March 2007 Archives

My hands were shaking as I opened the envelope.

It was not a calm or private moment, in any sense of the word.

I suppose it is hard to be either when you standing in a loud and crowded room, trying to remain stationary as tides of anxious people surge around you, both toward and away from the table with the envelopes. It is especially hard for a moment to be calm or private when it is being captured by a photographer from the Oregonian.

The sound of the rapidly clicking shutter melted into the dry rustle of paper as my shaky hands opened the envelope with my name on it, and unfolded the piece of paper.

I matched at Hennepin County Medical Center in Minneapolis, Minnesota. My first choice.

That was the moment. The moment that my future became definite, the reality of my departure from the people I love in Portland dropping like concrete from the little printed words on that weightless piece of paper. At the same time, the excitement about that same future began to set in. What a moment!

Congratulations to all my friends and colleagues who lived through their own future-defining moments at around the same time. My friend Tracy, who is applauding in the picture, had just found out that she got her first choice program in pediatrics and will also be leaving Portland. There were others who were not so happy - many tears were shed yesterday, and not all of them out of joy.

Fortunately, we were able to leave the frenzied masses and enjoy a much deserved drink at a cafe in a location far, far from campus. A bloody mary never tasted so good (which is why I had another one - that one tasted pretty good too.)
The rest of the day was dedicated to celebrating my birthday. I treated myself to a wonderful massage, which, after the two drinks and the general surrealness of the day's events, put me into an altered mental state that I remedied with a walk and a nice nap. Alex took me out for an absolutely delicious dinner. I finished off the night with a little bit of disinhibited karaoke with some of my favorite people in the world. People who I will miss dearly. Fortunately, most of them left before I decided, in a moment of ill-advised disinhibition induced by one too many amaretto sours, to sing Milli Vanilli's "Blame it on the Rain." That, and not the realization of my impeding departure, was definitely the low point of the day. For everyone involved.

Tomorrow is the day! Tomorrow morning at 10 am, I open an envelope that tells me where I will be spending the next three years of my life, if not more.

Its weird that it is already decided.

There are some people who find this period of uncertainty unbearable. For some reason I don't really mind not knowing. Because knowing makes everything final, it means decisions must be made and actions must be taken. It means finally planning for the future instead of simply enjoying the present. It means I might be leaving.

But its cool. Its cool. I'm actually excited.

Oh yeah, and not only is it Match Day tomorrow, but it is also my birthday! I'm not joking. March 15th. Good one, God! You really zinged me this year!

Most memorable birthday ever.

Yesterday I received an email from the National Residency Match Program letting me know that I matched... somewhere. But I don't know where! That special secret will be revealed on Match Day, which is this Thursday, March 15th. In 2 days.

The logistics of Match Day are fascinating. Every senior medical student in the country finds out where they matched at the exact same moment on the exact same day. The results are posted online, or they are presented to you in some form of ceremony. At OHSU, there are envelopes laid out on a table, and at 10am (1pm EST), after a gorging yourself on a lavish buffet breakfast of srambled eggs and fruit plates, you are allowed to open them. I hear that some schools make you open your envelopes on stage and read the results outloud to everyone via microphone. That is nothing short of torture.

As if this period of waiting in limbo wasn't torture enough. Personal pergatory.

And speaking of inflicting pain... every year there are a few people who unfortunately do not match. All of the slots at the programs they applied to filled with people who were not them. If this happens to you, you embark on a frantic process that is known as "The Scramble." (I am not making these names up - it does sound like some sort of amusement park ride or a sorority hazing ritual, doesn't it?). This is the reason for the preminatory email that we all receive 3 days in advance - it is a courtesy to those who did not match.

The Scramble takes place on the two days leading up to The Match, aka today and tomorrow. If you have to scramble, you receive a listing of all of the programs in your field whose spots did not completely fill. Then you frantically send out emails and make phone calls and fax your application to any place that might have you. And if you match there, then you go there, sight unseen. Scrambling is not fun, but it happens.

The thing that is so odd about this whole process - besides the ranking strategies, the patented algorithm, the nationally coordinated reveal, the Scramble, and the 3 week period of excrutiating uncertainty - is that the match is contractual. By participating in it (and you have to participate - there is no other option), you are explicitly agreeing to a contract which requires you to go wherever the match places you. And this is an employment contract: you will from that moment on be a future employee of the hospital of the program that you match at. Your salary, benefits, and work hours are pre-established and non-negotiable. It is very weird.

A lawsuit was actually brought against the NRMP by a group of residents in 2002. They argued, I assume unsuccessfully, that the match system is "anti-competitive and thus a violation of anti-trust laws." Doctors and doctoring organization rallied against the lawsuit, claiming that the Match "levels the playing field. It makes everything fair. … Before the Match, there were deals made under the table. People were picked based on who they knew. If you destroy the Match, you're going to Neanderthal times." I guess I don't want to go to Neanderthal times, if you put it that way.

Anyway, right now I am waiting for some giant computer in some basement somewhere to make a lot of beeping and whirring noises and spit out a slip of paper with my name and my match result on it. This large, cold-war era computing mainframe machine, which is probably called something like the Mr. Matchatron 4000, looks like this:

Nickname: the Winds of Destiny

When Mr. Matchatron 4000 prints out my piece of paper, it will say my name in its slow, cold, metallic voice. Fee-oh- na. It will probably mispronounce my last name. But its words will be final.

In the last entry we discussed the initial steps of the residency matching process, whereby U.S. senior medical students like myself apply to and interview at residency programs in their field of choice. And it was pretty simple, albeit very expensive and time-consuming. In this, the second part of our muli-act mini-blogoseries, we shall discuss the next step in the process: Making your Ranklist.

Each graduating medical student who has hopes of going on to practice medicine must decide which residency programs they might like to end up in. This decision must be made in rank order and submitted to the National Residency Match Program. So lets say you interviewed at 10 programs that you halfway liked. You submit a first choice, second choice, third choice... down to numero ten.

Meanwhile, each residency program must make a rank list of its own. All accross the country, in windowless hospital board rooms, around long tables strewn with pizza boxes and empty 16 oz latte cups, groups of medical faculty, program directors, attendings, and residents met for hour upon hour to make a list of their favorite medical students. Keep in mind, they are making their list from the hundreds of students who they interviewed over the course of the season. I've been told that in some programs they print out big copies of each of our application photos and post them on the wall, moving the photos up and down as each student rises or falls in the rank of hundreds. For all I know they also use a dart board, or pin-the-tail-on-the-donkey, or a collection of voodoo dolls to make the list. Perhaps it involves a seance. Perhaps an elaborate drinking game based on Star Wars. Or 52 card pickup. But somehow they too come up with a list of people, #1 through whatever. This list is then submitted to the National Residency Match Program.

And then a computer calcuates everyone's ranklist from all over the country, and matches each student up to a residency program. Hence, The Match. Then the computer tells you where you are going to go, and every medical student in the country finds out the results at the exact same time. More on this later.

Now, you might be thinking: Fiona, this doesn't sound that complicated. The computer program is likely based on a simple algorithm that weighs each rank list and calculates a reasonable result. What's all the fuss about? I'll tell you.

Yes, the match system is based on a simple algorithm. "This algorithm assumes that offers made to applicants for by various programs are determined by the applicants' preferred order lists (rank order lists). Applicants match into the programs listed highest on their lists that also ranked the applicant and had not filled all of available positions with applicants the program preferred as determined by the program's rank order list." That DOES sound simple!

What this enlightening and easy-to-understand statement from the NRMP does not encompass is the one cardinal rule that the Match is based on. (I love being involved in something that has one and only one cardinal rule!) "There is one cardinal rule for both programs and applicants: neither must ask the other prior to the Match to make a commitment as to how each will be ranked. Each party may express a high level of interest in the other; however, references to how each will rank the other should be avoided and should definitely not be solicited." (bold text is actually from the source).

This is important because the whole process is screwed up if someone guarantees you a spot, or if you guarantee that you are ranking them as #1. The hitch, though, is that residency programs want to have good stats. They want to be able to say that all of their slots filled from the top of their list, that they have never had to go past #20 on their ranklist, stuff like that. It makes them seem like a more competitive program that always gets the top applicants, which will then theoretically attract a higher caliber of applicant in the future. It thus becomes a weird strategy game where students try to give every program the impression that each is their number one choice, even if its not, hopefully then allowing them to be ranked higher. For some this involves emails and cards to program directors, stating their high level of interest. For some it involves lying, or stretching the truth, which violates the cardinal rule not only of the match system, but of several major religions.

I didn't want to play the game. I tried to be as honest as possible, which meant using generic phrases like "its a very hard decision for me." This, I came to learn, is universally taken as a phrase of rejection, which may have in fact hurt my chances of acheiving my ideal Match.

But the truth of the matter is that making my ranklist was the hardest decision I have ever had to make in my entire life. Having to weigh career choices, living situation, family, friends, boyfriend, aspirations, dreams, future, past, sense of adventure, sense of comfort... and having all of these forces play out into a single numerical list... it was agonizing. Honestly agonizing. It feels like you are being asked to decide the course of your life, knowing that whatever decision you make will change everything forever, but also not knowing what the result of the decision will mean. And with the match system, even a decision is no garauntee of a result, as you then have to leave it up to some computer (or as some like to call it, "fate") to decide.

For the days leading up to the ranklist due date I would get nauseous whenever I thought about it. I cried whenever I talked about it, and I talked about it a lot. I was scared of any possible outcome, my fear of making a decision outweighing the excitement that I should have been feeling about entering this new phase of my life and of my medical training. I was faced with only good options, but any option seemed to distance myself from someone that I loved.

In the end, I made a decision. I ranked one potential future higher than another potential future, and I left it that way. Although, to be honest, I did move things around a few times, and I spent a couple hours staring at my online list the day that ranklist was due. However, at the time that the list was officially certified online (February 21, 2007 at 9pm EST), I was out in Forest Park. For the 15 minutes leading up to that arbitrary decision cutoff time I walked into the forest along the creek, the soft grey of the trees closing around me, the moss hanging brightly from their branches. When 9pm EST hit, I stopped for a moment and stood still in the forest, listening to the slow, neutral trickling of the creek, smelling the damp beautiful rot of wet leaves and dirt, feeling the air cool on my cheeks. Then I turned around and walked back out of the forest, back along that same creek, ready to face my future.

Oh, that important email that I got earlier this morning from the NRMP... it said "Congratulations! You have matched."

This morning I received an important email from the National Resident Matching Program. It told me whether or not I was accepted to a residency program. The receipt of this email was one of the very last events in the long and arduous process of deciding my future. Or having my future decided for me.

For those of you who have no idea what I am talking about (and don't worry, most people usually don't - i find it rare that anyone does), I will fill you in on what is quite possibly the single most complicated and stressful job application system in existance: The Match.

The Match is a system that is wholly unique to medicine. Unlike in most academic or professional settings, where you apply for a position, have it offered to you, and then decide whether or not to accept it, The Match is a complex game of odds and strategy that culminates in a nationalized computer program printing out a little slip of paper with your future on it. Here's how it works:

Step 1. You simpy pick a field of medicine that you would like to dedicate your life to. This is easier said than done. Unfortunately, it is the easiest part. My career choice was Emergency Medicine.

Step 2. You fill out a computerized application, that includes your transcript, your board scores, a list of everything you have ever done, comments about you from virtually every person that you ever worked with or passed in the hallway, and a personal statement in which you modestly express how you are the most awesome, intelligent, and compassionate human being who ever picked up a stethescope. Oh, and a photo. You send this application electronically to a whole bunch residency programs in your field.

Step 3. Some of the programs offer you interviews (hopefully), based on your initial application. You then decide which of these programs you would like to interview at. This decision is based on the merits of the program, their geographic location, the cost of airline tickets, and, if you are like me, how many friends you have in the area that you would like to visit.

Step 4. You travel around the country interviewing at different residency programs. This usually happens in the months of november through january, is incredibly difficult to coordinate, costs varyingly enormous sums of money, and is referred to as being on the "interview trail," or more simply, "The Trail." As in, "when I was on the Trail I met a bunch of students from this one place and they all said that this other place totally sucked." The interview trail is basically a huge roving national rumor mill, where whispers about the qualities of various residency programs (or about other students on the trail) are exchanged in passing. I have a feeling that other things (like STD's) are exchanged as well, but I did not get any first-hand experience to support this claim. My personal interview trail took me from Oregon to New York to Minnesota to Oregon to California back to Minnesota back to Oregon then to Arizona.

Step 5. Once you have interviewed at all of the programs you were destined to interview at, you decide where you want to go. Now, I know that sounds simple, as if it were merely the last step in the residency application process. In fact, if it were any field other than medicine, it would be. Game over, end of blog entry. But as it turns out, Step 5 is where things get really interesting. Its where the game begins. The game called "Making your ranklist." Its so fascinating in fact that it is deserving of its very own blog entry.

I say this in complete seriousness. For some reason, this spectacle of medical fraudery and debauchitude seems to have gained some amount of crazed popularity among the television-watching public. I don't know who this "public" thinks it is, but I have no doubt that it is completely devoid of self-respect.

My friend Tracy and I found ourselves accidentally watching an episode last weekend. In our defense, we had been studying for our upcoming boards exam, and had rewarded ourselves for our hard work by watching a little of the so-called "boob tube." As it turned out, "boob" was right (in the old-timey sense of the word, whereby the term now liberally applied to female mammary anatomy was used to imply "a foolish person." And how.)

Now, Tracy and I are relatively smart gals. Between us we are near to completion of eight years of medical school and have an additional 2 years of a pathology student fellowship under our collective belts. But at one point we turned to eachother while watching House M.D., and exclaimed, "What the hell is going on?" All our years of medical training had left us unprepared to follow the plot line of House, a show based around a jerk-hole "genius" and his rag-tag team of young sexy internal medicine "experts" who together solve really challenging medical cases in a matter of hours, all the while learning valuable lessons about the meaning of friendship. Or something.

The episode Tracy and I watched was the one where Dave Matthews is an idiot savant who has something wrong with his brain. What is it? How can we possibly figure it out? It must be some logic-defying puzzle that can only be unlocked by the brilliant mind of one Doctor House, Medical Doctor.

All I know is that at one point the sexy young medical team was performing a carotid angiogram (something they would not know how to do), and then the next moment they were doing an upper endoscopy on a completely awake Dave Matthews (which is something that only gastroenterologists do - on sedated patients). Ooh! Now they are in the lab diagnosing neurosyphillis. Now they are snooping around somebody's house. And oh, what are they up to now? They are drilling through Dave Matthew's skull to get multiple brain biopsies!! I did not realize that in addition to being board-certified in Internal Medicine, the rag-tag team had also apparently completed a 7-year Neurosurgery residency!

Diagnosis after diagnosis is being spouted, one inappropriate diagnostic test after another is being performed by people who are wholly unqualified to perform them, all seemingly in a matter of hours. Is this entertaining to people who don't understand medicine? Does the fact that things are happening at lightening speed make them interesting, even if they are completely incomprehensible? I have yet to understand the psychologic complexities involved in the popularity of this show.

All I know is that in the end, Dave Matthews ends up with half of his brain removed, and Dr. House is a heartless lecherous jerk who is STILL addicted to pain killers and everyone else is, once again, surprised by it all. Case closed.

I am very aware that this entry reads like a very nerdy joke, in which I rant about televised medical inaccuracies that no-one else can understand, making my ranting more incomprehensible than the show that I am criticizing. But, ladies and gentleman, my life has turned out to be a series of one very nerdy joke after another. And with this I am entirely comfortbale.

I forgot to share my favorite memory from the Transition to Residency course!

We were getting a lecture by one of the state medical examiners about how to accurately describe wounds. There is a big difference, both medically and legally, between lacerations, abrasions, puncture wounds, contusions, etc. In order to demonstrate the accurate description of these various wound types, the medical examiner was showing us a series of autopsy photos of people who had been stabbed, slashed, beaten, shot... basically every conceivable example of human brutality and violence.

Fortunately, my good friend Patty had brought her 5 month old baby girl to school that day. So there she was, most precious little child, smiling and bright-eyed on the lap of a friend in the row in front of me. She was making wet babbly noises with her sweet mouth, exuding a glow of innocence and purity.

And behind her, projected on an enormous screen, was a close-up color photo of a man who had been "hatcheted" to death.

I suppose this image might be rivaled for the title of Best Memory from the Transition to Residency Course by the memory of trying on my academic regalia, including the green velvet medical doctoral hood, and getting my graduation picture taken. Naw.... cute baby juxtaposed with multiple fatal hatchet wounds to the head wins every time.

Two weeks ago we medical students spent a week in Transition to Residency, a required week-long course designed to prepare us for one terrifying, inevitable, and rapidly approaching reality: in june we will all graduate from medical school and actually become doctors. Shockingly, there is a certain amount of responsibility that goes along with this title. And if you were to think that four years of medical school is enough to prepare you to handle that responsibility, you would be wrong.

Fortunately, we just had one week of lectures and workshops that sorted everything out. Our lectures included such responsibility-laden topics such as Medical Malpractice, Death Documentation, Preserving Medical Evidence, Medical Licensing and License Revocation, Ethics and Liability, and Managing Your Student Debt.

We went through a two hour emergency medicine workshop where we were taken through acute scenarios such as "you are in clinic and your pediatric patient starts seizing - WHAT DO YOU DO?" or "you are called into the hospital bathroom and find an unresponsive man slumped against the wall - WHAT DO YOU DO?" or "you are the first responder to a cardiac arrest code and the patient is pulseless and not breathing - WHAT DO YOU DO????" And even though I know lots of things about medicine, and can make a long differential diagnosis for any list of symptoms, and have a thorough understanding of pathophysiology, and have taken and passed two different board exams, my first internal response to these scenarios is usually: "Holy shit. I have no idea what to do. Someone should probably call a doctor."

But as I was reminded approximately 4,000 times over the course of that week, in 4 months I will be the doctor. The doctor will be me. I will have a long white coat and the initials M.D. on my ID badge, and people will expect me to know what to do. Man. That is down-right freaky.

The first station that my group was assigned to was the "you are called into the hospital bathroom and find an unresponsive man slumped against the wall - WHAT DO YOU DO?" scenario (which was enacted in the student locker room by a nice young gentleman who was made up to look pale by white face paint.) Unfortunately, I happened to be in the front of the group, and actually had the thought that since I was going into emergency medicine I would maybe know what to do. Ha. So I valiently stepped forward and kneeled down next to the pale fallen man. Moments later, the following words literally came out of my mouth: "maybe we should do CPR or something?" Brilliant. Such confidence, such command of emergency medical resucitative techniques. Look out, unresponsive slumped-over patients, because Dr. Garlich is about to kick your ass back into the world of consciousness.

In addition to the humiliating realization that I am in no way prepared to handle a medical emergency, I learned the following things during that Transition to Residency week:

1. I can get sued for literally anything. The head hospital lawyer gave us several examples of residents who had malpractice claims brought against them. One resident biopsied a suspicious-looking mole, received a benign diagnosis from the pathologist, treated it like a benign mole, and then was sued when it turned out to be melanoma. One resident was sued for just being in the room during a labor that went bad. He didn't even touch the patient.

2. Getting sued for malpractice, even if there is no validity to the claim or if the suit is later dropped, will make your malpractice insurance go up, and might leave you unable to practice medicine.

3. I will be in debt for the rest of my life. The average student debt load for an OHSU medical student upon graduation is $120,000. I will be over this. The most common timeline for debt repayment is over 30 years.

4. Fortunately, I will be able to qualify for a deferment to postpone payment on my loans until after residency. The cause for deferment: Economic Hardship. The reason: with my salary as a resident, a monthly loan payment would put me below the federal poverty level. The federal poverty level! I never thought that I would hear the word "poverty" so much in conjunction with the phrase "becoming a doctor."

5. If you add up the total number of hours I will be working as a resident, I will be making less than minimum wage. I guess that explains the poverty thing.

I just realized that all of the things I just listed have to do with money. That is very pathetic and I apologize. I suppose that among the many things that I am worried about right now, money is certainly on the list. And it is the most tangible, quantifiable thing on that list of worries, especially since I will soon have to borrow money from my dad to cover my pre-residency expenses. But I do recognize that I am fortunate in my career choice in that I will do just fine financially in the long term. Most people that I know can't say that. But I think it is justifiable to feel extremely lucky and extremely stressed out at the same time.

Fortunatley, I now know how to fill out a Death Certificate, so I am able to sleep easier at night.

I just found out today that I have been elected to be the class speaker at graduation.

When the School of Medicine doctoral hooding ceremony rolls around in 3 months, I will be up there on the stage of the Schnitzer, wearing an unbearably nonbreathable black polyester gown, looking out onto an audience of hundreds, hopefully meeting their collective expectant gaze with a very inspirational and stirring speech.

This is a huge honor, a great responsibility, and, quite honestly, an enormous shock.

My first reaction when the Dean of Medical Education announced the results this morning, was... "are you people insane?" You realize, of course, that you have elected someone to represent you to your loved ones who can only think in terms of television analogies? Do you realize that you will very likely end up with a short recap of Lord of the Rings: Return of the King as your graduation address? And that's the best case scenario. Worst case scenario: I get the giggles on stage after having too many "wake-up" mimosas and all of your cute little grandmothers who flew 2,000 miles just to see you graduate will end up booing me off the stage through their bitter, bitter tears. Tears of disappointment. Tears of shame.

Is that what you want?

Boy, do I have a lot of preparing to do if I am going to prevent the aforementioned scenario from coming to pass. Better come up with some good ideas. Here are some possibilities:

1. I conduct the whole speech around the analogy of medical school as the show Lost. You know: medical school = the plane trip, the island = residency, the mysterious monsters = the attendings, "the others" = the other residents. You see how deep the symbolism is getting here. I feel like I could really explore this.

2. The analogy of residency as the show Grey's Anatomy. There are so many similarities! Because they are interns and we are GOING to be interns! This is incredibly deep. A good way to relate to the masses. Maybe I could rip off my gown and be wearing low-cut scrubs underneath. Just a thought.

3. I deliver the talk on stress ulcer prophylaxis in non-critically ill patients that I just gave during my last internal medicine rotation. This option would really cut down on preparation time.

4. I "wing it" and "speak from the heart." Hmmm. I'm back to the crying grannies scenario with this one. Too risky.

5. Better yet - I start giving a drab, academic-style prepared speech, and then I pause. I crumple up the piece of paper that contains my notes. And I look the audience in the eye and say, "You know what.... this isn't me." And I launch into an impassioned tirade about my own personal journey, and it will look like I'm winging it and speaking from the heart, but I will actually be reading it from a separate piece of paper.

6. BETTER YET! I deliver the high school graduation speech that Ione Skye's character gives in Say Anything. See if anyone figures it out.

Well, if anyone has any better ideas, please let me know.

(spoiler alert)

It has happened. After years of resistance, of living in the dark, of isolating myself socially and culturally, of misunderstanding my peers, I am finally allowing myself to embark on the spiritual journey that so many before me have undertaken.

I am finally watching Lost.

Right now I am still living in the innocent world of the first season, where polar bears and crazy french ladies and mysterious numbers and terrifyingly creepy people named Ethan live somewhere out in the jungle. The world where the ladies still wears clean clothes. And as much as I am enthralled by the mysteries of the island, I find myself annoyed by the actions of the main characters, who are apparently the only people who know how to do anything, and yet seem to feel the need to do everything in secret. With all of the perpetual character development that is going on, you'd think some of the characters would actually explain some of their actions to other people before they go storming off into the jungle.

But, non-suspension of disbelief aside, what I find most interesting is the medicine of Lost. The good Dr. Jack Shepard, spinal surgeon, has my undivided attention. I just watched the episode where he gives a blood transfusion to a crushed comrade using a sea urchin spine after performing a decompressive needle thoracostomy with a metal spike and instructing the heroin addict on how to instruct someone else on how to deliver a baby and, of course, after curing his arch enemy's headaches. I won't dwell on the fact that he jammed the spike through the chestwall too low (ok, maybe I will... its supposed to go up at the second intercostal space along the midclavicular line so as not to risk puncturing the heart), because what I find more interesting is the role of The Doctor in this little marooned microcosm of society.

The second the plane crash-landed, Dr. Jack emerged as the natural leader of the group. People looked to him for guidance, for answers, for decisions. He seemed, at least for a while, to be the only one who had any rational ideas or actions. Why is that? Is it because doctors traditionally hold a place of power and esteem in our society? Because there is an assumption of trustworthiness based on his profession? Or the idea that doctors are inherently good? [i can tell you right now that this is not true] Or maybe it is because there seems to be a bit of magic involved in knowing how to save a life, and knowing how to heal, and more importantly, knowing how to predict what will happen (prognosis: pro- gnosis, to fore-know or foresee: this was one of Hippocrates' major contributions to medicine). Personally, I think it was because Jack was attractive and manly with well-defined musculature.

I wonder sometimes, whether if I survived a plane crash on a mysterious tropical island, I would be able help people. Sometimes i think that I might have the capacity for leadership, but then I remember how long it took me to decide on what to eat at Typhoon the other night and I am not so sure. I suppose that is why I should probably finish medical school and then go to an emergency medicine residency. To be more like Jack Shepard on Lost. Ha! If only I could have brought this up in my interviews - that really would have wowed 'em.

Over the episodes, there have been many little medical events that have piqued my interest. Like the Post-crash Peritonitis, the Asthma Exacerbation, the Stab Wound, the Poisoning, and the combination of heatstroke, delirium, fatigue, and post-traumatic stress that causes everyone to either charge blindly into the jungle or pull a gun on someone else. But the Delivery of the Baby... this was the impetus for me writing this entry. Not to mention the fact that no-one had once discussed a birth plan with the cute little 9 month pregnant australian girl, or that perhaps she should avoid wandering off alone in the jungle (remember what happened last time?), or the fact that it is apparently possible to deliver a baby without getting a single drop of blood on your clothes... I want to know why television births always ignore the thing that happens right after the baby comes out.

Because there's something else in there that has to come out. What does everyone think the cord is attached to? The placenta! The placenta has to be delivered as well, and this is also accompanied by contractions and sometimes the need to push. It is the 3rd stage of labor, the stage where most complications occur, and the stage that all tv births fail to progress to. Probably because it is very anticlimactic, pretty gross, and raises all sorts of questions like how do you clamp and cut the cord in the middle of the jungle? Dr. Jack neglected to instruct the heroin addict to instruct the murderous bankrobber to clamp the cord after delivery, an action that is important in preventing the flow of deoxygenated blood to the baby from the detaching placenta and in aiding the newborn's circulation to reset itself to get its oxygen from the lungs. Since I'm pretty certain that most people get all of their medical knowledge from television and movies, I'm beginning to wonder if anyone in our society remembers that the placenta even exists.

This is perhaps a minor point in the setting of the beautiful symbolism of new life on the island, and my new life as a member of the Lost-obsessed. But what would be the fun of watching the show that everyone else has already watched without dissecting it a bit? Just don't get me started on House MD.