A Hodgepodge of Thoughts

As I pass through my neighborhood, I see my neighbors taking down their Christmas decorations that have mostly been up since Thanksgiving weekend. This makes me somewhat sad. Today is the 6th day of Christmas, which means that there are 6 whole more days of christmas to be celebrated (I know, you are all in awe of my superior arithmetic skills). So I hope you enjoy your 6 geese-a-laying today! Actually, does anyone else find the gifts given in that song to become progressively strange? How does one find 10 lords to be given as a gift and not only that, compelled to be leaping? And is it that they occasionally might break out into leaping or do they do a leaping routine or are they in a constant state of leaping?

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DC is a quiet place this time of year. Everyone has gone home.


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I've never really been one for New Year's Resolutions, per se, but it usually around this time of year I think about making some lifestyle changes. I think that has more to do the Bacchanalia that is Thanksgiving/Christmas/NYE.

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I'm more curious who the VP candidates are going to be. O wouldn't dare choose Biden again, would he?

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So I took my car to the shop to get my oil changed-- I know, you're shivering with excitement-- and as I waited there was a television playing the 'Maury Povich Show'. Before you ask why I bothered watching, need I remind you of the 'train wreck paradox' and the 'man and flickering image axiom' (that's the one where if you put a man within eyesight of a flickering image and he MUST look at it)? With these two excellent reasons I continued watching this pinnacle of daytime talk TV. Now, I'm pretty sure every single episode of Maury has had the same theme: 'Are you the father of my child?' After watching these totally screwed up family situations unfold, I thought to myself, "Watching men battle lions and each other in the Coliseum would have been a more civilized form of entertainment."

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Did you guys know that the NBA is back? Who knew? Rather, who cares?

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Merry Christmas and Happy New Year!

A Rash of Rashes

So, I don't think I even made it through a whole year of medical school before the questions started coming. I don't know why, but everyone I know is really eager to have their own personal physician, pro-bono of course (because you know those $20 co-pays are real wallet busters). Everyone, also, wants to know if I can prescribe narcotics and if I can take a look at some rash on their body.

With respect to the narcotics: I usually just laugh those questions off nervously as I hope that the questioner isn't serious but I'm not so sure as I see the glint in the eyes. Then I conjure up images in my mind of the DEA busting down my door and the Board of Medicine revoking my license in perpetuity, heh...

But the rashes, oh the rashes, how I hate rashes.

First off, let's just talk about me and rashes for a second. Dermatology is a field of medicine that I am not particularly fond of. Its subject may be the largest organ but it is also the most boring organ. Diagnosis is usually done by sight and nothing else, sometimes biopsies are taken. It is freaking disgusting at times (play around here at your own risk). My greatest fear in medicine is to be asked to describe a rash using proper medical terminology: macule, papule, plaque, patch, scale, ulcer, bulla, vesicle, and so forth.

Next, we have my ambushed encounters with rashes. "Hey, William, you're a doctor type person! what do you think THIS is?" They say this as they strip off clothing to give me a good view of the lesion in question. As I carefully inspect the rash, feeling for texture and raised edges, I put my best pensive face on and I think to myself, "Yup! He's got a rash all right." In my most confident voice I tell my patient, "Well, it's really hard to tell in this setting what exactly we're looking at... I would probably due a skin scraping and KOH test but it could be an atopic dermatitis [a big word for eczema], contact dermatitis [allergy], or some form of tinea [fungus/ringworm]. Try an over the counter antifungal/cortisone cream for a couple weeks and see if that works... if not, maybe you should go see a doctor."

Don't get me wrong, I think it is pretty awesome that I have the respect of my friends such that they want to come to me for medical advice. But the fact of the matter is, I don't know everything there is to know about all fields of medicine and especially not dermatology. So, bring me your sick, bring me your ill but DON'T, just DON'T bring me your rashes.

Imitating Nature

There are certain questions that are universal to the human mind or at least that's the way it seems when I talk to people outside of the world of medicine about my being in medicine. It's actually kind of funny how everyone asks me the same 10-15 questions, I really should start making notecards or a pamphlet to hand out to answer these questions. My favorite question, though, is, "Is it like House [or some other TV show]?" The simple answer is no, but where is the fun in that. As the ancient dictum goes, art imitates nature, so lets take a look at how well these arts truly imitate what they represent.

Dr. Gregory House
As the caption of the photo reads: Seriously, how does this guy keep his license? I mean, he breaks into people's homes, he nearly kills people with unnecessary treatments, he performs procedures without indication or proper consent and the guy is total a-hole. Yeah, everyone lies and we deal with it but we don't turn it into The Spanish Inquisition or A Few Good Men. Given that bedside manner is a more important determinant in a physician getting sued for malpractice than actually being a good doctor, House would have been sued 8 ways to Sunday. By this point, House's malpractice premiums would be through the roof and he would be unemployable. Then there is the issue of his team. House, head of diagnostic medicine (WTF is that?), has working under him a neurologist, an immunologist, a surgeon, a plastic surgeon, Kumar, and a variety of other doctors. This is utter nonsense. What House does have going for it is the way they portray the brainstorming sessions: we do do that.

Grey's Anatomy
Using a play on the name of the landmark textbook that no one actually uses anymore, Gray's Anatomy, Grey's Anatomy is a show that I've seen, maybe, about 5 minutes of. From what I can surmise, the apple fell off the tree, grew legs and ran into an orange grove. Call rooms are used for sleeping. Only sleeping. Maybe some work before or after sleeping. And people don't survive Stage IV melanoma, especially with metastasis to the brain and liver. NEXT!

Scrubs
I know what you're thinking, "there is NO way that Scrubs is anything like real life!" Well, minus the jumping into your pals arms and screaming "EAGLE!" while he lifts you into the air (at least that's my story and I'm sticking to it), and the funny business in the call rooms it is pretty true to life. Dr. Cox, the jaded mentor, who, beyond the callous exterior cares for his patients and proteges. Dr. Kelso is part the old guard who gets sick pleasure out of belittling those beneath him. The Todd is a surgeon. Elliot is that super idealistic girl who somehow keeps her idealism through it all. We go on rounds and get pimped. We deal with diseases and persons. We have lives outside of medicine and sometimes the two meet. And the janitor has it out for us all.

So there you have it. Now you have a better idea of what my career is like. Except it is not as interesting...

Show Me the Money

Some of my friends have asked me recently: "Why are you starting a blog?" These queries have not been asked in the standard interrogative, rather, in a tone that suggests, "Why in the hell would you be starting a blog? Isn't it kinda passe? I mean really, what are you, a teenage girl?" And when I say that this was suggested, these are things that my friends actually said to me. In answer to the question, I have this to reply: I don't know, it seemed like a good idea at the time... It's likely a product of having way too much time on my hands and a somewhat productive use of said time. But as I mused over it more I thought it would be a nice creative/artistic contrast to the world of medicine where I spend most of my time.

Now that I've given you an answer as to why I am writing here, perhaps you want to know why you should visit my blog.

• You're my friend and you want to make me feel important - seriously, humans are totally flattery operated and I am no exception. The more I see that hit count go up the more I think, "yeah, you're a rockstar, but you're going to stay true to your roots and remember where you came from"
  
• You're my enemy and are hoping to catch some dirt to use against me - think about it, I'm practically writing about whatever pops into my head. I'm bound at some point to say something you can use against me... there go my political aspirations, oh well
  
• You like to chuckle - I'd like to think I am marginally effective at accomplishing that, I reference this post. If you don't laugh at that, then you have no soul.
  
• You like variety - I will talk to anyone about anything. Seriously, I'd talk about trash cans if we could discover differing opinions on the subject but don't worry, I won't bore you with such nonsense. You will find in my pages medicine and non-medicine, arts and sciences, humorous and serious. As we speak, I am also wrangling up a couple guest writers that should provide differing opinions on a wide range of subjects.
  
• You want to help me conquer my student loan debt - did you know that Google will just give me free money? Just by you coming to this page and viewing the ads on the page over there >>>>> I get a fraction of a cent. And THEN if you actually click on the ad, they give me MORE money. The joke is on them, suckers. So, if you're bored, just come to my blog and go crazy clicking on some ads.

I make no pretense of being a good writer; I have little practice. I've avoided it all my life. I am pretty sure many of my major life decisions have been based on the amount of writing that would be involved, i.e., the less writing involved the more likely I was to choose that path. So you should not be here if you are looking for eloquent prose. I am not a visionary, ergo my writing will not likely incredibly inspirational, unless it is by some mistake and otherworldly muse speaking through this blunt instrument. I am not here to talk about politics; people do that for a living and I'm not really that tapped in. But if you can stomach my drivel, please continue to come back and read my pages.

An Honor and a Privilege

At the risk of sounding pompous and self-important, I am a keeper of an ancient and sacred art.

I am bound by an oath that is thousands of years old.

I have heard your most intimate secrets, secrets that no one else in the world knows. I have seen you cry as you've confronted your greatest fears. I know more about your bowel movements than any normal person ought to. I have seen you naked but our relationship is professional. I have touched your body in ways that that would result in any other person landing in jail. I know things about you that you don't. And I just met you ten minutes ago.

I shroud myself with the cloak of science. My stethoscope and hammer are my trusty companions. My white coat, with grime on the collar and sleeves, is my badge of honor. But it's a keen ear that is my most powerful tool. My weapons are diuretics and antibiotics.

I am expected to cure your ailments but you will most likely get better or worse no matter what I do. Truth be told, I am not that different from a sorcerer: standing over you reciting Latin and Greek and giving the impression of power while I let nature take its course.

I am a healer. I am your servant.

There's a hole in my stomach, dear Liza

Patience is a virtue with which I have a mixed relationship. At times, I am unflappable. At others, I am most-flappable. One of my greatest causes for flappability is the ineptitude of others (my own ineptitude I generally perceive to be brilliance that is merely not understood by my peers). 'Suffering fools kindly' is not a virtue to which I am particularly inclined.

This takes me back to an incident where my patience was put to the test. It was the middle of July, I was rotating through surgery and I was towards the end of my second month. I was miserable. Surgery is a specialty that, in my opinion, is occupied by only the most masochistic of masochists. I was on call. At about 130am, I hear the shrill "BEEP! BEEP! BEEP!" of my pager for only about the eleventy-billionth time that day. By this point my reflexes have become so attuned to silencing my pager that I manage to shut it up about mid-way through the third 'beep'. It read, "Please go see patient in ER#32." This was the fifth patient I had to go see since I had a break for dinner at about 9pm.

As I got up from my computer to make the trek down to the emergency department, I felt every last muscle in my body ache. I had been in the hospital for going on 20 hours. I had walked countless miles in that time, at least half of which involved climbing stairs. I was at the end of my physical and mental rope. This was not aided by the prospect of having another 10 hours in the hospital ahead of me. As I walked the long and lonely corridors my mind was void of content. Not blank but more like a television tuned to an abandoned frequency. At last, I arrived at my destination.

I met the patient. She was a 35 year old lady who was in the hospital with a skin infection. I started off the conversation with the usual introductions (though, lacking in the usual charm) and asked, "so, tell me what brings you in." Her story would have been considered coherent for a toddler, I had no idea what she was talking about. "OK, lets start from the very beginning... you have an infection, where? How did you get it? Wait, keep going back why did you have a tube in your stomach?" Patience was holding despite this patient's best efforts thus far.

So with a little redirection, I get her to tell her story. She had had a feeding tube in her stomach because she lost too much weight after bypass surgery. Reasonable. Last month her family went on vacation to a lake. Uh-huh. And she decided to go swimming... in the lake... with a hole in her stomach... At this point, my internal monologue started going wild Are you serious? You actually thought that was a good idea? There was a hole in your stomach! A HOLE! Anyways, the hole in her stomach got infected. Surprise, surprise, I didn't see THAT one coming! So she went to the local hospital where they removed the feeding tube and treated her with antibiotics and sent her out with a prescription for a full course. Strange, why do you still have this infection... But when she went to the store to buy the prescription, she decided it was too expensive and she had already received a lot of antibiotics in the hospital. Are you freaking kidding me? You can't possibly be serious! You have acrylic nails and your hair is done, that's what was more important than buying your medications? 


After a deep breath to calm myself, and a forceful biting of the tongue, I proceeded on to my exam. There was a hole in her abdomen that was leaking clear yellow fluid consistent with gastric juices, the area was infected. I hand her gauze so she cover the leaking hole but instead she uses the gauze to try to clean up some of the leakage but each time she wiped the pressure forced more gastric juice to be expressed from her stomach... giving her cause to wipe more up (I think you can see where this is going).  As she proceeded to play this futile game of whack-a-mole, I interrupted her, "STOP! Just cover the hole!" She replied, "But it feels like acid on my skin..." I starred blankly at her and counted to three, and in a dry monotone I said, "That's because it IS acid." In complete shock and perhaps horror she looked back, "It is? What kind?" She can't be serious, is she serious? I think I'm about to lose it. Again, counting to three, "Hydrochloric... Stomach acid." Knowing what was best for me, I quickly get her cleaned up and leave the room.

Looking back on that event, a couple things struck me. A physician's role is to be an anti-Darwinian agent. No, I don't mean that in the sense of needing to disprove his theory of evolution. I mean, rather, that a physician is there to defy nature's law of the survival of the fittest. Also, if I am to be a physician and an anti-Darwinian agent, then I need to develop a higher threshold for dealing with those who are other than the fittest.

The biggest day of the year

Medical students look forward to one day during their fourth year of school with unprecedented anticipation. That day is not graduation. Graduation is a mere formality and almost a nuisance. Fourth years are pretty much checked out sometime around October and are looking to their futures. They day that they are looking forward to is called 'Match Day'.

No, Match Day is not the day where medical students receive tips on how to match their shirts to their pants or their socks with each other (perhaps there should be some time dedicated to this in medical school because fashion sense is not something that medical students excel in). Match Day is a day in mid-March where medical students find out where they will be spending the next 3 to 7 years of their lives in that breeze in the park known as 'residency' (N.B., by "breeze in the park", I mean anything but a breeze in the park. 4 days off a month, working holidays, incessant pages (yes, we still use pagers) and more!).

The build up to Match Day is more than 6 months long. In early August, ERAS opens for editing. ERAS is a convenient universal form for residency applications. Although it is convenient, it is perhaps one of the most arcane and byzantine pieces of software I have ever used. Every action requires a click, followed by a window followed by two or three more clicks... and then you aren't sure if the preceding series of clicks actually completed the desired action, so you click back through again to make sure it did what you wanted to do. After all but 1 too many hours of working on this stupid abomination of a program, you let the application age and mellow until September 1st, the date ERAS opens for submission.

What occurs next is a process that is strange and I imagine is something like what occurs when high school athletes go through when looking at playing D-1 sports. Some places express interest in you and invite you for an 'interview', other places reject you outright, some places just leave you hanging, but it's clear, people out there want you... they need you. But wait a minute, Dr. Harvey, why did you put those quote marks around "interview"? How observant of you, I'm so glad you asked! Up to this point, my experience with interviews is a 1-2 hour process where you show up and the spotlight is on you, sometimes feeling more like an interrogation directed by members of the FSB. You'd imagine that residency interviews were something like this, but they are so far removed from the idea of an interview in your head that they don't even deserve the same name. These 'interviews' are more like hard-sell recruitment sessions. They start the night before with a dinner (one of these dinners was the occasion of my having a bread pudding that I call the 'ontological proof for God's existance', i.e., that than which nothing greater can be thought). Then the next day over the course of 6-8 hours you are fed at least twice, put through hours of slide shows as to why you should go to this program and why they are awesome, led on tour after tour (if I am led around the inside of one more hospital, it will be too soon) and then you have a 1 or 2 brief, low-key interviews. These interviews were described to me by a member of faculty as "making sure you're not some social freak."

People often ask me questions that would make sense like, "when do you know if you get in?" Or, "What if you get multiple offers?" But The Match is a whole different ballgame. In February, the warlocks of the NRMP demand of you your "rank-list" and likewise they take rank-lists from each applicant and program. They take these lists into their lair deep below Stonehenge, apply potions and perform seances (This is not the official story of the NRMP. They claim to use 'computers' and 'algorithms', like THAT is believable). After about a month, they return with The Match, which you are only allowed to find out about on Match Day. You are matched to one and only one program. You are contractually obliged to accept that position.

Kind of nerve wracking, ain't it?

On the Circulation of Traffic

Alright, DC Metro Area drivers, I've got some beef to pick with you. Y'all suck! I mean, you guys REALLY suck. Okay, okay, maybe not every last one of you, but enough of you people are so bad the rest of us can only drive around in sheer terror and frustration. Now, I understand that there are many respectable reasons why your driving might not be the best: you're not from around here (who is really? (well, I am (I know, strange, isn't it?))), there is construction everywhere (to this day, this is my biggest problem with the stimulus package), you have an important text to send ("OMG LOL U R MY BFF" do you realize with the advent of smart phones, it is actually harder to text that way?), you dropped your doobie and need you're trying to find it (seriously, man, you paid good money for that grass), you are from Maryland, you have DC plates (I'm pretty sure that having DC plates might be causal regardless of where you are from), you're a jerk... I mean really, the list could just go on and on but it's getting to be too much for me to handle. My not-so-internal-and-really-external monologue while I'm driving has progressed to the point where I am about ready to go Christian Bale on you. So, in an effort to save my soul, I have decided to put together a sort of primer to help save the lives and souls of countless DC area drivers.


1. Take the Metro- Look, I get it, driving inside the Beltway is tough. But DC has one the best public transit systems in the country, and with over 1 Million riders a day I'm sure they can accommodate one more rider. It may not be perfect but it's a hell of a lot better than making me want to kill you because I'm getting to the end of my rope and I might just snap. As my uncle always would say, "If you can't take the heat get out of the kitchen."


2. Under NO circumstances should you drive below the speedlimit- I can't believe I need to explain this to you people. Countless times I have found myself stuck behind drivers going only 45mph and needing to step on the break, this is unacceptable. The speedlimit on our freeways is 55mph: this is actually the lower limit to the speed that you should be driving.


Corollary A to 2. If you are in the left hand lane you are either passing traffic or getting out of the left lane


Corollary B to 2. When entering the highway you MUST accelerate. Again, I know you are probably not from around here and I don't know how they teach you to drive in North Dakota but you're in the Big City now. By the time that solid white line on your left turns into a dashed one, you should be at speed with the traffic you're about to merge with. I know it can be hard if you're driving a 1995 Geo Metro but you have just got to put the pedal to the metal and unleash that hamster. And the worst thing you could ever do when entering a highway is to slow down. If another person decides to slow down instead of speed up in front of me... well, somebody gonna get hurt.


3. Following closer does not make things go faster, it just doesn't- In fact, following closer would seem to cause more traffic problems than it solves: less time for reaction, enraging passive-aggressive drivers (like yours truly) who will slow down purposefully, no space for drivers to merge into, etc. So take it from me, touching our bumpers will get you nowhere... unless you're trying to get a good look at the back of my head. You will, however, be sorely disappointed, all the good stuff is up front.


4. "Oooh, look at the monuments! Oh my gosh, we're all going to die!"- this is what you should avoid at all costs. I can assure you, that despite how awesome they may seem as you are whizzing by, the monuments look far better when you are afoot (having had this as my home for well over 25 years, I speak from authority), just pay attention to the road.


Christ told us, "'Love the Lord your God with all your heart and with all your soul and with all your mind.' This is the first and greatest commandment. And the second is like it: 'Love your neighbor as yourself.'" (Mt 22:37-39) Each presents its own difficulties for me. I am seemingly tempted to break the second commandment every time I get into a car. So if you care for my soul, you might try following Dr. Harvey's two suggestions for driving in the DC area: 'Don't be an ass' and 'get off the road'.

On Becoming a Physician

In August of 2008, I made a decision, perhaps a foolish one. I decided to show up for matriculation to medical school. For better or worse, I stuck it out-- in part scared into sticking with it because of the massive amount of debt that I rapidly accumulated-- and am now less than six months from graduation. Now, I don't want you to get the idea that I resent or regret my decision. I am happy and proud of my accomplishment but I don't know that I would have made the same decision knowing exactly what went into becoming a full fledged physician. Despite being 6 months away from being allowed to append "M.D." to my name after 3.5 years, I still have 3-7 years of training ahead of me. Thank God for ignorance: it makes us do great things that we would otherwise avoid.

When I started medical school, I was haughty. I thought to myself: "pshah, I'm smart. I can handle it." I, in my naivety, could not conceive of the sheer quantity of information I had to learn, much less the rapidity with which I had to assimilate it for testing purposes. Needless to say, I struggled a bit to keep up with the Jones'. I'm not ashamed to say that I was not at the top of the class or that I was responsible for making the top half of the class possible. I was overwhelmed that first year. I had never developed good study habits up to that point, relying more on the seat of my pants, which were wearing thin at this point-- perhaps to the point of showing off my underoos; my undergraduate studies focused more on the thought process than on the assimilation of data; I was ill prepared. It was a good lesson in humility. After 2 semesters' worth of graduate level biochemistry, a semester's worth of epidemiology, a semester's worth of genetics, 2 semesters' worth graduate level human anatomy all condensed into 4 months, I had survived my first semester. 25 hours of classroom a week and countless hours of studying, I had made it.

I learned over the next 3 semesters how to study better and become, not a academic leader but brought myself to the point of respectability. I whined and complained, as I am want to do, at the time about how much work I had and how medical school was usurping my life. In retrospect, I had the life. I took to "home schooling", giving up on going to lectures-- the lectures were more like Death by Powerpoint-- and just reading the powerpoints and lecture notes on my own time. It worked pretty well, in my opinion. Then came "Crunch Month". This is that point in a medical students life where everything is in the balance. This is the lead-up to the ultimate test: USMLE Step 1, the great equalizer, the Smith & Wesson for medical students. I have never dedicated myself to any task the way I did during crunch month. For 30+ days I read my review books for 8 hours a day; I did hundreds of practice questions a day for another three hours; I grew a beard; I forewent (is that a word?) grocery shopping (At one point, I asked my roommate to buy me some groceries. He thought I was ridiculous at the time and I think he was somewhat annoyed at this request. A year later when he went through the same ordeal, he apologized for thinking I was ridiculous as he was running low on food.) Time off was scheduled in half days, 6 half days over the course of the month. The test was seven and a half hours long. I survived it and did quite well actually but I came out with severely impaired social skills.

I had a month off to re-acclimate myself to society and then I was out of the frying pan and into the fire that is 3rd year of medical school. I don't know that I can do justice here to the 3rd year but it is a truly strange experience, I'd imagine it's like having only read about Morocco and then being sent to Morocco as a tour guide and being expected to know everything there is to know about Morocco but no one really wants to know what you know about Morocco, they just want to know if you know it and pretend like you need to know it and have the responsibilities of a tour guide... if that makes any sense. But let me summarize 3rd year for you in the most relatable sense:

• about 60-70 hours a week carried over 50 weeks (3000-3500 hours) 
• averaging 4 days off a month 
• work days starting at 5-7am
• working 98 hours/wk at times
• 30 hour in-house call
• Studying for exams outside of clinical duties
  

I could go on but I don't want it to seem like I'm complaining. So I'll stop there, for now.

So what's my point in this seemingly interminable rambling? Well, other than a little complain/bragging and back patting, I want you to understand what goes into making a physician (but mostly bragging). Not for my sake but yours. I recently read an announcement of an acquaintance of mine talking about how after 650 clinical hours she had completed her training to become a nurse practitioner, albeit those hours don't include the hours logged towards her RN or working as an RN. I don't say this to belittle NPs; they're smart people and essential for the future of health care. But, I want you to understand what you're dealing with when you deal with a physician: A master of his domain

So next time you or some one you know says, "That doctor doesn't know anything!" or "That doctor has his head up his butt!"Ask yourself, could you do it? If so, come back in 8 years when you're done with your training.

Everybody's got a story to tell

Stories are a fascination of mine. I love a good story. A well told story is always a pleasure. And if told well, it doesn't matter if the story is about some great happening or a short trip to the store to grab some milk. All that matters is that the appropriate frame of mind and emotions are adequately conveyed to the audience. Frankly, I don't even care if the story is true (now, whether or not the story tells a 'truth' is a whole 'nother matter) so long as I, the audience, am captured. How does one tell a good story? I don't claim to be an expert on this sort of thing but I believe a good story mostly depends on just the right amount of exaggeration. Enough to excite and engage the listener's imagination but not too much that reason steps in rejects the image is improbable. There is plenty more that goes into telling a story, such as flow and a plot, but my personal consideration only goes as far as exaggerations.


Well, what's my point? Nothing, really. Just an opportunity to spout off some baseless nonsense that I know nothing about and to create a segue into telling my favorite story to tell. Without further ado, my favorite story ever:


The names and identities of the persons involved have been changed to protect their privacy. 


It was May of 2007 and I had just finished school in California. It was time for me to make an epic journey to my home: Virginia. I was ready to get the hell out of Dodge and had a long drive ahead but fortunately I had a good friend, Joe, driving with me and stops at friend's houses planed all along the the way. Despite giving Joe fair warning that my car was a stick shift and that he would have to learn before the trip, it happened to slip his mind. No matter, highway driving is rather simple and I could teach him during the trip... right. 


About 5 or 6AM on our scheduled day of departure, I wake up and head to Joe's room to make sure he is up and ready to go. He was up alright and let out a short 'sigh' that turned into something of a long 'ugh'. Without any prompting, Joe let me know that he just lost his cookies- all of them. Multiple times. Worried that he won't be well enough to head out, I ask him if we should postpone our departure. With another 'ugh' and a swig from his handy water bottle, Joe assures me that, without a doubt, he is ready to go. We pack our last few things into my already overloaded car and head out.


Now, I have to tell you: My absolute favorite thing about road trips is that they are the perfectly justifiable excuse to stop at McDonald's for breakfast. On the one hand, McDonald's breakfast is absolutely disgusting. One meal probably has enough grease to power a mid-size diesel truck for 500 miles. On the other hand, it is just so damn tasty! Seriously, I don't know what they put into it but if they sold breakfast all day long I would probably need to go into a twelve-step program and/or die of a massive heart attack before I turned 40. That being said, I was incredibly surprised... shocked and appalled... ashamed... concerned for my dear friend's well being when he said he wanted nothing from McDonald's for breakfast! I honestly could not grasp what was happening. Perhaps Joe just didn't understand what I was asking. So I asked him again. And again. And about 15 more times just to be sure. I couldn't even persuade him to get a coke to help settle his stomach. He told me his water bottle was all he needed. "Sucker," I thought to myself, "he doesn't even know what he's missing." Anyways, onward to New Mexico. To this day I still do not understand how he didn't even want ONE thing, hmph!


Onward, we traveled. The road we took was a rather steep 4-lane windy freeway that led us over the mountains of California. This led to a drive that would reasonably make an uneasy stomach want to eject its contents. I need to take a pause in the story at this time to talk about a crucial factoid that I have omitted and was unbeknown to us at the time. Regardless of the conditions of the drive, I'm not sure Joe would have been able to avoid throwing up again. You see, his water bottle that he had so diligently been drinking from had been sitting next to his bed half drunk for more than two weeks. One can only imagine what was growing inside of that bottle; needless to say, it was the kind of thing that provokes a person to lose his cookies.


What transpired next, I think, will never cease to cause me endless laughter. Joe turns to me and says, calmly and quietly, "Can you pull over, soon, please." Easier said than done. As I tried to make my way over through the swarm of California drivers, Joe starts rummaging through the contents of his seat well and emerges victoriously! With an empty McDonalds bag, nonetheless. Whelp, needless to say, he yacked into the bag and a mighty yack it was. As he sat there, looking somewhat relieved, he announced, "the bag... it's, uh, leaking." Simple solution to this problem-- but one must remember to always speak precisely. I said, "Put it out the window." By which, I meant to release the bag containing vomitus out the window of our moving vehicle; he, however, understood that he was to hold the leaking bag out the window and NOT release it. I am not really well equipped to appropriately describe what happened next but it was something of a puke-bomb, if there is such a thing, the effects of which were plastered to the rear passenger window of my forest green 1998 Honda Civic-- it blended in quite well, might I add. I immediately start laughing and between chuckles I yell out "LET THE BAG GO!" Joe slowly turned back to me, gives me a quizzical look and asks sheepishly, "And litter?" My response took no thought, "YES!"


After we pulled off the road and got Joe cleaned up, he turns to me and says in complete earnest, "I've given it a lot of thought and I'm pretty sure that's the first time I've ever littered." A Cardinal Sin for a native Californian.

Who is William Harvey?

William Harvey was a physician in 17th Century England, who was the first westerner to posit that blood circulated through the body. His seminal work, De Motu Cordis (On the Motion of the Heart), argued for and described how blood moved about the body- hitherto, it was believed that blood just sort of sat there... or something. Although he thought blood moved the opposite direct that it actual does, he was on to something. So why do you care? I don't expect you to. I just thought this was a good persona to adopt.