She came...

She came to him. After a long absence, she came and with one look, they both knew at once. They knew immediately what was on each other's and respective minds.
He looked at her with hungry eyes. She smiled and came closer. A long, warm embrace, and he could feel her body once more. The feel of the thin fabric of her dress under his hands, gliding so softly over her skin, filled him with desire. The touch of his hands sent a shiver down her spine. She closed her eyes, her lips gently grazing his neck.
"I missed you", she whispered... 

It's Time...

Big surprise... It's October and Lebanese Internet still sucks! Wow

Surgery, What's it like?

Morning round at 6:30 AM, end of shift 6PM if you're not on call, and the next day at 6PM if you're on call (36-hour duty), 6 days a week. What's up?

I've never felt or been so out of time for so long in my life. What's it like? Forget about having the slightest bit of time for anything unexpected like your car breaking down or your grandmother getting sick. These have no place in your loaded schedule and most days you have too little time to make a phone call or even to think about it!

On the floors, busy with more tasks than you can count, armed with a loud beeper that won't shut up or stop interrupting you, paged relentlessly by your numerous superiors and their ridiculous requests that could not come at worst times. You feel the need to be at 5, 6 places at the same time, and soon as the day goes by, like butter spread over too much bread.

You feel disrespected, unappreciated, and you want out. Out of the misery, the stress and humiliation. But somehow you pull through it all and get home almost too tired to get out of your clothes and crash on your undone bed and fall asleep to wake up a few hours later for it to start all over again. "Bring it!" seems like the only attitude to take if you are to have any chance of succeeding.

Here's what you do on the first year of a surgery residency.

First call on all your patients's issues.
Loads of paperwork.
Seeing and preparing all new admissions.
Keeping track on all occurrences and treatments done on patients in real time.
Making sure all the labs ordered on patients are within normal and making corrections as needed.
Handle incompetent nurses and be thankful that there are a few who want to help and actually know what they're doing.
Handle all of your superiors' scut work like ordering labs, getting consent forms signed, and transporting blood units or specimens back and forth between the OR and the pathology lab.
Keep track of everything your students are doing and making sure they don't screw up.
Dealing with obstinate and overconfident hypertalkative students, patients, and colleagues
Catering to every attending's immense ego.
Playing secretary and delivering messages between residents and attendings in the hospital who are just too stupid to talk to each other directly.

The list goes on. And the worst part of it is that you never get any form of recognition when you get all of this done right, but get reprimanded heavily at the slightest delay or bureaucratic mistake you make, to the demise of any shred of motivation you might still have had.

What a rush, what a time hole, making you appreciate your only off day in the week like someone starved for a year would appreciate a Big Mac. Wow.

But you know what? I love it! I love that feeling that no matter what happens this year, or the next, or the one after that, something is being built that seems to be worth all the crap you are forced to take. I have students under my supervision now. Students I have to teach, supervise, and help write progress notes. Students who - mostly - look up to their intern with respect and admiration.
And the single most rewarding feeling you have, that will make all of the above seem like a very small price to pay, is the recognition you get from your patients, who often are very sick people that you can help provide with a better life. And it's amazing just how grateful they can be, not because your attending surgeon just performed life saving surgery on them, but more because you devised a way for the dressing on their colostomy to stop leaking stool, the smell of which requires no description when it comes from s diseased colon, from their abdomen and onto their skin and bed sheets, keeping them awake at night. You do something like that, and you end up getting a disproportionate amount of gratitude, and that patient will smile every time you walk into her room.
This feeling, this gratitude, is worth more to me than the highest awards, from Penrose all the way to Alpha Omega Alpha (some of the most coveted awards), making them seem completely trivial once a sick patient calls you their guardian angel just because something you did helped them get a good night's sleep.
There's no beating that. And this mini surgeon is sticking round for more.

Overheard

At the nurse's station desk.

Urology resident on the phone: "the 'testicle' is coming make sure you get all the bloodwork by tonight.

It took time to realize he was talking about about a new patient coming for testicular surgery.

How random.

Step Back Inside.

Here comes some white to offset all the black I've been ranting about.
Here comes karma.
Here comes something to look forward to.

Mr. Rubik, your puzzle has been solved.

The contrast between black and white...

"Step out the front door like a ghost into the fog where no one notices the contrast of white on white" - The Counting Crows in Round Here.

Black and white... The best way to describe the past two months! White, then black and white, and then a big load of black is what happened.

Loving every second of your life can be a very tricky situation. Because you start wondering why and how it's happening, and then you ask yourself if it's as true and real as you think it is. Until something happens and you realize that it's been sort of helped along by a big bunch of bullshit.
A few discoveries that are incidental at first, then become targets of your unwinding obsession. Lies you've been suspicious of at first, and that were confirmed to you one after the other, sequentially, relentlessly, and repeatedly, until you just burst in frustration and helplessness. And you realize: So that's what it feels like!

Why is it that happiness always needs to be second-guessed, questioned, and put on on trial before it can be credible enough to be enjoyed, and shared?

Why is happiness so multi-disciplinary? so dependent on so many things and? and why does it have so many facets? I think that it's like that so people can hold it like some sort of a Rubik's cube and orient it in such a way to see only the positive parts, only those facets where all the colors match, and lie to themselves about still having to sort out the others. 

Well I have choked on your lies for long enough. 

I can take no more...

Blind Item

Weather Conflict! LoL

Is there such a thing as an accurate weather forecast?? Yahoo, get your act together!! There's no sun out today! And yesterday wasn't better!

And why is this weekend so gloomy???? Beach plans gone south for the second day in a row!

El Falamanki Review

I've been meaning to talk about this place for a while now, but I hadn't been there that often and didn't want to judge based on one experience. So here it comes now.

El Falamanki is a middle eastern restaurant slash lounge in the Sodeco area in Achrafieh. I kept hearing about it here and there and until I tried it a few weeks ago for the first time, I never understood the fuss.
But now I do... or do I?

Location: 10/10
The main entrance is very tidy and worthy of a castle. You are instantly greeted by our loved valets who are just dying to get a hold of your car keys, and later, your money. But that's everywhere. You give up your car and walk a few meters through a small terrace with a few trees scattered around and into the main dining area. Very tasteful and very "out-of-Beirut" feeling slightly - very slightly - reminiscent of Locanda Corcini if you've been there.

Atmosphere: 10/10
It's a very nice middle eastern atmosphere with a tasteful mixture of retro and modern decoration, and you'll be surprised to see things such as a nice LCD flatscreen laid in the  center of a very old middle eastern bronze frame, and retro furniture. The massively predominant but pleasant smell of nargileh tobacco, middle eastern music in the background, the static of scattered conversations, and the sound of dice furiously flying around backgammon boards puts you in an overall very pleasant dining area and if you're a first timer, you're smiling already.

So far so good.

Service / Welcome: 2/10
This is where it all goes wrong. Every time I have been to this place, I personally had to call on one of the waiters for us to be seated. Not once did they notice us stepping in. Not good. After being seated and almost prepping the table on our own, it usually takes another similar effort to get the waiter to come round and take your order. Felt special on the way in? Well not anymore. Now you're just another customer and feel like a burden every time you ask anything of the waiter.

Menu / Pricing / Taste: 3/10
More wrong here. The first thing that strikes you as you look through the menu is how poor it is. And the second thing is the pricing. At best a measly, measly mix of a few usual lebanese overpriced mezze and somehow as you look at it, you can guess - and straight up, I guessed it the first time - that the portions will be just enough to feed a moderately hungry bird. In the grill section, you get platters consisting only of two skewers of either beef or chicken or one of each for LBP 20,000 - 25,000. Yes, TWO skewers, for 25,000. That's 5-6 pieces of chicken or beef for the price of 1Kg of the same in a supermarket. This is the most outrageously overpriced food I've heard of in a middle eastern setting. Somehow I'm thankful for the fact that they don't have those big mixed grill platters they offer in other restaurants! It's sad that they don't, but can you imagine how much that would cost?!
And another thing, you don't even get the usual garnish you expect with a good old lebanese Masheweh platter. All you get is the skewers, some crunchy fries (not the regular ones), and a stupid excuse for a yellowish dipping sauce that I don't want to taste again ever in my life. Where are the parsley, grilled onions and peppers, the exquisite garlic paste that no decent BBQ lacks?? Am I at a steak house or something? Don't give me !@#king Bearnaise sauce with my Masheweh for god's sake!!

So once you get over the abomination that is the Falamanki Grill Menu, here's what we're looking at in terms of finances! (lol)

A Typical lunch or dinner for 2:
1 nargileh, 1 fattouch salad, 1 Lebanese sausage order, 1 Hummus order, a small basket of fries, 2 diet cokes, and one of the delicacy grill platters will set you back around LBP 100,000. And sadly unless you've just undergone a gastric bypass, you'll still be as hungry as you were when you came in.

Too expensive? Go thrifty and replace the lame grill platter with 1 turkey and cheese sage manousheh and you'll still end up paying LBP 90,000 for the lousy meal made up by a few fries, a salad, and a dollop of hommos complemented by a lousy LBP 10,000 Manousheh.

Now keeping in mind this is a middle eastern restaurant, and not a gourmet's heaven on earth - faaarr from it- , and that the portions are simply microscopic - all of this felt exactly as consistent as a happy meal - , this price is just astronomical in my opinion. And frankly, although the atmosphere's good and the food tastes great, both are just as good at any branch of Leila where you get a MUCH wider choice, MUCH larger portions, MUCH better service, for a lower price.
I gotta hand it to them though, they have THE best nargileh of any other restaurant in beirut. Hands down.

Overall: 6/10
El falamanki. An overall pleasant place for a nice afternoon nargileh and perhaps a cup of coffee or a Jellab. As a restaurant though? It flunks miserably, because any Lebanese person who knows what they're talking about will tell you that taking lebanese food and contorting it, overpricing it straight into almost a european fusion gourmet menu is just flat out wrong.
But hey, it's working for them and business seems good.
I give the place an all inclusive -generous-  6/10 grade.

Of Seaside Afternoons

Beirut, Lebanon - May 2011

Here we go again :)
After a hard workout and a lengthy shower. The cool sea breeze under warm sunlight, and Bruce Springsteen's Streets of Philadelphia blasting in my earphones for a very serene mood.
Love it.

It's here... It's finally here!

Here's to ending another long and intricate chapter in an incredibly long book -and to the first page of a new chapter with more and more drama  - Loving every page. Graduating in a few weeks and having this to look forward to is simply... Sweet ...!

This is everything I've wanted. The news is still sinking in 10 days after it came in.

You can bet everything that I will be thinking... Did I just bite off more than I can chew? ....

.... And shortly thereafter, answering : Bring it, Surgery! How bad can you be? I'm too excited to have second thoughts!

How bad? Well I've heard stories here and there. But I will be the judge of that this time, thank you. I'll be reporting live right here, faithful readers tag along :)

Ladies and Gentlemen, We Need Your Blood!

There are many organizations around Lebanon who have taken specific interest in blood drives. For a reason. Despite this, there has always been a shortage of blood for patients in need. It's simple numbers, there are so many patients in need of blood transfusions that the number of donors is just not enough. It's the same with organ donation.

What if you could help? What's in it to you? I mean It's a hassle, a traffic nightmare, it's a bit of wooziness after a few hundred milliliters of blood have been drawn from your circulation, why do it?
Well what about the idea that your blood could be coarsing through someone else's veins and help keep them alive? From the 22 year-old man I saw in the ER a few days ago who was run-over and pinned down for 45 minutes under an SUV, requiring no less than 11 blood units overnight, to the 80-some year old lady with hemolysis, a bit of YOUR blood can make the difference between life and death. Have you ever stopped to think about that? I believe that donating blood is like donating any other organ. A kidney, part of your liver, all the same, and even better, with blood you get to do it all over again in a few weeks!

To donate, please visit Donner Sang Compter, and register.

Hey F. ;)

A few facts about Blood donation, what you need to know

- Donating blood is neither painful nor dangerous. If you are a healthy individual and have no prohibitive problems, you will be cleared for donation and experience no sequelae beyond a few minutes of wooziness and perhaps some mild nausea.
- You will not become weak or ill after donating blood.
- You will NOT get an HIV infection. Needles are sterile, prepacked, and used only once.
- Your blood will be screened for common blood-borne diseases before it is used. (HIV, Hepatitis etc...) and you will be notified if any of those screens are positive.

What about blood type and compatibility?

- Blood = Plasma (Fluid) + Formed elements (Red cells, white cells, platelets...)
- You can be one of four blood groups: A, B, AB, and O, depending on which antigens are present on the surface of your red blood cells: A antigens for group A, B antigens for group B, Both A and B antigens for group AB, or No antigens for group O.
- Similarly, you can be Rhesus positive, or negative, depending on the presence or absence of the Rhesus antigen.
- So which blood types are compatible? To answer this question, there is a third important component in your blood that needs to be understood, your plasma. Plasma is the base fluid that constitutes your blood and in which your blood cells and platelets are carried around your body. It contains all kinds of molecules (proteins, clotting factors, antibodies, sugar, electrolytes etc...). Of interest for blood  transfusion are the anti-ABO antibodies. These are part of your immune system and are the basis of the danger of ABO incompatibility:
- A person of the A group has anti-B antibodies in her/his plasma. So if she/he receives red blood cells from a person of type B or AB, the antibodies will bind these cells and destroy them, creating clots and a systemic immune hemolytic reaction that can be fatal.
- A person of the B group has anti-A antibodies, so they cannot receive blood from group A or AB.
- A person of the AB group has no anti-A or anti-B antibodies. They are universal recipients because they can receive blood of type A, B, AB, or O.
- A person of the O group has no antigens, they are therefore universal donors and can donate to all blood types. But they do have both anti-A and anti-B antibodies, and therefore can only receive type O blood.
- Similarly (remember antigen, antibody) a rhesus positive person can donate only to a rhesus positive person.
- A rhesus negative person can donate to both.

Recap:
- Group A can receive type A or O, and can donate only to groups A and AB.
- Group B can receive type B or O, and can donate only to group B and AB.
- Group AB can receive ANY of A, B, AB, or O, and can donate only to group AB.
- Group O can receive only group O, and can donate to ANY blood group.
- Rh positive to Rh positive,  and Rh negative to both positive and negative for rhesus matching of any of the above combinations.

We need your blood. It's very simple.

Small World and Memories Past

Dear N. you sweet old lady,

I have only the faintest memory of you. I am told passionately by those close to me and to your family that I spent the better part of my childhood fiddling around in your house with your children's children. Now that, I do remember. You see when I was some 7 years old, I was infatuated with your granddaughter Z., P.'s daughter, A.'s sister. 

I have to look back, well at least at what these people have told me, and sit in wonder at the way our lives parted so long ago, and how they were brought back together on that fateful afternoon.

You are an ill lady, poor old N., 

I was surprised a few times to come across your name on our inpatient records. Always wondered how you were doing. Always wished you the best. 

I was surprised on said afternoon to see your name on the ER patient list. 

I was awestruck a few hours later as I heard your monitor beeping. Code Blue. 

I was there, in your final moments. I was helping. We fought hard to bring you back. It wasn't to be.

I was gutted, as your grandson A. said in no uncertain words: "let her go".

I am sorry. There was nothing more we could do.

I was tearful when I got out of your room.

I was torn to see A.'s face after all these years, calling the family with the news. Bluntness was the order of the day.

My dearest N. you see the people you have helped create, have made our life so much better. And from faint memories and tales told, you were keen to see us grow. 

I hate it that we had no chance to get reacquainted. 

My dearest N. 

May you rest in peace.

Thoughts go out to Z. my first childhood crush. and A., The ER physician who supervised resuscitation efforts on his own grandmother in steadfast composure, professionalism, and, ultimately, realism. You are an inspiration to us all.

Of Seaside Mornings

Beirut, Lebanon - February 2011

There's something about the sea during the morning hours. 

If you're a morning person - or an insomniac, of course - then I suggest a nice cup of coffee at the coast. 

Nothing better to clear your mind and get ready for an anticipated stressful day at work!

Location:Corniche

A Physician's Closest Enemy...

... is actually the patient's lifeline. That brilliant little invention called a Beeper or Pager that's designed and built to keep you alert and reachable,  and without which the phrase "on call" would have no practical meaning whatsoever.
That's all very nice. I mean it's really hard to conceive of a hospital functioning without pagers. Every single attempt at communication would invariably take longer, cost more, and be more burdensome on staff and patients alike. So here's how it should work:

1- Patient need something
2- Patient calls nurse
3- If nurse can handle it, stop here.
4- If nurse can't handle it:
5- Nurse picks up a phone and pages Dr. Fixit
6- Dr. Fixit shows up happily within minutes and sorts things out.

Great stuf right? 6 easy steps towards better patient care! Right? Well, only when it works!

BUT... (hehe) what happens when you mix needy and naggy patients, an incompetent nurse, and a doctor worn out by 14 hours of floor work during the day, and 3 hours of the same after sleeping hours? well things turn out a bit different... like so:

1- Patient needs attention = Patient nags about the lighting in the room
2- Patient calls nurse
3- Incompetent nurse prances in and freezes at such an impossible task as putting the patient to ease
4- Incompetent nurse freaks out, picks up a phone and pages Dr. Wornout at 3 AM
5- Dr. Wornout is bummed that the stupid pager's ringing again but humbly picks up a phone and responds
6- Incompetent nurse tells the story
7- Dr. Wornout cannot believe he's been woken up for such a lame story
8- Dr. Wornout screams and cusses out incompetent nurse
9- Dr. Wornout still might have to come over and talk to the patient or prescribe sedatives across the floor to get some peaceful sleep.

Ah, yes! This is perhaps a more accurate description of many of the calls we get on a night's duty. Thinking about it is funny. It really is! I can remember being paged for the dumbest stuff! And I swear all of these are true stories!

BEEP! 2:00 AM, 10 South: Doctor, doctor! The patient in 1026 refused to wear the face mask that was keeping him alive. He says it's too bulky, and his oxygen saturation went down to 70. But don't worry I called Inhalation Therapy and they convinced him. - "Wow good job, stupid male nurse! Thanks! "

BEEP! 5:00 AM 8 North: Doctor, Doctor! The patient in 823 Just called me and said she just had her period. - "OMG are you really calling me at 5 in the morning for this?! What do you want me to do, bring pads!?! Is this an emergency? Is she hemorrhaging?! - No - Well?!!? - ok thank you Doctor.

BEEP! 12:00 Midnight 9 North: Doctor the patient in 922 is ready for his blood transfusion, if you could bring up that unit? - Ok on my way - I get to the floor - Here's the unit, start the transfusion - Oh but Doctor the patient was taken down for his CT scan. - Is he coming back soon? - We don't know so we can't keep the blood unit here, in case it takes longer than expected; you have to take it back to the blood bank and check it out again when the patient comes back. - !@#%#$^$%&*^%$#!@#$#$@%@# You stupid MORON!!!!!!

BEEP! 1:00 AM 10 South: Doctor? I was wondering why the patient in 1036 is taking Methotrexate? - Ok I'll go along with this, He has scleroderma, to satisfy your hunger for knowledge at this hour of night... - Ooh ok, and Why are you giving him Tazocin? - For his pneumonia honey what's up? - Oooh true but why not Tavanic? and since he has pneumonia, why didn't you order him an incentive spirometer? - Hmm are you really calling me to suggest medical management is incorrect? Can I !@#$ing go back to sleep now?! Promise we'll talk in the morning!

No disrespect to nurses, but please help us out with our crazy duties! There are things you can handle, and things you can't, know which is which!
It's funny remembering all this stuff and I'd like to take a moment to say that not all nurses are like this! I've worked with a few nurses who had excellent judgment, knew how to talk to patients and resolve issues like lighting and air conditioning, but also comforted their patients for a peaceful night's sleep without the need for Lexotanyl! Some admittedly knew more about medicine than I did and they have my full respect and admiration. You make our lives easier.

Cheers to a completed Internal Medicine rotation! 

Of Friendship and Lack Thereof

What happens when you run out of outlets? What happens when your friends are leaving, one by one, caving to the attraction of a random civilized country with hope for a decent and secure future, and you're left counting how many of them you have left? Two or three? Or is it one? Shit I don't know anymore!
I'll tell you what happens. You're left with two or three mindsets that cooperate or take turns tearing your sanity apart, each one taking partial or complete precedence over the others depending on your mood and how your day is going.

On the rare but welcome good day, you'll feel optimistic about present and future -like I felt when I wrote my previous post-, and keep thinking to yourself, "staying here isn't so bad! I've almost got it figured, and it feels good to be home!" Expected, from someone who's already failed -miserably- to capitalize on the golden opportunity of a medical career in France due mostly to nostalgia.

On the more common average day you tend not to think about it too much. Because on the average day you have a lot keeping you busy, and there isn't much time for thinking and musing about life and its roller-coasters. You do catch a few ideas flying by, but these don't tend to materialize into something meaningful by the time your attention is caught by something else.

We're left with bad days. It is on those bad days, those days when you just can't seem to find anything to do with your time, or when you just seem to have woken up on the wrong side of the bed, that these thoughts go wild. You feel stranded, isolated, wondering what the hell you're doing at home or wherever you are. Your outlets are numbered and each has his/her own set of problems and obstacles. They're busy. You don't really feel like their gossip, trivia, and pettiness, even though you love them. She's unreachable! S. is in the U.S. B. is in the U.K. N. is in Kuwait, K. in Dubai, R. in France... I could go on...
And this is when it gets to you the most. Because what are you left with, if not memories of good times and intrusive thoughts and feelings of all sorts that make you question your own sanity sometimes? or a bad mindset and ensuing reactions and overreactions that can ruin friendships and relationships? And what can you do with these thoughts? Well you can either swallow them, or throw them in someone's face. I tend to do the latter, often with bad consequences, but that's another thing I never seem to learn.

But you know what? All that's about to change. I'm done. I feel like I've been changed. Yes, BEEN changed, by these circumstances. I've let them get the better of me, something I don't usually do.
I've gotten a few remarks which I admitted to, again, something not everyone around me is used to seeing. The changes are in motion, things will be different from now on.

Here's to not keeping all your eggs in one basket.

For those of you who know what I mean...

Another Catch-Up Post

Well it has been a while since my last post. I've been busy lately, and last night I happened to check out my blog and realized that I'd 'left' on a very sad note. Sorry about that!
So what have we missed? One relationship anniversary, one uneventful new year's eve, another goodbye to another good friend leaving the country, another monumental governmental failure (but we're used to those), another stupid Internal Medicine rotation, a few breathtaking days on the Faraya slopes. All these, among other things I've meant to blog about that would have kept my readers busy/amused/annoyed. No such luck; instead, here I am, once more, overwhelmed by my flying ideas, frustrated by my tantalizing muses, pressed for time (but we're used to this one, too), and struggling with my vocabulary trying to make something out of this heap of interweaved trains of thought.

Let's start here. I am happy. Happy, of course, being a word surrounded by a cloud of relativity, and perhaps a few drops of evanescence, but for the first time in a few long med school years, I can really say that I am happy. Happy with the way things are going in my life. Happy that I'm just starting to peer through that window onto the next steps in my life and career. Happy with my lovely L. Just overall, in a good moment I guess, the likes of which I haven't seen in a very long time.

Trying to pinpoint it is hard. but I think what has drastically changed my outlook on things is the fact that I'm done guessing what I want to do with my life. Over the course of one day, my career path has become clear to me; I am to become a surgeon, people, go crazy. There has never been a specialty better suited for me, I've always known it, and since I've applied to a surgery residency at AUH for next year, things have been different. It takes much more to worry me, I am more relaxed in my work, I'm optimistic and feel so hungry to take on this next chapter that I don't even feel like a med student anymore. Med IV is almost over. A few months ago I was excited at the prospect of beginning my last year of med school. Time flew, that's all I can say. and if you've read that post, you'll understand why I'd be keeping with the continuum if I say, Bring it, Surgery! Bring it, Residency, Bring it, long on call hours! I want to work my ass off in something that fascinates me, instead of sitting around the morning rounds in internal medicine for 5 hours wondering what the hell I'm doing there, trying hard as I can to stop my eyes rolling into the back of my head from boredom!

Did I mention I hated internal medicine? Well I'm sure it's obvious now! (Some other post, for sure)

So there you have it. The main update and now we can look forward to my admission (wish me luck) and to my Surgery internship next year which I'm sure will bring you many long posts.

Will keep you posted!