I got my hair cut today and ended up getting into a discussion with my haircutter about health care reform and how much doctors make.

No matter what I said about the oftentimes glossed-over hardships behind becoming a doctor — i.e. the decade of post-college schooling and training, the hundreds of thousands of dollars of debt we accrue DURING that decade, the YEARS of 100+ hr-work-weeks, the markedly higher rate of suicide, depression, and divorce, the substantially increased risk of exposure and transmission of disease — my haircutter simply would not accept any argument for why doctors are compensated as generously as they (sometimes) are.

She kept making broad, blanket statements such as, “doctors make lots of money” and “they all drive nice cars.”

She fixated on the end point, not realizing that the journey to get there required all kinds of sacrifices, all kinds of hardships.

Toward the end of our conversation, I told my haircutter about why I initially entered medical school (i.e. to help people), but that recently, given the reality of how doctors live and are paid, I was also factoring in which specialties had decent compensation as well. This idea that a doctor would care about the compensation he receives for the work he does was somehow anathema to her.

“It shouldn’t be about money! If you entered medical school to help people, you should just help them! No questions asked!”

I, perhaps foolishly, thought that if I laid out all of the different sides of the argument, she would be able to see that it isn’t always about what you want, it’s about what the situation permits.

Instead, what I got was an incensed, childish response loaded with unrealistic expectations of selflessness. A selflessness that completely neglected the reality that money DOES matter and shapes, or at least affects, a lot of the decisions we make as adults.

Regardless, even if I chose to pursue the highest-paying field available to me, it does not mean that I will suddenly stop caring about my patients.  Wanting to be paid well for the work I do is not a bad thing, especially if I do a good job and embody all of the empathy that made me want to practice medicine in the first place.

Ultimately, I had no effect on this person — she’s still set in her belief that doctors should work for cheap, regardless of the number of hours we put in, patients we see, or mortgages and loans we have to pay back — but our conversation affected me greatly. Her unshakable belief that doctors should serve, and only care about serving, troubles me. It makes me wonder whether everyone not connected to the medical field feels the same way.  Believes that we are greedy and selfish for wanting to be paid well; not realizing the personal consequences and sacrifices we bear to care for our patients.  I wonder if the public, like my haircutter, only sees the end point, and is blind to the hardships and reality of the journey to get there.

____

Just thinking. Writing.

“I wish I had better news.”

The weight of the doctor’s words sinks in, and the elderly man braces himself to hear confirmation for what he fears but already knows.

“Your wife has what is known as Creutzfeldt-Jakob Disease — it’s an incurable and ultimately fatal disease.”

The elderly man’s hands, initially tense and tremulous, become soft and steady as he reaches down to hold his wife’s hands. He buries her hands in his, intertwines their fingers and digits, and lets her know, one more time, that he loves her.

Today was a sad day.

An hour before I saw the patient, I thought I was so lucky to be able to see such a rare, exciting disease.  Up till now, medicine has been a purely academic endeavor for me, and I think I’ve hidden behind the scientific aspects of it.  Presentation, pathophysiology, lists of symptoms… all of them, tools to help reinforce a bloodless, hypothetical situation.  I feel almost guilty that I took pleasure in learning about this disease by charting its presentation and outcome via firsthand observation.  And though it’s irrational, I still can’t shake the comparison between myself and Dr. Mengele.

My other patient was diagnosed with ALS.

Today was a sad day.

I know in a few hours, I’ll be too engrossed in the details of neuroanatomy and the pathophys of yet another “interesting” disease to feel bad, but for right now I just want to feel crappy and ruminate on the gravity of what this day has meant for those two families.

Today was a sad day.

I always thought I was somehow above the pain that love can cause.  I was wrong.  For as long as I live, I will think of her; compare every girl I meet to her; wonder how differently our lives could have been; regret not being myself around her; and wish I had let her see me for the man I could have been.

I know I’m relapsing, but forgive and allow me this moment of weakness.

I loved her.

Joshua Radin – I’d Rather be with You

I went out to dinner with one of my friends tonight and got the opportunity to listen to him talk about a girl he likes.  I enjoyed it.  Even though I’ve had my own problems with girls lately; dealt with recent rejection and heartache; it warmed my heart to listen to him talk about this girl.

I don’t know; I think I’m in-love with being in-love.  I like being around people who are just starting to feel love for another person because their energy is so pure; their joy, infectious.  They talk with broad smiles on their faces and I can’t help it but to smile along with them.

I love it.  It makes me believe in miracles — that maybe, just maybe, with everything going on in the world, our perfect match in this world is just a moment away from being found.

I can’t wait till I find my perfect match.  I think I finally have the understanding and maturity to appreciate love and the patience to slowly show my match who I am and how perfect we are for each other.

TI ft. John Legend – Slideshow

Maino ft. T-Pain – All the Above

TI ft. Usher – My Life Your Entertainment

Okay, all.  Last night I felt pretty down, I had a fight with the Girl where I ended up looking really ridiculous and feeling like shit; fortunately, a few hours later, Diane gave me a really nice pep-talk and cheered me up.  She’s inspired me to form a plan of action, not for the Girl, but for my life.  Here is my two-year plan:

Academically:

1.  Everyone says they want to do well on Step I… I’ll go one step further and say that I want to make it into the 280s.

2.  I’m going to transfer.  Period.

3.  I want to learn as much as I can from here on out so I can become the best doctor I can be.

4.  I’m going to actively pursue research in a field I’m interested in.

5.  I’m going to pursue a career in Anesthesiology or Radiology.

Personally:

1.  I want to go back to church.

2. I want to stop using curse words.

3.  I want to continue training in Kung Fu San Soo and Brazilian Jiu Jitsu, with the intent of eventually becoming a black belt in both.

4.  I want to take up ballroom dancing again.

5.  I want to finish the P90X series and keep up with it.

6.  I want to find time to read more.

7.  I want to learn more Chinese and become fluent in Spanish.

8.  I want to grow as a person and be able to let the Girl go.

9.  I want to travel during my fourth year and see all of my other med school friends.

In two years’ time, I want to be well-read, well-mannered, well-toned, and well, happy.  I want to look back at this time in my life and be able to laugh — forgetting that I ever suffered such heartache and heartbreak.

I have so much bitterness and anger and sadness in me right now, but I know if I am ever going to become the kind of man someone like the Girl would admire, I have to let it go.  All of it.  All of my emotions, all my expectations, all my guilt.  I have to perfect myself.  I have to love the next girl just as fiercely, but be enough of a gentleman not to let my foibles destroy our chance together.  In time, I want to meet the Girl of my Dreams.

Expect a call in two years’ time.  I’m going to rock your world.

A few days ago, I spoke with Diane about the depression that seems to befall all medical students whilst they drudge through the dregs of school.  Right now, I think I’m suffering one of those moments acutely.

I don’t want to sound trite by writing yet another depressing blog-post, but I wanted to get this out on paper (or in pixils) to see if I can make enough sense out of my emotions to articulate them.

My fraternity holds an annual Thanksgiving dinner at our place; it’s customary for each member to bring a date.  Last year, I invited Jill and we had a good time.  This year, she declined my offer.  But I don’t blame her.

It’s not as simple as I’ve made it sound, she has a boyfriend now (or again), and I’ve made things far too complicated for things to be as simple as they were a year ago.  She weighed my invitation carefully… she thought about it for over a week, but ultimately, she had to turn me down.

While I am calmer now, more thoughtful, more in-tune with why she said “No”, I messed things up.  I got angry with her.  I felt disrespected, and my pride, my hubris, got the better of me… and brought out the worst in me.

I drove her away.  She is one of the few people here with whom I’m close enough to let my guard down.  She was a person with whom I shared many secrets and thoughts.  She was a confidante; a keeper of some of my most intimate secrets… and I drove her away.  We don’t speak anymore; I don’t know if we ever will.

I ended up asking another one of my classmates, Sara Janne, to the dinner.  She said yes.

Sara Janne is a lovely woman — very pretty, very affable, very friendly — but I couldn’t enjoy my night with her.  I kept comparing her and the entire night to last year — to Jill and the time she and I spent together.  It was a foolish thing to do.  It was an unfair thing to do.  But I did it anyway.

Initially, I thought if I could completely immerse myself in the night, live in the moment with Sara Janne, I could forget about Jill and the toxic BAD that I’ve wrought through my actions.  I threw myself into the actions; the motions; I made Sara Janne a Kawasaki Rose for the dinner, a token of my appreciation for coming — a symbol of my gratitude.  It was beautifully constructed; absolutely flawless.  It was perfect.

But then I thought about the first (and only other) Kawasaki Rose I made — I gave it to Jill last year when she seemed depressed… I stayed up for five-and-a-half hours folding and unfolding that rose… it was not nearly as perfect-looking, but I poured more of myself into making that one than I did making this second, perfect paper trinket.

As the night drew on, I pulled further and further away from her.  I felt hollow.  Numb.  I engaged in polite conversation, I joked, I “laughed”, I even danced a little.  But I couldn’t reconcile the fact that I didn’t feel as connected with Sara Janne as I did with Jill.  With Jill, we talked about books, authors, music.  We recognized how out-of-place we were with everyone else, so we crept to my room and just sat and talked.

That was the one of the happiest moment of my entire year.  It was the first time I felt like maybe I wasn’t so alone here.  That maybe there was someone just like me.  Someone with whom I could feel safe sharing my thoughts and feelings and insecurities.  Someone whose friendship I could claim and cherish, forever.

Sara Janne is a lovely girl.  Beautiful in the classic sense and refreshingly effervescent.  But I couldn’t live in the moment with her, no matter how hard I tried or how desperately I wanted to.  I just couldn’t do it.  And I felt like I was doing her a great disservice by feeling that way.

I lost one of my closest friends here over the trivialities of Respect and how I feel.  I lost her to my temper, and I drove her away.

Home-made chocolate Babke, home-made Kugel, that vibrating mascara wand from Lancome that supposedly leaves your eyelashes unclumpy, the Pedro Almodovar anthology, The Chipmunks Christmas special, Forgetting Sarah Marshall, Eternal Sunshine of the Spotless Mind, a single rose, Nu de Dos II by Alain Dumas, artisan chocolates, A star named after her.

All of these are ideas I’ve had.  Gift ideas I would give her for her birthday or some special event.  Honestly, even now, I know all the things about her that would make her happy, not even from the romantic angle, I just know it though.  If guys say they don’t know what to get their girlfriends, they honestly should pay closer attention.  And it’s silly for me to know what makes her happy because friends don’t just give each other gifts like that.  It’ll make her think I’m trying to get her.

It’s just unfortunate that I’ve become this attuned to what a girl likes now that I’m older, lonelier, and have no one to share my ideas with.  I think I want to feel useful.  I want to be appreciated.  I want to make someone happy.  Because, I think I’m happiest when I make others happy.  I want to find someone I can make happy.

Your distain for me is the final repudiation of my actions and character.  You distain me.  Unlike what I had so desperately wished for, you do not find me cute, funny, charming, nice, smart, attractive, or entertaining.  You find me annoying.

You would never admit it for fear of sounding harsh, but I know deep down, you wish that I would just disappear and leave you alone.

I know you don’t want to be around me.  I know that for you, the best part of our conversations together is when I say goodbye.

I dreamed all these dreams.  Delusional pretenses of a friendship and love.  I even bargained with God, asking him to change me.  To make me a better man so that you would love me.  If I never lost my temper with you, if I continued to show you every ounce of love I felt for you, if I tried and tried and tried and tried, you would give me a chance.

I tried today.  I made an effort to try some more.  And today, in that one instant, I became distainfully typical to you.  An annoyance.

I bankrupted my heart and feelings of self-respect.  I put myself through heartache and heart break all for the promise of your smile.  And I am now a fool.  A king of fools.

I wish I knew what made you tick.

One of my richer Republican friends sent me this article to change my views on economic policy (I have my own little analysis at the end):

Suppose that every day, ten men go out for beer and the bill for all ten
comes to $100. If they paid their bill the way we pay our taxes, it would go
something like this:

The first four men (the poorest) would pay nothing.
The fifth would pay $1.
The sixth would pay $3.
The seventh would pay $7.
The eighth would pay $12.
The ninth would pay $18.
The tenth man (the richest) would pay $59.

So, that’s what they decided to do.
The ten men drank in the bar every day and seemed quite happy with the
arrangement, until one day, the owner threw them a curve. “Since you are all
such good customers,” he said, “I’m going to reduce the cost of your daily
beer by $20.”Drinks for the ten now cost just $80.

The group still wanted to pay their bill the way we pay our taxes so the
first four men were unaffected. They would still drink for free.
But what about the other six men – the paying customers? How could they
divide the $20 wi ndfall so that everyone would get his ‘fair share?’
They realized that $20 divided by six is $3.33. But if they subtracted that from
everybody’s share, then the fifth man and the sixth man would each end up
being paid to drink his beer. So, the bar owner suggested that it would be
fair to reduce each man’s bill by roughly the same amount and he proceeded
to work out the amounts each should pay.

And so:

The fifth man, like the first four, now paid nothing (100% savings).
The sixth now paid $2 instead of $3 (33%savings).
The seventh now pay $5 instead of $7 (28%savings).
The eighth now paid $9 instead of $12 (25% savings).
The ninth now paid $14 instead of $18 (22% savings).
The tenth now paid $49 instead of $59 (16% savings).

Each of the six was better off than before. And the first four continued to
drink for free. But once outside the restaurant, the men began to compare
their savings.

“I only got a dollar out of the $20,”declared the sixth man. He pointed to
the tenth man,” but he got $10!”
“Yeah, that’s right,” exclaimed the fifth man. “I only saved a dollar, too.
It’s unfair that he got ten times more than I!”
“That’s true!!” shouted the seventh man. “Why should he get $10 back when I
got only two? The wealthy get all the breaks!”

“Wait a minute,” yelled the first four men in unison. “We didn’t get
anything at all. The system exploits the poor!”

The nine men surrounded the tenth and beat him up.
The next night the tenth man didn’t show up for drinks, so the nine sat
down and had beers without him. But when it came time to pay the bill, they
discovered something important. They didn’t have enough money between all
of them for even half of the bill!

And that, boys and girls, journalists and college professors, is how our tax
system works. The people who pay the highest taxes get the most benefit from
a tax reduction. Tax them too much, attack them for being wealthy, and they
just may not show up anymore. In fact, they might start drinking overseas
where the atmosphere is somewhat friendlier.

David R. Kamerschen, Ph.D.
Professor of Economics
University of Georgia

Okay, first off, this paper has been floating out on the internet for a few years now and from what I’ve learned, Dr. Kamerschen didn’t write this paper.

I feel like I keep having to go back to the same point over and over again with these people.  Yes, I agree that because more tax money is coming in from the rich than from the poor, if the rich stopped paying taxes, the country would crumble.  But the caveat is that if the rich do not give enough money through taxes, the country won’t be taking in enough monies to pay down the principle on our national debt, we’ll end up paying interest on top of interest, the national debt will rise, hyperinflation will set in, and then everyone’s money will become less valuable.  (At this point, the bar burns down and everyone — poor, middle-class, and rich alike — all go down in flames with it).  Also, studies have shown that a greater percentage of people in the top tax bracket, as opposed to those in the lower tax brackets, fudge their tax returns to report lower profits and greater losses, so as to avoid having to pay higher taxes (the rich guy fudges how much money he can actually provide for the beer… instead of the agreed upon 20% that everyone else is paying, he says he can only provide 10%, 8%, or even 0% of the cost of the beer).

Also, given the fact that UBS was just sued by the US govt for the names of US millionaires accused to using Swiss bank accounts to commit tax evasion, you really could argue that you can’t trust the 10th guy to honestly uphold his end of the bargain.

You are Beautiful.  Graceful.  Witty.  Opinionated.  Defiant.  And I love you.

I am an imperfect man, but I am the perfect man for you.  I will make you as happy as you make me.  I will complete you.  Satisfy and please you.  I will be everything you’ve ever wanted and never knew that you needed.  I promise.

I had a conversation a few nights ago with a friend of mine who happens to be a Republican and who also happens to come from money (in the spirit of full disclosure, I am fairly liberal and middle-class). Anyway, while talking with my friend, he brought up a series of talking points about Obama and Democrats that I had to dispute. I won’t go into details about our conversation (he wasn’t very well-read on the issues, so I spent the better part of our conversation directing him to sources that corrected or contradicted him), but that exchange finally got me motivated enough to write about one of the talking points I’ve been hearing.

It’s an argument that many of my richer Republican friends have used to justify their support of McCain’s economic policy.

Fair warning, this could get boring.

_______________

Have you ever noticed how idealistic debates about politics are?

I’ve noticed that whenever I talk with people about political matters, the conversation tends to come back to the question of what is “good” for America.

With Democrats, that question presents itself as a thematic motif.  (Universal) Healthcare reform, Welfare, Social Security, etc. — Democrats tend to support programs aimed at helping the less fortunate or the nation’s majority.  And not to sound calculating, distrustful, or inhuman, but this position of trying to help one’s fellow man is pretty much irreproachable from a moralistic point-of-view.  Simply put: the Democrats’ policies aren’t selfish.  Their policies do not assign benefits solely to Democrats — whatever benefit is reaped is shared with the entire population.  (Granted, pork barrel spending projects are the exception, but the major programs that Democrats are historically affiliated with, Social security, welfare, health care, are truly intended to be boons for society as a whole).

I think rich Republicans realize that.  And I think they acknowledge the intrinsic power of this moral high-ground (i.e. when the opposing party runs on a platform of egalitarianism, promoting any policy that only benefits the few becomes morally indefensible).

That unspoken recognition of what everyone feels is moral is why so many of my richer, Republican friends are reluctant to speak honestly about why they are Republican. Most of them, as I noted before, are rich – they support Republican policies for financial reasons; but, when you ask them about it, they don’t say they support a tax plan that gives tax breaks primarily to the wealthy (to themselves), because they know it would make them sound selfish.  Instead, they like to couch their reasons for being Republican in terms of what’s “good” for the economy and country.  E.g. “We’re a consumer-based economy, if you give more money to the wealthy, we’ll be incentivized to spend more, and then everyone in the nation will prosper as the economy grows.”  (And multiple, trickle-down variations on the theme).

Don’t get me wrong, I’m not against rich Republicans liking a tax plan that favors them.  Their motivation makes sense to me.  And who knows, in 40 years, I might convert and think the way they do.  Winston Churchill once said, “If you are not liberal when you are young, you have no heart, but if you are not conservative when you are older, you have no brain.”

That said, it’s not their motivation I have a problem with.   My problem lies with the fact that they try to hide their real motivations under the guise of what’s “good for the country.”  That kind of fake egalitarianism and “concerned” chicanery, is the tactic Bush’s Republicans have used to control the Republican base — a base composed of poorer to middle-class Americans, not sharing the same (financial/religious/geo-political) motivations as their leadership — in order to fast-track the personal agendas of the powerful few.

My contention is that without honest arguments about what we support and why, pleasant-sounding logic is all we’re left with — a kind of lofty, “half-truth” logic that is easily perverted… and just as easily lends itself to bullying and fear-mongering. (The last eight years under Bush, anyone?).

Argue intelligently. Make points that make sense. Debate and don’t obfuscate — try to relate, honestly.