Near Death Experience

I've ever been so scared in my life.

Still here in the Middle East, we decided to take a trip to another city within the country, and so went to a travel agency to buy our tickets. Now in the US, this wouldn't a big deal at all ... just book whatever flight was available or cheap and you'd be set. Unfortunately, here you have to watch out because some flights are aboard the infamous Tupolev planes.

If you're not familiar with Tupolev, read here and here. In short, Tupolevs are Russian-made airplanes that are notorious for crashing. They drop out of the sky like flies. All you have to do is look at one the wrong way and it'll crash.

Anyway we reserved flights that weren't on the dangerous airplane, and we thought that was that. However, on the day of departure, we were boarding the plane when a crew member stopped me to and told me to check in my little carry-on bag. I asked him why, and he said "these Tupolev planes are very small."

Um ... what?

My mom and I immediately faced each other and saw the shock in each other's eyes. We asked the guy to repeat, and he again confirmed that it was the airplane we didn't want -- the one aircraft we went to great lengths to avoid, the one aircraft that determined our travel plans for this little trip, and the one aircraft that prompted us to stay an extra night at that city (to avoid Tupolev flights).

The crew member tried calming us down, and for the most part he did, until I stepped foot on the plane ... and saw all the signs were written in Russian. Not calming. Neither was the fact that this plane was incredibly small, half-filled with broken parts (seats, floor boards, overhead compartments, etc.), and smelled like gasoline. I'm no rocket scientician, but I am pretty sure airplanes shouldn't smell like gas.

Luckily -- thankfully -- our flight was uneventful and we arrived safely. We were flying to the holiest city in the country, so it would have taken one mean God to bring down that flight. (Ironically/coincidentally/unfortunately, we were flying to the same city mentioned in the article above.)

I know this isn't much of a medical post, but I guess it does loosely touch upon some medical ethics ... namely, end of life issues.

Hello from the Middle East

Greetings from abroad! Yup, that's where I am these days. I came
across an internet cafe and thought I'd drop a quick note.

It is very cold and snowy here. (So to answer the burning question in
your minds: no, the Middle East isn't just sand dunes and deserts.) I
actually love snow, especially since it's a huge change from Southern
California. I am also eating a lot, shopping a lot, visiting people a
lot, and thinking about medicine not at all.

Unfortunately internet access is pretty difficult to come by (not in
the entire country, but just in the neighborhood I am staying) so
another post might not occur until my return home.

Till then ... happy christmas and holidays!

Leaving the Country

Dearest readers, I am leaving tomorrow for a 2-week family trip out of the country. The region of the world we are travelling to (mentioned frequently in the news these days) has unreliable internet connections, so I doubt I can post from there ... but never fear, I'll be back soon.

Merry Christmas!

Interview Thoughts and Random Thoughts

Now that my first round of interviews is over, I have a little time to breathe (and focus on my hard days of work on neuroradiology). Here are some recent thoughts I've collected. First, the post-interview thoughts:

• I wear a suit to all my interviews, as is expected. My suit is kept neatly pressed all the time, and on the mornings of my interviews I sometimes even walk around the house without pants (a la Seinfeld) while getting ready so that they don't get wrinkled unnecessarily early in the day. Also, I make sure my belts are tied, shoes are polished, and ties are straight. In other words, I make sure I look slick.
  
  Well on one interview a few weeks back, I was interviewing with the program director and sitting directly across from him with no desk between us. I may not have had the world's greatest answers, but at least, I felt, I looked damn good. Of course, nothing ever goes perfectly for me ... because afterwards I went to the bathroom, only to realize my fly had been open the entire time. Man, so close!
  


• I've noticed a mildly interesting association between gender and subspecialty choice. At some point during the interview day when all the interviewees are together in one room, we will be asked in what, if anything, we plan to sub-specialize. The trend I've noticed is that girls are interested in pulmonary medicine while guys are interested in cardiology. (And during the tour at my second interview, these two guy interviewees suddenly disagreed on a minor point about cardiology. They went back and forth a few times and then started geeking out -- they began bickering loudly over this useless point, drawing the attention of everyone in the tour. Not wanting to get caught up in this extraordinarily embarassing show, I quickly dropped back to the girls and starting showing newfound interest in the lung.)
  


• Updates from my night at Days Inn (aka, my night in the ghetto motel). The night actually improved: I figured out how to connect the light switches to the lamps; I got the bathroom light working after flipping the switch on and off about ten times; and most importantly, I was able to jerry-rig (gerry-rig? Jerry-rig?) the curtains so that I had some privacy (I used the clip on my hospital name badge to connect both of the thick curtains to each other so that they covered the majority of the window). However, the best part of the night -- which I failed to mention in my original post -- is that the hotel offered FREE wireless internet. That amenity more than redeemed Days Inn in my eyes.
  

Here are some other random thoughts collected as of late:

• I was at the farmer's market one morning last weekend, standing in front of one of the vegetable stands. This stand had a big box of fava beans, and upon seeing them I told my girlfriend "Ha, some people would die if they ate these", referring to favaism, seen in some G6PD patients (causing their red blood cells to lyse open). Some woman next to us overheard me say this and immediately began asking me "what? why? why?" and freaking out. Not wanting to get into the details with her, I just mumbled something about allergies and walked away.
  


• Financial aid disbursements haven't arrived yet, and tuition is due soon ... because I got a bill from my school for $21,000! That is a lot of money. Paying off my student loans will take a looong 30 years. (My blog entry on the day I finish paying it off will probably be my happiest one ever.)
  


• I finally found out that I passed the USMLE Step 2 CS. I still grumble over the $1000 I had to cough up to prove them I know how to speak English.
  

Acute Intermittent Porphyria

I swear the gods are sending me a message.

I think they want me to know about a disease known as acute intermittent porphyria. Why? Because this disease has been thrown in my face non-stop lately. The first -- and last -- time I encountered this entity was when I was studying for the boards. I learned it, took the test, and promptly forgot about it. I assumed I would never hear about it again.

Well the people up above would differ. In just the past week alone, acute intermittent porphyria was brought to my attention FOUR separate times. The first time was during my first interview, where a video providing an overview of the program showed a group of residents discussing a case, one of which had porphyria on the differential. It caught my attention, but only enough to think, "oh yeah, I forgot that existed."

The next time was on the show House, a medical show I occasionally watch, in which porphyria was the cause of the main patient's illness. After this episode I thought "OK, I guess I shouldn't forget remember this disease". Shortly afterwards I was watching an rerun episode of Scrubs, which I watch religiously, and one of their patient's abdominal pain was due to porphyria. This time I figured I had better remember it, having seen it twice in a row now. And finally, on my last interview one of the girls in the group (an extremely annoying one, too) said her previous interviewer pimped her by asking her to name the enzyme deficiency in acute intermittent porphyria.

What is up with this? Why, all of a sudden, am I having this obscure disease pop up everywhere I turn? I feel like Mother Nature is trying to indicate that one of my family members will get this disease ... or at the very least, one of my patients will.

In any case, it's safe to say this disease is permanently ingrained in my head.

In case you're wondering, acute intermittend porphyria is one of the porphyrias, which are a group of disorders caused by abnormalities in the production of hemoglobin (the molecule that carries oxygen in your red blood cells). It usually presents with acute abdominal pain, generally in young women. And the deficient enzyme is porphobilinogen deaminase.

I can't believe I looked this up.

Night Before an Interview

I am sitting here in a motel in San Diego, the night before a residency interview tomorrow. The program recommended this motel as it is the most accomodating one in the area. Accomodating as it may be (in terms of free shuttles and discounts to interviewees), it is no 5-star motel.

It was nighttime when I entered my room for the first time, and immediately none of the light switches worked. After I wandered around in the dark turning on lamps manually, I noticed that the one (large) window in this room was covered only by a curtain that was thin and see-through. I moved to pull the thicker curtains that were bunched up at the side of the window, but I realized that there was no track for them, and so they weren't able to be pulled across the window ... which means that with all the lights on in this room, people from the outside have an easy and clear view of what I'm doing in here. Which also makes me worry in this sketchy neighborhood that's only 50 feet from the freeway.

To top it off, the bathroom light doesn't work, so if I want to take care of business, it'll be in the dark. Luckily I know where all my boy parts are.

So again ... I'm sitting here in a motel in the middle of the San Diego boonies, unable to relieve myself, and probably being watched from the outside by some freak. Talk about the sacrifices one makes to become a doctor.