I am a powerful man. I can walk unannounced into the boardrooms of any Fortune 500 corporation with nothing but the slightest nod of acknowledgement from security guards. I may freely enter judge's chambers without showing identification or even announcing my name - my identity is unquestionable. With nay a raise of my hand, armed sentry will part before me so that I may pass into the most highly guarded rooms of the Pentagon. What is it, you may ask, that allows me such unfettered access to the highest reaches of power? It is what I carry in my hand - a simple, unadorned white plastic bag - for I am a Chinese take-out delivery man. Well, not really... I am actually a medical student, but in the course of my daily life activities, namely shopping, I often find myself carrying simple, unadorned white plastic bags, and I can't help but read the mind of the average passerby who thinks me to be, in my tattered grey parka, blue sweat pants, adidas sneakers, thick rimmed glasses through which my slanted black eyes forever look downwards, a Chinese take out delivery man. Were I not such a magnificent proletarian, I might take such assumptions as an insult. I am not a lowly delivery man, I am a doctor in training. I am more likely to be delivering your baby than your Kung Pao chicken, Lady. But alas, the song of the Chinese take-out delivery man needs to be sung, and sung proudly. So I will be the instrument through which you, Mr. Chinese take out delivery man, may deliver your most profound message. I am a man - a powerful man.

Ok, so I am up at 3AM last night unable to sleep so I start reading Marcel Proust's Swann's Way which has been sitting on my floor/bookshelf for the last few months collecting dust and lint, and what do you know, the first chapter is about someone who can't sleep and starts reading a book so he can fall asleep, and what else do you know, I fall asleep without even realizing it. Boy that Proust is good shit.

There is nothing more depressing than trying to prolong the life of someone who is in no condition to live.

This is my one day off per week from my subinternship which I have to say sucks bigtime, although I feel that I am getting better at doing the things I used to hate to do such as putting in NG tubes, IV lines, drawing ABGs, presenting patients to attendings, etc. There is some satisfaction that comes from becoming technically proficient at manual tasks, but is it the end all and be all of a satisfying career? Not to me. And then there is the incessant discussion of minutiae which in all likelihood mean nothing. Not that I am one to snub my nose against meaningless discussion. In my college days, I loved to delve into esoteric aspects of the most apparently mundane issues, the splatter pattern of a drop of coffee upon a wooden versus plastic table top, the average waiting times of pedestrians at an empty crosswalk on the west coast vs. the east coast, the calculated cost/benefit ratios of eating only the expensive portions of a meal when you are no longer hungry, etc. But this kind of meditation seems inappropriate in a medical setting where people are depending on you, waiting for you, listening to what you say. There is a time for idle discussion, and 8AM on a cold, blistery Saturday morning is not one of them. I sit there blank faced and silent during morning rounds wondering how many medical misadventures are prompted by laboratory margins of error, how many hours of precious youth are wasted obtaining blood cultures, urine cultures, sputum cultures, urinalysis, chest x-rays, comp panels, cbcs, abgs, lumbar punctures, ct scans, abdominal sonos just because the patient's temperature was roughly estimated as 100.4 instead of 100.2. Medicine is clearly not for me. I used to think it was the arbitrariness of medicine that bothered me most, but actually I think it is the lack of purpose that now bothers me most. Modern medicine has evolved from a service to an institution to a religion, in the sense that its practice has lost its original purpose which was to heal and relieve suffering of the sick and gained a justification for its own promulgation by virtue of its own unassailable principles. A fever in a certain type of person must be worked up in such and such a way. A complaint of chest pain in a certain type of person must be worked up in such and such a way.

Student: But why?
Doctor: Because if this study is positive, we will do this, and if it is negative we will do that, but I'm almost positive it will be negative.
Student: Is it negative?
Doctor: I'm not sure, lets ask the specialist.
Specialist: It is negative.
Doctor: Ok good, so now we can proceed with another test.
Student: Aren't all these tests taking a lot of time? And don't they tell us nothing but what other tests to order?
Doctor: Good point, lets proceed with treatment.
Nurse: The patient is doing better, doctor.
Doctor: Good, then the treatment worked. Lets send the patient home and do the rest of the tests as an outpatient.
Student: But doctor, why should we do any more tests if the patient is no longer sick?
Doctor: Well, because if the test is positive, then we will do this to prevent the patient from getting sick again. If it is negative, then we can do another test to make sure it is really negative.
Student: But doctor, then why don't we just do the second test first?
Doctor: Because it is more expensive. I have to go now. There are patients in clinic waiting for me.

The Godfather is such a kick ass movie.