
Entre nous, tes parents ont dû crever de rage
Non je n'ai rien oublié

Qui m'aurait dit qu'un jour sans l'avoir provoqué
Le destin tout à coup nous mettrait face à face
Je croyais que tout meurt avec le temps qui passe
Non je n'ai rien oublié

Je ne sais trop que dire, ni par où commencer
Les souvenirs foisonnent, envahissent ma tête
Et le passé revient du fond de sa défaite
Non je n'ai rien oublié, rien oublié

A l'age où je portais mon amour pour toute arme
Ton père ayant pour toi bien d'autres ambitions
A brisé notre amour et fait jaillir nos larmes
Pour un mari choisi sur sa situation

J'ai voulu te revoir mais tu étais cloîtrée
Je t'ai écrit cent fois, mais toujours sans réponse
Cela m'a pris longtemps avant que je renonce
Non je n'ai rien oublié

L'heure court et déjà le café va fermer
Viens je te raccompagne à travers les rues mortes
Comme au temps des baisers qu'on volait sous ta porte
Non je n'ai rien oublié

Chaque saison était notre saison d'aimer
Et nous ne redoutions ni l'hiver ni l'automne
C'est toujours le printemps quand nos vingt ans résonnent
Non je n'ai rien oublié, rien oublié

Cela m'a fait du bien de sentir ta présence
Je me sens différent, comme un peu plus léger
On a souvent besoin d'un bain d'adolescence
C'est doux de revenir aux sources du passé

Je voudrais, si tu veux, sans vouloir te forcer
Te revoir à nouveau, enfin... si c'est possible
Si tu en as envie, si tu es disponible
Si tu n'as rien oublié
Comme moi qui n'ai rien oublié

Sunday, March 15, 2009

I spoke too soon...

I felt it was too soon to celebrate. Too soon to speak, revel and bask. Almost 4 months and she went behind my back. She could not take it any longer and she went behind my back. I understand.
I had gotten her to stop and I was ecstatic. What a shame.

Now starting over from day one.

I feel gutted...

Monday, March 9, 2009

"Hypocrisy is your religion, falsehood is your life..." - Gibran Khalil Gibran

A contribution from a friend of mine. It goes something like this...

"an excerpt from Gibran Khalil Gibran's eternal and ever-applicable words:

...What is it that you seek, My
Countrymen? What ask you from
Life, who does not any longer
Count you among her children?

Your souls are freezing in the
Clutches of the priests and
Sorcerers, and your bodies
Tremble between the paws of the
Despots and the shedders of Blood

Hypocrisy is your religion, and
Falsehood is your life, and
Nothingness is your ending; why,
Then, are you living? Is not
Death the sole comfort of the
Miserables?

Life is a resolution that
Accompanies youth, and a diligence
That follows maturity, and a
Wisdom that pursues senility; but
You, My Countrymen, were born old
And weak. And your skins withered
And your heads shrank, whereupon
You became as children, running
Into the mire and casting stones
Upon each other.

Knowledge is a light, enriching
The warmth of life, and all may
Partake who seek it out; but you,
My Countrymen, seek out darkness
And flee the light, awaiting the
Coming of water from the rock,
And your nation's misery is your
Crime...I do not forgive you
Your sins, for you know what you
Are doing...

Gibran's words are revived with the coming of the 2009 elections, the results of which will bring back the same tyrants, maybe in different proportions.. what does it matter anyway? They are all the same. And Lebanon will remain a shining example of a country with divine gifts and a potential unequaled by any other country, struggling to be even called a country..
we have no one to blame except OURSELVES. "

Thanks N.

Pediatrics... Uh-Oh!

I've been wanting to write this for a while now but it's just been a hectic couple of weeks what with the classes, both skipped and attended, the exams, both near misses and lucky escapes.
So here's another foray into the earliest clinical experiences and their impact on a confused med student shopping for a marginally successful career.

I've always struggled to understand kids. I'm only consoled by the mutuality of this feeling when it comes to my younger brother and sister, my younger cousins etc... There's always been animosity and for a reason. I don't seem to get them. Trouble inexorably ensued!! For me, as far as kids are concerned, no one could have said it better than the late Bernie Mac: "...Oh shit come help me babysit these m*****f******s..."! I know that to the baby lovers and kid huggers among you I'm gonna sound like a Neanderthal but I'm banking on an outside chance of a few of you feeling about the same way that I do; so I'm out on a limb I guess...

10:15 am - Visit # 1 - The Regular Checkup for the Obnoxious Fat Boy
Phase 1 - 5 year-old kid walks in with his mom. A 2-minute dialogue between the physician and the kid's mom about diet, playtime habits, and vaccines follows.
Phase 2 - Physician invites kid and mom into exam room.
Phase 3 - Kid enters battle mode and seems to latch on to his mother's leg in a grip worthy of the most intractable centipede dead-locks!
Phase 4 - Kid is now on the exam table - don't ask how that happened - screaming his little butt off while physician desperately tries to hear something in between the groans and moans with the stethoscope, as the kid gasps for breath.
Phase 5 - Physical complete. Physician calls for the nurse with the vaccines (I named her the Shoot'em'up lady).
Phase 6 - Shoot'em'up lady comes in, tray in hand, with 2 shots worth of vaccines. "One in each arm please", says physician.
Phase 7 - All hell breaks loose as Shoot'em'up lady pricks the kid once and another time. Me watching, worried that the little demon's gonna fidget one time too many and break the needle off in his flesh with dire consequences. Shoot'em'up lady's job? Not for the faint hearted!
Phase 8 - Shoot'em'up lady in the sweetest of voices: "there all done! That was not that bad now was it?" Me in the corner, trying not to puke.
Phase 9 - Physician declares the session over, gives the kid a lollipop. On to the next one!

10:35 am - Visit # 2 - The Regular Checkup for the Demonic little girl
Same as above. Please replace "5-year old" with "4-year old", "mom" with "dad", "his, he, him..." with "her, she, her...", and "all hell breaks loose" with "My eardrums burst" and that's about it, all the rest is essentially unchanged.

10:50 am - Visit # 3 - The Regular Checkup for the Sweetest Thing that Has Ever Existed (now that's a change of pace!)
A 2 month-old baby girl with the face of an angel. Brought in by her mom and grandmother. Onto the exam table after the formalities of phases 1 and 2, she lay silent, her fists clenched and her tiny arms and legs twitching from time to time. Her big grey eyes desperately looking for something to focus on apart from the bright overhead light. The physician examined her, looked at me and said suggestively: "she has a very faint murmur you should hear." Even her guardians were nice and joked around, and actually acknowledged my presence, something no other parent/guardian managed to pull off, the physician's failure to introduce me as his apprentice notwithstanding, talk about professionalism! Would it be too much of an effort to say this is R., He's going to be learning with us today, please don't be freaked out by his curious eyes... but I digress... So here I was, awestruck, in front of a silent pediatrics patient, until, you guessed it, Shoot'em'up lady came in and screwed everything up with one little prick.

11:05 am - Visit # 4 - The Regular Checkup for the 2 Girls From Hell
This one was a bit funny, I have to admit. The older of the two went first. After a typical phase 1, phase 2, and phase 3, came a rather peculiar phase 4:
-Physician: "Let's see what's in your ears now all right?"
-Little girl, tears in her eyes, pouts and answers: "no. there's nothing there I checked!" I cracked a smile.
After going through phases 1 through 8, with the ruckus and the rivers of tears I had now adapted to, she looked at her sister (now in phase 4, the worst) who was screaming so hard that I was afraid her eyes were going to pop out. And then, in a condescending tone, one that flaunted her newly acquired wisdom to her sister, she quipped: "khalas! ma 3am ya3mellik shi! lesh 3am tebke??" translation: "Stop crying! what's the problem they're not doing anything to you!" I couldn't help but laugh, look at the Dad and say "oh, now she's wise!". The dad nodded, threw a fake smile my way and went on to talk to the doctor.

That visit ended at around 11:45. Another short uneventful visit (uneventful only meaning not any more eventful than the other visits, because you may imagine that there is no such thing as an uneventful visit to the pediatrician's!) and it was time for me to head out. And as I was getting ready to do so, the attending, having noticed my expressions of boredom and anguish, smiled and said: "It's a lot of repetition, this specialty." So I smiled back and said nothing. What could I say? "Yeah Doc it was nice watching you play and toss your stethoscope up and down while the nurse did all the real work" ? hehe no, I don't think so.

For me, it was an interesting experience, to be honest. Sure, for the most part all I could do is think about the best ways to shut the kids up, and these included hammers, fists, screaming in anger, but also, I have to admit that a nice strawberry lollipop and a reassuring kiss on the forehead went a long way sometimes. So what am I saying here? Hold on... I'm not so sure anymore! I mean when I started concocting this thing you're reading I imagined it ending very differently. Somewhere along the lines of "Kill the bastards", or "Fucking kids!" or... you get the drift... But as it turns out, I am just realizing now, as I'm typing, maybe I don't hate the little buggers as much as I used to... Maybe I did think that the little wise-ass girl was funny and cute, or that the helpless silent baby girl was just to die for... I must be growing up. Go figure. Well some of my closest friends would say: "it's about time"...

Saturday, March 7, 2009

I got her to stop...

On a long afternoon drive home, she looks at me, tells me to grab her purse and take out her 2 packs of Lights as she pulls the car over to the side of the road right next to a garbage receptacle. "Throw them out" she said. I looked over in disbelief, wondering speechlessly if it could have been so. Could it have been? that after 30 odd years of smoking, she had finally decided it was time? Time to finally listen to me? Time to be sensible? It appears as if my tantrums, my rants, the wicked looks I gave her whenever she lit one up, the fights, the ruined lunches and dinners, my desperate pleas urging her to consider the consequences of the worst case scenario, had finally paid off. It took a few years of fighting, but she had opened her eyes, and she could see...
3 months now. Going strong. Fingers still crossed.

Tell That To The Patient!

Presenting Le et La Colleague on their glorious day off.



What do two model medical students do when it's sunny out?
-They ditch med school and head to Faraya!

Is this perfect or what?



I thought it came together perfectly!