Peoria Two Months In

It is said that it's not good, no matter how pleasant it was, to dwell on the past at the expense of moving on in the present.

Agreed.

However, I find that I will forever be viewing the present with relation to the past, and that I will no doubt try to recreate (but not necessarily duplicate) the pleasant experiences that made just a few years ago, a time to remember for the rest of my life.

A noun, as School House Rock tells us, is a person, place, or thing. Thing is too generic, though, so I will stick to describing the first two.

People:

I realize that the older we get, the more we become the person that we were in our younger years. The insecurities, the sensitivities, the quirks, and the characteristics that define us in other's eyes only become accentuated in social circles. People form an opinion of you and it becomes difficult to change unless you develop significant friendships that give others an in depth understanding of who you are. I have found this to be true of the teachers, classmates, and pretty much everyone else that I have met here.

I also think about the type of people I would like to be around as a physician. The school offers a Rural Preceptor Physician track in our third year for all students (including those not necessarily going into rural). The pros: more individualized attention, more self-driven learning. The cons: small town, primary care emphasis (assuming you're not inclined toward either of those things), 8 monts away from classmates. I don't know if I want to practice rural medicine, but a few months removed from Dixon, this option certainly appeals to me more than it has in the past.

I think about Christians that I have met here. The preceptor I had during my recent primary care immersion week grew up in Africa, went to Wheaton College, did med school here in Peoria, and decided to practice urban medicine here. His children are/were homeschooled and they attend a non-denominational church here in Peoria. He strikes me as caring, a little soft spoken, and, in certain social settings, a little awkward. (I suppose this description could easily be a projection of my self-image but that's an entirely different issue). I went sailing with him and a couple friends last weekend, and the friend that owned the boat gave us all writings that amounted to a testimony and stories of faith. I remember reading them later and thinking to myself, "this is totally something that I could see my mom doing...in Chinese of course."

Places:

I could begin with school. I spend lots of time there everyday. Sometimes I'm awake and sometimes I'm sleeping. Often, I'm somewhere in between. I've been to my friend Jin's parents' restaurant a couple times...it strikes me as the type of place I would go often even if there were other restaurants that had better food simply because familiar faces can make the simplest foods taste better. The pastor at the church I have been attending was kind enough to make a key for me so that I could get access to the church piano whenever I wanted. This has brought back memories of college when 24 hr. access to the music building made life that much sweeter. Speaking of piano, I hope to meet up with one of the music professors at the local university here who says that he may be willing to take me on. My time in medical school has showed me that I am unable to give up the piano...as if there were still so much that I need to learn. .

End of the Soup Kitchen?

Today, I received an email from Jeff about how the Catholic Worker House is planning on closing down the soup kitchen. The phrase "different priorities" came up in describing the reason for this. I wonder what those different priorities are?

Weddings!

A good high school friend of mine got married today.

Ah, there's so much I could say about today. I got to stand in a wedding for the first time, and, admittedly, there's something unexplainable about watching a friend stare into the eyes of the love of his life. As Hugo says in Les Miserables, it's one of those moments when the infinite above comes in contact with the infinite below. Hugo uses these words to describe prayer but I'd argue that it's just as applicable when it comes to love.

Bride and Groom





Turns out that I was the only high school friend there which placed me at a wonderful awkward and lonely position considering that most of the young people there were either college friends or part of the extended family. Still, at any given moment, it was hard not to be happy for my friend and it's nice how in celebrating the guests of honor, it becomes much easier to forget momentary discomforts. Plus, it's always fun to hear potentially embarrassing family stories.

Groom and Best Man, the morning of



Wedding Cake-- white, carrot, and chocolate



Rehearsal Dinner-- Hanger Steak



Oak Community Church-- listed as Hinsdale Baptist in my GPS (another one of those denominational drops)

Closing Thoughts and Miscellaneous Pics

Today, I was able to spend some time with an Internist, and, by chance, essentially got to spend time in all the other departments that I hadn't had a chance to spend time in before. This was because Dr. Khan was covering for two other Internists and was in ER-backup call. So, I ended up spending time in the ICU, and Med/Surg floors while also seeing a code blue down in the ER.



I had a fantastic time partly because Dr. Khan was an excellent teacher and he took the initiative to go over history taking and pointing important things along the way. It turns out that he just joined the volunteer faculty for Peoria for 3rd years, which means that should I want to come back to Dixon, I could request him as a preceptor. Dr. Khan did his US residency at Cook County Hospital in Chicago (Now Stroger) in 1991 and so he probably falls into the old-school breed of physicians. I think patients like him because he is very clear, very direct and assertive, and explains everything thoroughly (as evidence to his complete med-student like histories which usually take up at least three pages when transcribed). He has a remarkable mind and doesn't need to write any of his patient's data down when he takes histories. I spent time with Dr. Khan both in the clinic and in the hospital, and if I hadn't checked out at 9 pm, I would have also ended up in psychiatry with him. We even went to a physicians meeting that lasted all of 30 seconds when we finally got there (they needed a quarum to vote on some issue).



Regarding one patient Dr. Khan made an interesting point. "This patient is so thankful and says that I have saved her life five or six times. That's nice, but I don't think I am saving her life. I am just doing my job." Even though it sounded kind of strange at first, I realized then just how much the man loved what he did.

Petunia Festival

Every year, as part of the Fourth of July festivities, the people of Dixon have their "Taste of Chicago"-like event . I happened to go on the first day of festivities so there wasn't too much going on since the carnival part hadn't opened up, but as you would expect at an event like this, there was an assortment of overpriced food vendors and kiddie entertainment





The event took place right by Dixon high school (pictured above) which looks more like a castle than a school. I hear that it's not the best school district (of course this was told to me by a doc who was responding to my comment that his eldest college-bound son was probably a pretty bright kid).



One of the "games" there was this nifty contraption. Yes, that's a toilet on top.



As my contribution to the Dixon economy, I purchased this 10'' Italian Sausage for 7.00 (which isn't all that bad for an event like this) but my stomach was questioning the decision beginning from the first bites. Still, after downing a smoothie that was supposed to be a berry blend but tasted like bubble gum instead, I was able to keep things under control.

Basketball Jones Origins

Tonight at the Y, I played ball with one of the Dixon natives that I've met over the last few weeks. He just graduated from high school and has been working an assortment of jobs this summer for the income. I'm about five years older than him, and while I can pretty much take him off the dribble any time I'd like (the height advantage helps too), he certainly has me outpowered down low (now only if he could learn to dribble and finish in the post I'd have some serious issues). Still, we have a pretty good time playing 21 and I get a chance to try out some of the things that I try to work on during the week.

When I stop to think about it, all of this reminds me of when I was in elementary school--in the first grade to be exact. This was back at our old house when my parents had gotten me a basketball hoop for the driveway. My parents bought the hoop from Service Merchandise (which is now out of business) and I remember the agony endured between its purchase and its installation. We had decided to get the hoop cemented but rainy whether kept delaying the debut. When that final day did arrive, I remember standing in the driveway as the repairmen drove their pickup truck out of the driveway for the final time and staring up at the hoop with the red trim around the edges, the crsip white net, and the Jerry West logo imprinted on the lower left hand side of the backboard.

My neighbor across the street also went to the same elementary school. He was in fifth grade, and so, naturally, I looked up to him. I believe he was half Filipino and half Chinese (last name Wong, first name Alex). He used to come over after school and play ball with me. When he moved onto junior high, his bus would always come later than mine and so I would always eagerly rush outside and shoot around waiting for him to get back. When the yellow bus did drop him off, I would always stop and stare towards his driveway expectingly, ocassionally say hello, but always hoping that he would utter those magic words: "I'll be right there."

When I think about, I don't know why Alex played with me as much as he did. Perhaps he was simply a good friend, an older brother figure of sorts, or maybe his mom encouraged him to do so. The important thing is that he did spend those many afternoons with me, challenging, encouraging, and, in those moments of frustration, admonishing me.

This summer, both at the Y and at the Rural Health Camp, I've played ball with high schoolers and it still feels strange that I would be the oldest one on the court. I find myself trying to get everyone involved, even if it means encouraging people after an ugly shot or horrid pass, or drawing up a play to get someone an open shot. All of this makes me reflect on the days where I was the young, timid one on the court--getting patted on the back after a made shot and looking for the encouragment of the older people who ruled the courts. But now, I realize that in settings like these, I inevitably become a different person, though I can't completely describe why this is.

So here I am now, with many of the same frailties that remind me of the child I still am and with ever increasing reminders that I am not altogether the same person I used to be. Lord knows those childhood basketball days have passed me by, save for those nights where I find myself dribbling and shooting in the empty gym, imagining that I'm back on the cement driveway, fighting the gusty crosswinds while swishing up game winning shots just before the final buzzer sounds in my head.

Family Medicine Reflections

Today was my last day with Dr. Myers and Reckamp at the KSB Oregon Clinic. I don't know if it's because it was my last day, but, for whatever reason, I felt pretty engaged throughout the day. I don't think I would want to treat small children (because as cute as they are, the fussy ones make these pretty miserable), but there's something to be said about getting the first stab at spotting all sorts of various ailments or simply following up on a pregnant woman throughout the course of her pregnancy. Maybe this is a reflection of my own interests, which tend to be scattered all over the place. Both docs that I spent time with had pretty different personalities, and in the end, I respected both of them for their distinguishing qualities. Most of the patients that we had were pretty pleasant people, which was quite a contrast to the ER where people came in with some sort of trauma/extenuating circumstances that contributed to their sometimes unpleasant dispositions. I remember a couple weeks in, I wondered if I might get bored doing Family Practice, but, after today, I am certainly entertaining the notion.

"Crop Circle' Festival

Every year the city of Oregon invites artists from all over to come make designs out of the cornfields that litter the farming landscape. This morning, I went on this plane at the Ogle County Airport to go see their creations



Turns out one that my fellow passenger was a photographer for the local newspapers and he took pictures as a hobby. With my Powershot (SD850 IS), I still managed to capture a few photos of Oregon, Byron, Mt. Morris and the other towns in the area.



Here are some of the designs that we saw. There were actually only four of them but considering that the artists only have a few days to do this, it's pretty impressive. My favorite is probably the last one with the bison/buffalo, wolf, and whatever that last one is. I'm not really sure what the one in the first pic (left side) is.






Nothing screams rural town like nuclear plant. Here's one that's in Byron, which is supposedly a pretty nice area and has good schools (whatever that means these days).

These are photos of the Rock River, and as you can tell, it's pretty brown. One of the locals told me that they periodically get notices about Radium levels and other fantastic substances.




This last pic I found at a store that I went to today.



I also had a chance to visit a local soap shoppe in Oregon. The owner used to be a nurse for a while and then decided to that she wanted to open her own store. She has been able to use medicinal knowledge in making her own soaps, and her daughter who helps out at the shop is, coincidentally, going into pharmacy school at UIC Rockford (after, of course, she has her baby in September). I had a fun time smelling the different soaps and learning about what all these strange chemicals do. There were soaps for "stinky pits," "insomnia," "chocolate," and any kind of skin condition you could think of. I was given a sample of "study soap" which has peppermint, which is supposed to wake you up, and lemon, which improves concentration and reduces mental errors. Apparently, in China, they are infusing lemon over the ventilation system for computer workers and it has been found that the number of errors has been reduced 54%. That's certainly a lot cheaper than blowing cash on Ritalin or other ADHD drugs, and I'm sure there's a lot fewer side effects.

Update of the various sort

The internship is quickly coming to a close and there's almost an anti-climactic feel to the whole experience. This past week I spent in time in psychiatry which was a rather eyebrow-raising experience. Most of the patients I saw were pretty much people you might meet in the classroom, on the streets, in your homes. The only difference is that society has diagnosed these people as in need of psychiatric help--or at least in need of protection against themselves (in the case suicidal thoughts). Still, when I think about this whole notion of suicide, I think about the lady in the clinic who argued that all of us, at one point or another, entertain some sort of suicidal thoughts--what distinguishes one from the other is whether or not one actually decides to carry it out. Perhaps it is because I find myself of a more somber disposition that I tend to agree with this assumption, or at the very least, I could just as easily find myself in a psychiatric ward arguing with the psychiatrist that despite all the meds he can cram down my throat, he still will never really understand my "psychological state." Aside from having one of the patients hit on me, I was able to talk to the social workers, nurses, and music therapist that worked there. While I can't always see how what they are doing helps, I can at least acknowledge that I myself, at this point in time, wouldn't have the patience to deal with some of the cases that I saw that day.

As part of our community service learning project for this program, we compiled and designed a community health services guide. The cover features a picture that I took of the Rock River. Here are some of the pics that my roommate and I took.




As for the basketball saga at the YMCA, that's still been going. All of the games have been limited to games of 21 and 32 partly because there are usually no more than three of us there at a time. Plus, we're all a disproportionately different levels to even entertain the possibility of a competitive game. Still, it's better than nothing.

Every week I on my way up to Oregon to the clinic, I pass by this farm along the highway. When the sky is clear and the sun is just rising, there's nothing like seeing green crop fields littered with a cluster of farm structures. I haven't gotten a chance to try to capture the sunrise but one of these days, I'm going to have to try to do that. In the meantime, here's what I've gotten so far.

Flattery

I was getting an ultrasound today and it seemed like the tech was taking a lot more pictures than I would have expected. I asked him why he was doing that and he told me that he likes to take lots of pictures so it will be easier to detect changes if the next time should reveal some unwanted developments.

He then added that he likes to do so because, unlike most people, my organs are really clear. "See?" he says, and then he proceeds to show me my gall bladder, liver, and pancreas as I stare up at the screen.

To put it mildly, I was flattered.

The Basketball Jones saga continues: in which I find someone with a helluva lot more basketball jones than me

Tonight at the Y I met JJ who recently moved to the area from Wisconsin. He played college ball at a DII school in Wisconsin as well as football. In short, he was much better then the three of us who played with him, but I haven't had this much fun playing competitively since the last time I played ball with a whole bunch of superiorly-athletic black people last summer. And the best part of all of this is that we may finally have ourselves some regularly ballers at the Y. Is JJ holding back at times? Sure. Do I still need to develop an inside game? Definitely. Do I still need to add some more muscle so my skinny frame doesn't go flying against the wall at the slightest bump? You betcha.

I guess if there is a silver lining in my game it's that I've managed to develop a somewhat consistent mid-range game. The lost art just so happens to be my only art.

Pharmacy

The pharmacy rotation today probably was the most instructive in terms of seeing how the microbiology and biochemistry fit into clinical practice. Blood clotting and antibiotics primarily came up in terms of in-patient medication. I spent most of the day with Rob, who I thought would be a great teacher in any kind of setting. I learned a lot from him--including how much I still needed to learn. I also was able to sit in on some department meetings that included discussion over incident reports and specific drug usage. I saw how open communication between health care workers is crucial for patient care and how stubborn physicians can tack on a few hundred dollars per patient or even lead to poor medical decision making.

Basketball Jones meets some locals

During my daily trip to the YMCA, I ran into three graduating high school students on the court. Unfortunately, I forgot their names, the white guy and the white girl, but I did remember the black guy's name--LaShard. We played some casual two on two (and I mean casual) but it was really nice to actually play a game with some people who did play a little ball--even if we didn't keep score or really up the intensity (and played with a woman's ball). I talked to the WB (white boy--let's call him this until I find out his name next time) a bit and he told me that there indeed is not much to do around here, aside from drinking and working out. All of them don't intend to go very far for college (if they are going), and the girl tells me that she works at Subway year-round. The WB works on a temp basis at the Rayovac plant in town. I hope to see these folks more often, but who knows whether this little interaction tonight becomes a saga of some sort or remains merely a short story.

Physical Therapy (Last Tuesday)

This was one of the most engaging days in the program. In the morning, I shadowed one of the PTs in the clinic and was exposed to the Neurocom machine, a $100,000+ machine originally designed by NASA for its astronauts to gauge visual and vestibular functioning. Essentially, this was like a simplified virtual reality game. The afternoon was spent driving around the area with Jeff, the PT who does the home care visits. We visited three patients and each was pretty memorable. Among these patients we essentially hit three spheres of society--the wealthy upper/middle class, the mid-lower blue-collar working class, and the farm. Between homes, I enjoyed some delighful conversation with Jeff ranging from his "Magic" cruise (he plays the card game), how he ended up from Dixon after growing up in Wicker Park near the city, and many other random topics. Below are some photos from a farm in Harmon, IL that boasts a population of 300 or so.


n


One thing that stuck with me was Jeff''s reason for coming to Dixon after spending much of his life in the city. What he had realized was that after spending time in both settings as a student, he realized that he would be doing the same exact thing in both settings and that the only striking difference between Chicago and Dixon was the people. People were "nicer" in Dixon. In Chicago, most people were "just civil" at best and he didn't want that. The home visits were also pretty memorable because, as Jeff put it, we were entering an intimate setting and helping people in the environment where they felt most comfortable and could be the most vulnerable, in contrast to the sterility of a doctor's office. What more, home visits enabled the health care worker to see the environment in which an individual lives and understand even the simplest obstacles that a person must overcome on a day to day basis when dealing with a medical issue

Rural Health Camp

For the last couple days, I was in DeKalb, IL (another one of those MON places--but more along of the lines of the rural university town) for a Rural Health Camp put on by Northern Illinois University. I helped out as a camp counselor for a group of kids the included 39 and 7 high school girls and boys respectively. The students are nominated by counselors/teachers in their communities to participate in this two day event which exposes them to different health care fields including speech/hearing, nursing, physical therapy, clinical microbiology, and a few other fields. It's really a neat camp that I wish I would have gone to when I was in high school.

Many of the kids participating in these programs come from poorer areas of Illinois where the expectations educationally are rather low. In addition, these are areas where higher education is often viewed in a negative light. It isn't surprising, then, that many of these kids came bearing family/social-related problems that extended far beyond the classroom. This camp reminded me of my friends who are currently teaching in underprivileged settings, both rural and urban and also reminded me of how these children are desperately searching for positive role models in places where they are scarce. And, of course, seeing the limitless potential in some of these children made the temporality of these last couple days that much more difficult to handle.

Coming back to Dixon this morning brought back memories of those afternoons after getting home from one of those youth group church retreats. It's a strange feeling to be around so many kids at one point and then come back to silence. On one hand it's refreshing and relaxing, but, on the otherhand, it also produces a lonely effect that hopefully blows away at the start of a new week.

What I've been doing when I haven't been checking out flea markets or chilling at the YMCA

Um...I should also add surfing the net and watching TV to the heading as well, but then I wouldn't have anything else to say here.

I suppose, I could just give some general observations from my stay here.

1. Hospital food- we get it for free here. Breakfast, lunch, and dinner is all paid for. I've never gotten so many non-water drinks with my meals in my life. My favorite so far is the "all natural" Mango Snapple. We've had some weird dishes though. The "Mexican Lasagna" with corn in it jumps to mind. When in doubt, there's always a decent salad bar. I'm a big fan of cherry tomatoes, kidney beans, and cottage cheese. One of the cooks is a professional chef and he makes all sorts of pastries that are pretty good.

2. Foreign doctors- there are a lot of them here. Residents and post-training physicians alike. The big winners here are the Indians and Arabs. Unfortunately, the hospital's website could use some cultural competency. One of the listed languages for the Indian docs are "Indian" and for one of the Filipino docs, his language compentencies include "Filipino." Needless to say, within the health care system, there's quite a spectrum of "diversity." Of course, the hospital's motto isn't "Hey, we're PC" but rather "It's the people." So I guess in this respect, a little ignorance doesn't hurt.

3. Antique shops and dollar stores- there are a lot of them here. I am a sucker for them. This past weekend I spent a lot of time in them. Until the weather clears up, these will be my source of entertainment.

4. Super Walmarts- there are a couple around here. They remind me that I have still some connection to civilization.

5. On probably being the only non-physician Asian here-- I think I want to be the only here because it would make me special. Until I see another one, I will continue to think this and revel in my uniqueness.

6. Public health issues-- Over the last week I've been exposed to many of the issues that I have learned about when it comes to underserved populations. Seeing them firsthand, through the physicians interacting with patients, watching the hospice/home care/physical therapy/medical discharge teams collaborate, or even walking around town, I realize that sometimes, I'd rather not face these issues and leave them for other people to take care of. But that's stupid, right? I shouldn't be in medicine if I didn't want to deal with them in the first place.

7. This morning, I noticed that there were literally five churches along two blocks. There are 39 churches in a town of 16,000. I don't know what to make of that.

Flea market bonanza

Today, because we are in the MON (middle of nowhere), my roommate and I drove about 15 miles west to the neighboring city of Sterling and its twin city across the river, Rock Falls. Sterling used to be considered the "hardware capital of the world." Thus, we did manage to find a lot of abandoned factories. Economically, Sterling and Rock Falls (which is across the river) is poorer than Dixon and has about 10% below the poverty line, and is one of those cities that over the last few years has been hit pretty hard by the economic downturn. The main reason why we went was because they had an indoor flea market (shown here) there that I wanted to check out. I got a lot of amusing photos for your enjoyment in addition to some pictures of the somewhat shabby city. There were some true historical relics on the four floors of this building, which used to be an old bank. I couldn't believe some of the things people would actually try to sell.

What did I find? Dear reader, I am so glad you asked...


Nothing screams traditional girl toy like Barbie and the one I found had a hometown twist. I have a friend back in Chicago who has practically every Barbie known to women but I'm guessing she doesn't have this one. In retrospect, I should have probably gotten this for her but I prefer to keep these anatomically distorted figurines in their rightful place, on the shelf and sealed in a box in some musty basement. Speaking of dolls, I never actually saw Bride of Chucky because I was only in junior high when this came out and hadn't really begun watching Rated R movies yet. Still, I had heard enough from the older guys in my youth group about the original Chucky to be a little unsettled by the notion of freaky dolls.

I have fairly fond memories of eating Jello growing up. Even if it was just made out of water, pig fat, and sugar. One of my high school friends really liked Jello and he really liked apes. This other book is probably a must-have for college students because if there's anything worse than BS-ing assignments, it's doing a poor job of BS-ing.

The great thing about flea markets is that you're never quite sure what you'll find. I'm not sure why people sell empty beer cans at a flea market, and I can only speculate as to why someone would be trying tell old porn magazines.

I think it would be great to hang these two signs in a classroom. The second one offers sage advice.

Sterling has a historical mural society so we came across many buildings that had murals on them. Here's one of the presidents that had visited Sterling.

There's not much of skyline in Sterling or in Rock Falls. We did find lots of these, though. As you might assume, the downtown area that we were in was pretty much empty and aside from the pubs, all the stores here closed by 4pm. I used to complain that St. Louis was pretty dead on the weekends but what we saw today just blows that out of the water. Even the shots from the bridge that separates Rock Falls from Sterling were not so hot.





Hopefully, when the weather gets a bit better, we'll be able to go visit some of the state parks and take some more memorable pictures. When the main attraction of a town is its Super Walmart, you know there are some issues. Still, I know that part of the reason why it seems like I'm in the MON (besides the fact that I am) is because I don't know to many people here and when it comes down to it, it's really about who you're with as much as it is where you are.

Basketball Jones Remix

I went running the other day looking for a trail along the river. Unfortunately, the path that I took ended up taking me through residential areas. When the weather is nice, the river is a beautiful site. They also tell me that the water in Dixon has some issues, something about receiving mail notices about traces of radium and arsenic in the water. Beauty kills, I suppose.

The YMCA here has a basketball court and for the first time in while, I have finally found an indoor court that is pretty much people-free during the summer. In the suburbs, this is pretty much impossible and, what more, memberships are kind of expensive. Unfortunately, I am pretty much alone here and, had I not been in Dixon, IL, I would have called up my buddies to come here and play ball. Aside from the interesting glances I get from the natives here who probably don't see too many Asians, let alone Asians on a basketball court, I'm pretty much left alone.

Shooting around has brought back so many childhood memories: from playing on the varsity basketball team in junior high (we had a small school) to coming in early in the mornings so that my gym teacher could help me work on my form. In some ways, solitary shooting has been therapeutic and running suicides, euphoric (um, ok, that's a stretch).

I have decided that I want to learn how to throw behind the back passes this summer in addition to regaining an erratic stroke that I used to have sometime during high school. Obviously, it would be nice to have some pick-up games but so far it seems that playing ball doesn't seem to be popular thing here.

Nursing or Medicine #2

I feel like I ought to preface this entry with something that says that what I experienced wasn't anything that I wouldn't have expected, but the fact of the matter is that today was draining in many ways. The nurses ended up having me shadow a resident, Dr. Diana (insert long Ukranian name here) since they knew that I was a medical student,

I saw a variety of patients throughout the day including an assortment of children, a ninety-five year old lady with 13 great grandchildren who had lived all over the world with her now-deceased husband who was in the military, and a diabetic who called everyone "brother." Maybe it was because I had to stand up all day (most of the rooms didn't have enough seats) or perhaps I found the procession of patients kind of boring but I was ridiculously tired by the end of the day. Days like this make me wonder if family practice is for me.

The last patient of the day was known for her frequent visits. She wanted a letter that permitted her to find another job without being fired due to stress. If she were to be fired, she would lose unemployment, health insurance, etc. The woman had two young children and a husband who worked. She said that she worked at a company where there were eight people left in the department, among which four were expected to be let go. Her job involved some sort of commercial writing and she had been recently admonished for making errors in her work despite the fact that, unlike her boss, she lacked a second pair of eyes to look over her work before the final submission. Her father had recently passed away and she confessed to needing to always be active but could not handle the stress of her job and the repercussions on her family if she lost her job. She had been taking medication for her anxiety attacks but they seemed to have limited effect and she did not want to drug herself up. When asked about seeing a psychotherapist, she said that wasn't a route she wanted to go down ("I don't need a psychiatrist, I need relief"). She cited the economy and a criminal record as reasons why she couldn't find another job (two very good reasons might I add). In addition, she talked about feeling bored with life, that the idea of having a job, coming home to the family, and preparing for the next day all struck her as meaningless ("As religion would say, I'm looking for truth"). Still, despite her suicidal thoughts in the past ("I think everyone has suicidal thoughts at some point in their life...they just don't act on them") but would never do so because of her responsibility to her family. At the same time, she confessed that if she lost her job, there's no telling what she would do in such a moment of desperation. All this time she is telling us this, her young child is jumping around, throwing things, and adding to the frustration in the room. Needless to say, you needed to be there to experience the full drama of the moment.

It turns out that this woman had this same issue at two previous jobs and that the company that she says she is currently at is not the place where she is now. The doctors wanted her to see a psychiatrist before moving foward with anything, but, in reality, they are just fed up with her. I believe when one of the nurses was telling me about her at the beginning of the day, her description was as follows: this woman is crazy.

Before discovering these last few facts, I couldn't help but empathize with this woman's position. The line between insanity and sanity (at least as our society tries to define it) in this woman's case seemed almost Dostoevskian. Societal services such as medicine, social work, psychology all seemed useless in this situation partly because they relied on a particular rational framework. Although this woman turned out to be less than genuine didn't diminish the ideas and issues that she had raised because no doubt there are many people in situations like these. Of course, one might point out that it is in these situations where religion can become as much of crutch than a solution, but, at the same time, I cannot see how medication, "learning to cope with stress" (almost in a Buddhist, pain-transcending sort of way), or reason can help most people cope with these situations.

Medicine Rotation #1

Now that I have my camera, I've been eagerly looking for unique shots as I drive around Dixon and the surrounding cities. Today, I had to go to Oregon, which is about 15 miles north of Dixon to follow some family physicians. This morning was gorgeous, it was one of those mornings when the sun peaks through an assortment of clouds, shining off hills, trees, and water, painting a breath-taking picture. Unfortunately, I was not able to pull over and snap a few as I would have liked but, rest assured, I won't let the opportunity slip through my fingers next time.

I ended up having a fairly short day since this afternoon was to be dedicated to 120 high school physicals. This morning, I was reminded of the pitiful plight of primary care in addition to being reminded of how much I had forgotten over the last nine months. As I had been told by other physicians in the past, the primary care scene certainly presented with a variety of patients: young, old, infants, pregnant, mentally retarded, very old, etc. I suppose it would have been cool to have taken pictures of all these people, but, unfortunately, that would have been difficult to pull off without repercussions of some sort.

This photo was taken as I sat in the drive-thru at a hot-dog stand in Oregon. I suppose a picture of the food joint would have been more stimulating but this picture highlights the interesting juxtaposition of luxury and more modest housing that is fairly prevalent in this area. Pictures like this, in addition to the abundance of nature, remind me that this isn't quite the suburbs.

The next few photos I took from the bridge that crosses the Rock River that runs through Dixon. These photos are from behind the hospital and represent some rather pathetic attempts to capture unique perspectives of otherwise boring subject matter. One of them shows the YMCA where I signed up for a membership today.



These last couple photos were taken near my apartment. One of the photos includes a piece of the Berlin Wall. One of Dixon's sistertowns was in Germany, and this little historical relic made its way to Dixon after its demolition.