I'm closing this blog down. Elsha and I are opening a new family blog in a more secure part of the interweb.
If you're interest in keeping up to date with us, head over to HaberleFamily.com. You'll need to quickly register to view the site, but it's painless and we'll never spam you.
Well, here's my rank order list for anyone interested. It's due tomorrow, Match Day is March 18th.
1) University of Iowa Hospitals & Clinics 2) University of Utah/Intermountain Health 3) University of Colorado Hospitals/Denver Health 4) University of Wisconsin Hospitals & Clinics
And Kim: Seriously? You have to be pulling my leg.
This is one of my favorite movies of all time. I don't know why -- the plot is predictable and oversimplified, the acting is horrible, and the action is lackluster.
Maybe it's because I used to watch this show and think to myself that Elizabeth Shue was really attractive, and how Elsha (my friend --> crush ---> girlfriend --> wife) looked exactly like her.
#7. I can't ever, ever say the phrase, "I personally believe" without thinking about this stupid girl and laughing out loud.
#6. I never get tired of exposing people to this mess.
#5. TEAM BUILDING EXERCISE NIGHT TONIGHT!!!
#4. The Rick Roll.
#3. I'd always suspected that Tom was a Dark Lord of the Sith.
#2. For my Mom. Who made me watch this every Saturday (no, not SNL.)
#1. "I put up all this wicker up, just for you"
These guys' brand of comedy is hilarious. It's sort of an awkward joke to watch these guys in action. I guess Absolut Vodka approached the comedians (Tim Heidecker, Eric Wareheim, Zac Galifianakis) about doing a commercial for the website -- and allowed them complete artistic control of the content. The only stipulation was that they had to mention the product. What follows is unscripted, unrehearsed awesomeness.
So, I don't exactly know why I find this whole thing hilarious, but I do. Maybe it's the Golden Girls-esque wigs or the strange context under which these guys would be meeting. Maybe it's the awkward and abrupt pace and editing.
Maybe it's the incense, the ferns, the color of the mini golf ball, the size of the hot dogs and the quantity of ketchup, the rides being not scary enough, the wave runners being too slow, the chair being too big . . .
I just got back from my first interview at the University of Wisconsin.
But before I go into that, I should explain a couple of things about the California programs I applied to. First, you have to understand that I have sincere interest in only about 2-3 programs, but the price of applying to 10 residencies is the same as applying to one. So, I added a bunch just for fun. Some of those were a few in California and the Northwest. It was a surprise to me that I got an interview at UCSD -- not a big surprise that I was turned down at Univ of Washington and that I haven't heard anything back from Stanford. Let's face it, I'm not the "IV league" style kind of guy -- I like my work, I do my job well, and I'm pretty good with my patients -- but I'm not the serious researcher/academic. That's just not my thing. Do I enjoy a little clinical research? Sure. I like mixing things up. Do I want to base my entire career around research? No. If that were the case I would have gone to graduate school.
My point is: These schools are big research driven school, where the residents are self-selected to be the kind of folks who want to be leaders in their academic fields and make awesome discoveries and write grants and publish papers.
I want to be a clinician-educator. I definitely want to stay close to academic medicine, but not because of the research. I want to be in academic research to teach interested learners, to improve medical education, and influence patient care in that regard. I think I have a talent in this area that needs to be developed -- and I would be remiss to give this up in order to go to program that was maybe more "prestigious," but lacked the ability to formally meet my career goals.
Also, California is screwed up. Bad economy and ridiculous housing costs. Why would I want to move my family there to rent an outrageously priced two bedroom apartment, when I could stay in the Midwest and buy a two story home?
So, I canceled my California interviews. I don't want to waste their time and I definitely don't want to waste my money traveling.
And now onto Wisconsin.
Madison, Wisconsin is a beautiful little place about 3 hours Northeast of Iowa City. It's an hour west of Milwaukee, and maybe about two hours northwest of Chicago. The downtown area and University campus sit on the shores of calm, icy blue Lake Monoma. Despite the air being crisp, there are a lot of people walking around the downtown streets and riding their bicycles to the campus. A couple of sailboats appear floating serenely on the lake as I watched them from the window of my hotel room. The city was obviously bigger than Iowa City, but nothing I would call a bustling Metropolis.
The hospital was excellent. Appeared new, well kept, and well staffed. It's hallways seamlessly attached to the VA Hospital, the Medical Education Building, and the Health Sciences Library. The VA was so nice, it made our VA look like it was falling apart.
The program director was soft spoken but eloquent in his description of the program. In a few words: the program was rigorous, thorough, diverse, and family-oriented. He stated that his philosophy was that everything you do as a physician must make sense within the context of what is going on at home -- what is happening with your family life, and that no honor or award in the workplace would ever amount to the same importance as what you needed to achieve in the home with your family.
I did a double take. I would have thought this guy LDS were it not for his unabashedly large orthodox Jewish beard and lengthy hair descending to the middle of his back, tied in a thin braid.
The day proceeded with tours and explanations, marketing and questions, expensive cuisine and small talk.
I had three interviews. None of them should be called interviews. A better way to describe them would be, "sales pitches." They were opportunities for me to ask a couple of questions about how the University of Wisconsin could meet my needs, and 40 minutes of answering. I felt that my application was an afterthought. It was almost as if they didn't even care what my name was, they just wanted to know what they needed to say to persuade me that their program was a good fit for me.
I'm not sure how I feel about this experience. Were they personable? Sure. But I guess I was expecting them to use pieces of my application as a springboard to discuss these topics. I think I needed more of a personal touch during at least one of the three interviews.
Overall, it seemed to be a very good program within an excellent, family-oriented community. Do they offer anything I can't receive at Iowa? I don't think so. Maybe a few marginal things. Are the benefits of relocating and leaving a community of which I'm quite fond worth the cost to me and my family? I really don't think so.
I was very appreciative of the opportunity to visit their program and would highly recommend it to anyone who was interest. The residents all seemed very, very pleased and appeared to be of a high caliber.
Oh, yeah . . . Colorado. I haven't purchased plane tickets and they are now more than $600 for the timeframe in which I need them. I need to evaluate if I'm serious about interviewing there, because they don't provide hotel accomodations (unlike Wisconsin) and the trip could get very expensive.
Looking forward to seeing what Utah it like this Friday.
I've added a little list of my interviews off to the side of my blog rather than editing an old post. This way I can post when I have new additions and have it update my RSS feed.
I have an interview in Irvine, California . . . but am likely to cancel it. I've gotten plenty of other interviews at schools I'm more interested in, and California is just too expensive for our family right now. The cost of living is twice as high in Irvine as it is in Iowa City, and the salary would sadly be lower.
I just got notice today of an interview opportunity at the University of Colorado. I'm excited to go see this program; they're supposed to be one of the best internal medicine programs in the country. We'll see if it's worth the relocation.
I'll keep this post updated with the interviews I get and when they'll be happening.
Univ of Nebraska (Omaha) - November 6th -- New! Univ of Wisconsin (Madison) - November 16th Univ of Utah (Salt Lake City) - November 20th Univ of Iowa (Iowa City) - December 21st
1. U of Iowa (Iowa City). Already have good relationship with staff. Love the hospitals. Very good pay. Free health benefits. They keep residents for fellowships. Iowa City is pretty laid back town to live in. Good elementary schools/family environment. Cheap cost of living. One of the best programs. My research work is ongoing here. They offer a Masters in Clinical Education degree to residents, which fits my long term goals.
2. U of Wisconsin. (Madison). Nice place to visit I hear, and it’s close. Just an interview I can drive to and make me feel better about staying at Iowa. Family trip if I get an interview.
3. U of Nebraska (Omaha). Same as above. Drive to the interview, good to compare just for the experience. Very low interest, but hey . . . supposed to have an awesome Zoo there.
4. U of Utah. I’ll go and just verify that all the bad things I hear are true. Who knows, maybe I'll like it. There are a few positives about the program. I would actually like working with the LDS population as patients, the more I think about it. Probably warrants at least an application, if I feel strongly about not interviewing there I won’t.
5. Oregon University (Portland). Very good program, friends in residency there seem to like it. Portland could be fun.
6. University of Washington. One of the best top programs. Probably won’t get an interview, but I indicated I’d be interested a program where you do your 2nd-3rd year in Boise. We’ll see.
7. University of Colorado (Aurora/Denver). One of the best/top programs. Closer to home. Might be bad to their residents, need to check it out. Actually a contender for residency.
8. UC San Diego. One of the best programs. Too expensive to live, but I might be able to do this and UC Irvine at the same time. I doubt I will even get an interview. But if I do, also an excuse to take a trip to San Diego.
9. UC Irvine (Irvine/Orange County). As above. Not a particularly strong program. Also, home of In&Out burgers.
10. Stanford. One of the best programs, has a good clinician-educator program. Too expensive to live, but if I got an interview there it would be worth the experience to see Stanford.
This was shared with me by a patient. It's a true story. I hope you'll read and enjoy taking pause at how out-of-touch medicine can be. I hope I hear stories like this constantly to keep my focused and grounded in what's important in patient care.
This story is called "Screwed."
The phone call came on a Wednesday evening in the middle of September.I knew from my sister-in-law's voice there was a problem."Bill needs to talk with you," she said.
My brother got on the line. "Hi," he said."I have something to tell you, but I don't want anyone to make any fuss."
"What is it?" I answered.
"I'm screwed," he said.
"What?"
"I'm screwed.My doctor told me I have cancer and it's too late to do anything about it."
My brother's message caught me totally unprepared.Six months before he’d had his annual checkup and all was well.I grabbed a pad and pencil.
"Bill," I said "when did you see the doctor and what tests were done?”
"I first went three months ago.We were getting ready to go on vacation and I hadn't been feeling good for about two months.I was having trouble sleeping and I didn't feel much like eating.I had lost some weight.The PA at my doc's office examined me and couldn't find anything wrong.He jokingly said that maybe the problem was my wife's cooking.I told him that since retiring a few years ago,I did most of the cooking.
“I spent the vacation lying around, feeling tired.I didn't have much of an appetite.A couple of weeks after we got back I still didn't feel any better. I called my doctor's office and made an appointment.The PA asked me a bunch of questions, did another exam, didn't find anything wrong and drew some blood for tests.I went home with a prescription for some sleeping medication.I got a call two days later that the tests didn't show anything abnormal.
"When I didn't feel any better after two more weeks, I called and made another appointment.I went in last Tuesday and this time my doctor saw me.He did an exam and took some urine and blood for more tests.He asked if I felt depressed since retiring. I told him I had felt fine until just before I went on vacation.Then on Thursday morning he called and said he wanted me to have some radiology tests done.I went in Monday and had the tests.And then yesterday afternoon his office called and asked me to come in today and, if possible, have my wife also come.When we got there he told us that the radiology tests showed a tumor in my right kidney.Then we met the urologist who works in that group.He said the cancer had spread outside of the kidney and was too large to treat by surgery.They scheduled me for a biopsy this Friday.So that's what I know, and I decided to call you."
My brother lived in a suburb of a large city.He was a retired Professor of English who had taught courses on contemporary American films.His family physician practiced in a multi-specialty group connected to a small community hospital.A large academic medical center with an NCI-designated Comprehensive Cancer Center was located in the city.Thursday, the day after my brother's call, I phoned his physician and got some additional information.It was uncertain whether and what kind of treatment was going to be recommended.They needed to get a biopsy to be sure, but everything pointed to a renal cancer.I phoned a colleague I knew at the nearby large academic medical center to gather more information.When I mentioned the name of my brother's hospital, I was advised to get him transferred.My colleague said, "That place has a poor reputation." My colleague put me in touch with a medical oncologist at the cancer center who specialized in urologic cancers.
The following day I got another phone call from my sister-in-law.
"Bill went in for his biopsy this morning but while they were doing it he became
confused and agitated, so they kept him there.His doctor is gone for the weekend
and a different doctor is in charge.I talked with that doctor but he didn't seem to know much about Bill's situation.He said he ordered some sedative for Bill to calm him down.I'm really worried.Something's wrong.I'm not sure Bill recognizes me.They have his arms tied to the bed and they put a catheter in his bladder."
"I'll be there as soon as I can," I said."It's about a 16-hour drive.I'll stay in touch on the way."
When my wife and I arrived at the hospital late Saturday, we found my brother alone in his room, confused, agitated and fully restrained to his bed.His wife had been at the hospital most of the day but had left earlier because she had a severely autistic teenage son at home and no caretaker for the evening.One nurse and an orderly -- a community college student who had only started working at the hospital that week -- were responsible for a very busy patient floor.The nurse told me that because my brother was confused and kept trying to get out of bed, he had to be restrained.The covering doctor had ordered the restraints and the catheter.I asked to see the doctor, but he never came or called.
I spent all day Sunday sitting at my brother’s bedside.He remained restless and poorly oriented.I requested to get him transferred to the university hospital.When a bed became available at the Comprehensive Cancer Center Sunday evening, my brother was transferred from the community hospital.As the ambulance moved down the expressway, I sat next to him stroking his head and listening to his wandering incoherence.In spite of the dismal prognosis, I felt a smattering of relief.I knew he was headed to a first rate facility.
The first hospital had read the biopsy as undifferentiated carcinoma, likely of renal origin.The university hospital did some additional studies on the biopsy material and confirmed a renal origin.On Monday morning an oncology professor arrived in my brother's room along with fellows, house staff and students.The professor told one of the fellows to get the x-ray films from the other hospital.That afternoon the films arrived.Tuesday morning the professor and his team returned.There seemed to be a problem with the x-ray films.They had my brother's name on them, but the abdominal image showed a previous surgical procedure.My brother had never had abdominal surgery.An official assessment by radiologists at the cancer center revealed that the x-ray films were of a female patient.On Wednesday my brother's films were delivered, and they showed that he had a large renal tumor.
My brother's mental status continued to wander between somnolence, confusion, and agitation.His orders read NPO and he had an IV drip.I kept his lips moistened with a wet face cloth.Three times a day a person from dietary arrived and placed a tray of solid food on the table next to the bed.About two hours later a clerk arrived and removed the tray with the food untouched.After three days in the cancer center, my brother had yet to receive any nutrition.I spoke to the nursing staff and they told me he had to remain NPO until he had been given a swallow test.The test had been ordered when he was admitted.They would check to see why it hadn't been done yet.A patient with his mental status was a risk for aspiration and hospital protocol required a swallow test before allowing oral intake.I told them that dietary was delivering meals to him three times a day.They would look into that.
I learned from the oncology professor who visited my brother’s bedside on rounds each morning that my brother had been admitted to the cancer center because he was a candidate for a clinical trial testing a new agent that targeted the blood vessels of tumors and had showed some promise in the treatment of renal cancer.The professor had published an article on the preliminary results and now had a grant to conduct a large clinical trial.Each morning the professor and entourage appeared briefly.
About seven o'clock on the fourth evening an orderly arrived with a gurney to take my brother, who was still confused and intermittently agitated, for a CT scan.I told the orderly that I would go along with my brother to the radiology suite.After securing Bill onto the gurney, we rode an elevator to the basement of the hospital and made our way through narrow hallways with low ceilings strewn with pipes and cables and reached a large empty waiting room with a sign over the entrance that read Department of Radiology.
"I'm going to leave you here," said the orderly."Someone from radiology will be with you right away."Then he left. I stood next to the gurney holding my brother's hand and stroking his brow."They're going to take some pictures, Bill," I said."It's not going to be uncomfortable."Bill gave no clue that he heard what I said or knew who was standing next to him.Each time I said something or touched him it stimulated a response.Without opening his eyes or appearing to be speaking to anyone in particular, he would smile and in fragmented, slurred sentences talk about Louie, the manager of the movie theatre where as a teenager Bill had worked as an user, or mumble some lines from an Edward G. Robinson movie.
After forty five minutes without seeing another person, I began to wonder whether anybody in radiology knew we were waiting.Then a different orderly arrived pushing a gurney carrying a woman who appeared to be in her early twenties.The orderly left the gurney in the middle of the room and left without saying anything.Restless, the young woman continuously scanned the room.I could hear the sounds of people moving inside of the radiology suite and told her that I thought someone would be with us soon.
Just then a door opened, a technician appeared and without saying a word to the young woman, pushed Bill's gurney into the suite.I helped the technician situate my brother for the procedure and then joined her at the viewing console behind the protective barrier.As I watched the CT scanner probe my brother's body, my thoughts kept returning to the anxious young woman on the gurney out in the waiting room alone with her fears, and without a hand to hold.
On his fifth day in the cancer center my brother became delirious and more agitated.He remained that way for the next three days.The food trays continued to arrive and depart three times a day.On morning rounds the discussion centered around whether my brother’s mental state reflected meningeal carcinomatosus, metabolic encephalopathy or a drug reaction.
Nobody ever came to do a swallow test.I began going to the cafeteria and purchasing orange juice and yogurt to feed to my brother.He took them avidly and swallowed without difficulty.
On the three days after my brother became delirious, the rounding team walked past Bill's room each morning without stopping in.I wanted to know if a plan had been made for Bill's treatment and I asked to see one of the fellows.He told me that my brother's mental status had made him ineligible for the clinical trial and that he was going to be discharged.As I looked into the fellow's face I could tell that he was uncomfortable having to tell me this.He knew that I knew.They needed the bed.They did clinical trials.
Yes, it's that time. Application time. The most dreaded of all times. Thus readeth the scriptures:
"And lo, the time soon cometh when he who is required to borrow and spend shall be yet again servitude to the Church of the Online Application, and yea, it doth verily cost much money. And yea, it doth require much time and effort. And yea, it doth even break the will of the soul to continue living, and it forceth he who is required to borrow and spend to declare himself quasi-suicidal, yea, even ready to terminate all his doings in the State of the Frozen Corn, and open the Temple of the Taco in the Land of Pineapples & Hula Skirts." 2nd Cheeler, 65: 190.
The worst part of any application, imo, is the "personal statement" portion. I HATED doing this for med school. It was the biggest piece of smoke-blowing garbage ever written by man. My residency statement may not be too much further from that. Here's what I've got so far:
"Internal medicine is awesome. Or, at least it doesn’t suck as much as other fields do. Especially surgery -- man, that was just plain horrible. Really, I just want to play World of Warcraft all day and night. But, I guess this will do. Vote for me, and all of your wildest dreams will come true."
Thoughts? I think it's a winner. UCSD, here I come.
For asuccinct, excellentexplanation of the current economic problem, with particular emphasis onthe banking industry,here’s a link to a story done by“This American Life,” by Chicago Public Radio (I heart Ira Glass, btw.) You can listen to the episode (I think that you can maybe download a copy to iTunes) or download the transcript. It’s very entertaining.
My opinion for the masses (or the relative few who read my blog):
Americans are greedy and self-entitled. This is the root of all our current evils. The more self-entitled, greedy, fat, and credit-spendy we become, the more power werelinquishto make decisions for ourselves and society. This is naturalconsequence of these behaviors. We turn all of our attention to ourselves as our society becomes more individualistic and less socially responsible.
Who’s forced to pickup the ball to make sure we don’t kill ourselves and our future generations?
TheFederal and State Governments.
So, if you’re like me and don’t think the government should be extending its powers on a yearly basis,stop being greedy and self-entitled and start thinking about being more fiscally and socially responsible in your own home.In the meantime, thank you, Mr. President, for having to make these hard decisions that I’m sure no one– from thegovernment, to the banks and citizens– isthrilled about.
I don’t spend a lot of time on Facebook, but I do have an account and sometimes I do check it. I have the mobile app for my Ipod touch, but I hardly ever use it.
But for the relatively low time spent on Facebook, I’m really learning to hate it. Here’s why:
I don’t care what your status is. In other words, I tire of reading things like:
“Ethel is soo excited that she’s gonna have a hot dog tonight!”
“Nancy Sue is saving the world by digging ginormous wells for thirsty children in all of the third world countries in the universe.”
“Bruce is currently forcing his retarded political views on all his Facebook ‘friends’ by making a statement in his status that actually has nothing to do with his current status! Woot!”
And some people are worse than others. There’s this one guy who added me as a ‘friend’ on Facebook because he lived in my neighborhood when I was a kid. We were never really friends, in fact, I kinda always thought he was a d-bag. Anyway, he’s notorious for changing his frikkin’ status every 20 min with wonderful message like:
My daughter just made a poo-poo!
My daughter just made a pee-pee!
My dog just made a poo-poo!
I just made a poo-poo!
No, he’s not joking around. I’m being a little hyperbolic of course, but really, this guy updates wayyyy too much and really needs something more interesting going on in his life. Like a book or something. Even a movie, or at least a box with flashing lights in it or something.
In conclusion, I feel I must remove some of said people from my ‘friends’ list in Facebook to save me the angst and despair on behalf of humanity every time I log into it. Does anyone know how to do that?
I watched a lot of this one, mainly because I thought the youngest son's shenanigans were pretty funny. He was like a real life Bart Simpson in a way, but for some reason this show didn't carry the "bad tv show" stigmata that the Simpson's did for my parents. I watched the Simpson's anyway, but . . . I digress.
What was the story with this guy anyway? I mean, if you're a fat guy that shows up on my door and insists that you wanna work for me and take care of my children, I'm calling the police and pulling out my Sai's.
Awesomeness. And speaking of awesomeness, the combination mullet, techno-genius, and stoned-washed jeans on the protagonist of this next fav' can't be beat (shout out to Teeke here, who probably knows all these episodes by heart).
And now for a recent favorite.
I've always been a bit of a Sci-Fi nerd, but I'm also skeptical of "made-for-TV" Sci-Fi movies with series spinoffs. The following series was something I tried to ignore for a long time, but was finally convinced by a few fellow nerds to just embrace my geekiness and give this show a try. And man, was I impressed. How do you summarize a series with deep treatise on human nature, the problem of advancing technology with stale ethics, philosophy and sophistry v. religion and spirituality, monotheism versus polytheism, political science and intrigue, family dysfunction, dynamic, and resolution, true love, individualism v. social responsibility . . . and SPACESHIP AND ROBOTS???
Two Words: Battlestar Galactica. Check it out. You won't be disappointed, I promise.
And lastely, possibly one of the best shows ever to grace television.
Television was a common choice of entertainment in my household as a kid. But who didn't watch a lot of TV as a kid?
Anyway, I have a lot of good memories surrounding some of those TV shows. We used to sit around as a family on Sunday nights, eat popcorn, and watch a serial TV show. I know, how dare we watch TV on Sunday!!! (gasps). But honestly, we had nothing else to do. There were eight of us, and television may have been the only thing keeping us from tearing each other to pieces or disassembling our house bit by bit.
This one was a favorite for a long time on Sundays:
Ahhh, that makes me want to buy the seasons on DVD and rewatch them. I'm not kidding. Now when I say we watched these shows as a family, I don't mean we kinda watched it and some people came and went and the old man fell asleep, etc. This was SERIOUS BUSINESS TV TIME.
Here's another that we didn't watch regularly, but by virtue of our mom being an avid fan, I still probably ended up seeing almost every episode:
And from my early childhood, a classic favorite (sorry the quality is kinda poor):
The final TV Show for this installation is something a little more manly. I found this show primeiring on CBS at like 2AM one night when I couldn't (wouldn't) go to sleep as a teenager. It was probably Sunday . . . those Sunday naps ruined me Sunday Night.
Highlander was cool. BOOSH!
More to come soon. Post up comments about some of your nostalgic favorites, if you have any! bwahahahaha.
Fine, so as you can see from my wife's post, I was indeed called a "duplicitous german red-bearded cherub of a man-boy" by a patient last week. Fair enough. All I have to say is:
1) I don't know what duplicitous even means. Sounds buttery, though. 2) German: yes. 3) Red-beared: Only a little. I prefer the description "barbeque flavored." 4) Man-Boy: Sure, long-live adolescence. I still laugh at very common anatomical words on a daily basis, despite knowing better.
Completed Interviews: Univ of Wisconsin, Nov 16th Univ of Utah, Nov 20th Univ of Cali - San Diego, Nov 23rd (Cancelled) Univ of Cali - Irvine, Nov 24th (Cancelled) Univ of Colorado, Dec 4th Univ of Iowa, Dec 21st
Upcoming Interviews: Univ of Nebraska, Jan 5th (Cancelled)
Declined my sexy: Univ of Washington Oregon Health Sciences Univ Stanford Univ
Farewell
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