my proudest achievement

today at the hospital i got to shoot lidocaine into a patient's chest, cut into it with a scalpel, and then squeeze all the pus out. it was the greatest thing i'd done all day until i ate ribs for lunch and didn't spill any bbq sauce on my white coat or shirt or tie or pants. all in all, obviously, a great day.

...started makin' trouble in my neighborhood

last weekend we had a couchsurfer from belgium stay with us. he had a pretty extensive knowledge of the united states, which had been almost entirely formed by his experience watching american tv shows. he knew that east st. louis is a bad town because of a simpsons reference, he went to baltimore because of the wire, his trip planning was based on a philosphy espoused by george constanza, and his expectations of the chicago suburbs was framed by family matters.

so when he arrived by train in philadelphia and noticed that he was in a fairly rough part of town, he figured he must have disembarked in the western part of the city, because "in west philadelphia, born and raised/on the playground is where i spent most of my days..."

incidentally, this only serves to advance my long-held belief that knowledge of at least most of the words to that theme song is a universality among people of a certain age, regardless of where in the US you're from. when i was studying in spain i was delighted to find that my teachers knew the song--in spanish! (i recorded them performing it, and i still remember how it starts: "al oeste philadelphia, vivia y crecia/sin hacer mucho caso a la policia"). and so the legend grows--i think i'm ready to modify the theory to the entire western hemisphere. next i need to start asking people from south america if the words "the license plate said fresh and there was dice in the mirror" mean anything to them. i'll keep you updated...

the politics is always the last to go.

dementia and senility are pretty scary things. i can't say what it's like to experience them myself, but i do know that it can be disturbing to watch someone slowly lose their mind. and i think it's even harder to watch someone be confronted with what they've lost, because while the mental decline is a slow, insidious process, the moments of realization are usually very sudden, jarring episodes of realizing that while the patient wasn't looking, things have been slowly disappearing.

yesterday, my team of doctors interviewed a lady in her 70's who came into the hospital when she told her daughter that there were "little people" surrounding her in her kitchen. "i know it's silly," she said as we talked, trying to hide her embarrassment with a self-conscious chuckle, "but i believe they were there to punish me. i really do believe that." as her mom complained that the hospital stole her trash can and her cell phone, her daughter told us she'd been forgetting things more and more over the past year, but this recent decline was sudden and unprecedented.

doctors use something called a mini mental status exam to assess basic mental function in this kind of setting, both at a given moment, and its change from day to day. it consists of a series of simple questions, the answers to which are recorded. so we began:

"do you know where you are right now?"

"why do people keep asking me that?!? of course i know where i am! it's a..." and here she paused, realizing she didn't have the word she wanted, and apparently looking on the floor around her for where she'd misplaced it.

"it's a place where people go when they're sick. does that help?"

"don't rush me!", she snapped.

after a few minutes, we told her she was in the hospital, and asked the next question:

"what year is it?"

"1999", she answered confidently.

"who is the president?"

she paused, and then unmistakably, a light came on--she knew this one.

"obama," she scoffed in disgust, rolling her eyes and glancing at us with a look on her face that said "and you people think I'M crazy?!?"

now in convenient travel size!

hello, blogland readers! it's been awhile, i realize that. and i can understand if you're mad. or you just don't come here any more. that's ok. but i've been doing some thinking about you all, and about the blog, and i've come here to tell you something.

first, the obvs: med school is really busy! it's busy, like, all the time! and i find myself with little time to tell you all the funny or sad or touching anecdotes that talking to sick people all day can bring at the same time that i find myself in the midst of many such anecdotes. it's sad, and a little overwhelming. i keep wanting to tell you all about all the things, but the longer i wait the more impossible it becomes to catch up. and on top of all of that (!), i really miss you all, and i wish i had some way to be in communication with the many people i like and care about but do not come into contact on a daily or weekly or even semi-annual basis. (even if that communication is only mostly one-way...at least i'll feel like we're all still together somehow. or that you haven't forgotten me).

so i'm taking the advice my mother gave me when as a kid i'd let my room get a little too dirty to conceivably ever get it cleaned in time to go to my friend's house: start small. in my room's case, that meant cleaning one corner and going from there. in the blog's case, it means i'm making thejeremydiaries travel sized. on your right, you can see a twitter feed. that's right, i have a twitter account. and with this twitter account, i can post various tidbits about my life from my phone, whenever i have a minute. you can come here and see what's the latest, or you can go to twitter.com/jeremydiaries . if you are also a twitter person, you can follow me...i imagine you know how to do that already.

finally, i wouldn't say i've given up on posting actual things here. and when i do post things here, i'll probably link them in my twitter feed. so now you can always know what's happening in my blogland. and hopefully that will be more than nothing.