Penultimate Rambling Conversation with a Lumbering Asian Bear-Mammal

(Not really medically related. I’m sort of busy this month and don’t have the energy to really organize my thoughts. My apologies but if this kind of thing will make you get all hissy then please come back to my blog in a few weeks when I expect to have more time to write a friggin’ thesis.-PB)

Who has had the greatest influence on your life?

My father, hands down, no question about it, of whom I have only good memories and who raised all of his children right. My father immigrated to the United States in the 1950s and, unusual for a Greek, after a one-day stay in New York and a ten-day bus trip ended up in Idaho. I say unusual because Greeks tend to clump together and form their own communities (as anybody who has been to Astoria can tell you). He had an Uncle in Idaho but let’s just say the state is not exactly a hotbed of Hellenic culture. My father was an engineer and an officer in the United States Navy. If I am half as successful or half as respected as my father when I die I will have had an exceptional life.

My wife, of course. I was nothing when I met her. Just a washed out college student. And I don’t know that I would have had the drive or even the desire to succeed at anything if it wasn’t for the universal desire of good men to impress their wives. But the last six years have been very hard on her which is probably a story I should have been telling you, oh my patient readers. She gave up a lot of security to let me go to medical school. I wouldn’t say we were rich back then but we were not teetering on the brink of financial ruin as we are today. Poverty in marriage is something you expect at the begining, not after sixteen years. I know intellectually that we will do all right in the end, the Good Lord willing and the creek don’t rise, but eight years is a long time and you can only rob Peter to pay Paul for so long before Peter gets wise. We knew it was going to be tough, of course, and it seems like a hundred years ago when we first sat down to plan out the long years of medical school and residency. It didn’t seem as daunting back then and it has been nothing like we expected. Frankly, for my wife it’s been like trying to stuff a tiger in a sack. It can be done but it doesn’t stay sacked long. Without giving away too many personal details, those of you with a family need to consider carefully what you are giving up and what it is going to cost.

My wife’s philosophy is not to let us think too hard about the future. You’ll drive yourself crazy if you do. We have no future. Medical school and residency is so demanding of you and your spouse that, unless you are independently wealthy, it’s best to just muddle through, living one month at a time until, almost by surprise the years have melted away and the end comes into view. This is difficult for both of us because we have always been forward thinking people.

Who are your heros?

Ronald Reagan comes to mind. That guy was a lion. Perhaps the best president and one of the greatest Americans in history. He was a man who came at exactly the right time as those of you who remember the malaise that had settled upon our country after Viet Nam, Watergate, and the lackluster Carter administration can attest. He also brought the Republican Party to the masses wresting it as he did from the so-called “Country Club Republicans.”

I also like Rush Limbaugh. I have been listening to him since he got started almost 17 years ago. Rush made conservatism cool. I mean, there have always been conservatives in American politics but since World War II they tended to be marginalized. Certainly conservative opinion was almost nowhere to be found in the mainstream with the possible exception of The National Review. Just as I am trying to give residents the conceptual framework to discuss their dissatisfaction with the current residency training system, Rush gave conservatives the vocabulary and the awareness to make their opinions known….which explains his popularity. Conservatism is nothing more than common sense writ large and even in this propagandized and in many ways excruciatingly silly age, most people have a deep core of common sense. He’s also a very funny guy, a brilliant satirist, and always highly entertaining. (The reason liberal talk radio has never really caught on is that most liberal talk show hosts can never expunge the bitterness and ill-humor that characterizes the political left.)

I am a great admirer of President Bush and Vice-President Cheney. Mr. Cheney, in particular, is perhaps the most intelligent man in Washington and it is a shame that he is not the kind of guy who could get elected President in our above-mentioned silly and superficial age.

As for heros from sports, well, I am almost completely asportic. I have absolutely no interest in professional sports of any kind and I think the emphasis we place on them as a society is both silly and inexplicable. I understand that the gridiron can be both a metaphor for life and war but…and maybe I just lack imagination…it’s just a leather ball that a bunch of guys are trying to run down the field. I can understand the player’s motivation because they get paid a lot of money to do it but how this translates into anything meaningful for the spectators is one of life’s great mysteries. I’m not against professional sports, and I have no objection whatsoever to atheletes making huge salaries to play what are essentially children’s games, but I just don’t have an interest.

Except for the Olympics. Every four years I go sports mad and, like the salmon, swim furiously up the spectator river to spawn before returning to the tranquility of the deep sportsless ocean. There’s just something about it. My wife and I also get a big kick out of the pagan, Cirque-du-Soleil-inspired opening and closing ceremonies. Proof that bad taste is an international phenomenon. They’ve been trying to upstage Hitler since 1933 and I think the Chinese might finally be the ones to do it.

As for actors, musicians, and the like, with the exception of John Wayne and Charlton Heston they are all pretty much interchangeable. I certainly don’t care about their opinions on anything important simply because they are trained performers. How the ability to play the cello or memorize lines translates into geopolitcal or scientific expertise is a mystery. A lot of my conservative friends have trouble paying to see movies featuring extremely liberal actors but what does it really matter? If I vetted entertainers for political opinions who would I have left? Unfortunately, the talent that allows someone to turn something silly and meaningless into entertainment also means that a lot of entertainers are somewhat silly and meaningless in real life. They can’t help it. The class clown (I went to high school with Greg Kinear, by the way, who was the class clown) or the girl who sings the lead in every high school play are not the kind of people who operate in the concrete world and they don’t necessarily gravitate towards conservatism which is not an ideology for wishful thinkers. So you have to give them some leeway.

Except for Whoopi Goldberg. Good Lord, does that woman grate. As far as I’m concerned she ruined every episode of Star Trek:The Next Generation in which she was featured. I have Tivo just so I can fast-forward through her scenes and I think in the wonderful internet future where we can download the Library of Congress in a couple of seconds someone could go back and seemlessly edit her out of everything.

Any Movies You Really Liked?

I just watched Mel Gibson’s “Apocalypto”. A wonderful picture and not at all the preachy, “White Man Bad, Indigenous Meso-American Peoples Good” slobber-fest I thought it would be. Hey, those Maya were some vicious bastards who cut off their captive’s heads just fer’ fun and sent their decapitated bodies spinning down the steps of their temples, all completely independent of the European mind-control that is usually blamed for recent third-world atrocities.

Not before cutting their hearts out, mind you, which leads me to my only objection to the picture. In one scene the high priest cuts out some poor son-of-a-bitch’s heart and shows it to him. Son-of-a-bitch looks at his heart in terror and then dies. Come on now. Would you really live long enough to look at your heart if somebody ripped it out of your chest?

Only Bruce Lee could do that.

But other than that it’s terrific. A really solid story coupled with a glimpse of a world that we have never seen depicted on the screen, at least not with such realism and attention to detail. Does Mel Gibson take liberties? Sure he does. The Maya weren’t as bloodthirsty as the Toltecs and the Aztecs or as Despotic as the Incas but he’s making a movie, not a documentary and human sacrifice was practiced by various meso-American cultures at different times. Additionally, many of their cultures were imploding by themselves when the conquistadors arrived. Cortez with his 500 soldiers could hardly have subdued an empire that was not already on the verge of collapse.

The guy can make movies. The Passion of the Christ was excellent although I hesitate to say I enjoyed it, or that I would watch it again. It was a little too intense and since I am from the South and the Bible-belt to boot, let’s just say there wasn’t a lot of the usual popcorn eating and chit-chat while it was being shown. We’re all hypocrites, of course, but that doesn’t mean that we don’t believe, a concept that is apparently lost on the entire entertainment industry with the exception of Mr. Gibson. I assure you that thoughtful movies on any number of biblical stories would clean up at the box office if they were presented in a way that was neither patronizing nor written at a teenage level.

I took my four-year-old and seven-year-old to see Disney’s Ratatouille. It was completely enjoyable and believable, which is kind of the point when you’re making a movie about a rat who aspires to be a chef. The kids loved it and were glued to their seats which is not always the case at children’s movies. My daughter likes to help me cook and the funny thing is that you can learn a lot about cooking from the movie. Typical of Disney, while it is a children’s movie, it was not aimed exclusively at children. I can hardly watch movies like Spy Kids which the kids like but have nothing in them at all for adults. They’re just silly which Ratatouille was not…but it is…cause it’s a rat…but it’s believable. The only better Disney picture we have seen lately is “The Incredibles”.

Transformers, which I saw with my oldest son, was fantastic. It’s not “Chocolat” or “The Unbearable Lightness of Being” but the fact that it’s not some arty film in which nothing ever happens except a lot of angst and nihilistic dialogue is a definite plus. Nothing worse than a movie were nothing happens and you dislike all the characters intensely. Give me a good robot movie with heroic Special Forces and lots of things blowing up any time over one that is a chore to watch and requires work to appreciate. Hey, making it entertaining is the directors job. If I have to force myself to enjoy it he has failed.

Not to say I don’t enjoy the classics but they’re classics because people want to watch them.

What does your wife think about doctors now?

The magic is gone, I mean now that she knows what’s involved in our training. We’re just people, after all. Okay, generally more intelligent than most people but still people with all of the faults and defects of any other people. I know she trusted doctors a lot more before I went to medical school. Our pediatrician completely misdiagnosed our newest child with “Reactive Airway Disease” and we tortured her with nebulizer treatments for six weeks before my wife got fed up and demanded the antibiotics which fixed the problem (a croupy, intermittant cough) in about three days. The conventional wisdom seems to be not to give antibiotics to sick kids but in this case the doctor got caught up in his dogma.

She also recognizes all of our tactics, including the “brush off” and the “buck pass.”

On the other hand she has developed some unexpected sympathy for us, especially now that she knows how the business works. My wife knows, for example, that most physicians don’t have all day to chit-chat and they appreciate a patient getting to the point of the visit. A lot of patients don’t realize this and think we have all day for them. In the normal working world, everybody spends some of the work day in idle conversation, surfing the internet, or just pretending to work a la Office Space (another very funny movie) but this is not the case in much of the medical world. When the Emergency Department is busy, for example, we tend to mercilessly redirect rambling patients, something that the older generation who expect their physicians to listen silently for as long they care to talk, neither understand nor appreciate.

It’s not rudeness but the very real demands of the schedule and fifteen minutes wasted in the morning is going to be paid back somewhere else with some other patient who may need the extra time.

My wife sometimes says, when I am not the pillar of stoicism that men are expected to be, “I can’t believe you were a Marine.” Now, when I do something dumb or fail to grasp a concept which she has to patiently explain she says, “I can’t believe you’re a doctor.”
But we’re not perfect and while I think I’m a good doctor, I’m fairly average when it comes down to it. I have quite a few collegues who are an order of magnitude smarter so you see that perspective is everything. No doubt our patients think we are all Wiley E. Coyote-esque super-geniuses but among ourselves there is definitely some variation.

(To be continued…)

36 thoughts on “Penultimate Rambling Conversation with a Lumbering Asian Bear-Mammal

  1. eye to eye brother. obtw, for a great historical read about the conquest pick up “the hummingbird and the hawk” by padden. available at amazon of course. riveting.

    since you are in residency still and at the center of academics i have a question i have never heard a good answer to… if overprescription of antibiotics and overuse of any sort is paving the way for superbugs then why do we not here of the superbugs developing in, say, mexico, where you can get most antibiotics over-the-counter.

  2. Hey Panda,

    I’ve been reading your posts since my sophomore year in college. Now I’m about to start medical school. Your posts have been a great resource and put many things in perspective. They are sharp, witty and incredibly enterntaining. Thanks and keep up the good work!

    P.S. I chuckled when you mentioned Astoria 🙂

    – D

  3. Not into pro sports? What about college? I guess it depends highly upon where you grew up and what school you went to.

    I’m not a Rush Limbaugh fan. What do you think of Ann Coulter?

    (I like Ann Coulter.  She’s very intelligent although she is not nearly as urbane as Rush.  I am perplexed at the hatred the left has for conservative talk radio.  Neither Rush, Sean Hannity, nor G. Gordon Liddy are even remotely offensive except that some may not agree with their opinions.  They are certainly nowhere near as mean spirited as (failed) talk show host Al Franken.  It’s part of our culture, unfortunately, to view someone who disagrees with your opinions as a mortal enemy.

    I believe there are whole sectors of the internet devoted to refuting Rush.  Which is fine, of course, but as most of what Rush delivers is opinion (but well researched, of course) the question of “right” or “wrong” is irrelevant.   It’s as if I said, “Capitalism is better than Communism,” and you accuse me of lying.  Come on now.  It’s an opinion.

    The ironic thing is that when I was a young man, the liberal credo was, “While I may not agree with what you say, I will fight to the death for your right to say it.”  Now, the liberals (as represented in Congress) are continuously looking for the legal formula by which they may “Hush Rush,” i.e. by trying to invoke some sort of “Fairness Doctrine” to help liberals get some radio time.  It’s disgraceful.  If there was a market for liberal talk radio people would listen.  But even liberals don’t want to listen to some leftist hatemonger venting about how much he hates Chimphitler McBush.  It just gets old after a (little) while.

    But I love talk radio. Not that I have time to listen much anymore but one day I might.

    By the way, I do not allow ad hominem attacks on political figures on my blog.  If you have a beef with, say, Hilary Clinton you had better tell me more than she is “stupid” or a “bitch.”  I don’t care for Mrs. Clinton, Obama, and the whole panoply of Democratic stars but I have an old-fashioned respect for elected officicals.-PB)

  4. I wonder if you would be happier not doing clinical medicine. I do like your writing, but you sound tired and angry. Maybe try a michael Crichton career path?
    PHS, MD

    (No, I like dinical medicine.  I just don’t like being sleep deprived and getting paid like a taco jockey. -PB)

  5. You do know that a third of the country are self-identified conservatives, don’t you? Also, and this may be a shock for many of you, I would say that the medical profession, as a whole leans decidely to the conservative and Republican side.

    The trouble is that a lot of otherwise intelligent people float in liberal bubbles, academia is one such bubble, and cannot imagine any other point of view but theirs.

    Rush, by the way, has 20,000,000 listeners a week and can be heard in almost every city in the United States that has a talk and news station. I also believe that his demographics are largely educated middle and upper class listeners.

  6. Residency sucks, no doubt about it. But you didn’t have to go into medicine, buddy. How cool would it be to be able to directly affect someone’s life as a diagnostician and healer, and also be able to get 8 hours of sleep every night and spend weekends playing with your kids. You can’t have it both ways. Medicine demands a commitment and self-sacrifice that other “jobs” don’t. You want to make a boatload of dough and sip martinis at the country club every night? Go into banking. Manage a fund. Be an entrepreneur. There’s plenty of ways to enjoy an enriching lifestyle.You’re the one who applied to medical school, though. There’s a responsibility that comes with being a doctor, not an entitlement.

    Most of my best moments in residency happened at 3 in the morning. I was exhausted, beaten down, angry, irritated, fed up and brain fuzzed. But you can’t get the experience any other way. I performed 4 emergency cricothyroidotomies in residency; all of them after midnight. I’m no hero. That was my job as the in house surgery resident at the time. Trust me. Suck it up now. Put in the hours. Exhaust yourself. Neglect hobbies for a few years. You’ll be a better attending some day.


    (I am the ICU senior on call tonight and I have intubated three patients, placed two central venous catheters, a radial arterial line and managed a code, making the nurses proud at how well they’ve raised me.  But most call is not like this and it has been my experience that with the exception of the ICU (which is a second home to our residents) and the Emergency Department, we are looked upon and used as incredibly cheap labor to keep the meat moving in and out of the hospital.  That’s the reality.

    Now, I’m glad I went to medical school and, as I am done with call (except for the ICU which doesn’t count, you understand), I like residency a whole lot more than I did a couple of years ago.  But if I knew eight years ago what I know now, and it was almost impossible for me to know what  I was really geting into back then (although because of websites like SDN it is probably easier to get an idea nowadays), well, if I knew then what I know now I probably would have stayed in engineering.  It’s worth it now because I have invested six years, I like it well enough, and I’m almost done but eight years ago?  Who knows?

    Medicine does involve sacrifice and commitment.  But for whom are you sacrificing and to whom are you committed?  It’s easy to say, “The Patients,” but it is also true that residency training, because of the availibility of cheap, unprotected labor, has evolved into a highly inefficient enterprise where our time is wasted in various bureaucratic tasks which add nothing to patient care and can only exist because there has been no incentive to change things.  We tolerate it because first, we have no alternative, and second because most of us do care about our patients and work to give good care despite the system, a system which seems engineered to preclude compassion for them as it sometimes resembles a combination of goat rodeo and meat packing plant. That’s why I refer to the phrase “Patient Care” as a blunt weapon.  “Patient Care” can be used to justify any abuse of the house staff. -PB)

  7. How does that quote go? “The liberal at age 50 has no brain, the conservative at age 30 has no heart”, or something like that.

    It seems to me that most of the opinions of most people have very little to do with rational thought (common sense just being the particular tagline conservatives have decided to attach to their movement). Whether it is religion, raising kids, or political philosophy, what most shapes people’s attitudes is how they were raised. The child of a conservative is likely to be conservative, the child of a liberal is likely to be liberal.

    As for why conservative talk radio is far more popular than liberal, I have a few theories. One, it is more comfortable to listen to someone calling the other side stupid, naive, and misguided than it is to listen to someone calling the other side uncaring, selfish, and evil. Two, moderate conservatives are far closer to the extreme conservatism expressed on the radio than moderate liberals are to radio-broadcast extreme liberalism. Three, conservative philosophy is interested in keeping things as they are, and the people most interested in that are the ones with time to listen to talk radio – they are the ones working office jobs, having long commutes, raising kids, etc.

    Anyway, good to see this more personal side of PBear.

    (Very interesting comment, especially about moderate conservatives being closer ideologically to guys like Rush.  But Rush is not an extreme conservative and he is not on the far fringes of the right wing.  In fact he is a lot closer to the center than people who don’t listen regularly understand as he reflects mostly mainstream American values.    “Extreme” conservatives are the black helicopter bunch, the Klan, and other people who think Rush is too liberal (if you can believe it).

    Conservatism is not just about keeping things the way they are for the sake of keeping them the way they are.  The root of conservatism (although most conservatives can’t express it) is that mankind has no history, meaning that since human nature is immutable, the traditions and customs which have evolved through history should not be discarded casually.   No doubt we can identify a few times when change is good but on the other hand I can point to a lot of social pathology that is the direct result of abandoning traditional values.

    The other reason conservative talk radio is so popular is that conservatives have previously not had an organ for their views to be disseminated and reinforced.  A liberal can turn on PBS or NPR and get his information through the filter of the liberal world view.  Same with CNN or the most of the major media which, although they probably try to be balanced, really don’t understand how to be balanced as they live in something of a bubble.  See my comment on Hollywood which wants to make movies that people will see but doesn’t really understand that most people not living in the bubble want solid, non-offensive fare.

    As an example, in the otherwise completely family-friendly “Transformers” the writers threw in a masturbation joke.  No big deal to Hollywood but I took my nine-year-old and my four-year-old and it was completely gratuitous and unnecessary.  The director had to know that this was a movie to which parents would bring their kids but it never occurred to them that the majority of their target audience might find it offensive.  -PB)

  8. Hi panda – great post! I give you and your wife a lot of credit making the choices and sacrificing to achieve your goals. Good for you!!

    You said some really nice things about your family and you know you are all blessed to have each other.

    I honestly did not know that asking too many questions or being chatty hurt the doctors. Mo one ever said. Obviously if there is a medical concern it should be addressed but I am friendly and know I have gone off track. (feeling guilty) My private Doc is just as chatty and I guess that is why it didn’t occur to me. Also, having worked with ER – I am not familiar with office concerns. Lesson learned!

    I am in total agreement with you about Regan, conservative views etc. I would cross over and vote against my party if I felt someone were the better choice but so far it hasn’t happened.

    I apologize for getting wordy here but you struck some chords within me.

    I was a kid and teenager during the Vietnam war and I remember seeing the body bags every night on TV and the green jungle. I remember seeing all the peace rallies and protesters and all kinds of liberal views on TV.

    I grew up in a conservative household and my uncle had been in WWII for 4 years as a medic and was in 4 invasions and toward the end he helped liberate people in a concentration camp – I don’t remember which one. He lived and worked in Vietnam before we got involved in the war. He lived in Saigon and traveled into Cambodia and Thailand. He said the people were the nicest most loving people and they did not want to live under communism. He made friends over there. He believed in the domino theory and always said if South Vietnam goes – Cambodia will too (we know what happened there) and he felt that they should have declared it a war and been done with it. But because our government officials were more concerned with their votes it dragged on and even more people were killed. He was visibly upset when he was watching the Vietnamese people left behind running to the choppers and planes begging to go, knowing full well they would be slaughtered etc. and the boat people willing to risk their lives. Obviously too much to say here but I said all that to say that there was no other point than the liberal points of view espoused. Nothing to balance it out and possibly effecting a better outcome – we will never know.

    Then there was the awful way our soldiers were treated. Again – no balance. I didn’t know him then but my husband was in Vietnam and he has his thoughts too.

    So when the liberal left squawks about Fox News
    or conservative talk radio I am both amused and frustrated. Really? They want to SILENCE FREE SPEECH? Now THAT is fair and balanced! They had more than a monopoly for so long but thank God for satellite because ALL views can be researched and challenged immediately through various mediums.

    I don’t understand something though? Why exactly do they feel they need more talk time? How is Fox, Rush, etc. preventing that? Do they not have the same rights through free enterprise etc, to buy stations, get sponsors and through FREE speech say what they want to say? Just do it! I don’t want to stop them! But please don’t try to SILENCE free speech!

    I remember the first day I heard Rush. I was in the car with my family, driving down the parkway to the Jersey Shore. I was flipping through stations and came across this guy talking like a conservative and I couldn’t believe what I was hearing! I was relieved, happy and hooked. If people want fair and balanced all they have to do is flip the channels. We watch a lot of MSNBC at home and there are other points of view I want to hear and respect as well but please do not take away the public right to choose what they WANT to listen too. We need that balance and I think it keeps everyone on their toes.

  9. You really think Hollywood is a good source from which to get accurate historical facts? You gotta be kidding me.

    (Did you not read what I wrote?  I said Mr. Gibson took some liberties.  But as I am an avid but amateur historian and have a read a little about meso-American civilizations I get the sense that his gestalt was not too far off even if he amalgamated some elements from many cultures.  Those blood-thirsty bastards did, in fact, sacrifice captives and make incessant war on each other.  Sorry.  -PB)

  10. You do know that a third of the country are self-identified conservatives, don’t you? Also, and this may be a shock for many of you, I would say that the medical profession, as a whole leans decidely to the conservative and Republican side.

    Actually yes, I did know that. However, where I attend school, I am guessing that most of the more conservative people in my class know enough to keep their mouths shut. I know a bunch of people up here in the north who’d want to know whether you’re one of those conservative ER docs who denys women Plan B too. (I really don’t want to know and don’t care.) It’s just interesting that where I live, I’m probably one of the more conservative people around (who talks), but compared to you I’d probably seem disgustingly liberal. I also might add, there’s a difference between being “conservative” (or “liberal” for that matter) and walking around with your brain unplugged.

    (As for conservtives keeping their mouths shut, this has never been my MO and I am always very open about my political beliefs even when I was at Duke, the weeping sphincter of liberalism in medicine. 

    Let me tell you a story: One day when I was at Duke a resident was declaiming against President Bush and laying the usual conspiracy-theory charges against him.  Rather than remaining mute for politeness sake (which is also an alternative not exercised enough by everybody) I basically told him, “Screw You, I love President Bush and you are a mealy-mouthed little girly-man.” (Politely, of course)

    His criticisms sort of rambled off and after he left some of the nurses congratulated me for making him shut up because they also were conservatives and Republicans but such is the climate of fear for conservatives at Duke that they have always felt too intimidated to speak up.  Personally, I don’t care what mealy-mouthed girly-men think of me so speaking up has never been a problem.  It’s not as if I was eager to stay at Duke anyways or join the faculty so paradoxically I had no incentive whatsoever to make nice and besides, I wouldn’t want to belong to an organization like that anyways.

    My other point is that politics do not belong at the office and I rarely discuss them unless asked and then usually only among friends who are either conservatives or comfortable enough in their liberalism to not take my contrary opinions as a personal attack on them.  But assuming that everybody is as liberal as they are is typical for many liberals, most of whom do not have the good manners to think who they might be offending before they open their mouths.-PB)

  11. Just to be fair, Transformers had a PG-13 rating for “intense sequences of sci-fi action violence, brief sexual humor and language”. Now, it is silly to put a movie like that out that kids want to see with a rating of PG-13. I won’t take my kids to see it, though they want to see it badly. I guess they’re appealing to the adults who grew up with Transformers more than to those who are kids now. It really makes no sense to me.

  12. If you are at all interested in meso-american culture and history, check out the book “Aztec” by Gary Jennings. It is an amazing historical fiction novel that accurately outlines the horrors and wonders of the Aztec culture (and by some extension the Mayans).
    I too thought Gibson did a great job on Apocalypto, but that may be because I appreciate the realism of the movie and difficulty he must have had making it.

  13. “…denys [sic] women Plan B…”

    That’s funny. All those women kept away from their God-given… wait, can’t be God-given…mmmm…well, anyway, prevented from exercising their right to take whatever pharmaceutical they want. It’s a travesty! [end heavy sarcasm]

  14. Panda, I always enjoy your blog. I’m also a second-career physician (general internist)who started medical school at 35. I am also a military veteran (Army). I remember listening to Rush when I commuted to medical school – he’s very entertaining, even if you don’t agree with him. I used to amuse myself fantasizing that he’d come in with chest pain and I would be the only physician available – so he’d have to allow a “Feminazi” to treat him or continue to be in pain. I was really disappointed with him turning out to be just another prescription narcotic junkie, though. Funny how his fans never thought he should be investigated over that, kind of like now David Vitter’s family thinks that in matters of sexual indiscretion the press should butt out (not what they thought of Clinton…) I am more of a libertarian myself – Most of the conservatives I know are fairly hypocritical. Anyway, I think you’ll be fine. It is very tough on our families when we go through this as an older person, but once you’re out of residency, it gets fun again. My two daughters are now in their early twenties and they don’t seem to hate me for having gone to medical school late. One is third year medical student (couldn’t talk her out of it!)


    (Hypocrisy is the natural state of mankind.  From the liberal public school teachers sending their kids to private schools to the environmentalists burning thousands of gallons of precious fossil fuels to fly to environmental conferences I can point out plenty of hypocrisy on the left as well.  Like I said, we’re all hypocrites.  On the other hand, the sign pointing to Boston doesn’t have to go to Boston, if you get my drift, and it is almost an ad hominem attack to refute someone’s argument by accusing them of hypocrisy.  I get it.  People are hypocrites.  Now move on.  You can’t let your fear of appearing hypocritical cause an intellectual paralysis and the expectation that it should is one of the more disturbing trends in our excruciatingly silly age where the only remaining sin seems to be hypocrisy.

    And for ferreting out hypocrisy in others the left has a puritanical zeal no different than the urge to burn witches at the stake.

    In other words, Rush Limbaugh is not the Pope or anyone else for whom infallibility is part of their job description and his fans are fans, not followers.  It ain’t a cult and Mr. Limbaugh is not our guru.  I agree with most of his opinions but that’s because we happen to agree on most things.  He just has the charisma, the voice, and the talent to sell a radio program to sponsors while I toil away on my rinky-dink blog for free.-PB) 

  15. I have no problem with conservatives. What I simply can’t fathom is that conservatives, of all people, still support Bush. He’s running up deficits, his war in Iraq is an obvious misadventure which by all measures is helping al Queda, he seems to find the Constitution and Congress as annoyances. If you do, too, fine. But then you have to say you believe in an imperial presidency (which I assume you’d stop doing if the next president is, say, Hillary. Other than also running up huge deficits and ignoring the Constitution in the Iran-Contra affair, I sort of like Reagan too. Nice guy. Affable. I liked his “tear down this wall” thing. Had he not reversed Carter’s oil policies, we might be out from under OPEC by now; but maybe not.

    I get conservatism; I’m not much of a flaming lefty, myself. But for the life of me, I can’t understand why true conservatives aren’t out there with pitchforks and torches, demanding the end of the Bush presidency. We may never recover from the damage he’s done. Really.

    (I think a lot of you don’t appreciate the nature or the severity of the threat from islamofascism.  If you did, and if the Western World did, and if we had the political will (which we do not), we would mobilize a la World War II for a broader and more ferocious war than the ones we are currently fighting.  Instead, we wring our hands and cry piteous tears that we spend money killing an enemy who needs to be killed even though the great, great majority of Americans, by a factor of 1000 to 1, will never be called upon to cross swords with the enemy and can go about their business as if nothing has happened and everything is hunky-dory. 

    As for “true conservatives,” without demanding that the man be perfect (an inexpilcable characteristic of American politics), even those with policy differences both like and respect President Bush.  Sorry.-PB)

  16. I personally dislike most pundits who like to “partisanize” everything. Coulter and her left-wing counterparts act as if the “bad guys” (those with different viewpoints) want to destroy America and watch it burn, baby burn. I certainly feel like Hillary acts the same way – I’m pointing fingers at both sides. I think a number of Fox News show hosts like to invite guests for the sole purpose of going “Mwahahaha, I’m right, you’re wrong, and you’re an idiot!” rather than actual intellectual debate/discussion.

    That’s why I like your blog so much – you explain your viewpoints on healthcare flawlessly, and I feel enlightened on the situation after reading a number of your entries. On the contrary, after listening/watching the pundits on TV, I feel like nothing is ever accomplished. Nothing is explained, no one is convinced, and the other side hates the other side even more than before.

  17. “I am guessing that most of the more conservative people in my class know enough to keep their mouths shut.”

    Why is it necessary for conservatives to keep their mouths shut? Are we not allowed an opinion that differs from yours? I find that scary, indeed.

  18. I also want to point out that in my article, I told you about some of my beliefs but in no way did I denigrate anybody else’s or accuse anyone of being an idiot for their contrary beliefs. That’s the thing. I express my beliefs in a positive manner, a la Ronald Reagan. Why this leads to hatemail and the like (of which I have recieved some) is beyond me. All that is necessary is for you to say, “Well, Panda, I don’t agree with you, this is what I believe and why and these are people that I admire.’

    For example, if you told me you loved Obama I’d shrug my shoulders and say, at worst, “It’s a free country.” I would most certainly not attack your motivations or your intelligence.

    I love everybody except the French who are despicable, cheese-eating capitulation monkeys.

  19. “”“I am guessing that most of the more conservative people in my class know enough to keep their mouths shut.”

    Why is it necessary for conservatives to keep their mouths shut? Are we not allowed an opinion that differs from yours? I find that scary, indeed.”

    Just wanted to second Lynn’s opinion. I’m neither conservative nor liberal (I’m more of a libertarian), but surely you can see the offensive and oppressive nature of your statement… can’t you?

  20. Conservatism is not an ideology for wishful thinkers? And you’re a fan of Bush and Cheney?

    Their entire foreign policy is based on wishful thinking, completely devoid of the realism that characterized Bush I and oddly, Cheney a decade prior.

    Or maybe you mean that they have bastardized the term “conservative”, in which case I wholeheartedly agree.

    People who get fired up either way about Rush are silly – he’s an entertainer, nothing more, nothing less. He knows it, and that’s why he’s so good at it. Left wing talk radio tries to hard to convince, and that’s why they fail.

    (Rush is a political commentator, a satirist, and an original thinker.  He is very convincing in that he frames his arguments well and believes in what he is saying.  It is a meme of the left to dismiss him as just an “entertainer” while at the same time working hard to silence him, as well as the rest of conservative talk radio, through various legislative means, all in the interest of “fairness” of course.  Look at it like this.  Al Franken is just an entertainer but the Republican establishment doesn’t exactly go around attacking him like the left occasionally do to Rush.  In fact, the term “Vast Right Wing Conspiracy” was coined in reponse to the success and influence of Rush Limbaugh and other conservative radio talk show hosts.  I guarantee that you do not listen to Rush if you think he is just an entertainer.  Like I said, he made conservatism cool but that doesn’t mean his show is fluff. -PB)
    Your affection for Ann Coulter given that you don’t care for ad hominem attacks is odd, because that’s pretty much the gist of her schtick. While Rush occasionally engages in it, he’s still got more “fun”, if you will, in his show.

    (I don’t allow ad hominem attacks on my blog.  Miss Coulter is our attack dog and I have no influence with her whatsoever. -PB)

  21. “(I think a lot of you don’t appreciate the nature or the severity of the threat from islamofascism.”

    However much one appreciates it, it’s hard to escape the conclusion that Bush et al. have done a poor job combating it. When the entire Republican field in ’08 distance themselves from Bush’s conduct of the Iraq war until the start of the surge, that should tell you something.

  22. Let’s break up the political talk for a bit. A simple FYI – Steelhead return to the ocean, not salmon.

  23. Do they distance themselves because he handled it singularly poorly or because disapproving of the war is part of the political climate right now?

    I admire Pres. Bush for having the fortitude to stick it out. I think our country may be incapable of fighting wars because we don’t have the political stamina any longer. I admire a President who through force of will has fought that in this case.

  24. obtw,
    if you want to work with boarded ED docs who hare all prior service and all of like mind with you then come work with us. great job. i’m serious.

  25. “I guarantee that you do not listen to Rush if you think he is just an entertainer. Like I said, he made conservatism cool but that doesn’t mean his show is fluff.”

    Rush is not a “conservative”, at least in any Goldwater/Reagan sense, or at least hasn’t been since 2001. He’s a Republican first, conservative second. I listened to Rush extensively while Clinton was in office. Once Republicans took control of everything, he lost his edge because he had no one to blame the screwups on. Sure, he’d elevate some minor congressman here and there, but it lacked punch. Hopefully he’ll get it back with Dems in control of at least 1/2 of Congress.

    (Whoa.  Like I said, I am a huge fan of Rush Limbaugh and I’ll have you know that when the Republicans took control of congress in 1992 his rating soared and the number of “occupied” markets increased from around 400 to 600 or so.  I think his popularity has peaked but only because there are no more radio markets to conquer as you can hear Rush in every city in the United States.   I believe his program is the highest rated radio program of any genre.  Look, if you don’t like the guy just say so.  No hard feelings.  But your attempt to be dismissive is typical of the left who can’t decide whether they should a) ignore conservative talk radio b) pretend it’s only uneducated rubes who listen to it and thus of no consequence, or c) attack it at every opportunity as a threat to democracy.

    The other thing is, it’s just a radio program.  An influential one but Rush just articulates conservative opinion, he doesn’t drive it.  -PB)

    “Miss Coulter is our attack dog and I have no influence with her whatsoever.”

    It’s just odd that you would have such a personal distaste for ad hominem attacks but condone Coulter, that’s all. But you do illustrate the problem with modern politics – you think you’re on a team, and she’s a member of it. That distorts issues into “my side/their side” and reduces them into either/or propositions, when in reality, most problems are not as simple as the RNC and DNC paints them.

    (The left is like the playground bully who can dish it out but can’t take it.  Various liberal luminaries have made careers out of accusing conservatives of being racist, greedy, baby-seal killers and have won accolades from the major media as thoughtful statesmen. Let an articulate conservative woman turn the tables and my, my, how they shriek in horror.   I don’t allow ad hominem attacks on my blog because it’s my blog and I don’t want it to turn into a forum where people vent against “that bitch Hillary” or that idiot “Chimphitler McBush.”  This ain’t the Daily Kos, we are all friends, and there is nothing more pathetic than a small-minded person petulantly spinning his conspiracy theories to explain why everything in the world is not structured the way he would like.-PB)

  26. Why is it necessary for conservatives to keep their mouths shut? Are we not allowed an opinion that differs from yours? I find that scary, indeed.

    I was being intentionally vague about my opinion on the subject, but I find it interesting that you all thought I was ADVOCATING that conservatives keep their mouths shut. My point was simply that they wisely keep their mouths shut in order to avoid being lambasted by the liberals in the class. Listening to moral self righteousness on either side can be tiresome. Now, what was I saying about walking around with one’s brain unplugged…..

  27. “The left is like the playground bully who can dish it out but can’t take it.”

    Are you serious? After 13 years of Republicans being in charge, or at least sharing power, are you really calling “the left” a bully?

    When Ann Coulter qualifies as an “articulate conservative woman” then you can tell the movement has lost its way from the days when Elizabeth Dole or Margaret Thatcher were given that sort of title.

    I’m not questioning your decision not to allow ad hominem attacks. It’s a good one. It’s just odd who you put on your “team” given your clear preference for intelligent debate without meaningless name calling.

  28. “I was being intentionally vague about my opinion on the subject, but I find it interesting that you all thought I was ADVOCATING that conservatives keep their mouths shut.”

    If you’re going to be vague, you open yourself to misinterpretation. I’ll make a slight edit to my original statement; Why is it necessary for conservatives to keep their mouths shut? Are we not allowed an opinion that differs from yours? I find that scary, indeed.

  29. Ach. Missed the edit:
    Why is it necessary for conservatives to keep their mouths shut? Are we not allowed an opinion that differs from yours? I find that scary, indeed.

  30. obtw,
    i thought the first year of medical school was terribly hard but then again i was four years out of college and was a history major. the hard sciences kicked my ass but i did fine.

    my class was heavy in engineers and masters of biochem etc… folks and they had a leg up.

    also, the grade spread was eye-opening. i scored 89 on my first anatomy exam and thought i had done well. the grade spread was 84-100 and i was in the bottom 1/4 of it. wow.

  31. Panda, I respect your opinions and appreciate your contributions to SDN but wow…this post was a real eye opener. How am I supposed to enjoy reading the blog of someone who thinks Dick Cheney is a good guy and listens to Rush? Come on dude, Rush is a self-important jackass who flys around in million dollar jets, all “earned” by his radio show where he engages in only the most inane political tripe in existence. I thought you were smart :/

    If you actually listened to Air America radio, you’d realize that it’s not just “Bush sucks” over and over, many hosts are super witty, intelligent, and do their research. I wouldn’t listen to anything if it wasn’t well done, and it is.

    I’ve noticed that you constantly insert derisive comments in your writing directed at liberals and others who you feel do not possess enough “common sense” or “responsibility.” All I can say is, you need to get out more. Maybe your Marine background didn’t expose you to a lot of intelligent people or what, but wow… couldn’t have things more mixed up in your head.

  32. Whoa. What we have here is a difference of political outlook. Conservatism of the kind espoused by Rush, Mr. Cheney, Former President Reagan, and other prominent conservatives is a legitimate world-view built on solid philosophical ground. The fact that you disagree with some conservative theories does not mean that I have things mixed up, just that you probably cannot make the intellectual leap required to consider that you, yourself, might hold a few beliefs which are wrong.

    Why the danger quotes around “earned.” Rush has built a one-man media empire through nothing but talent, determination, and hard work. Even his critics agree that he is one of the hardest-working guys in radio. Again, the fact that you disagree with him does not mean he is wrong, just that you disagree philosophically with him.

    I reiterate, Vice President Cheney is the smartest guy in Washington. And he is a decent guy. I’ve actually met him. (Many years ago when he was in between gigs.) Again, your dislike is nothing more than a difference of political opinion.

    I suggest when you interview for medical school you announce in a loud voice your opinion about the intelligence of Marines because I guarantee that at least one attending physician in earshot will have been either an enlisted Marine or a soldier. While it is true that it doesn’t take a rocket scientist to be a Marine, the Corps is full of intelligent young men who decide to “get out more” and have a little adventure rather than go to college, an activity that is terrifically over-rated for all the good it does most people.

    And I deride liberals because they deserve derision. Not one of the social pathologies of which I see many every single day are anything but the result of liberal social policies gone terrifically astray.

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