Blog Photos

Saturday, February 28, 2009

One thing I remembered...

Picture Taken: Friday, November 21, 2008, 12:38 PM

My last post reminded me of something I wanted to write about a few months back; sort of in the same 'mood'. To your left is a rather large caliber hollow-point bullet that I found embedded in a wall on my balcony at home. I wanted to dislodge it and keep it as a souvenir, but the prospect of it exploding and blowing my fingers away, however unlikely, has persistently kept me from fiddling with it. A nice close-up will have to do...
Who knows where this came from, how far it traveled, who fired it, and what/who it might have hit before it came to rest right outside my room? I don't even know how long it had been there before I noticed it... it could well have been there for decades for all I know, and so all I know is that I'll think twice before I sit outside for a nice peaceful cup of coffee and enjoy my view of the airport and Mediterranean in the distance from now on. Not just in wartime, but also in peace time; maybe someone got married a few kilometers away, maybe someone important spoke on TV, maybe... I don't know!! I mean these seem to be excellent excuses to whip out the old machine gun and shoot up the neighborhood! In good spirit too!
Owell... It's our beloved country again. Smile!

P.S. I asked around, and I still don't know what the 'gunman' was so happy/pissed off about yesterday night... I'll keep you posted.

Friday, February 27, 2009

We are Eastern Switzerland, Apparently...

I wonder what kind of place we live in, what kind of a society we are...

...when I struggle (in disbelief) to get off a packed elevator because someone waiting to get on just seems to absolutely HAVE to get into the packed elevator the absolute Goddamn second the doors open, even if it means pushing through the stampede of the people who are also trying to get off, and making it inside like they're saying "fuck you, I'm getting on NOW" one grunted syllable at a time.

...when a close lady friend calls me on my cell from her car, sobbing and scared shitless, because some guy she sassed and flipped off in traffic stepped out of his car and was banging on her door -as we spoke- to beat the living crap out of her, rabidly yelling all kinds of profanities at her. Thank God it was locked.

...when I get home after a 2-hour, just 20-km drive in insane traffic, after dodging about 250 four-wheeled projectiles aimed at me, only to find that the the security and comfort of my home is being raped by a guy in my street shooting with an AK-47 in the air for whatever reason.

Really, all in one day seems like too much to handle, and I just wanna leave...

When our reputation precedes us as a country with such a rich heritage, such a rich melting pot of cultures and influences, all I can think of is the following: What about our political crap, our even stinkier economic crap, and all the crap in general that has fallen on this country?? It all stinks like hell...I really wonder... How the hell can we live in a place like this and have the nerve to call it the Eastern Switzerland or the Eastern Paris?? Have we even seen Switzerland or Paris??
Why so Proud?
Proud to be Lebanese? Proud of our nonexistent and yet so vehemently flaunted, overstated hospitality, friendliness, culture and sophistication? I'm sorry, I just can't see any of it, and what's worse for me, I can't seem to forcefully convince myself of it like everyone else does. No, Not me... All I see is a less-than third world country, a fucking jungle, with lots and lots of big animals feeding off each other and defecating where others live. Switzerland looks nothing like this, and Paris? Not even close.

Just because a lucky few get to live in Achrafieh or Verdun, shop at Milord and Emporio Armani, and sip on Grey Goose martinis at Skybar later in the night, doesn't mean we live in Europe, or that we're even close to being a civilized, developed country. To me the shame of not having any form of civilized services, homeland security, or any shred of sovereignty in our stupid government (let's not get into that right now), the country's poverty, and the staggering, mostly hidden savagery of the so called hospitable Lebanese are much more meaningful than having a few imported cultures that aren't even ours to begin with.

But that's just me...

To see what others seem to think about Lebanon and its people

"Lebanese society is very modern and similar to certain cultures of Mediterranean Europe. It is often considered to serve as Europe's gateway to Western Asia as well as the Asian gateway to the Western World.." - Wikipedia on Lebanon

And when others say it better than me... Welcome to the Real World.

Very different opinions indeed.
Excuse the language...

Thursday, February 19, 2009

For a nice afternoon drive...

This Year - The Mountain Goats

I broke free on a saturday morning.
I put the pedal to the floor.
headed north on mills avenue,
and listened to the engine roar.

my broken house behind me and good things ahead,
a girl named cathy wants a little of my time.
six cylinders underneath the hood crashing and kicking,
ahhh listen to the engine whine.

I am going to make it through this year if it kills me.
I am going to make it through this year if it kills me.

I played video games in a drunken haze
I was seventeen years young.
hurt my knuckles punching the machines
the taste of scotch rich on my tongue.

and then cathy showed up and we hung out.
trading swigs from the bottle all bitter and clean
locking eyes, holding hands,
twin high maintenance machines.

I am going to make it through this year if it kills me.
I am going to make it through this year if it kills me.

I drove home in the california dusk.
I could feel the alcohol inside of me.
picture the look on my stepfather's face,
ready for the bad things to come.

I downshifted as I pulled into the driveway.
the motor screaming out stuck in second gear.
the scene ends badly as you might imagine,
in a cavalcade of anger and fear.

there will be feasting and dancing in jerusalem next year.

I am going to make it through this year if it kills me.
I am going to make it through this year if it kills me.

Monday, February 16, 2009

Psychedelic Sunsets

Faraya, Lebanon - January 2004
Picture taken: January 1st, 2004, 5:46 PM

A stripped treeline against the gorgeous Faraya Mzaar sunset sky captured on good old 35-mm film. This picture was taken on new year's day after a wild night and at the end of a fantastic skiing trip. As the shutter snapped, I accidentally kicked over the tripod, causing the blurred effect. I thought that the picture was ruined and snapped another one of the exact same composition. When they came out the blurred one looked so much more vivid for some reason...

Zouk, Lebanon - June 2006
Picture (Right) Taken: June 6th, 2006, 7:27 PM
This sunset silhouette of the Zouk Powerplant Chimneys was taken using a point-and-shoot digital camera from behind sunglass lenses for added underexposure beyond the maximum offered by the camera. Makes me miss summertime.

The 3:00 A.M. Outlook

It's 3:00 A.M. and I find myself thrashing in my Renal Pathology slides trying to make things stick, and what better, more potent distraction than the seemingly grim outlook on life, career, and future as looked at through the pessimistically polarized prism of present dissatisfaction and knowingly unjustified fears of complete, utter, and miserable failure? I've told people repeatedly, and I've been told repeatedly, that life just has a way of working out in the end, but somehow, for some reason I just can't see it right now. Sometimes, instead of fears of complete, utter, and miserable failure, you get scared of a life that ends up being sub par, somewhere below self-set standards and ambitions and it's just as scary when so much time and effort has been put on the line. The obstacles are just too many and the premonitions too ominous for even an optimist such as yours truly to overlook... well they are, at least during a 3:00 A.M. last minute cramming session... I need my sleep.

Monday, February 9, 2009

Blind Item

Would you wonder what the hell is wrong with people?
When a fully equipped Emergency Exam Room in our proud ER is transformed into a waiting room to accommodate the tens of people, family/visitors that come in with the patient! Screw the monitors, screw the MedVac lines, and everything else of medical value, everything that could help save a life in an incoming emergency, because we need to get all these people out of the Doctors's way!! 8 brand new chairs in that room.
Only in Lebanon.

Did I mention the very comfortable, purpose-built waiting room exactly 10 meters away from that makeshift lounge? It's got a vending machine too!
I wonder...

Friday, February 6, 2009

The First Clinical Experiences

Towards the middle/beginning of the end of Med II, medical students are supposed to go on these so called 'Shadowing' sessions with the practitioners of health care; their mentors, superiors, attending physicians, whatever you want to call them. This is some kind of apprenticeship for more clarity... Needless to say, almost all medical students are tired of sitting in class and sitting for exam after exam after exam every week by that time of the curriculum (Med II is the last predominantly didactic year in the med curriculum). So these eagerly awaited sessions are the very first opportunities we get to see actual patients, and understand and witness how, and sometimes whether, what we learn in the classroom is brought to fruition in the real world.
I thought I'd share my experience with my first few 'encounters'...

Med Students and General Trends

So these sessions are generally very rewarding for med students. Well at least they should be. After all, these are the first few times we are exposed to the workings of the health care system and get a chance to experience a touch of what it feels like to be a "Doctor". Remembering the day of our absolute first PD (Physical Diagnosis) rotation, it was a day like no other! Everyone was dressed to impress, the ties, the suits, and the button down shirts -why? we have a formal dress code in our Medical Center (MC) - made it feel more like going to a wedding reception than to class! Right then and there the impressions began to rush into my mind as the personalities, values and norms became more and more public in our prided med students. I can't help but smile as I type this, because I'm remembering my thought process as I saw and analyzed the reactions and moods among the students (myself and my own included, see below). A select few couldn't care less, and it was just another day at the office for them; " hell with the dress code I'm wearing my sneakers today!". To others it meant a slight bit more, as I could tell from the tidiness with which their ties were tied, how neatly their shirts were tucked under their pants; nothing too excessive here, just a different mood you don't see everyday. Still others made a complete, full-fledged rite of passage of the matter and there was a billboard above their heads, piloned to their shoulders, that said "M.D." That stayed on long after the rotation was concluded. The billboard, naturally, came with the awfully unusual and unexpectedly excessive and outright creepy fake friendliness they greeted other, more 'normal' people as well as their colleagues with, not to mention their glue-on, fake, arrogantly proud, or maybe proudly arrogant ear to ear smiles that lasted for hours on end... Some found it would be cute to dangle their stethoscopes around their collars, even among those who were on the dermatology or ophthalmology rotations. Of course, these same students also thought it would be even cuter to keep their lab coats on after they left the hospital, and to flaunt their newly found glory and self-satisfaction and self-approval at the university's main gate and around the better part of the whole campus. Id tags and stethoscopes dangling from lab coat and shirt collars, respectively-and here you err into the nature and discussion of pride, status and meaning of the white apron and stethoscope, the social impressions, the implications and how fake and stupid they may be, but I digress...

My Personal Experience; and a Bit of Introspection to Go...

That morning, I woke up a bit earlier than usual. I can't deny the excitement, the expectations that I had on a day that was a bit more... important?... no... perhaps I should say, a bit different than other days. I put on my new shirt, my new tie, with the pants that I wore to my uncle's wedding some year or two ago. Here's a dead giveaway; my tie was very tidily tied, after all "A well tied tie is the first serious step in life" according to Oscar Wilde! So I left home in a mood that felt brand new. A mood that just seemed to put everything else that was going on at that time on hold. The stressors, the studying, the few nearly failed exams and the financial troubles; everything that had been restlessly gnawing at my brain since even before the day I started med school, was simply swept aside as the new order of the day was to discover what this excitement was all about. Also on my mind was what it would be like to see the inner workings of our MC, to see patients and cases from that new perspective! I can't remember ever starting a day like that before. After a serene 6:00 AM drive to university, a one-hour session of caffeine-kick starting to my system, and an Immunology lecture from 8:00 to 9:00, it was finally time to go to the Ophthalmology department at the AUB MC!

Here, I would have loved to say that the session was a fantastic, life altering experience because not only would that have been wonderful for me to write about, and for you to read, but it would also have been a perfect culmination to everything I've said before. But sadly it would be a lie. The fact is that it was a 35-minute session of show and tell. The ophthalmologist in charge of our group just sat there and force-fed us a review of the anatomy and histology of the eye... and then showed us around saying "oh this machine does this, that one does that..." and a bit of "I know so much more than you do!"... such a disappointment, especially when we got to see the other groups coming right out of Cardiology, ENT (Ear Nose Throat), etc... with their stories and now-even-wider fake smiles! The stuff that I do wanna write about, however, came in subsequent rotations so let's skip to those!
There are two patient encounters that really stuck with me. Two patients that made me realize how thirsty for knowledge we medical students are. Let me start from the end and say that as we got out of the respective rotations in ENT and Dermatology, we were blown away. Blown away, yes, but why? Because in the words of the human embodiment of high-end refinement that is the medical student and future Healer, "it was so cool. it was so interesting, a great case to start off with!" It is here, and after long thought, that I felt something was off and I lost a bit more faith in the medical community... Why? one would ask what the big deal was... I mean I've been rambling about how these experiences are what we've been looking forward to for years and years, why is is such a problem that they turned out 'cool and interesting'? Let me put things into perspective:

Case 1: the very cool case in ENT
A 5 month old baby girl referred to the OPD because she had intranasal obstruction and externally visible swelling over the upper part of the nose. After clear fluid started dripping from her nostrils, an MRI was requested and revealed an invasive mass that had worked its way up through the cribriform plate and into her brain, which explained the Cerebro-Spinal Fluid (CSF) drainage.

Case 2: the very interesting case in Dermatology
A 25 year old man (M.S.) that had a Bone Marrow Transplant (BMT) came to the OPD accompanied by his mother with a generalized exfoliative rash. One of the first signs of Graft Versus Host Disease (GVHD). In his own words: "I had a BMT exactly 120 days ago and this rash has developed lately [...] I'm worried about GVHD and we need to take biopsies[...]".

The implications of these problems/complications that the patients encountered are devastating. Really I don't think I have to explain to the lay person that a tumor reaching and invading the brain is bad. On the other hand GVHD is a complication of immune competent cell transplantation (Bone Marrow and sometimes blood transfusions) in which the grafted/transplanted cells mount an immune response against host tissue, often resulting in multiple organ failure and death. And to see M.S. and how he was handling something he knew so much about was a sobering experience to say the least. He started talking about his condition and throwing the acronyms around, telling the doctor which meds he was on by active ingredient and mode of action! It took me a few minutes to reach back into my rusty and dusty immunology memory and figure out what the hell he was talking about! I was afraid to make an ass of myself if the doctor asked me a question! Skinny M.S. looked tired, and when he undressed to show his rash, the scars scattered on his spent body told the tale of the time he spent on the operating tables. The dermatologist added two more as he biopsied his skin in two places. "I'll call you in a few days and let you know what turns up!" he said to MS. I left the clinic and never heard about MS again.
And there we were, a few hours later, with our "cool" and "interesting" and ooh my case was more interesting and bloody than yours, about life threatening and life altering complications that destroyed lives of patients and their families. That's right, I finally know what a GVHD rash and patient look like, and how a tumor can work its indiscriminate murderous magic! But it's the meagerness of our reactions to these catastrophes, and just how insipid and trivial we made them seem, that gets to me...