Not Quite The Beginning - Part 2

Carter grimaced when he saw the number. Pushing the side button on his phone, the call disappeared from view but remained in his mind. Could it have really been 3 years? Leaves crunched under his feet as Carter cut through the small park toward his dreary apartment building. The wind nipped at his exposed skin and forewarned the coming cold front and autumn storm. Trash littered the worn stoop of the old brick building before him. Dropping his shoulder to push open the heavy door, Carter doubted himself. Did you really think he wouldn't show up? Come calling as soon as he was out? You know him and you know he'll never change. But can't I change, he thought, arguing with himself.

After he had climbed the four flights to his one bedroom apartment and set down his bag, Carter's phone vibrated against his thigh. The accompanying tinny ringtone stopped when he pushed the talk button.

"Carter Hamilton, it's about time you picked up," Jackson's familiar voice said. "You really gonna leave an old pal like me hanging?"

"Jackson," Carter said, "how are you doing?"

"What do you mean, 'How am I doing'? How would you be after breathing free air for the first time in 3 years? I'm fucking fantastic. Glad to be out of that concrete shithole."

"I can imagine," Carter replied. Specks of dust drifted through the air in front of him, catching the evening light.

"Well now, no you can't, can you?" Jackson spat. "You weren't caught. Weren't even arrested or talked to, if I remember correctly," he added. Carter stopped pacing. Seconds ticked by. "But, let's not rehash the past. A new leaf and all that bullshit." Carter heard the squelch of a train through the phone.

"What can I do for you?" he asked. Unease twisted through his stomach, as he waited for the words he knew would come.

"I've got a job," Jackson replied. "And I could use your services." Carter felt bile seep into his throat.

"Jackson," Carter began, "I don't know if I ca-"

"You shut it. Stop right there," Jackson interrupted. "I don't want to hear a thing. Not one word. I knew you'd go soft with me gone. You never had a damn backbone." Carter closed his eyes and willed himself to say something, anything. "I don't know what you don't understand. You're the alarm guy. That's it. You deal with all the electronic crap, cutting your wires, and I handle everything else. Stealing ain't exactly a complex science."

"You don't understa-" Carter stuttered.

"No," He said. "Just meet me in an hour at the old diner on 23rd. I could use some real food." And with that, Carter heard the line go dead.

A Little More Personal

In honor of a previous post of mine, I've decided to again talk about things I like and/or like to do. This stems not out of disdain for my current academic situation as before; we've only just begun second year and I think I'm going to like it. Instead, this blossoms from my simple desire to think about things I like and have something to do while my better half isn't around. So, without further ado:

Things I Like More Than...Other Things?


-Extra computer storage space. External hard drives, USB sticks, blank CDs/DVDs, I am an equal opportunity advocate. I don't actually know why I have such a fascination with extra space (I may or may not have three external hard drives, two USB sticks, three spindles of discs, and an iPod), but I think it goes back to a feeling of freedom and potential. Do I have space to buy that [electronic media]? You bet your ass I do. I have space three hundred times over.

-Naming inanimate objects. This partially ties to the previous comment as I also name all of my computer drives (don't tell me "T-REX" isn't cooler than "C-Drive"), but it goes beyond that. My computer? Persephone. My T-Rex? Winston. Turtle Ottoman? Herbert. iPod? Nightwing. Phone? Alfred. Doing so just gives everything a bit of punch and personality. Try it. Need to kick you off? Spartacus.

-Discovering my water bottle to be full without remembering having filled it.

-Forgetting about E-learning assignments for class (online assignments) only to find that we never had any.

-Stepping outside on the first real day of Autumn. The air has just enough chill that you know Summer is finally over.

-Fruit snacks.

-Having a good author draw you in and then finding out he/she writes a series or has additional books.

-An indie girl, an odd but wonderful group of people, and two crazy Frenchmen.

-The Library.

-The Wire. I'm through season 3 and would argue it's the greatest story told on television, and I'm a frakkin' Lostie. ((+10 nerd points if you know what else I'm referencing here)).

-The unusual feeling/pain that you feel in your face after laughing so hard you start to cry and can barely breath. This exclusively happens with friends, usually when ridiculous stories are being told.

-Anything that satiates my ridiculous need for trivia.

-The ultimate gateway fruit.

-Hanging out with old friends, and feeling so at home it's almost like you never left.



Thoughts? I'd love to hear them in the comments below.
Until next time.

Ongoing Changes

If you can't tell, I'm in the middle of shaking somethings up around here.

You may or may not have noticed if you came here from a bookmark or previous address, that there was a feeder page and my blog has a new URL. If you're currently going, "What are you talking about?" you can pretty much ignore what I am, in fact, talking about. I originally wanted my blog to be orderly and systematic in its makeup. That flew out the window when my desired address, to match my desired title, "Paging the Doc," was not available. This led to the use of the alternate address -pagingdocgib- that you know and love (or maybe just bookmarked). Imagine my delight when I discovered my ideal name, that which so perfectly captures the essence of my writing (or maybe just the title of my blog), was available. I snatched it up!

So what does this mean for you? Nothing if you don't want it to. You can go to pagingdocgib.blogspot and be redirected here (although you will no longer see new posts in feeds/notifications), or you can do what the cool kids are doing and delete that old mismatched bookmark and save yourself a new new. The choice is yours. Choose wisely.

"But MG," I hear you -faithful reader- calling, "What about a real update?"
Well. If you insist.

From where we left off, I have now successfully finished my first year of school and am currently doing some summer work in Pediatrics. Let me repeat that.

I HAVE FINISHED A YEAR OF SCHOOL.

This is also known as, Good-lord-how-did-time-go-by-so-quickly or I-don't-feel-like-a-quarter-of-an-official-doctor. Other milestones? I have also now been married for over one year and, as expected, lived in a new city/apartment for the same amount of time. I cannot believe it.

The summer work in Pediatrics is going swimmingly. I have really enjoyed getting to see how the hospital system works, met some really interesting and fun patients, and its nice to see if I might want to do Peds for real. You know, when I'm done in 3 years (=insane.) The most amazing part thus far? Just how resilient and upbeat children can be. Some of these patients have acute problems that will be done in a week, others have lifetime chronic illnesses that will put them in and out of the hospital every year or six months, but all of them are so joyful and happy. They really add perspective, in the best possible way. Sometimes it's been heartbreaking, yes. But overall? I wouldn't change a thing.

Well. One thing. That my own sinuses would obey me and stop acting out so that I could be at the hospital now, rather than at home, seemingly blowing my brains out through my nose. I haven't had anatomy of the head yet, but I'm sure there's some kind of pathway/condition that could make that possible.

Until next time.

What Really Happened

So everyone is clear: this post is my response to the LOST finale and frustrated place to vent about how some people just don't seem to get what happened.

So: if you're a LOST fan- SPOILERS.
If you're not a LOST fan- sorry, this blog will suck.

Begin rant:

Did other people just not get it? People seem to think that the characters were dead all along, or there was no plane crash, or they all died when the nuke went off, or that the island was purgatory. No, no, no, and no!

The island is/was decidedly NOT limbo or purgatory. As Christian (Jack's father) said, everything that happened in life and on the island was real. The plane crashed, the oceanic 6 went home and went back, everyone time traveled. All real. Jack fixed the Well of Life, that last bunch of people got off the island, and Hurley/Ben took over guarding it. Jack died on the island. All real. Thinking anything else is simply not understanding what happened on the show.

The ONLY THING that was them being dead/in purgatory was the sideways world that we STARTED TO SEE after the bomb went off at the beginning of the season. In "real life" the bomb exploded, brought the characters into present time, but the island/life never "reset." The writers simply started showing us the sideways purgatory world at the same time.

"What was the point of the sideways world?" you ask.

It allowed the show to essentially give us, the viewers, half of a season of character resolution. Having the sideways world be the characters post-death was perfect. It allowed us as viewers to see what each character truly thought of themselves at their core and then reconciled those feelings with the happenings and conflicts of the tumultuous lives they had with each other on the island. We got to see Sawyer be the good man he knew he could be and always wanted to be as a cop in LA. Jack became the father and family man he never had. Kate was no longer a murderous fugitive, but an innocent fugitive. Locke lived a life where he loved others and, most importantly, loved himself without feeling shorted for being in a wheelchair.

The characters being "touched" (by Desmond or otherwise) and remembering each other was them remembering their REAL LIVES and being able to then grow and move on (which is what happens in purgatory). How could it get any better?! Ben stayed outside the church because he was not contented with himself and the life he led, hence him not moving forward. People you didn't see in the church? All people who had either moved on individually (as I suspect Richard had- he knew what he wanted- his wife) or weren't ready yet, such as Daniel Farraday and Charlotte (this is what Desmond and Eloise were discussing at the concert. Desmond was not "taking" Daniel because he wasn't ready).

((Fun Did-You-Remember Moment: Sideways (aka dead) Jack looks in the mirror and asks his mother where he got that scar on his abdomen because he doesn't remember. She says he had his appendix out. We know better than that now. StabbedbyFakeLockeduringtheEpicLastBattletoSavetheIsland.))

The only people who will be truly upset are the ones who don't understand what happened (but now hopefully they do with my explanation) or those who do not accept that the show is about the characters more than the mysteries (which it always has been). People will ask about Michael/Walt and other characters, or other mysteries on the island (the numbers- etc), but I respond: we KNOW answers for most of them and for the others- who cares? Will it make any difference knowing those details? We know Michael has become a "whisper" on the island- which is what happens to people who die on the island but are not finished. We can assume Walt has gone on to lead a normal life. The numbers relate back to Jacob's master plan of bringing the candidates to the island to save and protect it. They stem from the lighthouse, as each candidate had a number (1-108). 4,8,15,16,23,42 were the numbers of Locke, Jack, Sawyer, Hurley, Kwans, etc.

It comes down to this: Did you enjoy watching a thought-provoking, well-made program, that is and will be different than anything on television?

For me that answer is a resounding YES. Well done. Fantastic finale.

Thoughts? Comments?

End Rant. End of LOST. Sad face :(

Until next time.

A Return to Form?

With the point of this blog being to keep me writing, it would probably be more effective if I actually wrote something once in a while instead of posting comics.

I'm rather taken aback by the fact that it's almost the end of April. I cannot believe that the school year is nearly finished. No small amount of disbelief hits me when I ponder the fact that I'm almost a quarter of the way through my medical education. Well, let me clarify: I'm a quarter of the way to being a doctor; I'm nowhere near close to even remotely thinking about the end of my medical education. I'll probably finish my schooling when Winston, my faithful and inquisitive T-Rex, finally stops questioning every aspect of the world.

Read: Never. His curiosity is insatiable!

Side-Note Medical Reminder: Ladies- do a self breast exam once a month. Fellas- same goes for you with your testes. Seriously. I'm not kidding.

At this point I would like to remind all of my faithful readers that medicine can be gross and you should consider yourself warned. The following isn't a detailed description of a random medical procedure or graphic photo, just my musings on the poor word choice by those in medicine. Examples are, however, given.

The terms that people in medicine use to describe different aspects of things that can go wrong with your body disturb me sometimes. In addition to using food-words such as caseating (from the latin caseus meaning cheese) to paint the delicious image of dead and decaying body tissue onto the blank canvas of your imagination, the particular description that currently gives me the creepies is- wait for it - "like a bag of worms." This line of text would be where I normally delve into all of the medical details none of you find particularly interesting. Instead, I think a more fitting option is to simply let that phrase- like a bag of worms- float around, wafting in the air while you silently shudder and try to imagine what it could be used to describe.

(If you really must know, it describes the widening and dilation of veins that run from a man's testis- aka Varicocele. Not awful or really even that disturbing. It was just more fun to portray it that way.)

Until next time.

The Beginning of the End of the Beginning

This just might be the current feeling. Or at least the one that seems to crop up right at the end of any breaks.

(Click for better view)

Thoughts?


Until next time.

A Different Type of Battle

You wouldn't think that multiple choice exams could be that intense, right?

(Click for a better view)

I'm thinking of doing more drawings. Thoughts?


Until next time.

Health Reform? Huh?

If you find yourself asking the above question, look no further.

Well, look further if you'd like, as I'm only posting my summary, but the info is pulled from both my school and the Kaiser Family Foundation (a great resource for impartial info- I recommend it over any news-media sources).

I'm going to outline what's up and then give my brief opinion of the situation for those who are interested. More extensive information will follow after my opinion. It should be a pretty good outline as to what's going on as of today. (Certain things might change if the reconciliation package passes the Senate- namely the removal of special preferences for specific states and a restriction on the proposed minor tax on really wild insurance policies.) Let's go!

What's going to happen change right now? These things will happen in the first year.

• People who are currently deemed "uninsurable" due to preexisting conditions will be able to enroll in a new federal insurance program that should be established in 90 days. This will serve to kind of get the ball rolling until such conditions are banned outright for adults in 2014.
• Children under 19 cannot be denied covered due to preexisting conditions. Parents will be able to continue covering their children on their plans up until the age of 26 (unless they are offered insurance through their employer). This helps give kids access.
• The Medicare Part D Coverage Gap (the giant "doughnut hole" in coverage for drugs for the elderly) will be halved, with 50% being covered (up from zero). This helps fix a huge cost issue in providing pharmaceuticals to the elderly. Fun fact: Want to know the quality of the legislation that made Part D coverage, passed in 2006, so awesome? The main proponent of the legislation and head of the committee on pharmaceuticals, Former Congressman Billy Tauzin (R-LA), quit Congress two days after it passed and then immediately started working for the PhRMA lobbying group. Insane.
• Small businesses (less than 25 employees/wages of less than $50,000) qualify for a tax credit of up to 35% of the costs of health insurance premiums for employees.
• No more lifetime caps on insurance coverage and restrictions will be placed on annual limits.
• Insurance companies not cancel coverage retroactively except in cases of fraud.
• Increased government oversight of insurance costs and overhead. Companies must report how much they spend on medical care against administrative costs.

Fast Facts

- Everyone will be mandated to have health insurance. To help with this, insurance subsidies will be available to individuals making $14,404 to $43,320 or families making $29,326 to $88,200. People below these ranges already qualify for coverage through Medicaid, or if old enough, Medicare. The subsidies would be given on a sliding scale. If you already possess insurance through an employer or group, nothing changes. You keep your insurance and continue as usual.

-If you do not purchase insurance, you will be fined. It is $95 dollars for an individual, starting in 2014, and increases to $325 in 2015, and $695 (or up to 2.5% of income) in 2016. For families, the maximum would be $2,085 in 2016, however, people can be exempt from this fine because of financial hardship or if they are Native American (and thus already provided with a degree of federal health insurance).

-Preventative health care visits, regular check ups, and many cancer screenings can no longer have a co-pay and will be free in some cases.

-The Medicare payroll tax of would be raised to 2.35% (from 1.45%) on individuals making more than $200,000 a year and couples making over $250,000.

-The reform is estimated to cost $940 billion dollars over the course of a decade. However, with all of the changes being made, the reform will actually decrease the federal budget deficit by $138 billion over the same decade. In addition, it is estimated to reduce the deficit by ~$1 trillion over the second decade.

My Thoughts?

Very briefly, I think that the bill will do much more good than harm. It extends coverage to people who need it while adding regulation and changes to the industry that will help make it more viable for the future and help the national economy (Health care is currently ~16% of the GDP and rising, that needs to change. In comparable countries it's less then 10%). I get frustrated with people who want something that is XYZ-more liberal or ABC-more conservative. To me, and I view this as being more practical, the question must be if this is the best step in the right direct that we can take at this moment? Does it lay the groundwork for things being better both now and in the future?

In my opinion, belief, and thoughts, it does. The reform does not murder Liberty or kill Freedom. The Constitution is still intact and well. We are not becoming a crazed totalitarian nation and this doesn't set us on that path, or close to it; such notions are nothing more than the rantings of those trying to make money or short-term political capital, preying on fear and appealing to the extremes.

Nothing will ever be perfect. Remember, the object is to form a more perfect Union. I think this qualifies as more perfect than what we have now.

Your thoughts?

P.S.- Want more info? About how this affects things in the industry? Here's some summary:

HOSPITALS: "The hospitals are ultimately the winners — one doesn’t increase spending on health care by nearly $1 trillion without some significant part of it flowing to hospitals," said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.

· Pros:

o Worried they might get hit hard by the health legislation, hospitals were the first industry to make a deal with President Barack Obama and the Senate Finance Committee last year. Hospital groups agreed to give up $155 billion in Medicare funding over the next decade. But they are expecting that to make more than that – at least $170 billion - by having to treat fewer uninsured patients.

o An individual insurance mandate and subsidies for low-income Americans to buy coverage means hospitals will have more paying customers.

o Hospitals got guarantees that cuts in federal Disproportionate Share payments that they receive for treating the uninsured wouldn't occur until the insurance expansion is in place. And even then, some of the funding will remain to help hospitals treat illegal immigrants and recipients of Medicaid, the state-federal program for the poor.

· Cons:

o Hospitals are slated to lose $155 billion in federal funding over a decade.

o A new independent commission would have broad authority over Medicare spending, though most of its powers don't kick in until 2018.

· Mixed

o The bill sharply expands Medicaid, which will reduce the number of uninsured patients. But Medicaid typically pays less than private insurers or Medicare.

INSURERS : In the short term, insurers will gain enrollment but the bill may cost them in the long run if health costs don't come under control," said Peter Kongstvedt, a McLean, Va.-based insurance industry consultant.

· Pros

o The individual health insurance mandate, along with subsidies for low-income Americans, will bring insurers tens of millions of new customers.

o The expansion of Medicaid will also provide new customers; many recipients will be covered by private managed care plans.

· Cons

o The bill calls for $132 billion in cuts to Medicare Advantage plans, the private health plans that cover one in five seniors (only one in ten seniors in Kansas).

o New taxes on the industry total $70 billion over 10 years, beginning in 2014.

o Insurers are facing a new requirement to spend 85 percent of their premium dollars on health care, potentially leaving less money for administration, marketing and profits.

o The so-called "Cadillac" tax on high-cost health plans is aimed at insurers, though it won't take effect until 2018.

o Lawmakers called for relatively low penalties -- just $95 in 2014 – for not buying insurance, which could encourage many healthy people to skip coverage.

PHARMACEUTICAL COMPANIES: "Pharma is one of the big winners," said Nancy Chockley, president of the National Institute for Health Care Management, a nonpartisan health policy research organization funded by Blue Cross and Blue Shield plans and government grants.

· Pros

o The drug industry will put up $84.8 billion to help fund the legislation. Part of that goes to making brand-name drugs more affordable for seniors who hit the Medicare coverage gap - the "doughnut hole." But pharmaceutical firms stand to make much more in return. With more Americans insured, more can buy brand-name drugs.

o Expensive biologic drugs would get 12 years of exclusivity protection from generics. Obama, AARP and the generic drug industry were calling for a 5- or 7-year limit. While biologic drugs are only a small portion of industry sales, they represent the fastest-growing segment of the market.

o The legislation, despite the pleas of some lawmakers, doesn't make it easier for Americans to buy less expensive drugs from abroad. Nor does it allow the government to negotiate lower drug prices for Medicare.

· Cons

o The industry will pay out $84.8 billion in new fees, rebates and discounts over the next decade.

DOCTORS : "Primary care doctors got a bump up in funding and overall doctors got a pass," said Gail Wilensky, a senior fellow at Project Hope and former head of the Medicare program.

· Pros

o Primary-care doctors and surgeons practicing in areas with a shortage of physicians get a 10 percent bonus payment from Medicare from 2011 to 2015. Medicaid will pay primary care doctors Medicare rates in 2013 and 2014, to coincide with the Medicaid expansion. Medicare typically pays at least 20 percent higher rates than Medicaid.

· Cons

o No significant medical liability changes are in any of the overhaul bills, though there is money for states to run pilot programs.

· Mixed

o The Medicaid expansion, to everyone under 133 percent of the federal poverty level ($29,326 for a family of four) means more patients have insurance, though at the lower Medicaid rates.

o The current Medicare physician payment formula that each year threatens to slash doctor payments was left untouched. But Congress traditionally steps in to nullify the cuts.

NURSING HOMES: Because most nursing home patients are covered by Medicare or Medicaid, reducing the number of uninsured doesn't really help the facilities. As a result, the industry doesn't see much gain in the overhaul.

· Pros

o The bill would establish the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary insurance program that would allow people to finance their long-term care in advance through payroll deductions. It would provide a cash benefit of about $50 a day for long-term care, including nursing homes, in the home and adult day care.

· Cons

Nursing homes would see their Medicare reimbursements cut by about $15 billion over the next decade. While Medicare comprises only about 13 percent of nursing home revenue, the industry relies on the money to offset low Medicaid reimbursement.

Must Be Done

UPDATE: Victory. Check out the facts here. Rock Chalk.

In honor of the game tonight, I post a reminder of the last encounter and follow with a preview of what's to come this evening.

Reminder:


Preview:

I fully expect this to be a good and challenging game. My desired outcome is slightly obvious.

Rock Chalk.

A Complex Situation - Part 1: Politics

UPDATE: I really am going to post parts 2/3. I promise. School has just swamped me and I'm not sure when I can sit down and devote the time I want to present everything clearly. Until then: why not leave or check out the comments?

NOTE: This discussion will need to be split into multiple blog posts. There's just too much information for a single one. The discussion will most likely be divided into the categories of Politics, Insurance Companies, and Philosophy. Don't worry; I'll cover everything that everyone commented about.

I think that my title pretty much defines the current state of health care. If you're just joining in on this little session, I highly recommend that you read the very different opinions and views expressed in the comments of this post as I'll be summarizing and referencing peoples thoughts here.

Looking at each person's response, the reason for debate/fighting/disagreement pretty much slapped me in the face. Out of the six of my friends that commented, each brought up different issues, concerns, and possible solutions. Now think about how we have 300+ million people in our country . Yikes. No wonder people are heated about things.

The common fact that everyone acknowledged: something needs to change. No one thinks that our status quo should be maintained. Health care needs to change.

So, I've decided to make the discussion more manageable by breaking it down into the subcategories of (I think) Politics, Health Insurance, and Philosophy. I'll try to pull points from each person into the category where it most fits for my discussion/presentation. Don't worry if you think I've missed something right now as I'll likely bring it up in one of the following posts. Where possible I'll link/cite facts that I've learned. Let's go!

First up: Politics.

-Caleb said the predominate issue is the "time in which to revamp" health care and that he thinks Democrats are trying to rush things through to bolster political power. Instead, the process should slow down because it is "affecting everyone...not just the deaf Democrats in power." He thinks "that Obama's tactic of "we must pass everything now, no questions asked" is dishonest and insulting."

-Tyler talked about how the US is behind Europe in health care standards and that if "legislation allows some Americans a higher quality of life, but is an imperfect plan, it is worth it." The final goal and objective should be to "improve quality of life." [Side note: the US ranks 37th in the WHO rankings from 2000 (most current) and yet we by far spend the most money]

-Kevin said the government shouldn't have access to medical records or "the right to determine, based on set criteria and yes/no symptom check sheets, whether or not an individual receives medical care." He also thinks the government should "slow down when developing a new system of health care" because it's often a flawed design and concept of an idea that leads to problems and failure. The role of government, and politicians, is to analyze the situation and revamp healthcare "for the fulfillment and benefit of the majority," because "legislation passed without adequate consideration for the people fails."

-Megh talked about how she thinks health care should be free and paid for through taxes because anyone can get sick at any time, but acknowledged that the US will likely never have this reform due to the financial stakes of large companies. She also linked an article that spoke of the need for Democrats to maintain their push for legislative reform despite the short-term implications it may toward re-election.

My Thoughts?

First, I take issue with the idea that the problems of healthcare reform are somehow the individual fault of either the Democrats, Republicans, or the Obama administration. In my opinion, if blame were to be assigned it would fall at the feet of Congress, both Left and Right alike.

As previously stated, most everyone agrees that the country seriously needs reform. Sadly, the big problem of passing/not passing any legislation is not because of the differing views of the political parties but instead the issue of politicking. Both parties have become so obsessed with winning and being correct that the legislative process has ceased to function. Democrats in Congress, feeling jilted from decades without full political power (holding both Congress and the Presidency), seem to occasionally feel the need to flex their power over the GOP and not compromise. This could be really bad if someone wanted to compromise. Republicans, upset about this and their lack of a cohesive party theme/identity, have essentially stuck their fingers in their ears, tucked their head, and hoped that Democratic failure=Republican success. You have one side attempting to enact some kind of payback and the opposing side trying to not do their job and hope that it leads to being re-elected.

This is no way to run a country.

Kevin said it best in his comment, explaining that we

"elected them [Congresspersons] to make decisions not necessarily based on their goals or ambitions but based on our [the citizens'] situation and needs. It is their job to view the current national and global situation from every possible angle. It is their job to make sense of things and then approach the problem with the goal of improving the lives of those they serve."

I think most everyone in the country would agree with that. We need less politicking, fighting, bickering, partisanship, and worrying about the next election and more cooperation and accomplishment. How does this play out in health care and with the reform that is being debated now?

Like most everything about health care: it's debatable. The current bill is HR 3590- Patient Protection and Affordable Care Act (that's the FULL TEXT- you won't read it). There are also quick summaries from the Democratic and Republican parties. As an overview, the bill would reform/regulate circumstances for physician malpractice, prevent insurance companies from denying coverage to anyone with a preexisting condition, expand health insurance coverage to the ~40-60 million uninsured Americans (I quote a range because we learned how about each year millions of people lose/gain coverage; it's a cycle), offer a federal pool for those without insurance to buy into, and require everyone to have health insurance (much like mandatory auto insurance). This would be paid for through taxes on individuals making more than $500,000 a year (actually repealing an old tax cut), people with really ornate health plans now (I refuse to use the name of a certain car brand), and through cutting/reworking existing programs and funds. It is estimated to cost ~$850 billion total over the next 10 years, but actually result in a ~$150 billion deficit reduction over that time.

Now most people see those things, having heard about them in the news, and go "Whoa, those are all the things the Democrats want. None of the Republicans want that." To that I reply: not exactly. Surprisingly, that reform is actually more of a centrist option. Many people who are far left or far right would prefer something different (a single-payer and completely private system, respectively but they'll be more of that later, under the Philosophy post). HR 3590 actually isn't that different than the current Massachusetts health care system, signed into law in 2006 by Republican then-governor Mitt Romney.

Now, I know that's a lot of information but sadly it's really just a quick overview of the current situation. Don't worry, I'll present a discussion/reasoning of the various different types of health care systems during the Philosophy post while going through more comments. The gist of all this? Congress, meaning both political parties, need to cut the crap, do their jobs (meaning make the necessary changes to fix the country), and stop worrying about their own job security.

Lastly, and this is more of a detail, I don't think Obama can be blamed for allegedly pushing reform through too quickly or- and I'm paraphrasing- for playing the urgency card too much, simply because he does not set the pace. (All of this assumes one thinks things are going too quickly.) The president's role is to set the agenda. A pillar of Obama's campaign message was health care reform; it makes sense to me that he would be calling for Congress to tackle such legislation (not to mention it makes up ~14-17% of our economy). The reform itself and its timing is an issue of Congress and their responsibility to write and pass.

Personally, I don't think that there is ever going to be a "right time" to work on health care reform or any big issue for that matter. Don't get me wrong, I want things to be well thought out and done right, but health care reform is not a new issue. FDR, Truman, Johnson, Nixon and Clinton have all attempted comprehensive health care reform. Only Johnson succeeded (partially) with the creation of Medicare and Medicaid. (Fun fact: FDR was going to propose socialized medicine until a certain country had to go crazy with that whole whacked-out-final-solution-socialism-world war thing. It's in this book which I've recommended before.) With the current political environment of every action being analyzed through the prism of the next election and everyone too worried to simply do the job they were hired for, I'd rather Obama make it a national issue (thereby doing his job) and try to get Congress to finish it.

Still with me? If so: more to come later.

Until next time.

*While I don't think it's a fair way to describe any of my readers, Glenn Beck is probably certifiably insane and terrible for our political process. Regardless of political views.

A Quick Update

First off:

Thank you so much for the responses on my last post. I really appreciate it and will be parsing through everything and posting a response tomorrow. "Why tomorrow?" you may ask. And I respond: Cardiopulmonary is finished (and has been beaten into submission to be more accurate) and I'll have the time to get everything done the right way.

In the mean time, to hold you over, check out this fantastic little number:

That is wonderful. Want to see it for yourself? Well, check it out here.

Until next time.
(tomorrow)

A New Decade

2010, eh? I'm down with that (but really only if we call the 00s the aughts like we're supposed to).

While everyone seems to be excited about the new year (and sure, I'll go along with that), I'm more excited about the prospect of a new official decade. When I look back at the past decade, my mind explodes when I see just how much of my life has changed (and oddly stayed the same)

What changed? During the aughts I:

-cycled through middle school, high school, college, and am now studying medicine.

-have lived in three different towns and progressed from living at home to living "on my own" with people who are essentially brothers (if I didn't already have 3 good ones- that I gained in this past decade) to being wonderfully married.

-went from being an awkward and strange single teen to an awkward and strange (but very lucky) husband.

-became an uncle to not one, not two, but three hilarious boys.

What didn't change? I still:

-read incessantly (but like to think that I read better now thanks to that whole college degree thing)

-play and/or unabashedly enjoy video games/comic books/computers/tv shows/etc. (although I like to think my that tastes have refined)

-maintain a ridiculous competitive streak that school has been kind enough to keep alive.


The point of all this? I don't really know. Perhaps just to stop for a moment and think back at what's happened and changed over the past 10 years. You should, too. This is, after all, your life. Don't forget the immortal words of advice.

Until next time.

Edit: Upon reading this post, my new year resolution will be to slash my use of parenthesis. My bad.

Not The Most Diligent

Okay, I may or may not have been a wildly ineffectively blogger for the past few weeks.

I understand this. Let's all just move past it.

We left off at the beginning of the Cardiopulmonary module. The first half the module, Cardio, is now over and I'm pleased to report it was a rousing success. While I now know more than I ever wanted to about the electrophysiology of the heart, it has been interesting and a good module. We've learned much more doctor-ly things such as how to read ECGs (there actually is information in those squiggly lines) and listen to the various heart sounds (<--INTERACTIVE!). To me, learning about heart defects has been one of the more interesting subjects. While I won't go into big hairy details, one aspect is too cool not to share. In general, I think we can all agree that having a heart defect would be an unfortunate thing. That is, unless you've got more than one defect. Sometimes, having a heart defect can actually save your life. More on that later, but first, a bit of background to fully appreciate what's going on here.

Your heart is made up of four chambers (atria and ventricles), separated by four valves, and can be divided into left and right halves. The ventricles are the lower chambers of the heart and are the real workhorses. The atria (plural for atrium) function to kind of "prime" the ventricles and keep the blood flowing.

Blood that has been in your body (deoxygenated) flows into the right atrium. From here it passes through the tricuspid valve and into the right ventricle. The right ventricle pumps blood through the pulmonic valve and into the pulmonary artery where it goes to the lungs to gain oxygen. Once the blood has oxygen, it flows from the lungs and into the left atrium. From here, the blood passes through the mitral valve (named for a bishop's mitre) and into the left ventricle. The left ventricle pumps blood through the aortic valve and into your aorta where it goes to your entire body and provides that much needed oxygen.

Having a hole in your heart that changes this flow of oxygenated/deoxygenated blood constitutes a fairly large number of heart defects and many of them either close on their own or can be fixed. (In fact, when you're growing in the womb, it's normal and necessary to have one so your blood bypasses the lungs.) But I digress.

One major heart problem is called Transposition of the Great Vessels (technically dextro-TotGV, but we're simplifying here). Because of a problem during development, a person's pulmonary artery and aorta are switched. Aside from this sounding scary (which it is), it prevents blood from undergoing its normal exchange of oxygen. Oxygen-rich blood simply cycles from the lungs, through the left side of the heart, and back into the lungs. Oxygen-depleted blood from the body enters the right side of the heart and is pumped into the aorta and back in to the body. Having this defect on its own is, as they say in school, "incompatible with life." (How's that for cold medical talk, eh?)

"Bad News"---^

Now you may be asking yourself (if you're still reading), Okay, Matthew, where does the coolness of this all come in? Cause right now, you're just talking about fatal heart defects.

I understand, dear reader(s). The cool part about this is that if a person has transposition of the great vessels AND another hole-in-the-heart defect (such as Patent Ductus Arteriosus or Atrial Septal Defect), the second defect allows just enough oxygen to intermingle and flow what is normally the wrong way that the person stays alive. When this dual defect is coupled with the (hopefully) astute actions of the medical team delivering the baby, the doctors are able to recognize what's going on, rush the baby into surgery and swap the vessels around to where they are supposed to be.

That's right, crazy-emergency-heart-surgery-on-a-baby-that-has-a-success-rate-of-OVER 90%. Medicine FTW! (FTW= For the Win)

Until next time. (Which will be much sooner- I know, I know.)

Real Med School

That is how our current module, I2, was described to all of us, the wee-little first years, by a few of the M2s. Sadly, three weeks into the module (with the test looming on this coming Wednesday) it seems they are correct. Evidence of this? My lack of blog posts. Inflammation and Immunity, while great for a person's well-being, seems to be decidedly bad for any free time I might have had this month.

That being said, what have I been doing for the past half an hour?

Not I2.

After finishing my review of this morning's lecture and review (that's right, a review...of...a...review...) I felt like a break was in order before a student panel here in a few minutes. As some of you may or may not know, I have one blood sibling, an older sister, who also writes a blog. Now, while she is a great sister, loving mom, and probably caring wife, she also exploits her children for blog-hits. I thought, If she uses my nephews, why can't I?

So! Behold! I present photos that my sister took in an attempt to capture the spirit of her children. Sadly, where she fails, I succeed. She captured their expressions; I have revealed their true thoughts.

*Note*: As my sister was the photographer, the thoughts of the subjects naturally reference her.

Series 1!

Series 2!




This is all. I must study. Again.

Until next time.

What Think You I Take My Pen In Hand?

The Gen/Neo module currently dominates my calendar and all its time enclosed. So, in order to escape from its tedium and rote memorization, this post will instead focus on everything not medicine related. Specifically...

Things I Like More Than Gen/Neo:

-Pouring just the right amount of granola into a cup of yogurt so that it doesn't spill over when I mix it.

-Being able to "hide" the annoying status updates (such as "Farmville" and "MafiaWars") on Facebook.

-The chill an autumn evening's air leaves in your chest.

-Feeling completely content wandering through a book store, even when not buying anything.

-The 3rd or 4th bite of a really good apple, once you've really broken through the skin and can get a crisp chunk of it.

-Getting an unexpected package, letter, magazine, or item in the mail.

-Jason Sudeikis on SNL.

-Opening the door to the mail box and seeing anything there.

-Top 10 (or 20/25/30/50/100) lists of just about anything, but particularly things to do with books or movies.

-The Sandman series by Neil Gaiman.

-Getting a really good Sporcle game when the "random" button is clicked.

-Hyperlinking.

-Writing with a really nice pen.

-Coming up with (what I think are) clever tags for blog posts.

-Freshly baked chocolate chip cookies.

-Having a wonderful wife (not at all because she will make a few extra said cookies when she's making them for work).

-All of the backgrounds and photos of InterfaceLift.

-Hitting a crosswalk at just the right time so that you don't have to break stride.

-Getting more than 6 good songs in a row on Pandora.

-The Office.

-Reading.

-Finding a good excuse to not study.



Until next time.

Am I Ready For Some Football?

One of the most rewarding aspects of my life as a medical student thus far (aside from the known wonders that are my wife, family and current friends) has to be the relationships and friendships that have begun to flourish. Proximity and shared evils (or struggles if you want a synonym) will inevitably cause the fellows of my class to bond and gain an understanding of one another that typically never develops in daily life. On top of even this, occasionally something will come along to unite a population to a new level. Such a circumstance has presented itself to us. That event?

Football.

A.k.a., the gridiron where the 1st year students (M1s) will boldly triumph over their second year oppressors (M2s).

In a few hours, the two classes will meet on the grass battlefield for two games of "flag" football: one men's game, one women's game. Throughout the day, via email and with the cunning use of YouTube videos, trash has been electronically talked and the School of Medicine now has 350 very rowdy and excited students on their hands.

While the outcome of the game technically remains unknown (come on, the M1s will dominate), the fun of anticipation has likely made it worthwhile for all those involved. Having this game to look forward to helps remind all the students that we can still have fun and not study every waking hour. Plus, a bunch of money is being raised for Harversters through ticket sales.

I leave you with one image and two links to better summarize the coming clash.

M2 Trash Talk

M1 Honesty

A taste of what's to come:
Until next time.