Tuesday, December 21, 2010
Thursday, December 16, 2010
- Me, entering the room for the first time, smiling: "How are you today Mrs. [...] ?"
- Her, stating the obvious, pointing at her distended, asymmetric, diseased abdomen: "Well, how do you think I'm doing?"
Realizing the retrospective absurdity of my question to a woman with a mass the size of a basketball inside her, and many other little ones scattered around her frail and broken body, I froze for a second, and nodded, with my stupid, embarrased smile still stuck to my face, and proceeded to interview and examine her, gathering a few pieces of information to write my stupid little note in her chart.
How? How can you be pleasant to a dying person? I'm still learning here... perhaps learning that oncology is the single most impossible specialty for me to work in. Oncology, cancer, that indiscriminate, slow killer that catches persons and tosses their bodies around for seeming ages.
Cancer means you see your patient on Friday and think he's doing a bit better:
- Mr. H, a nice and unfortunate old man: "Thank you doctor for coming to see me, it makes me stronger"
and then you go away for the weekend and on Monday you hear the news that Mr. H passed away on Saturday, his son's wedding day. They tell you that Mr. H's son had been pushing since thursday for a discharge so that his father can die in his hometown, and to kindle a glimmer of hope that his father would get a chance to see his son get married, even if he has to feel this fatherly pride in a wheelchair. No such luck.
It's too much for me to handle. Too much to see this losing battle day in day out, too much to see so much suffering. Too much to see so much harm coming from what started as a small nodule, a small blip on a chest radiograph... Not for me.
Thursday, November 4, 2010
Why is it that those things you are completely oblivious to one day seem like insurmountable obstacles the next morning?
What happens to people overnight?
What in the world gets into people sometimes?
How do you manage, for the first time in your life, to end up alone at some random bar on a Thursday night, sipping on a glass of scotch and asking yourself all these questions?
Why am I so disappointed?
Thursday, October 21, 2010
Or when you meet your new pediatrics resident for the night's duty and realize that his father was actually the pediatrician who followed, treated, and probably terrorized you through the better part of your childhood, 0-18 years of age. In a puff of smoke.
Such a shame how far that apple falls from the tree... but I digress...
People are always afraid of losing time. Time, time, time.
"We're late, we need to hurry!" Of course. Time is gold.
"I'm growing old, look at these wrinkles" says she, in her mid-late 20's, dripping of youth and beauty as she speeds down a wrong way road to her plastic surgeon's office, stone-coldly ignoring all pleas for a healthy and graceful maturity that's still far far away.
But why? Why should I be so preoccupied with time, when the harder I try to save it, the more acutely aware I am of my helplessness toward it? Why can't I be less attached to that Monday? or to that October, or to that year that October has ruthlessly dragged down with it for the 28th time? And why can't I look back at my great 28 years in this world and smile, instead of looking just ahead, terrified of turning 30 in 2 years?
2 years. More like 2 Mondays, 2 more weeks, 2 more Octobers; it's all the same. Maybe that's why...
Meet me back at that curb...
Sunday, October 3, 2010
Saturday, August 14, 2010
|Faqra, Lebanon - July 2010|
This unedited picture was taken on a beautiful windy night in Faqra, Lebanon; a half-empty, half-full glass of wine, backlit by a raging barbecue fire. With the aperture wide-open, a slow shutter speed of some 2 odd seconds allows the wind-stricken flames to merge together in an apparent explosion, and leaves the core of the fire appropriately overexposed. It could be criticized for hand shaking during the exposure, inevitable at these slow speeds, which is evident from the smeared contours of the glass and reflections. Sure, a tripod would have made this a better picture,strictly technically speaking, but as I've learned, it is photographic imperfections such as this one that so often seem to add a little something to a photograph. Something raw and unexpected, something beautiful. In this case, a nice snapshot of the way I was seeing that night after the few watered down glasses of wine that preceded this one...
Wednesday, August 11, 2010
- The beiteddine festival: Have you ever bought a soggy, hyper-salted, minuscule Saj man'oushe for 7,000 LBP [~5 USD]? if you haven't, please take a long drive to Beiteddine and do so at the entrance, where the monopoly of saj has blown the prices right off the chart. And whether you like it or not, and no matter what you order, you are getting the "Amira" specialty man'oushe because the lady who makes them will MAKE you. just go there and you'll know what I'm talking about.
- Beach resorts: Jiyyeh and Jbeil alike, the amount that a nice enjoyable day at the beach will set you back is sizable! 20-30 $ entrance fee, 15-20 $ for a quick bite at their restaurants managed by some of the most incompetent people on the planet, you're talking at least 40 $ for some sun! More if you feel dehydrated and feel like getting a cold drink. Sun beds line the pools in almost all resorts and renting one will set you back another 20-30 $. Oh and did I mention the "bouncers" at the entrances? apparently they're concerned about the male:female ratio and won't let single or groups of men in... PLEASE! It's a !@#$ing beach resort!
- Restaurants: How much profit do you want to make? selling a 500 LBP bottle of w ater for 5,000 LBP is just ridiculous. Selling teabags for 7,000 LBP is even worse! We had dinner last night at Beib el Mina at Byblos. Some of the nice usual Lebanese mezze like Tabboule, Hummus and Baba Ghannouj, followed by fries and 3 fish dishes, with a few cokes and glasses of wine. Good food, good times, crappy service as usual. The bill? 850,000 LBP [566 USD] for 16 people. I didn't even feel like I'd just had a meal. Ridiculous. And it's like that everywhere.
- Pubs, Night Clubs: Always with the 30 - 40 $ minimum charge. Always with the dinner requirement to get a decent table. And most of them do not inform you until you receive the bill and can't believe your eyes because you've just had a 35 $ glass of Red Label, a 750-cL bottle of which costs no more than 13 bucks at your local minimarket! Did I say a glass of Red? I meant a glass of ice, with a scent of whiskey for you to fantasize over. That's not a night out, that's a JACK!
It seems to me that going out in Lebanon, especially this summer, has become more of a hassle than a pleasure. Factoring in the indescribable Lebanese traffic and all of its associated road rage, or the heat if you're unlucky enough not to have A/C in your car, followed by the ridiculous return you get on your hard earned money, I'm becoming more and more of a fan of house parties and dinners, and I cannot stand the sound of the word Jemmayze when my friends call me up to go for a drink...
Going to the beach is no better.
Monday, July 12, 2010
Wednesday, July 7, 2010
"At that time it should have been finished. They should have punished her only once. Her documents say she is innocent. She paid for the crime five years ago." - CNN Article
Wednesday, June 30, 2010
I have to say I was deeply impressed by their performance.
I had gone to Beiteddine expecting nothing more than a 'circus' and I was pleased to attend the fine act of precision choreography that is Le Cirque Invisible. Don't miss it.
Tuesday, June 29, 2010
Monday, June 28, 2010
But seeing Italian referee Roberto Rosetti admit to the Mexican players because he knew that the goal scored seconds earlier by the Argentinians was an offside play, and apologize to them because the FIFA wouldn't allow him to change his decision...
Seeing this and how players earn free kicks, penalties and get their rivals booked or sent off by sheer drama school acting at this level of the game is just something that I can't understand...
Get video refereeing and a clean game for everyone.
Sunday, June 20, 2010
If Adolf Hitler complains of this...... I loved the ending.
I thought it was cool at first, but as I watched more and more games, the headache grew! During yesterday's game between Denmark and Cameroon, there was this shot of the crowd and this huge group of Danish supporters. They were cheering and flailing their arms and flags around while there was a lone african fan in their midst, standing there, completely still, a Vuvuzela pressed against his pursed lips. Makes you feel like shaking the life out of him until that thing of death falls out of his death grip!!
Join bloggers's quests to get these annoying horns banned!! lol
Monday, June 14, 2010
|Hamra, Lebanon - June 2010|
Wednesday, June 9, 2010
|Hamra, Lebanon - June 2010|
Monday, June 7, 2010
I have to say that today, the ER delivered. Today, I couldn't help but think that what was happening was some kind of response to what I wrote and felt a few days ago when I was just starting out...
The ER never faltered, even in the med III ER rotation, in showing us how little we knew, and how completely unprepared we can be for handling situations and patients beyond our qualifications.
Saturday, June 5, 2010
Cranial nerves are nerves that arise from the encephalon. They are responsible for many reflexes and control of many automatic functions, such as gaze coordination, taste etc...
There are 12 cranial nerves (CN), numbered CN I-XII in the order that they enter or arise from the brain. If you're interested, here are the known Cranial Nerves:
Tuesday, June 1, 2010
I hope it turns out as good as Med III.
Starting out in the family medicine rotation. It turns out i'm first in line (with a colleague) for a PM shift in the ER lasting 7 hours (4:00 pm - 11:00 pm) on the very first day. Rough start!
Blogging from the ER lounge (Where I love the Air Conditioning! Just FREEZING!), I just finished seeing a patient with an elbow injury. First thing that came to mind: I miss the ER! I miss the speed with which things were done; I miss the frantically scribbled less-than-one-paragraph-long notes on board-charts. The patient I just saw was triaged, seen by an attending orthopedic surgeon, 2 residents, and myself, taken down to x-ray and back in just under 20 minutes. As comparison, consider that an out-patient case takes about 2-3 hours to be handled.
I miss it. I do.
Bring it ER! Bring it Med IV!
I want my M.D.
Monday, May 31, 2010
Wednesday, May 26, 2010
Saturday, May 8, 2010
Tuesday, May 4, 2010
Is Your Jar Full? When things in your life seem almost to much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar......and the beer. A Professor stood before his philosophy class and had some items in front of him. When the class began, wordlessly, he picked up a very large and empty mayonnaise jar and proceeded to fill it with golf balls. He then
asked the students if the jar was full. They agreed that it was.
So the Professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles rolled into the open areas between the golf balls. He then asked the students again if the jar was full. They agreed it was.
The Professor next picked up a box of sand and poured it into the jar. Of course, the sand filled up everything else. He asked once more if the jar was full. The students responded with an unanimous "Yes."
The Professor then produced two cans of beer from under the table and poured the entire contents into the jar, effectively filling the empty space between the sand. The students laughed.
"Now," said the Professor, as the laughter subsided, "I want you to recognize that this jar represents your life. The golf balls are the important things - your family, your children, your
health, your friends, your favorite passions - things that if everything else was lost and only they remained, your life would still be full. The pebbles are the other things that matter like your job, your house, your car. The sand is everything else - the small stuff." "If you put the sand into the jar first", he continued, "there is no room for the pebbles or the golf balls. The same goes for life. If you spend all your time and energy on the small stuff, you will never have room for the things that are important to you. Pay attention to the things that are critical to your happiness. Play with your children. Take time to get medical checkups. Take your partner out to dinner. Play another 18. There will always be time to clean the house, and fix the disposal. Take care of
the golf balls first, the things that really matter. Set your priorities. The rest is just sand."
When he had finished, there was a profound silence. Then one of the students raised her hand and with a puzzled expression, inquired what the beer represented. The Professor smiled. "I'm glad you asked. It just goes to show you that no matter how full your life may seem, there's always room for a couple of beers."
Monday, April 26, 2010
Thursday, April 22, 2010
I stumbled a cross this bit of news on CNN (Read News Article) reporting that Southpark creators Matt Stone and Trey Parker might have gone too far on one of their notorious skits on religion and major religious figures, by allowing one of their episodes to feature Muslim Prophet Mohammad wearing a bear suit.
"This is a show, after all, that once painted God as a gap-toothed rhinoceros-monkey, portrays Satan as a simpering milquetoast and regularly features Jesus as a superhero -- the kind who's not afraid to ignore the peaceful teachings of the Sermon on the Mount to smite his opponents. The show has mocked Jews, Catholics, Mormons, Scientologists and atheists, among (many) others." - CNN
I have been a fan of Southpark for years and years so this really caught my attention because, while I found their fun poking at religion and its figures was witty, hilarious, and as bold as one can imagine, I've always wondered when and how it would get them in trouble (and I'm laughing as I write this!).
So here it is! "Revolution Muslim" a radical Islamist organization and movement based in New York City that advocates the re-establishment of a structured Islamic state, terrorism in both the US and in democratic countries around the world, the removal of the current rulers in heavily Muslim populated regions, the destruction of Israel, and an end to what they consider 'western imperialism' - Wikipedia -- Is it just me, or does it sound a bit odd that this group would be based in NYC??? Excuse my digression! -- has taken offense at the portrayal of their prophet and has released a 'warning', or so they called it, to Trey Parker and Matt Stone, reminding them of the murder of Theo Van Gogh, who was killed in 2004 by an Islamic extremist. Among his works was "Submission, a short film about abuse of women in Islam. The release included pictures of Van Gogh's dead body. According to the group, however, this was in no way a threat but a mere warning of what might happen as a consequence of the airing of the episode.
I can't help but laugh at the wonderful work of the makers of Southpark. Of note was one representation of almost all religious figures in a group gathering, with Prophet Mohammad covered by a black square with the word "CENSORED" contrasting in white.
I am not sure about the repercussions of this and what they can be, or if any other movements with more power have taken more serious offense than Revolution Muslim. And if they have, how different would the reactions be in NYC as compared to the Middle East? I am also wondering about freedom of speech and how it applies in this case! How can groups be allowed to run around threatening people who don't live by their values?
Video From CNN
Thank You Ayaan - You are the first Muslim I have ever heard speaking with such objectivity.
Sunday, April 18, 2010
Saturday, April 17, 2010
Monday, April 5, 2010
One promising modality for the treatment of Laron Syndrome is recombinant IGF1 (marketed under the name Increlex in the U.S.), which can bypass the action of GH on its deficient receptor, thereby restoring growth satisfactorily if treatment is initiated in a timely fashion.
Sadly, Increlex is unavailable in Lebanon. And apparently it is a very expensive drug, which as you might have concluded makes it a problem for an OPD patient struggling to pay even the LBP 10,000 OPD fee.
As documented in K'.s chart, K.'s mother was told about this treatment when they had last visited OPD. She was also told that it was not available and that there was no way she could afford it even if it were. She was coming a couple of years after that visit in the hope (in her own words) that "Dr. N had something new for her and her son".
- Dr. N: There still are no significant efforts to market the drug in Lebanon.
- Mother: Oh.
- Dr. N: As I told you last time we are trying but your son's condition is so rare that it's hard to find proper treatment here. And the expenses would be just impossible.
Friday, April 2, 2010
Friday, March 26, 2010
Wednesday, March 24, 2010
|Shweifat, Lebanon - March 2010|
Tuesday, March 23, 2010
Walking on Bliss street had never been such a complicated task, what with all the 10-year old –or less- mendicants and lottery ticket ‘agents’ or shoe cleaners. For the longest time I felt annoyance at the heavy task of brushing off these pesky and persistent solicitors that seemed to be after nothing other than your money. The annoyance not circling around the money itself, but about the ethics and principles of discouraging the presence of alms-askers and the associated child abuse and whatnot; let me not digress and wander off into these treacherous discussions for now.
So one of my tricky walks along the famous street, while I was looking for that after lunch cup of coffee, got me to Epi D’Or. -Don’t let the name “Epi D’Or” fool you. Fancy name for a place that’s affectionately and more commonly called “Abou Naji”, the little store across the street from the AUB main gate-. Waiting for my coffee, I get elbow-tugged outside by an as-yet unknown figure who turned out to be one of Bliss’ seasoned shoe cleaners
. “Here we go”, I thought to myself. But then, all thought processes angled at getting rid of that annoyance were instantly stopped by the cleaner’s marketing skills… “Eza ma 3ajabak ma tedfa3 wala lira!” Translation “If you don’t like my work don’t pay a dime!”
Said in a convincing and confident tone, these words made me think ok what the hell? My shoes were dirty, hadn’t been cleaned in a while and a good buff would do no harm! So I told the guy to do a good job and he got to work. I have not seen hands move so fast. The sound of swishing as his run down piece of tissue carved through the air and onto the now polished leather told the tale of a shoe cleaning veteran with years of training!
All done, shoes shining, and face smiling as M. took a few snapshots of the event, I was thinking about the going rate on a premium job like this! So I thought 3,000 LBP. M. frowned in disagreement and so I gave him 5,000 LBP.
In retrospect, seeing how his face lit up as he tugged on that bill and all the good wishes for prosperity and long life I got at that time, I know I overpaid! But I would do it again and pay the same price!
But hey. An honest living, a job well done, make me rethink my stance on the good shoe cleaners out there! This is one rite of shoe-cleaning passage not to be soon forgotten!