uhhhhhmmmmmmmmmmmmm.......... uhhh..... better to say nothing at all than to strain yourself trying to say something worthwhile. sometimes you’re tired. sometimes you got nothing to say that is all that worthwhile. sometimes you got nothing.

there were some revelations in the emergency room today. one of them was being in that room with the toddler who was screaming and crying, and in the creases of his skin was pure redness. bro had something wrong with his skin. i had no idea what was going on with him. the only thing i knew going in was that his parents were doctors, and there was some remark made about how it’s intimidating to take care of a fellow doctor.

our attending noted that the only thing worse than that would be to have a patient who is a lawyer. some joke about how she would defer the case to a colleague. better to avoid litigation at all times. it’s not about patient care so much as it is about protecting oneself from litigation. and it’s not so much about protecting oneself from litigation as it is about making jokes which help the day pass by more smoothly. it’s not that deep. none of the things that doctors say are that deep. they’re just doing a job. they’re wage slaves who managed to find a job which gets them into the upper classes. they get to have these nice houses in exchange for years of training and hundreds of thousands of dollars, either up front or in debt that they will pay back in due course..... in exchange, as well, for lots of hours spent on the job. in the case of this particular doctor, she was able to maintain a quite casual air the whole shift and drink sips from her starbucks cup in the patient rooms.

it really does make a difference to be in a good mood. it makes people more at ease. it makes them more comfortable laughing when you laugh.

the toddler wouldn’t let me ultrasound him. he kept pushing the probe away and screaming. his dad took the probe and started scanning his chest, and he was able to get some really good views of his heart. no effusion, but that’s all we were able to see.

the attending asked me to look up the five e’s of cardiac ultrasonography. the whole point is that we can evaluate each of them just by looking at the heart under the ultrasound. one is equality. the right ventricle should be about two-thirds the size of the left ventricle. the main thing is that we don’t want the right ventricle to be larger than the left ventricle. the right ventricle only pumps blood into the lungs, so it shouldn't be as muscular as the left. if it’s too big, that tells us we might have a lung problem. some kind of congestion, maybe... then you have effusion and ejection. we can look for pericardial effusion, free fluid inside of the pericardial sac which separates the heart muscles from the outside world of the body. there can be fluid in there which makes it more difficult for your heart to beat. ejection is ejection fraction, which is a percent value that likes to be around fifty percent. the details don’t matter so much as the fact that we want to see good contraction of the left ventricle, which is the thing that pumps blood into the aorta, which then carries the blood to the rest of the body. we can guesstimate ejection fraction by looking at the mitral valve, which in the parasternal long view we can easily visualize as this thing that flaps open and closed and open and closed over and over, and if the valve hits just about all the way to the septum—I forget which septum it is—then we have a good ejection fraction. but if the flaps don’t move very far, then we would say that the ejection fraction might be compromised. we don’t actually get to learn the actual fraction, but we get to see if the fraction is tolerable or worth investigating further. equality, effusion, ejection. and then the last two are entrance and exit. entrance, as in, we want to visualize the inferior vena cava entering the right atrium and dumping blood into it. and finally, exit. is that not just like the left ventricular outflow tract? is that..... exit, and... uhhh, ejection... both of those...... well, no.... uhhhmmm..... well, i’m not fully confident on that last point, but the beautiful thing is that i don’t need to be, because like.... i’m not doing this. i’m not going to be a doctor. that’s just how it is. i’m not being a doctor. well, i am being a doctor. but if i ever end up practicing, it’s going to be later in my life once i’ve gotten all this youth out of my system.

this is scary. i think we might be having a day when we want to do medicine. oh, god... oh god. cuz wait, i’m gonna miss medicine. fuck lol i’m gonna miss it, aren’t i? goddammit. i’ve been led astray.... i’ve led myself astray???

i really just find that this whole institution is quite rotted indeed. i need to supplement my understanding with more reading. i need to make myself more... you know.... educated on these matters.

ouch! life is clearly going to continue after all is said and done with medical school. just imagine for a second, if you will, for example, 2028. imagine that year. we haven’t given that year any thought yet, but it will happen. life does go on. and the nuke doesn’t seem like it’s getting dropped. although there is that element of unpredictability, that impossibility of ever seeing the future, of ever knowing if this is going to be the final moment, if there is an aneurysm in my aorta that’s going to dissect, and i won’t seek medical attention quickly enough, and they won’t be able to save my life.... er...... yeah.

monky but then there’s the monk on the train yesterday who made me once again think of the monastic life... which i still think is not for me.

but what comes next, you know, what comes next? is there anything left to do?

i’m not sure. there’s no way to know. no way to know, indeed... no way, indeed, to know... but continuing is still important, so i will continue to continue. one thing about me is i will continue.