Zeros Galore!

With the Mega Millions estimated annuitized jackpot prize at $970,000,000 (zeros) and Powerball at $430,000,000 (zeros!), it is more than tempting to blow a few dozen bucks on tickets. Even knowing the cash values are a mere $548,000,000 (ZEROS!!) and $248,000,000 (SO MANY ZEROS!!!!) respectively, it's hard not to think of everything I could accomplish with all those zeros. Never have to work another day in my life. Get out of debt. Buy a house. Buy a house on an island. Buy an island. Try a different hobby every day for the rest of my life. I'd really like to get into sailing the world, but why stop there? I bet the Sea of Tranquility is lovely this time of year. I think of all these things fondly, with the subconscious belief that these things, and ultimately money itself, are a worthy goal unto themselves and will bring me fulfillment.

It is a big burden having to plan your steps in life with the practicalities of finances in mind, especially when you have a huge amount of debt. Add to that the nagging preconceived notion that you're sub-par and are destined to eke out an existence taking the crappy positions no one else wants, and it's hard to be optimistic about the future. But there's hope. In Psalm 50, God said he owns the cattle on a thousand hills.* While this was not said in the context of him being able to provide for our needs, it does highlight the fact that God is not wanting for anything. More to the point, in Luke 12 and Matthew 6, Jesus says we shouldn't focus on or worry about our physical needs. Instead, we should be focused on God's will. Wanting to win millions upon millions of dollars goes well beyond the desire to get out of debt and have financial stability. It gets into the realm of wanting to dictate the course of my life and be the master of my world.

Two guiding questions came to mind: Are my desires for my life in line with what God wants with my life? Do I trust him to provide the resources to accomplish these plans? If I can honestly answer "yes" to both of these, suddenly the lotto jackpots don't matter anymore. Even with all those zeros.



* This surely meant something to the ancient Israelites to whom this was initially said, but to help put this concept in terms we can understand today, I made some assumptions, did some measurements of the hills around Jerusalem on Google Maps, spent way more time researching cows than I thought I would have to, then ran some numbers. Estimating the average hill in Israel is at least a square mile, each hill would have 640 acres or more of grazing land. A thousand hills would thus provide 640,000 acres of grazing land. The USDA recommends 1.8 acres per cow (https://www.nrcs.usda.gov/Internet/FSE_DOCUMENTS/stelprdb1097070.pdf). For simplicity, I assumed modern US cows and ancient Israeli cows would have similar grazing area needs. This would put God's herd on a thousand hills at 355,555 head of cattle. The average US cow at slaughter prior to the advent of intensive selective breeding in the 1970s and later widespread use of growth hormones in the 1980s was 1,047 pounds (https://www.beefmagazine.com/genetics/0201-increased-beef-cows, https://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm055435.htm), which I'll use as an estimate of the average ancient Israeli cow. The current price of a bovine is about $111/cwt (http://www.agcenter.com/newcattlereport.aspx, https://beef.unl.edu/faq-2009beefprices). This translates to our average 1,047 pound cow being worth $1,162.17. We modern day folks could therefore think of God as saying he has $413,215,354.35. Kind of anti-climactic that this ended up being less than the current jackpot amounts, yet if we focus on the big picture, God created everything on which the value of money is based, which makes the concept of assigning value to cows or money rather silly and leaves God alone as having worth.

New Journey. Overdue update.

Long time no see.

I am winding down my first position as an attending physician, and as of my departure, I will have been in the position for just over a year. There are several reasons for this, but the main one is that the way in which my employer wants me to practice and the way in which I'm comfortable practicing are not aligned. I have pretty strong mixed emotions about this whole situation. On the one hand, I was ready to settle down, grow roots, and be a part of a community for the rest of my life and career, and now I'm yet again moving on to something else. On the other hand, I am glad to be leaving an employment situation that is not to my liking and it's sort of exciting transitioning to something different. It gives me a sense that my life is going somewhere and I'm not just stuck in a rut. Additionally, I have learned a lot about the real world of being a physician and what my preferences are in practice. I still have unanswered questions about what I want to do long term, but I will soon be learning a lot about that.

My plan is to do locum tenens, which is basically travel doctoring. I will be filling open positions for 1-6 month stints around the country, potentially even around the world if I work at US military bases. Because it is standard for housing at the locations to be covered, I will be giving up my apartment and basically become a nomad. I'm going to keep an official address and a storage space in my home town, which will help me feel rooted somewhere, but I think I'm going to feel like a resident of everywhere and nowhere all at the same time. One of the reasons I'm doing this type of work is that it is highly flexible and I'm not locked into a contract for more than a few months at a time. I can pick and choose the positions that don't require seeing too many patients in a day so I don't have to feel pressured to churn through appointments too fast, which is my highest priority at this point.

With the flexibility, though, comes the fact that I'll soon be a nomadic 1099 contractor, so I'm figuring out how to finagle car insurance, driver's licensing, taxes, health insurance, retirement accounts, packing away most of the trappings of a modern household into storage since I can't feasibly move them with me, etc. Above, I alluded to the fact that I'm feeling stuck in a rut in my current life situation. This mindset is somewhat concerning, because there is still a large part of me that wants to settle down and grow roots, but if I start feeling stuck in a rut every time I try settling down, I'm going to run into serious contentment issues. Perhaps I just need to find the right setting to settle into; one of the things I'm hoping to gain from seeing so much of the country and so many practice settings and working with so many different people is a sense for what type of personal and professional life characteristics I want in the long term.

On that note, I'll sign off and wish you well until next time, which hopefully will not be another three years.

September update

I'm clearing the cobwebs off my blog again. Speaking of cobwebs, the brown widows are going crazy making webs out on my patio. I keep hoping the weather will cool faster and kill them off because, while it's exciting knowing that at any time I may get bitten and have hours of agony, I'm not too keen on the whole process of flipping out and doing a spastic jig every time I get stuck to spider silk.

Still single. Still a resident. Two current sources of frustration. Not a whole lot to elaborate on in this setting, but prayers on both fronts would be appreciated. In any case, life keeps moving on and I keep looking for ways to grow closer to God and grow as a person through all the frustrations. Learning yet again that life is a process of continual growth, not of "arriving" once and for all.

I just ate a Reuben at Subway (thanks for the gift card, Mom). It was quite tasty; I would recommend it.

May update

For my morning Bible study, I've been in Romans lately. Describing the actions of people who have turned from God, the apostle Paul says the following: "For they exchanged the truth of God for a lie and worshiped and served the creature rather than the Creator, who is blessed forever. Amen." (Romans 1:25) It stuck out that while in the midst of denouncing all the terrible things these people are doing, Paul doesn't just skim over the concept of God receiving praise, but pauses to give his endorsement to God being blessed (held in reverence, honored in worship) by saying amen after that thought. After taking that time out, he continues on with describing the situation of these wicked people. While standing firm against all the anti-God sentiments an movements in our society, I pray that I don't lose sight of God being praised. We aren't fighting to win arguments. We are ultimately fighting to bring praise to God, which along the way includes winning people over for him.

In other news, I'm moving along in residency. I will be finishing up at my Family Medicine program in two years and two months (not that I'm counting) and then hopefully going on to a Hospice and Palliative care fellowship afterward, which focuses on care for patients with terminal conditions and the families of said patients. I never thought I would be interested in end-of-life care, thinking it would be too depressing, but I've lately had rewarding experiences in that area, and I think it would be a fulfilling specialty for me. It's interesting that I had several patients die in the months preceding my own grandfather's recent death, and I was able to give my mom insight along the way as she faced his declining health.

From a personal standpoint, I have actively started looking for someone to marry (no, that's not an invitation to set me up with every single woman you know, thanks for offering). I don't know if it was my recent attainment of a third decade or what, but it feels like it's about time. As part of this process, my focus has been drawn to personal issues I need to address so they don't hinder such a relationship, so I'm working to iron those out.

No promises, but hopefully I'll get back to blogging more regularly.

Scott

EM, Finances, and Relationship with God

We are on four-week blocks, doing a different rotation each block. This block is my Emergency Medicine rotation. Despite being a rather laid-back rotation and having some interesting cases come through the ER, I have had a tough time on this block. Actually, I think it's because it's so laid back that it's tough (remind me of this next month when I'm whinging about having too much to do). Since the ER documentation system is different from what the rest of the hospital uses and we residents aren't set up to use it, I don't have to/can't record anything on any of the patients. This also means that I basically have no official responsibilities while on this rotation, a situation that lends itself to feelings of uselessness. A good system has been to watch the board for new patients, then act like I have responsibilities to care for them. I do a history and physical, then report to the attending ER physician what I've found, what I think is wrong, and what I would like to do for the patient. We can then discuss what may be going on and I can get critiqued and learn from the case. This makes it feel like I'm actually doing something meaningful and definitely engages my mind more than just floating about doing half-hearted H&Ps and homing in on just the cool stuff.

Speaking of cool stuff, I have sewn up a machete cut and stapled up scalps split open by a 2x4 and a door edge. We have also had a patient actively seizing; a snake bite victim; myriad belly and chest pains; a mostly-resolved stroke; a possible medication ingestion; and a psychotic patient who taught me that psychotic people can have the full range of fears, anxiety, and childish immaturity that non-psychotic people have.

I am more or less following Dave Ramsey's Total Money Makeover plan for getting out of debt, and I am seeing some exciting progress on my highest-interest loan. It is really heartening to feel like I am getting a handle on my finances and I am really thankful that God has blessed me with this income. Some of my fellow residents have the mentality that they're doctors, so they can start spending like doctors, and it's an odd feeling to be in the same boat as them, yet living much more frugally. I'm living in an apartment that's not just cheap in regard to its cost, I'm driving a car that's pretty well lost its curb appeal but that I take pride in maintaining, and I'm not buying stuff left and right. Now and then I'll want to buy a new car or a bright, shiny toy, but for the most part I'm getting a good deal of satisfaction from living responsibly and paying off what I owe.

It has been made apparent that my relationship with God has been distant lately. I want to be a great husband, father, and physician, but above all of these, I want to be a devoted man of God. I keep relearning the fact that my relationship with God is an ongoing process of getting to know him better and not a one-time action after which you can just coast. I guess you could say I've thrown it back in gear and have stopped coasting. Back to the part about being a great husband, if I'm not interested in growing closer to God and try to start a spark of godliness just so I can be with a woman who is devotedly following God, that spells trouble. But if, already having the flame of desiring to grow in my walk with God, I find a woman who fans ablaze that flame, great! "How did you go from your walk with God to finding a godly woman," you ask? Well, it's a long story. In any case, the next paragraph is related.

The other day, while browsing a Christian dating site, I felt so weary of wanting and waiting to get married and worrying over how much to invest in a relationship each time an opportunity comes along and whether it's going to lead anywhere. I prayed that the next time I got involved with a woman would be the relationship that leads to marriage. Later on, I found the profile of a woman who, as far as I can tell, is devoted to living for God and growing closer to him. On her profile, she mentioned that since she isn't subscribed to the site's email service, one would basically have to Facebook stalk her to get in touch. Having become adept at this, Despite not having done this before, I was able to find her rather easily and sent her a friend request and an email. She accepted my friend request, but said in her reply email that her intent had been to reject this friend request from some random person, but accidentally hit the wrong button. Had she hit the right button, she wouldn't have seen my message. I believe her accidentally connecting with me on Facebook was a work of God, but my hope is not in assuming that we will get married, but rather in knowing that regardless of what pans out in my relationship with her, God is working "all things for the good of those who love him, who are called according to his purpose." This is an unexpected bit of peace in a situation in which I typically would be champing at the bit to forge ahead in this relationship. "Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus." (Philippians 4:7&8) Praise God.

Scott

On Call

Call continues to be the most stress-inducing part of my job. I was just on call last night from 6-6, which actually translated to me being at the hospital from 5:30pm-7:00am. I'm on call again tomorrow night from 6pm to midnight, then again on Friday from 6pm to midnight. Definite growth experience for me. What really causes the anxiety leading up to and during call is the possibility of having admissions and codes to take care of, on top of handling any issues arising with the patients already in the hospital on our service. When those above my pay grade decide that a patient should be admitted to the hospital to the residency service, it's my responsibility to go see the patient, get their history, do an examination, come up with a list of what's likely going on with them, and a course of actions to take to get more clarification on their situation and/or treat them. I then run all this by the senior resident who's on call with me to make sure it sounds halfway decent, then report everything to the attending physician who's on call at the time. In a given night, you could get no calls about current patients and no admits, or you could get called every 5 minutes with complicated questions and have to do a dozen admissions. It's just the luck of the draw. Amidst all this, if anyone in the hospital decides to go into cardiac or respiratory arrest, you have to drop everything and run to take care of them. This will probably take at least an hour by the time you've run the actual code, then dealt with the necessary calls and documentation afterward. Time management becomes critical.

This all is so hard for me because I like to take the time to figure a problem out and totally wrap my mind around it before taking care of it. If I have a bunch of disorganized tasks that involve concepts I don't fully understand with additional tasks getting thrown at me, it is very difficult for me to function. With time constraints, there is no way I can fully wrap my mind around everything and complete all my tasks perfectly. As a perfectionist, this is a hard pill to swallow. Also, the more times I'm on call, the more things I realize I need to be doing during a shift, so it feels like the more experience I get, the farther I get from adequacy. This is quite disheartening, since everyone knows you're supposed to get better at something the more times you do it.

I'm working on thinking through my call duties in manageable chunks. I know how to round on patients. I know how to take a history. I know how to do a physical exam. I'm trying to think of the call night as a series of individual tasks I know how to do as opposed to a nebulous, monolithic impossibility. There are things I still don't know how to do, and I'm trying to have the perspective that I can learn and get better at each of these individual things, instead of seeing them all as a unified, insurmountable obstacle.

Tomorrow brings a new rotation for me. I'll be doing Emergency Medicine, so I'll be in the ER, seeing patients and working with the ER attending (full-fledged) physicians to get treatment initiated and either get the patients back home if they aren't too severe, or passing the patient's care on to another physician who will admit and care for the patient in the hospital. Word has it I'll be able to do a good amount of procedures while in the ER. This includes doing stitches, starting central lines, pelvic exams, chest tubes, etc. That part should be fun. Since we have clinic as an ongoing part of our training, I will actually spend tomorrow morning in clinic (typical primary care doctor's office) seeing my patients there. And, yes, call continues regardless of which rotation I'm on.

Fourth of July!

This is why I get misty-eyed whenever I hear the Star Spangled Banner (I did take a bit of license):

It's the war of 1812. Still a baby, the United States of America has just suffered devastating and demoralizing losses to England, their former ruler. Looking to cripple and finally crush the young US, England has now set its sights on the important seaport of Baltimore, whose harbor is protected by Fort McHenry. From his vantage point on a ship several miles distant, Francis Scott Key watched with bated breath as the British ships’ 25-hour bombardment of McHenry raged on. Imagine standing where he stood, watching for an entire day as THE military power focused its wrath on a vital link in your beloved country’s armor. As sunset approaches, you can just see the flag waving atop the walls of the fort. You can’t sleep, worried about the fate of your country and your own fate as a supporter of that rebellious collection of colonies. Each explosion, though heart-wrenching as it could herald the end of your nation, also causes your spirit to soar as the brief light shows the flag still flying high above the fort. Passing out with exhaustion in the pre-dawn hours, you are soon awakened by a commotion among the crew. You turn to them and ask, “In this early-morning light, can you still see what we were watching with such pride as the evening light faded? We watched as its broad stripes and bright stars flew strong above the fort’s walls throughout the vicious battle. The bombs and rockets only encouraged us more as their light showed our flag to still be there. So, tell me: does that star-spangled banner still wave over the land of the free and the home of the brave?”

 

The answer is, “Yes! It does!”

 

While this is an emotional song for me and I do consider myself patriotic, I don’t put my hope in this country, nor in the redemption of our nation’s widespread immorality, nor in the rise of some other nation that could stay focused on God better. I would love for the US to return to the God-centered principles on which it was founded, but my hope is not in that. My hope is instead placed on the fact that God is still in charge and has a plan that he is bringing to fruition in his own timing.

 

In personal news, I am settling in to my new life situation without too much trouble. I am meeting people and getting connected, which is so encouraging for me. As a natural loner, it is easy for me to isolate and get lonely and depressed. While there is still a component of that, it is less than in the past and I am able to deal with the loneliness in a much more healthy manner. I am much less anxious and have a much more positive outlook on the coming year than I expected. Again, that’s not to say everything is perfect, but I’m handling bumps in the road better than I could in the past.

 

Scott