April 2007 Archives

For the past few nights I have been plagued with insomnia. It came upon me gradually, night upon night of sleep that was a little more long in coming, a little more restless when it came, bit by bit more tenuous and elusive. It culminated last night in a fitful period of desperate sleeplessness that lasted from 2 am til after 7 am.

Now, I know that there are many bad things that can happen to a person. I recently saw the Last King of Scotland. I read two hundred pages of The Kite Runner last night, which filled my mind with images of horrible loss and desperation and suffering. (that probably didn't help the cause of me trying to find sleep). I know that me getting less than 2 hours of sleep falls pretty low on the list of Horrible Things Human Beings Have Been Forced to Endure. Nevertheless, insomnia is an awful thing. You know that feeling when you are so exhausted, craving sleep more than anything else in the world, and yet for some reason it continues to escape you? And the fact that you cannot sleep begins to dominate your thoughts, filling you with a frustration that is physically tangible and ultimately incredibly counterproductive? That. If you are me, you read, you try to convince yourself to fall asleep with the light on, you try lying there and counting forwards and backwards, you read some more, you cry a little, you move to the couch, you try to convince your cat to give you a back massage (which he often does when you lie on your stomach), and your cat responds by repeatedly scratching at the front door and then scampering all over the apartment.

You see light beginning to creep through the windows, and hear the sounds of the neighborhood awakening: the recycling truck and its horrible explosive crashing, the sounds of traffic, of alarm clocks going off, of showers turning on, of the downstairs neighbors talking, of someone softly singing. And each sound is a jarring, cruel reminder of the fact that you are STILL not asleep.

It feels like you are in the midst of an epic internal battle... but against who? The clock? Your own mind? The injustice of human existence? The inevitable passage of time?

I finally drifted off for a couple of hours, comforted I think by my own resignation to my sleepless fate, and the soothing arms of a very kind man who had to get up and go to work.

I have waged the war of insomnia before. Once in a while, usually during periods of great stress or emotional upheaval, often the night before anything remotely important, sleeplessness will rear its ugly bastard head. Like when I was studying for Step 1 of the medical boards. So why has it come back to visit me?

Well, I guess I am done with medical school. My last little rotation had an anti-climactic end last friday, and now I am faced only with planning for the future. Packing, selling books, buying a car, trying to get more loans to buy a car, filling out employment paperwork, planning a last-minute trip to Australia (!!!).... now that's all I have to worry about. That and the pressure to enjoy my last days in portland, and the pressure I put on myself to be productive, which is promptly followed by the deep dissatisfaction I feel when I am not.

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Today I am in a daze.

Have you ever noticed how sleeplessness makes things go slightly wrong? Maybe its clumsiness and thoughtlessness from the lack of the mysterious rejuvenation that sleep brings, but I swear that stuff has gone disproportionately wrong these past few days. My front brake cable snapping yesterday, my new bike light breaking without warning, my library pin number not working and the line to fix it shockingly long, the guy at the coffee shop not putting enough loose-leaf tea in my tea bag, me forgetting my laptop power cord (ok - that one was my fault).

And today. Check this out. Two hours after I fell asleep I was awakened by a phone call, which, in a state of incredible confusion, I mistakenly answered. And then I was prevented from returning to my dearest sweetest loveliest sleep by the sudden intrusion of a very loud noise. Someone appeared to be power-washing the floor directly above my head in the apartment above me with a machine that was likely developed to clean mortar debris from soviet tanks. And when the incessant hissing and churning sound moved on to a floor that was not directly above my head, it was replaced by the sound of steady dripping. I got out of bed to explore and found that a brown liquid was leaking through my kitchen ceiling and into the light fixture. Very soon, this brown liquid completely filled the light fixture, casting a sickly murky glow when I inadvertently turned the light switch on (and quickly off again). Then this brown liquid began to overflow, creating a very surreal fountain that cascaded in splatters from my ceiling to the floor below, soaking through my kitchen rug, pooling along the base of my cabinets.

I honestly thought I might be dreaming. If not dreaming, then in the middle of perhaps the funniest and most well-executed joke of all time. Good one, Universe.

Soon after that there were strange men with ladders in my kitchen as well. I tried to drink my tea and eat my oatmeal like a normal person who got a normal amount of sleep while the nice man fixed the brown liquid kitchen fountain.

Seeking solace, more caffeine, and a quiet, non-leaking place to compose my muddled thoughts, I left my apartment and found my way to one of my favorite coffee shops. Literally less than 10 minutes after I sat down (a mere hour ago) A PARADE OF SMALL CHILDREN descended upon the same coffee shop. This seemed like an even funnier joke than the one with the brown water pouring out of my kitchen light.

For a while they were standing outside the window near where i am seated (guided there by the hands of satan himself), cupping their little pre-adolescent hands to the window, making gregarious faces, chanting to eachother, occasionally banging on the glass. One of them did a funny little dance in her oversized rubber rainboots. Then they all came inside, wearing little fluorescent name tags, inexplicably on some sort of coffee shop tour. They were relatively well-behaved for a group of thirty 6-10 year olds, and they were of course appropriately supervised. But I thought it the most perfect and beautiful practical joke ever designed that the place that I went to to escape the weird chaos in my apartment, after a brutally sleepless night, was promptly overrun by literally dozens of energetic little children on the world's first and only coffee-shop tour for montesorri students.

Touche, Universe. You have really outdone yourself this time.

Last night Alex and I attended a lecture at OHSU, a part of the Complimentary and Alternative Medicine lecture series. The topic was "Superfoods: 14 Foods that will Change Your Life" and it was given by Steve Pratt, MD, an ophthamologist who wrote a book with a similar title and who (as he often reminded us) has been a guest consultant on Oprah.

Now, I'm not usually in the habit of plugging books (especially new york times best seller books that don't need my help), but I can feel comfortable in the act of putting in a plug for nutritional education. Dr. Pratt's investigations into how nutrition can help prevent eye diseases like macular degeneration progressed over the years to how certain foods can prevent other chronic diseases. He compiled a list of foods that, because of their high concentrations of various beneficial compounds (anti-oxidants, carotenoids, lycopene, omega-3-fatty acids, etc), their scientifically demonstrated beneficial health effects, and their use by various human cultures for countless millennia, he thinks that everyone should try to eat.

It was a very good talk (I will forgive the good Dr. Pratt for his deplorable enunciation). I was even thinking of buying the book, but I settled for just writing down a list of the "superfoods."

Dear reader, so that you may lead long and healthy lives without spending money on fad books, here is the list:

1. Beans
2. Blueberries
3. Broccoli
4. Oats
5. Oranges
6. Pumpkin
7. Wild Salmon (specifically wild Alaskan sockeye. Never farmed)
8. Soy
9. Spinach
10. Tea (especially green tea)
11. Tomatoes
12. Turkey
13. Walnuts
14. Yogurt
15. Dark Chocolate (the audience literally cheered when he got to this slide)
16. Apples
17. Avocado
18. Spices - cinnamon, black pepper, tumeric (he takes a 1g tumeric pill every day)
19. Extra virgin olive oil
20. Garlic
21. Onions
22. Honey (ideally dark, buckwheat honey)
23. Kiwi
24. Pomegranate
25. Dried fruits (especially tart cherries)

There were lots of things that I liked about the talk, and this list. For one, it confirmed a lot of my notions on good foods to eat (I was able to feel very self-congratulatory about eating oat bran every day and about my recent dinner of chickpeas and swiss chard). It reminded me how important nutrition is in human health, and how incredibly little we learn about it in medical school. It was also nice to get this information from a practicing MD who had put years of study into peer-reviewed scientific literature, and it was nice that these decades of research have confirmed what most people know deep down (and what naturopaths have been telling everyone for years): that eating whole fruits, vegetables, and grains is very very good for you.

It was also nice to get the following piece of data: Blueberries have been shown to reduce the neurological effects of the radiation from space travel. I repeat, space travel.

With that in mind, Alex and I biked home and made a delicious desert of yogurt, oats, toasted walnuts, honey, and, of course, blueberries. You never know when you might be forced to board a rocket ship and travel through the endless infinity of space, incurring all sorts of neurological damage. I just want to be prepared.

The match is over - long since over - and the reality is setting in for me and most of my colleagues. It is incredibly anticlimactic, though, because once you open that envelope you basically start living in the future instead of the present. Emotionally, that is your last day of medical school, and you spend much of your time from that instant on planning your cross-country drive to Minnesota in the car you have yet to buy and fantasizing about your new apartment in Uptown Minneapolis which will ideally have a balcony and be in walking distance from the Bryant Lake Bowl. However, technically you are not done with medical school. You are in the middle of a rotation (Radiology at the time) and you have return to the hospital the next day to learn and study and attend conferences and work on your final presentation. You may have a couple rotations to go before you finish. This would indeed suck.

Fortunately, my spring schedule has worked out to my advantage.

A few months ago I was perusing my schedule for winter and spring quarters, and noticed that I was scheduled for things that, even though I had signed up for, I in no way wanted to do. For example. We are all required to do a sub-internship rotation during our 4th year. It is so titled because your responsibility level in this rotation is supposed to be similar to being an intern - ie, a first year resident. You are required to do it in a field of hospital medicine such as internal medicine, surgery, or pediatrics (nothing froofy like Emergency Medicine - of course that doesn’t count - how silly to even suggest it! Just because you have already done two demanding, responsibility-laden rotations in that, your field of choice, doesn’t mean they should count as anything more than the electives that they are).

Anyway, I found that, on a very odd whim last March, I had gotten myself signed up for a surgery sub-I at St. Vincent’s. Now, while I thoroughly enjoy the process of cutting through skin and messing around with people’s internal organs, I do not enjoy other aspects of the surgery rotation lifestyle. Namely, awaking at 4 am everyday, spending literally 15 hours each day at the hospital, holding retractors in uncomfortable positions for hours on end while attempting to field questions such as “describe the lymphatic drainage of the distal third of the pancreas.” Also, this rotation would have had me riding my scooter in the dark over the West Hills, a line of cars forming grudgingly behind me.

So what did I do? Like any other 4th year medical student who was getting used to the whole evenings and weekends off thing, I panicked. At the last possible moment, I dropped the course and signed up for one that proved to be much easier, much awesomer, and much less dependent on awakening before dawn (although I did have to get up at 6 am - a small sacrifice). It was a very fortunate occurrence.

As part of this schedule reorganization it came out that, due to the incredible amount of electives I took as a first and second year (like the Art of Healing where we literally sat on the floor the first day and drew pictures of our emotions), I only needed 1 credit during spring term - and that just to collect financial aid. So what did I do? I immediately dropped the month-long 6 credit rotation in Infectious Disease. I mean, really. How important is that?

Now, to my credit, I was attempting to schedule another emergency rotation abroad and I needed the time. Also, it appears that I am incredibly lazy and am trying to get away with the minimal amount of work possible. In all fairness, I have worked very hard in the past few years, and will soon be working even harder when I start my residency. Plus, dropping Infectious Disease has given me the opportunity to do what I am doing now:

A week-long “reading elective” in Toxicology! The nice folks at the Poison Center were kind enough to let me come back and hang around again for a short period, in exchange for a single credit. But while most people take their “reading elective” at home or at their friendly neighborhood bar, or perhaps on the beach in Cancun (the emphasis in these cases being on the quotation marks instead of what they surround), I am actually doing reading. And lots of it. I am currently spending the majority of my day at the Poison Center, scouring the literature for reports of colchicine toxicity. On Monday I went to the library and dug up old copies of JAMA and Spine from 1988 with funny old medical ads in them. I spent all day yesterday helping to write a “Morbidity and Mortality Weekly Report” on two recent cases of fatal colchicine toxicity that we are going to submit later this week to the CDC.

Then later I will be able to say, “Oh yeah, that was the time when I submitted that MMWR report to the CDC” and people will say “Wow, you must be really motivated and not at all lazy” and I will reply “My point exactly.”

Later this week I might just do some research on pediatric Visine ingestions. Why? Because that’s just the kind of person I am. (And because they told me to).