BLACK MONDAY...

For those of you that don't know...today is affectionately known in the academic medical world as Black Monday...the monday before the actual match. You get an email in your inbox at 11:57 AM titled "DID I MATCH?". Double click. Valsalva... Sphincter clench.........F*&^ING LOAD ALREADY!!!!!

Congratulations! You have matched.

Check the Match Site at https://services.nrmp.org/r3/ on Thursday, March 18, 2010, at 1:00 PM eastern time to find out where you matched.

Exhale...Try not to be creeped out by my 6'4, bearded friend who is both crying and hugging me in joy. Go back to radiology class...

I'm pretty convinced that the NRMP consists of a bunch of sadomasochists performing a massive social experiment on one of the most anxiety prone segments of the population. I mean really...I've spent the past 4 years studying until I died, reading Robbins until my eyes hurt, taking board exams, doing the scuttiest of scut, being demeaned by every level of the health profession (Janitor to CEO), running all over the northeastern US dressed up in a suit answering stupid questions about my personal life and agonizing over where I want to spend the next 4 years of my life, just to get to this point...the match.

At noon on Thursday, all of us lemmings will simultaneously open our envelopes and finally know where the hell we're going in June...every range of human emotion will be played out. Exciting? Yes. Nerve wracking? Yes...I'll be starting a course of protonix tomorrow morning to ward off the ulcer. And partying...lots of partying...because beer is cheaper than anxiolytics.

Match day is coming...if you know a fourth year med student, please give him/her a hug, share a refreshing adult carbohydrate beverage and reassure them that everything will be all right.

Welcome to the Jungle...

So I sucked it up for the past month on the Medicine floors paying the hospital about $200/day to play intern... and I have never been sooooo frustrated with how things run in the medical world. Diagnostics/studies/consults are ignored or delayed because of where the patient's request was put in line behind the other 600 beds in the hospital. Nurses are paging with annoying dietary/social work complaints that my 8 years of higher education have not prepared me to deal with. Patients are left to rot over the weekend because their nursing homes "don't accept transfers on the weekends"...even though they had no reason to be there in the first place and there is no good reason they couldn't be tossed from stretcher to bed by the medics.

Just to rub in the awesomeness...Snowpocalypse hits, not once but twice in 1 month causing every service in the hospital to be sent home by noon...except for the medical call team...which happened to be my team both times. Not only did most of the medical housestaff shirk their responsibilities (leaving us to pick up the slack), but they drove home in the middle of a blizzard for the express purpose of shirking their responsibilities. For Christ's sake, the nurses and techs were sleeping in empty beds, lounges, offices, etc to make sure that their responsibilities were taken care of despite the snow (which made them understandably happy to be at work for 36+ hours straight), but the housestaff skedaddled as soon as they were told it was a half day. Such a ridiculous disparity...

Then there's the spectrum of attitudes from the nursing staff which varied from loving (hugs, smiles and cookies) to legitimate questions of patient care ("How do I mix this tube feed at half strength? Tap or sterile water?") to downright adversarial (from a covering nurse, "I've never seen this done in 30 years of nursing, you are incompetent" because I'd rather give an IV antiemetic regimen that worked wonderfully this morning before the patient pulled her IV access instead of IM because A) she is unable to tolerate PO, B)is going to bitch and complain about any IM medications because she has the pain tolerance of a 2 year old and C) has annoying, micromanaging parents who will have you page me every 10 minutes until she stops being a giant baby about her arm hurting...more on this to come in a later post).

Looking back, I've been spoiled with my time in the ED.

The team just works better in that environment. Attitudes are generally directed at patient care over making it through the tedium of the day. The problems with the patients are more often acutely medical rather than dietary/social work. My hours aren't spent documenting the full diagnostic workup and recovery of every patient for weeks on end. People go home when I say they go home. The consultants come (usually) when I need their help. People get a CT within 2 hours of me deciding they need a CT. Labs come back within 45 minutes. There are no rounds to dissect every morsel of the patient's life and how they may contributed to their metabolic syndrome. There are no pagers. There are no pages over ham sandwiches at 9:30 at night. The nurses don't blow me off when I'm managing their patients and address their doubts about my competence with helpful guidance instead of thinly veiled disgust.

I'm just not cut out for the floors...I'll take a double shift in the pit any day.

Against Medical Advice

Time for a little thought experiment here folks:

Imagine that you weigh about 500 pounds. You get one of those big boy beds with the inflatable mattress that prevents new decubitus ulcers on your ass (like the one you have at home). You haven't moved said ass from your bed since last fall. You've got a couple new-ish metal joints because your massive girth destroyed the perfectly good ones you were born with and you can't even move your own legs because of their enormity.

Yeah, you remember the glory days when you qualified for the 1980 Olympic games in Greco-roman wrestling (but didn't go because of Regan) . You were an Engineer and that white coat wearing kid is talking down to you when he explains hypertension. You don't want to eat the low-fat, low-sodium diet ordered for you and send your tray back to the kitchen. It tastes like cardboard...

However, you are too ignorant of your own health to remember that time you were in florid pulmonary edema and dyspnic back in May. You got an ultrasound of your heart showing some diastolic heart failure...but they treated you with maalox and you got better. You're on an ACE, a Beta blocker, a duretic, lipitor and aspirin...the standard care for heart failure...but no one ever told you that you had heart failure.

Now imagine that you're hungry because you've been in a few hours of tests, and all you really want is a nice big ham and cheese sandwich...an no one will get it for you. You're ordered for a cardiac diet. Now imagine that you call the nurse and demand that your diet be changed to allow you a ham and cheese sandwich...shouldn't be a problem, the doctor will fix that right away. MMMM salty ham and fatty cheese...you're really hungry. Good thing you got rid of that crappy dinner tray 10 minutes ago...too many veggies.

Now imagine that some jackass in a short white coat comes in and tells you that you have a history of CHF (Surprise) and HTN and that a low salt, low fat diet would be best for you and that he's not going to change your diet...no you can't have your sandwich. You've never had CHF, no doctor ever told you that!!! That has to be wrong, get that out of your charts.

When he's paged a second time (you really are hungry this time), he proceeds to remind you of this CHF thing that no one ever told you about and explains how a salty diet will make you retain fluid and cause you to go into heart failure and get you into the same situation you were in last time. You're livid and want to talk to an administrator to have the CHF thing removed from your record...it's 8PM on friday and you want a damned sandwich...no that fruit plate and 2 bowls of cereal won't do.

The next time he's paged that fucker pulls the echo report from may and points to the words "Dyspnea" and "Edema" under diagnoses. He explains how even though your systolic function was ok for the time being, your dilated right heart will cause you to drown in your own juices if you have a regular diet...so no ham sandwichs for you! Well, you might as well leave this place cause they're not going to feed you (that dinner tray looked too healthy) you tell the nurse that you want to sign out AMA. Someone will drop you off at home and get you into bed...you can get those Q8Hr antibiotics at home anyway...i mean you just hook them up to the PICC.

That fucker in the white coat is back with the AMA form all filled out for me to sign. You'll have to find your own way home? In the snow storm? The medicaid crane to move you back to your bed at home at 9:15PM?? No one is setting up care for you at home if you leave now and there's the chance you may die of sepsis??? That's it...you're calling your lawyer. You're going to sue everyone over a ham sandwich? They can't threaten me with death and heart failure. How? You'll find a way...you were an olympic athlete!

Oh, the nice nurse is going to get you a nice low-sodium grilled chicken sandwich from the overpriced hospital cafe...that'll work! How can that white coated guy be concerned for your well being??? He won't even give you what you want for dinner! Thank you ma'am...

Reason number 1,000,000 I will not be going into internal medicine...stupid shit like diet orders and ignorant patients.

Can we strangle patients?

Have you ever had one of those days where your stupid patients have stupid problems that the poor nurses have to page you for? Here's two dandies from today:

Patient 1- 30's female with a personal and family history of DVT, now at 15 weeks gestation with a DVT in her thigh. Should be simple enough, hypercoaguability work-up, heparinize and discharge on lovenox. Yeah, right...

• "Where was your lovenox made"- New Jersey...perhaps the one place on earth scarier than China.
• "Are there any preservatives in lovenox"- not in the single dose form that you'll be getting...but that room-temperature, unpasteurized, farm-fresh, organic kefir you're chugging might contain some brucella or mycobacteria bovis...I hear those are bad for babies.
• "I've read there are all sorts of side effects of that nasty drug lovenox"- Most of them are bleeding related...it beats a PE that could kill you and your baby! We could always try rat poison.
• "Can I eat an avocado? I read all about the food interactions of heparin and avocado was on there"- you read about warfarin, avocados and many foods interact with warfarin. Lovenox works by a completely different mechanism. Bon Apetite and I question your sources.
• "I've read that people who inject their skin with insulin loose fat at the injection site. Will that happen with lovenox?" No lovenox is not a good way to lose that pesky baby fat.
• "Why is the hematologist so interested in all of those tests...what if I don't want to know?"- Wait...you just asked me what preservatives are in lovenox and you don't want to know if you have a clotting disoder? Either be OCD or non-chalant about it...don't flip-flop.
• "What are the potential side effects of ultrasound on my baby? I've read studies about them damaging the ears and eyes and I know it hasn't been studied because there isn't a big enough group of un-ultrasounded women out there." Um...no. Actually due to your advanced maternal age, you may want to consider an ultrasound to screen for potential birth defects since women of your age are at an increased risk. The benefits would probably outweigh the risks. I bet you take your immunization advice from a porn star too!
• "What percentage of EMLA cream is absorbed by the skin into the body?" Um...adults don't generally use EMLA cream...no idea.
• "My homeopathic doctor...blah blah blah"...not that I'm skeptical or anything, but crystals and accupuncture aren't going to fix your DVT or genetically based hypercoaguability.
• "With my first baby, my membranes ruptured on Sunday and I delivered on Thursday...my midwife got a little worried on Wednesday"...Um ever hear of chorioamnionitis or GBSS? Oh, you never saw an OB or had an ultrasound?...no wonder your dates were a month off.
• How'd that lovenox shot go? ::dramatically:: "Oh it was so horrible!"

Patient 2: 25 yo guy admitted for a CF tune-up, ended up having an exlap for an intussiception, on a PCA for pain control. POD#3, just got the NG tube out and starting to eat. Still has PCA (Patient Controlled Analgesia) pump with dilaudid.

• He pounds down his liquid breakfast tray in under 10 minutes, and has belly pain shortly there after. Covering SubI (who witnessed the first episode of belly pain leading to surgery 4 days ago) was paged. Explains that the bowel "goes to sleep" after surgery and while taking opiates. Downing his tray so fast was probably a bad idea...take it easy on the food for now.
• SubI paged for worsening abdominal pain. Now rolling on the floor, howling in pain, patient is still able to text and talk about his wife and make a few jokes. Benign exam...I'll reassess in an hour
• SubI paged for worsening abdominal pain. "This feels like right before the surgery"...patient not texting any longer but still a benign exam. SubI orders STAT labs and imaging and pages surgery, discusses with medicine attending who agrees to examine the patient and is not very impressed either but agrees that labs should be sent anyway. SubI calls his resident to cosign STAT orders. Writes progress note re: plan.
• SubI reassesses patient after ordering labs. Patient eating dinner tray, talking on phone to wife, pain well controlled with PCA pump. "Yeah, I just decided to start using my PCA pump again. I feel ok now man! Hey do you play Dungeons and Dragons?" SubI explains the finer points of the PCA machine (Push the green button until the pain is tolerable...if you're unconscious, you're gonna get a rude awakening). And no, but I do play fantasy baseball and football...no you're not getting a draft invite.
• "I get lonely in here...thanks for talking to me man" SubI checks his not-ringing pager, excuses himself to answer his phantom page, calls resident to cancel STAT orders because the patient is a fucking idiot, writes a progress note that the patient is a fucking idiot, bangs head on desk and questions so many of his poor decisions in life...like going to medical school.

It was a long day...and I only covered 12 patients...I felt bad for the interns who had to cover dozens of them and the resident getting killed in the ED with admissions...more fun tomorrow

Stupidest dispo of the week

96 yo M- medically cleared for transfer to Inpatient Psych Unit for suicidal ideation

Listen...if I ever make it to 96 (and I plan on killing myself with a lifetime of bacon, red meat, beer, scotch and family cardiac history long before that) and I feel like dying, just put me on Comfort measures and send me to hospice so I can have some compassionate care instead of medical wards or the fucking locked psych ward!!! The poor guy will get knocked over by one of the aides or another patient, break a hip and throw a lethal DVT...please rethink that one kids.

Words of wisdom

I love old folks because they drop these hilarious little pearls off the cuff without thinking twice.

Yesterday from an 81 yo guy:

"You know you've become old when moving your bowels is better than sex ever was."

Man, I hope I never get old.

my whereabouts

I know that I've been a bad blogger...but 4th year has been sort of more than I thought it would be.

What have I been up to since October when I used the blog as a procrastination tool for step 2?

1. Training for my first marathon in March, sort of half-assing it through partly due to weather, partly due to interviews/traveling and partly due to laziness
2. Residency interviews- invited to 16, went to 14 and ranked 13 with some really phenomenal programs in the mix. We'll see where that goes on March 18th at noon. There's a significant chance that I could remain a Bostonian in NY for a few years to come...saving me that awkward blog transition.
3. I was either at home doing nothing worth writing about, on the road, skiing or sitting in the library on my tox rotation...nothing really to write about
4. SubI- I'm on my medicine subI right now and it is everything I hate in the medical world with a fucking beeper attached to my hip. And it never stops buzzing for the stupidest shit...case in point happened today:

• "Are you covering X?"
• no, I was last night though
• "Do you know who is?"
• nope, there's like 100 patients on the medicine service, 12 interns and 6 subI's. If you look at the bottom of any progress note, the pager number for the intern is there
• "I didn't want to have to walk alllll the way over to the chart rack"
• glad I could help

Anywho, subI is crushing my soul and providing plenty of fodder, rage and learned helplessness for me to polute the interwebs with. You'll note the new privacy settings...I was getting sick of spam comments. Anyway...gotta get up in a few hours, might as well sleep.

~BinNY

Cross posting...

Two things that I put on my facebook page today that I'm cross posting...

1) the above picture
2) this link: Suck it up, America (via DocShazam)


Now it's time to watch some TV and pack for the drive back to Massachusetts tomorrow...huzzah

FML...AGAIN

Lappy is expired again...t-3 days until exam...FML. Looks like I'm sitting in the library for the next few days.

I'm pretty sure that the poor innocent Dell tech support guys had no idea what to do with the irrational, angry, over-caffeinated, sleep deprived medical student on the other end of the phone blabbering on about some sort of "medical licensing exam" with "major career implications" threatening to buy a Mac and trying to get a free windows 7 upgrade out of the whole thing me.

3.5 days left...AAAAAH

Lappy is now back and fully functional thanks to its third motherboard and the nice technician that came out to install it! I spent most of Saturday on campus using the computers there (shudder) and had some serious flashbacks to my first two years of med school. Luckily one of my friends let me borrow one of his 3 computers and I managed to get by alright.

I had been thinking about postponing my CK for a week and Saturday's little FML incident nearly pushed me over the edge. The constant 5 week beating from USMLE World had completely eroded my confidence, and I have been watching my average slowly decline over the past week. So I took one of the NBME exams just to see how I did, and it was in the acceptable range...so I'm sticking with my date this Friday. I'm self-imposing a blogging ban since I have like 3.5 days of studying left, but I'll put something up afterwards.

GAAAAAAAAAAAAH...FML

Not sure if everyone's seen this website but it's called F my life, pretty classic stuff on there. If there is such a thing, I had the med school equivalent of that today.

I'm taking Step 2CK in 6 days and I woke up to find my computer dead with 30% of USMLEworld to go. FML.

Welcome to Neurosis...

In behavioral health/psych, we learn about obsessive-compulsive disorder which is mainly characterized by intrusive thoughts that cause anxiety and compulsive behaviors that alleviate the anxiety. (DSMIV criteria can be found here.) Whenever OCD comes up, there's always the half-joking/half-serious tag added on that "a little bit of this isn't a bad thing in medical school," and we all nervously chuckle and look around at all of the other medical students sitting around the lecture hall.

Well, my fourth year is begining to feel a little bit like that. My brain is entirely somewhere else during the day and I can't stop thinking about the match, interviewing, my step 2 exams or other asinine med-school related stuff for more than a few minutes to pay attention to the docs patients. One of the caveats is that the worries can't be about real life concerns...so I think I'm pretty safe there, but I'm still absolutely unable to concentrate because of this chronic, baseline anxiety. The only thing that makes it better is checking my email to see if the programs I applied to are offering interviews yet...and I know that there won't be very much movement this week due to the ACEP meeting in Boston, but I keep on checking anyway! It's totally inappropriate, but I'll slink away to a computer between patients and pull up my email to check. Fortunately, I see other fourth years going through the same motions on the wards and pulling out their iPhone's every few minutes to peak at the inbox...

It doesn't help that I'm on my mandatory PM&R rotation this week. The requirements of the rotation are to sit in a little exam room with a PM&R attending (who looks amazingly well rested, in shape, and happy by the way) and struggle with the patients through her Russian accent and brusk mannerisms. Between her and the tales of woeful chronic back back pain it takes me about 2.4 seconds to zone out wondering when I'll finally get home to start mowing down USMLE world questions or get my next interview (up to 3 now!). I can't muster the energy to care. However she does manage to drop some randomly awesome physical diagnosis knowledge from time to time, but I have to cut through the fog of aweful surrounding the rest of the day...

55% of USMLE World questions down and 10 days to go...I figure 3 blocks of questions plus review should get me done by the middle of next week before my exam. Still getting smacked down by the occasional section, but there's a steady average trend...

USMLE World...

Is slowly killing me. Although, it is GREAAAAT at exposing the weaknesses in my fund of knowledge: Apparently I suck at peds and psych. And the roller-coaster of performance isn't very confidence inspiriting either.

I've also noticed a disturbing trend in reviewing questions: the longer I go with questions during the day, the worse I do. The earlier in the day and the more awake I am, the better at thinking I am...but after a long day on the wards when I come home and try to get through my questions, I can get through a section alright, but the second section of the day tends to be worse every time.

Oh well...14 more days of this stuff until the real thing!

Where's the awesome???

Fourth year of medical school is supposed to be the promised land after years of slogging through the pre-reqs, the pre-clinicals and the core clinical rotations. My EM rotations over the summer were PHENOMENAL and I will share my stories when they're not subject to search and seizure by the programs that I've applied to...not that I'm paranoid much in due time.

However, Geri put the brakes on the momentum of the year, subsequently derailed by the neurosis of residency applications, Step 2CK studying and the onset of acute lack-of-time-and-money-itis. So instead of being that cool and confident 4th year who's partying and putting his ducks in a row, I'm just that mildly out-of-shape dude in scrubs who looks perpetually over-caffeinated and sleep deprived from checking his email constantly and only talks about USMLE World (TM) questions and interviews. (Maybe they'll give me some cash for dropping their name???).

I stuck out the rest of Geri without very much effort difficulty but managed a generally positive performance review from the course director and attendings. I think the most educational part of the rotation was a peek of what a visit from the medical marijuana associates JCHAO does to the flow of a hospital. I think the floor of my unit was buffed twice daily for 2 weeks straight (so much that I got to know the guys by name), the patient's call bells were answered in a timely manner, the residents washed their hands obsessively, the food in the cafeteria was markedly better and the demented old people who were usually restrained were all magically on 1-to-1. Oh, and everyone was on edge...for like 2 weeks straight. I thought the unit clerk was going to lose it when she found out that the hospital started spreading rumors that JCHAO was in house when they really weren't coming until the following week...it was a pretty slick move by the admins.

So now I'm slacking my way through a week of Anesthesia (actually lot of fun!) and a week of Rehabilitation (Physiatry) before my Step 2CK exam in the middle of October. If you remember, I'm a big fan of preparing for standardized exams. Fortunately, I have a couple of hours to distract myself in the clinic before pounding out 2 hours of questions every night. I'm about 1/2 way through my prep and my scores are pretty much all over the place still...depending on how tired I am while taking it...but I'm consistently sucking in Peds and Psych. My current plan is to focus my studying on the weaker stuff in hopes of picking up easy points, but we'll see how that goes.

Anyway, I'll continue my infrequent and vague postings as my life rolls along, I hit the interview trail and tick off the days left in medical school. I'm sure there will be some fun stories to share...

Positive physical exam findings

After examining hundreds of normal people finding something on physical exam that isn't right is sort of a novelty. Today I had a couple of them in one poor old guy who had a problem list extending to number 18:

1) AAA actually does feel like a pulsitile mass in the abdomen...but I knew about that one

2) Bruits in almost every large vessel...knew about the PVD and carotid stenosis too

3) I definitely hear crackles in the RLL...you didn't hear those medicine resident? Never mind...you wrote the worst admitting H&P ever! Lemme go read the official CXR report...he's got an infiltrate to match his findings...maybe there's something to the physical exam crap.

4) Stage 1 decubitus ulcers look like some redness that doesn't blanch...noted.

5) Contracture vs lead-pipe rigidity...I couldn't tell the difference, but he's on cimetedine so he has Parkinsons in someones mind.

It really helped that I was on the Geri floor and had time to mess around with this poor demented old fellow...some cool findings that I might not ever see again.

An indecent proposal

I'm drawing some blood from one of my little old ladies today...actually my own patient...bent over her bedside palpating her contracted, cachetic little arms to try and find ANY vessel that I can stick a 22 guage into.

LOL: Tell me that you love me...

Bostonian: Ok...Berta, do you even know who I am?

LOL: No...I thought you were my man.

Bostonian: Well we just met this morning, I think we're moving a little bit fast here.

LOL: (getting tearful) But I love you. Why won't you say that you love me?

Bostonian: Ok Berta, I love you.

LOL: Why won't you take me like you used to

Bostonian: Berta...do you even know who I am?

LOL: No...I thought you were my man...I love you

Bostonian: Sweetie, I'm just your doctor, you're going to feel a little pinch in your arm.

LOL: Ouch...why do you treat me so bad. Won't you take me like you used to???

Bostonian: I'm just here to get some blood...I'll see you tomorrow Berta.

Whiplash and Teamwork

Whiplash

After finishing up a wonderful couple of months in the ED's of Massachusetts, I headed back down for my September Geriatrics rotation in the Bronx. One of my EM attendings predicted it would feel like whiplash...and it has!

Talk about polar opposites of the health care spectrum...I went from managing 7-8 patients per shift from presentation to managing 1-2 patients at a time...without the ability to do ANYTHING. Not look at labs, not order tests/meds/care, nothing. I stand on rounds for 2-3 hours per day, drop my notes and suffer through the seemingly endless didactics (over 12 hours per week). Not only that, but I am the only student in the Medicine Department right now because the third years just finished their medicine rotations. I looked around the room the other day during grand rounds and I was one of three native English speakers in the room...great.

Teamwork

Ok so it wouldn't be aweful if I didn't deal so poorly with being scutted in it's most evil form. I don't really mind doing blood draws, IV's and rectals on other people's patients, but most of the patients I've been assigned have come from the interns on their last day of hospitalization...so guess who gets to do the discharge paperwork. Yeah...that's right...me! Here's the kicker: I'm not technically allowed to sign the discharge papers or fill them out.

Well that caveat came back to bite the entire service in the arse. I picked up a patient for maybe 3 hours, presented on rounds and took care of the last minute social work, got the discharge meds from the resident and put the discharge summary in the chart. I notified the intern that the papers were finished and in the chart. Well, she never signed them, the resident never signed them, the fellow never signed them, the attending never signed them and the charge nurse made sure the patient was on his way out the door. Well the nursing home was a little bit upset when they didn't see anything signed and that there was a little bit of a heftier dose of ampicillin than usual...so they called to double check on that. And so my team proceeded to throw me under the bus...yes it was my fault for not double checking the resident's dosing, not waiving the discharge papers in front of everyone to sign and not signing the document that I'm not even supposed to fill out.

There's my other scut. Working in NYC exposes you to all sorts of races, languages, beliefs and sexual practices. We were rounding the other day and one of the Spanish speaking patients is screaming that he wants a sleeping pill because he hasn't slept in like 3 days due to his pain...en Espanol of course. So forgetting that I was the only one with any sort of western language skillz, I accidentally translated what he was saying...my big secret came out. Yes, I can understand and speak some limited Spanish. All of a sudden, I am translating for EVERYONE.

Ever tried to get a history from a demented old man with an old stroke in a language that you only sort of understand? Ever tried to take a history in a language that is not your own for a hematologist? Ever tried to explain an AV-fistula surgery in Spanish?

Only one week of this left...I've never been so happy to leave a service.

Insurance = Care???

I started writing a post sometime back in August about the health care debate and sooo many of my gripes with both sides and how stupid the whole process was...and then it sat as a draft because it was pretty much unreadable and full of half-formed ideas and grossly stated opinion...but it started something like this:

Putting aside all of the death pannels, town-hall screaming matches, etc. here's my bottom line: you cannot equate health insurance and health care.

And then I read an amazing article that included my point in a rationally stated, down to-earth manner. So here's the link from Atlantic Monthly. Hopefully it saves you from my awful writing.

less aweful reading

b-9

Radgirl's path was benign!!! Best of luck with recovery

And now for some aweful reading...

One of my more faithful readers Radioactive Girl was just diagnosed with cervical cancer following her recent surgery and had the courage to write about her surgery on her blog.

My heart goes out to her and her family. Please send her your positive vibes as she's waiting for the path results. I can't even begin to imagine the horribleness of having to wait for these things.