Crazians?

Cross-posted to Twitter:

I know there are a lot of "Crazians" who play poker at the Bay 101, I just didn't realize how proud they were of the label.

Yes, I'm Jewish. What's it to Ya?

I was born a Jew and raised to be proud of my heritage. I was picked on occasionally by all the neighborhood Catholic kids because we were the only Jewish family they knew. In retrospect, it wasn't antisemitism, it was just a way for kids to pick on each other. I made it easy for them because I was a geek. They picked on my geeky ways and my high GPA. They also made fun of the fact that I was always wearing hand-me-down clothes from my rich cousin: "I thought all Jews were rich!" and "Aren't you supposed to have a big nose?" The worst was, "Hey, there's a penny. Go get it, Jew!"

But, what did Judaism mean to me? I know we celebrated Chanukkah. I remember going to my cousins Bar and Bat Mitzvahs. I think we went to Temple once, or maybe twice. I had seen (and heard) a shofar. I'd worn a yarmulke. I'd eaten matzoh (and matzoh-brie for breakfast - yum!).

But the big unspoken thing was my Bar Mitzvah. As in, I didn't have one. I remember asking my dad about it. My cousin, who was 6 months younger, was either getting ready for or just completed his Bar Mitzvah. He got tons of presents and was a Big Deal. What about me? Dad gave a non-committal reply. I think he asked if it was something I really wanted. Did I want to go to all that extra school to learn Hebrew? You know, that means cutting into your play time? Are you sure you want it? I eventually stopped asking and time went on. No coming of age ceremony for me.

I now have a 12 year old boy. He's asking the same questions. We took him to the Temple and met the rabbi. He was genuinely interested... for about a week. When I asked him again if he was serious, he said no, probably not. We have a family Bar Mitzvah coming up next month. I think I'm going alone.

Today on the golf course, I was paired up with a threesome which included Ares, an Israeli Jew. The first question he asked me was if my oldest (who was with me) was a Bar Mitzvah. I told him no and mentioned that I wasn't either. He gave me one of those looks, like, "Oh. I see." Then we let it drop.

I'm Jewish. My wife is Jewish. My family is Jewish. But what does that mean? I honestly have no idea. I have asked both of my kids if they've ever been picked on for being Jewish. They both said no. Lucky kids. For me, I got to experience all the downside of being Jewish with the only tangible upside being that I got presents for 8 days when my friends only got them on one.

BBT5?

I may actually try to play.

Last Day

No melancholy here. I've been mentally preparing for this day for quite some time. It was amazing to me how many people stopped by to shake my hand and thank me for our time together. Some surprised me. One of my techs wouldn't let go of my hand until he told me that I've been an inspiration to him and he wants to be like me. Seriously? I had to think really hard about our interactions and honestly I can't come up with anything specific (or even general) that would make him so passionate. Regardless, I was honored by the sentiment.

I did get to tell a great story on my last day. I have been teaching residents now for 6 years. It takes 5 years to become a radiologist after medical school. One year is internship and the other 4 are with me. I take extreme pride that in my 6 years, we've had a 100% pass rate on the oral boards. I had a part in that.

Anyway, E was a brand new 1st year resident in my second year on the job. I was still new at the teaching thing and thought humiliation was a viable teaching tool. E was taking a case in front of a large group of doctors and he was butchering it. It was obvious he didn't know normal anatomy. I interjected and forced him to stop taking the case. Instead, I just pointed to stuff and had him name the parts. I got in a lot of trouble for my actions from the command, but to his credit, E came up to me afterwards and told me that I was the first attending radiologist to actually give a damn in case conference.

Fast forward to last month. E is now a graduated radiologist. He was lucky enough to stay on at our hospital as another attending doctor. He is no longer my student - he is now my colleague. He and I are sitting in a cardiology conference, and his pager goes off. He looks over at me and asks, "Can you get this for me?"

WTF?

He told me later that when he thought about what he asked, he got a little queasy. Seriously, I would NEVER have considered asking one of my attendings to respond to one of my pages. Even now! We both had a good laugh about it. He even admitted that he lost a little sleep over it and even went home and talked it over with his wife, trying to decide the appropriate action. Should be apologize? Maybe I didn't notice.

I noticed.

In the end, it was a great 6 years. Every student should have the opportunity to give something back. I've paid my dues many times over. Now it's time to move on.

Detritus and Ruminations

Many bloggers post their random thoughts. It's my turn. Unfortunately for you, I'm no Otis. He manages to put his random musings together in such a way as to make it seem insightful and profound. In contrast, this will seem unfocused and will likely leave you feeling unsettled. It may cause a metallic taste in your mouth. You might even think you wet yourself. No, wait. That's what I tell patients who are about to receive IV contrast. In any event, you've been warned.

Tomorrow morning I will sign a contract to start my new job in California. It's very good money, even though it's a huge pay cut. There is almost no price I'd be willing to pay to be with my family, so I'm okay with the lower dollar figure. I'm certain it will be used against me in the argument about why I shouldn't buy a Ferrari, and that bothers me far more than it should.

It's not the perfect job, but it's damn good. I will only work 4 days a week and still get 6 weeks of vacation. No weekends and no call. Good, no great, people to work with who are really excited that I'm joining the team. Challenging work.

The downside is that I'm leaving a dream job, and a job I feel very comfortable with, for the unknown. I don't fear change. The military fixed that. I just try to live my life without regret, and I never want to regret leaving this job in Washington. I'm surrounded by good people who value my opinion. Just today I was talking with another radiologist. He makes the schedule and he was forced to make me double cover every day this week. I told him I didn't mind because I like being the "go-to" guy when things get tough. I take pride in that and I do it willingly.

The other negative is that, even though I'm closer to my family and will spend many more nights at home, I'll still have to get a place near the imaging center because it's 90 miles away from Palo Alto. It still kind of feels like I'm not all the way there. At least I don't have to go to the airport twice a week and deal with shitty flight attendants and the worst on-time record of any airline in forever. Damned Alaska Airlines.

I don't need sympathy. I don't need a pep talk. I know it's better because it's closer. I get all that. I just want it to be perfect. Is that too much to ask?

Bad Ass

You think you're a bad ass? You will never be THIS bad ass. (H/T to The Bloggess)

My First Cigar

I'm such a damned goody goody. I've never tried cigarettes or drugs. I never did anything seriously bad other than wreck my dad's car (a couple times). So why would I feel compelled to smoke a cigar for the first time at age 42?

Well, that's what you do when you celebrate (or so I'm told).

I'll have a "new job" post for you as soon as I sign the contract. As many of you know, the last time I posted here about my new job, things went busto. Instead, I want to tell you about this cigar thing.

As I tweeted, my simple review was, "I didn't throw up." That's the best thing I can say about the experience. The cigar was supplied by my new partner (I hope), and he's not one to buy a cheap cigar (or a cheap anything from what I can tell). It was from the Dominican Republic and I know I should have paid attention to the name for you aficionados out there, but I didn't. It may have started with the letter "T."

I had to ask for some basic instructions on how to light the thing. He told me to bite off the end and wet it. When I compared mine to his,* I may have bitten off more than I was supposed to, but not by much. He had this invisible jet lighter that sounded like a rocket engine, but I still had the darnedest time getting it lit. Then when it was lit, I couldn't keep it lit. I suppose it gave me more time to practice my lighting technique.

Even though I find second hand smoke somewhat nauseating, I can usually tolerate cigar smoke. The smell of this cigar was better than most. The taste was a bit surprising. I don't know what I expected, but this wasn't it. Thinking about it now, there were many different tastes - kind of like a good wine. There was an initial impression, a body section (which was very short since I didn't inhale) and some subtle changes with each exhale. I can see why some people get addicted. There is a lot to experience there.

Fortunately or unfortunately, I could get past several things. First, there was a sense that I was doing something very bad. My mom died of lung cancer and as a radiologist every day I see the horrible things that smoking does to your lungs. Also, there was very real nausea. There was also a vaguely unpleasant lightheadedness that made it difficult to hit my golf ball. Seriously, I had been playing well up until I lit the cigar. I accept that it could have been a general nervousness about the smoking act, but I've heard enough about first time smokers to know that it was probably from the cigar. After all was said and done, I only smoked about 1/4 of the thing.

Finally, here I am the next morning - almost 24 hours after my experience - and I still can't get the taste out of my mouth.

So, for all you cigar smokers out there, I get it. I really do. I just won't be counting myself amongst you.

*Wow - that almost sounds phallic. OMG...

Two Things

I'm on a mandatory poker hiatus, so you'll have to bear with non-pokery awesomeness.

Number 1: If you've ever been to Rome, you likely stopped in the Sistine Chapel. Even for a Jew like me, it was chilling and awesome. Even if you haven't been there, you should check this out. Of course, you'll first want to zoom straight up, but spend some time and check out the far wall.

http://www.vatican.va/various/cappelle/sistina_vr/index.html

Number 2: I am off my rocker. This is no surprise to most of you, but let me make sure you are convinced. I've seen a UFO and a ghost. These events do not define who I am which is why you've probably never heard me talk about them. I also believe I can turn off streetlights just by driving by. Don't believe me? Check out this video I shot last night (yes, it's the same one I posted on Facebook):

No Wonder My Ego is So Big

As many of you know, I am in the process of finding a new job in California. If this were anywhere other than the bay area, I would have a job already. In fact, facilities in Texas, South Carolina (Greenville!) and even Minnesota are literally throwing money at me to get me to come. The bay area is different, so I'm forced to take a more formal approach. The first step was to humbly ask for a letter of recommendation from my colleagues. Many physicians are hesitant to give letters of rec because of a recent law suit where a well endorsed doc turned out to be a dud and they held the endorser accountable.

With hat in hand, I went to several of my workmates. Without hesitation, they all agreed to write me a letter. What follows is the letter from my boss, who I also consider a friend. As an aside, if you ever need to write someone a letter of recommendation, feel free to use this as a guide.

-DrC


To Whom It May Concern,


Dr. Chako is interested in a position as a diagnostic radiologist at your facility and has asked me to write this letter on his behalf. As Chief of the Department of Radiology at _____ Medical Center, I have known and worked closely with Dr. Chako for 6 years. We collaborate regularly in the care of our patients, training of residents, and administration of the department. I believe I know him well enough to ably judge his suitability for employment and am very pleased to offer my fullest and most unqualified endorsement.

We were excited to receive Dr. Chako as a member of our clinical faculty in 2004 following his tour of duty at a small U.S. Army community hospital in Germany, where he served as Chief of Radiology and, for a time, Deputy Commander of Clinical Services. Since then he has earned a well-deserved reputation within our hospital as a well-rounded, reliable, and highly effective general radiologist. He served in numerous academic and administrative capacities, including Chief of Mammography, Chief of Thoracic Imaging, Chief of Cardiac Imaging and ultimately Chief of Diagnostic Services. As Diagnostic Services Chief, he oversaw efficient and effective clinical operations for a patient volume exceeding 13,000 examinations per month. I value his experience as a leader, and his ability to fill a variety of roles has been instrumental to our department’s success.

But most importantly, Dr. Chako possesses outstanding personal character and integrity. He is trustworthy, reliable, and able to efficiently and effectively manage a busy service. His rapport with patients, clinicians, staff, and peers is exemplary, balancing a mild-mannered, relaxed demeanor with a fierce commitment to his patients and his profession. He is patient and nurturing, yet also possesses the moral courage and fortitude to stand up for what is right. He is direct and to-the-point, but tempers candor with the tact required to facilitate cooperation among individuals and clinical services. These qualities were most evident during late 2007 and 2008 when he deployed to Iraq: he excelled as a combat radiologist and returned as a recipient of the Bronze Star.

Dr. Chako is the complete package, and I know he will excel at your facility. His innate clinical expertise, passion and experience, and superior interpersonal skills make him exceptionally qualified. I recently learned of the unique employment opportunity afforded his wife in California; I very much regret his decision to leave us, but I understand the importance of family and support his efforts to seek employment near them. Select him without hesitation. Please feel free to contact me at (xxx) xxx-xxxx if I may be of further assistance.

Sincerely,


Dr. Chako's Boss

Silly Doctor

Mastodon Weekend grows in legend by the day. It was more fun, more ridiculous and more insane than those of you who weren't there can possibly understand.

It's also the weekend I almost died.

So far, no one else knows about this (hi, honey!), so I thought I'd break it on the blog. On Saturday morning, I woke up very early. I was still on west coast time, so 10 am seemed like 7 am and the sun (as well as those damn runners) caused my eyes to pop open. Right after noticing the sun and the noise, I reached for my phone to check the time. Hold the phone... the most intense and searing pain I've felt in many years gripped the outside of my left arm. It was so bad that I may have yelped a little. Not a girly yelp, but a manly aiiippp! like a wounded doberman. Or something like that.

I laid back down in the bed and tried to figure out what I did. I wasn't shooting wrong handed darts. I didn't arm wrestle lefty (or righty for that matter) and I didn't enter a shoulder punching contest. It must have been the heavenly bed - it was trying to kill me. That's the only explanation. Of course, the doctor in me was trying hard (and losing) to suppress the idea that this might be something bad. You've all seen enough movies to know that left arm pain can be the first sign of a heart attack. I did a quick inventory. Chest pain? Nope. Fast or thready pulse? Nope. Sweaty? Nope. The good news was that if I didn't move, the pain wasn't so bad. The bad news was that it didn't go away for most of the day.

I couldn't stop thinking about my dad. He had his first of several heart attacks at age 56. Most risk stratification tables say your chances of a heart attack increase if you have a primary relative who had a heart attack at age 55 or below. Whew - I'm safe!

I'll be damned if I'm going to die before I own a Ferrari. I know there are several things I could do to help. Baby aspirin. Statins (that's for you Bracelet). Diet. But first, I had to confirm what I already suspected. A quick EKG would show ST and T wave changes indicative of damaged heart muscle. I surreptitiously consulted a good friend who hooked up an EKG for John Doe (can't have anyone in the hospital know) and waited for the results.

What do you know? It was totally normal. I guess it really was the heavenly bed. Bring on the filet mignon. And the lobster. And the Ferrari!

Last of the Mastodon Pics

I just found a few more...

My other favorite pic from the weekend. The things some people will do to win a prop bet. All Drizz needs is a 70's porn 'stache and and some bow chicka wow wow music...

The Mark surveys his creation. And it was good.

BG (who's last blog post was July 2009) tweeted about a short walk to Mary Beth's for a limited, but really good breakfast menu. He was right. Goat cheese scrambled eggs FTW.

Dr. Chako's Mastodon Weekend

Here there were many, many words. Fawning praise. Drunken revelry. General lunacy. Then Otis had to go do his thing and render it all meaningless. Or meaningful. One of those.

Go read what he wrote. It's all you really need to know.

For my part, it was all worth it. Any chance I get to associate with this strange, eclectic group of friends is time well spent. Now enjoy some pics.

One of my favorite pics from the weekend. This terrible twosome was to my immediate right at the final table. Collusion!

A look at the scorecard from our fantastic round of golf. Notice that the girls had an incredible rush, winning 4 holes in a row. Thanks to my partner, we squeaked out a half with his killer putt on 18.

I may or may not have been staring at CK's butt during this shot. And every shot, actually. Dammit, the only reason I played golf over frolf was because she promised to wear a skirt and tights. Who could resist?!

Bad Blood strikes a pose after winning a T-shirt from the great folks at Bustout Poker. Thanks again for the swag and overlay. If you ever need a team physician, give me a call.

Mastodonia

I am back from the land of Mastodonia. I drank too much, partied too hard and only embarrassed myself a little.

All totaled, it was the perfect trip.*

I hope to have a more detailed trip report in the next couple of days. For now, I need sleep.



*Having The Wife there would have made it perfect, even though she would have spent all her time flirting with my fellow Neanderthals.

New Motto

I read Scott Adams blog via Google reader. His post from today was funny because it's similar to discussions The Wife and I have. Even though we were both in the same place, we often have very different views on the event. He also talks about being a little nuts and hopefully fitting in, which lead to the final quote from his article. It's now my new motto (See above. For RSS readers, you may have to click through).

Speaking of The Wife, she's in Brazil (Or Chile. Or Argentina - it's hard to keep up some times. It's some place that's shaking a little). She's there on business and yes, she's traveling in style once again. I'm just hoping she gets back safe. I don't want to go to Mastodon Weekend with any guilt.*



*but I'd still go

I Don't Have a Job!

Meh. I knew it was too good to be true. The doctor who initially loved me doesn't have the heart to fire his current team. Oh well, back to the search.

My only beef is that he informed me of his change of heart via text message. Let me repeat that:

I GOT DUMPED VIA TEXT.

I rarely if ever use this, but FML.

(Edit: I still have my awesome job in Washington. I just didn't get the California job)

I Have a Job!

Well, let me qualify that and say that I think I have a job. Until I actually start working and get my first check, I won't breathe that first sigh of relief.

Searching for a job was never something I thought I'd have to do. It's a humbling experience. For years I've felt like a rock star. I get job offers weekly - sometimes daily - that would make your head spin. Unfortunately, they are usually in out of the way places. If I was the sole bread winner, we'd already be in Texas where they've been begging me to come for the last 4 years. Well, life had different plans and we are Palo Altoans. If you've ever been here, you know how beautiful this place is. You can also understand that, since it's such a desirable place to live, no one ever leaves. Plus, with uncertainty about Obama-care, hospitals just aren't hiring.

I enlisted the help of a recruiter. As recently as two to three years ago, this was the job to have. Recruiters get between $20,000 and $50,000 to place a radiologist and the good ones could place at least one a month. Well, these days some of them are looking to get into real estate, to give you an idea how bad it is. The first recruiter was a bust, so I got a second. And a third. At last count, I had 12 recruiters "working" for me. Just today, I had another recruiter call. He agreed to work for me as long as I paid him a $1000 retainer. I was almost desperate enough to do it.

A couple weeks ago I decided to take matters into my own hands. I googled for imaging centers around Palo Alto and just started cold calling. A couple places were so unprepared that I actually had to print out my CV and fax (!) it to them. Believe it or not, it was one of those faxed resumes that did the trick. We met today, had lunch and we really hit it off. I'll let you know in the 30 to 60 days it will take him to cut loose his current teleradiologists and get a contract together. I'll be a 1099 contractor, which is fine by me (thanks for our benefits HP!), and it will be a big pay cut, but I'll finally get to be with my family full time. There's almost no price in the world that beats that.

Here Comes the Sun

If you've ever written a song, you know that a lot goes into it. Working up a song in a group is even more challenging. Here's how two masters do it. I was especially struck when Yo Yo Ma (do his friends just call him Yo?) asked James Taylor, "Do you mind doing it a bunch of times?"

The Stuff I Use

Falstaff had a throwaway comment about using a note taking thingy (Evernote?) that interfaces with multiple programs. It sounds great and I'll probably see if I can get it for my MyTouch phone. That got me to thinking. What things do you use every day? You might assume everyone knows about the obvious stuff, but you'd be wrong.

In an effort to find some cool stuff, I'm willing to open up my geekiness so you can all see what a troglodyte I am. Keep in mind that common things I hear about like Digg, Torrent and someone named Doctorow (EL?) are foreign to me. Sure I can Google them, but I already have a lot of stuff. Do I need them in my life?

Here is what I use every day:
Google Reader - especially weather and movie listings
Google Maps
iTunes and my iPod
Gmail
MyTouch phone - especially Phit Droid (mindless game), Instant Messenger and a cool ap called Guitar Tuner
Motorola H721 Bluetooth earpiece
Twitter
Facebook
FerrariChat (duh)
Sony Vaio laptop (POS, but functional)
HP desktop (yay, HP!!!)

What am I missing? What one thing would enrich my life?

Crazy Doctors - The Reveal

Once again, if you need to catch up, start here.

Then read this (the cool post with the CT scan).

And now (drumroll please), your answer.

In this case, I noticed that her upper lungs had fibrosis. Fibrosis in the lungs is a rare and bad disease, but it usually only occurs in the lower lungs. It's generally called interstitial lung disease (ILD). Very few things cause upper lobe fibrosis AND exclude the lung bases. One of them is chronic hypersensitivity pneumonitis (CHP), which is the diagnosis in this case. Congratulations if you got it right.

CHP has a variety of causes. One well known cause is exposure to exotic birds, but it can happen with any birds, actually. It's probably exacerbated by an unclean environment. In this case, her morbid obesity is preventing her from adequately cleaning up after her animals. Unfortunately, even if she sells all the chickens and ducks and moves into a totally clean environment, the damage is done. Hopefully it wouldn't progress any further, but you never know.

Thanks for playing along. FWIW, I have a ton of similar cases. If you're interested, I could probably post one a week.

Crazy Doctors - Part II

Thanks for stopping by. If you need to catch up, start here.

I had no idea people were this interested! Truly, every day in radiology is like an episode of House (without the attitude*).

Rather than simply tell you what it is, let me show you what I saw. These images are from her CT scan (obviously, all patient info has been removed. We are a teaching institution and there is an expectation that people will learn from you whenever possible).

Any ideas?

*Hopefully