it's finally over...suprisingly..it didn't turn out like how i pictured it to.  No one was exceptionally carzy about the EOS being over.  i knew i was, but i am not about to show it. 

Going to go back to my hometown soon...as for now...i need to breath and sleep-simple as it sounds...not many of us do it properly. :)

systolic 120/80..guess i am still okay...it's tuesday

alluding myself to think there's still much time...

*shallow breaths*

it's so close to EOS now...if anything i should be freaking out...

Went to the beach today...and i caught a sea cucumber!! it's a mushy slimy thing.  I was digging into a mud hole when it happened.  I felt some tube like thing. It was very soft at first but it slowly became stiff.  Then i started to dug furiously with one hand while grabbing it in another.  Then i yanked and there...MY VERY FIRST SEA CUCUMBER...lol...what happened next was disgusting.  It started spewing out it's gut.  It was sticky and slimy.  According to my bro, that is it's defensive tactic.  The fishes will normally go for the guts while it slowly retreats into some stone or crevices.  Very smart!

Oh..i love the beach...:)

this is something funny i found while

doing my PBL...enjoy!

I HATE HISTOLOGY

A motivational drama for students beginning their medical school education.

(Actors: Go SLOW and ham it up. Setup. Joe Patient enters. Doctor Goodvibes is watching TV. It's turned up loud to a static channel. Enter Joe Patient).

Hello. My name is Joe Patient. I'm not feeling well. I've got a runny nose

(Sniffles)

and I have a cough.

(Cough cough.)

I'm almost certain it's just a cold. My managed care plan says I can go see Doctor Goodvibes. I have great confidence in Doctor Goodvibes. After all, he is so highly educated. He knows the body inside-out at every level. If there's something wrong with me, I know he'll find it and know exactly what to do about it.

Hello, Joe. I was just getting my CME credits watching medical TV.

Hello, Doctor Goodvibes. Gosh, I'm glad you're keeping up with everything in medicine. I have great confidence in you.

Yeah, medical TV is great. It keeps me fully updated. Except I leave the room whenever they show stuff under the microscope. I hate histology. I say doctors shouldn't focus that much on science, it makes you less loving and caring. When I was in medical school, and we had a test in histology, I just crammed the night before. I never saw the use of learning histology. Nowadays even the pharmaceutical ads in the journals have pictures of stuff from histology. Same blue and pink as in a hematoxylin and eosin stain. So I don't look at them, or I pretend they're modern abstract art. I even hate the pictures of hair follicles in the hair replacement ads in People magazine. It reminds me of how much I hated histology in medical school. Also, I ignore research articles on stuff like what causes atherosclerosis. They are all full of talk about the different layers of arteries, and what happens in them. Since I never learned histology, it doesn't make any sense to me. As far as I'm concerned, arteries are just tubes, and I don't see why to bother knowing the difference between events in the intima and the media and the adventitia. For me, the fundamental mechanisms of health and disease at the tissue level are just words on a page, stuff that I memorized out of the class notes. I've been doing medicine by rote memory for so long that it's second nature. A good doctor is compassionate and caring and blows off basic science, especially histology.

Doctor Goodvibes, I think I just have a cold, but would you check me out?

Certainly Joe. I make the big bucks because people believe I have an overview of the human body at every level, so that they trust me to deal with every new situation that comes up.

(Listens to his chest through his stethoscope.)

I'll just listen to your lungs. Deep breaths in and out.

What are you listening for, Doctor Goodvibes?

Oh, fluid in your lungs.

What kind of fluid?

I have no idea. It was something from that stupid histology course, and I never believed it was important to know what the stuff I'm hearing really is. All I know is that if I hear crackles in your lungs, it's some kind of fluid in your little air thing-a-ma-jigs, I forget what they are called, and I have to put you on whatever antibiotic the pharmaceutical rep told me about. I don't think a doctor needs to know the lung's cells and its fine structure actually look like. I act abrupt and superior to conceal my lack of knowledge.

Well, how do my lungs sound, Doctor?

I hear a lot of crackles. I had better send you for an x-ray.

(Dr. Goodvibes has, of course, heard the static on the television set. Enter Radiologist at the other side of the room. Joe Patient goes for his x-ray.)

Hello. You must be the radiologist. You must be very learned, too, a specialist able to figure out what something is.

Yeah. My histology class was such a bore. I hated it. I decided for sure I'd do something that didn't ever require using a microscope.

What do you see on my chest x-ray?

(X-ray goes up.)

Gee, Joe, you have a spot on your lung.

What could it be?

The differential diagnosis is in my radiology book. It's all words. I haven't seen a real lung since my surgery clerkship. I ditched histology class, and my pathology course was all based on lecture handouts with no pictures. I don't have a clue what the stuff actually looks like, or why different things make white fuzzies on x-rays.

(Enter Doctor Goodvibes)

Gosh, what could that lung mass be?

Well, it has a tiny fleck of calcium in it, which means it's probably a caseating granuloma. In Kansas City, that probably means starling poop fungus. I don't have a clue why, I just memorized it. But you'd better do a bronchoscopy.

(Doctor Goodvibes produces a bronchoscope, Joe Patient lies on the table and gets bronchoscoped.)

What did you see, Doctor Goodvibes?

Well, the slippery surface part thing -- I can't remember its name or what it's for -- on the bronchi has this little bump thingy on it, and I biopsied it. I'm going to take it over to Doctor Friedlander the pathologist. he'll tell me what it is, then I'll look up in my Merck Manual find out what I'm expected to do.

(Enter Doctor Friedlander, eating a burger, and twitching.)

Moo!

Hello, Doctor Friedlander. Will you look at this lung biopsy under the microscope and tell me what's wrong with my patient?

Sure, Doctor Goodvibes. Pull up a chair and we'll look together.

Aw, I hated histology. I never learned that stuff. I just count on you to tell me what the diagnosis is. Anyway I hate even coming to see you because I know so little.

Don't have a cow, Doctor Goodvibes. It's a lot of little blue cells. It must be small cell undifferentiated bronchogenic carcinoma.

(He writes.)

Here's my report.

Thanks, Doctor Friedlander.

Moo-ooo-ooo!

(Doctor Friedlander drops dead. The lawyer and the judge carry him out, down an aisle.)

Joe, you have small cell undifferentiated bronchogenic carcinoma.

Doctor Goodvibes, you're the one doctor I know personally and who I trust. Did you look at the biopsy yourself?

Of course not. I can't tell lung from liver under the microscope. People call me doctor because I am supposed to have the overview of the human body at every level. Also I am very compassionate and a good listener. I've called the oncologist. He is going to do a bone marrow exam and give you chemotherapy.

(Enter Oncologist.)

Hello. I'm your oncologist. I'm glad my days in basic science are over. I'm going to get bone marrow so we can assess your suitability for chemotherapy.

(Oncologist drapes the Joe, does a marrow exam with drill, silly string representing marrow squirts up.)

Gosh. It is good to know that I am being cared for by people who are so knowledgeable. Are you going to look at the marrow yourself?

Of course not. I'm too busy making wads of money and I don't even remember what the cells in marrow look like. I pay a technician to do all that. So now when I wipe out marrow, for me it's all just a bunch of numbers like an accountant.

(The oncologist gives Joe a drink from a bottle with the skull and crossbones.)

Arrggh!

(Starts throwing up. Optionally he leaves and comes back with no hair)

I felt fine when all this started, and now I think I'm going to die.

(He falls dead. Judge and lawyer put him on bench, toe-tag him)

I am the new pathologist. I don't know about you, but I worked really hard in histology. For me, it was more than learning the labels on pictures. I saw the body working as a whole, at an entirely new level. I learned things I had always wondered about. Everything made sense if I thought about it. And then, because I knew histology, I had a great time in pathology while everybody else was bitching and moaning about how hard it was. Everything made sense because I could correlate the microscopic picture with what the patient actually experienced and what the clinician saw. I love what I do. Now that I've autopsied Doctor Friedlander and looked at the histology on his tissues, it turns out that he died of Mad Cow disease. His brain was affected very badly. That must be why his diagnoses were so far off at the end of his life. Now let's see who is to be autopsied today.

(Reads toe tag.)

This is Joe. He was a chemotherapy patient. Let's see what's inside of him.

(Reaches into Joe's shirt, pulls out mushrooms and shows them.)

Look! A fungus infection! It must be an opportunistic infection from the chemotherapy. Oh! Here's that little caseating granuloma from the x-ray. The chemotherapy and resulting immunosuppression allowed the fungus to escape confinement and spread and kill Joe Patient. I'm sure glad I understand the why's. While I'm waiting for the autopsy glass slides to come out, I think I'll look at his old biopsy that Doctor Friedlander signed out on this poor guy.

(The biopsy goes up again.)

Hmm! Doctor Friedlander called this small cell carcinoma. He was unable to make an accurate diagnosis, or realize his problem, because he had Mad Cow disease of his brain. This is just a cluster of normal lymphocytes. They do look kind of like small cell undifferentiated lung cancer. Doctor Goodvibes probably saw a tiny lymphoid aggregate on bronchoscopy. He didn't remember from histology that these little bumps are normal. He biopsied it and thus the error was made. What a pity. Joe never had cancer.

I'm sorry the oncologist killed Joe with the chemotherapy. It's a shame that Doctor Friedlander had Mad Cow disease and made the wrong diagnosis. I hear the oncologist has taken a one-way plane flight to Brazil. It's a shame I don't know how to recognize lymphocytes.

(Enter Lawyer. Hands subpoena to Doctor Goodvibes.)

Hello Doctor Goodvibes. This is a subpoena. You may never have learned histology, but you know medical terminology. Sub means under. Poena is your penis. I've got you by the balls.

(Lawyer takes Doctor Goodvibes to court)

Your honor, it certainly is a shame that Doctor Friedlander is dead. Now Joe Patient's family can't get a huge malpractice award.

Come now, Doctor Goodvibes. It has always been a duty for a physician to explain clearly to patients what is wrong with them. Your lack of basic understanding of histology prevented you from doing so. Your ignorance deprived Joe of his right to make informed decisions involving his own health. And in the managed care era, a primary care physician is now expected to possess a far greater range of skills and breadth of understanding than in the past. To begin with, the system expects you to be able to interact in a collegial way with the pathologist, and this includes looking at your own life-and-death biopsies. Under the law of deep pockets, you share the pathologist's liability, and since he is dead, you are now fully responsible to pay Joe's grieving widow.

(The Lawyer takes Doctor Goodvibes's wallet, open it, looks around and grins. The Judge takes Doctor Goodvibes's shirt and pants off showing long johns.)

I am going to tell the Year I's to pay attention and get actively involved in learning histology!

(All the other characters get up and shout Yes Yes! and cheer.)