Marching Up Country

(With Apologies to Xenophon)

The campaign draws to a close and will end like many such expeditions do; in a victory of sorts for I have certainly marched into and through the Empire of Medicine with my fellow mercenaries, outwitting the enemy on many occasions, laying waste to his crops and orchards when necessary, and always keeping one step ahead of his mighty armies that sought to harass and encircle me.  And yet the cost has been immense and I arrive at the end of this journey with treasure sorely depleted, footsore, battered, and weary with miles to go until I am truly home.  Still, having survived this far seems a monumental achievement although at the time it was just a slow slog through inhospitable lands, a wretched journey punctuated by moments of excitement and terror.

Now crest the last hill and view, stretching to the horizon, the glittering waters of the Black Sea beckoning to us like a welcome friend and a reminding us that that we have now come through the worst part of it although many adventure still lie ahead.

The sea!  The Sea!

What I Now Know

Most of the job of any doctor is ridiculous. So ridiculous in fact that to get through the the day it is necessary to engage in a little doublethink as you pleasantly churn your way through the reams of useless paperwork, the incredibly asinine patients who you treat just for placebo’s sake, the waste, the inefficiency, the bureaucracy, and every manner of obstacle between you and what you must occasionally convince yourself is a meaningful job.  I know this very well.

Occasionally I give narcotics to an obvious drug-seeker or start an enormous work-up on a patient who is surely a malingerer and the nurses give me that sarcastic, rolling-their-eyes kind of look to imply that I am too trusting of the patients and if they were in my position they’d throw the bum out with a couple of Tylenols and big glass of water.  Fair enough.  Cynical they may be but they are usually spot-on in their assessment of who is really sick and who is missing some essential gonadal chromosome.  Although frequent fliers and malingerers occasionally present with hidden but extremely severe acute medical problems, for the most part they and the constant procession of patients with minor complaints need no more of a workup but a good history, a focused exam, and an admonition to return without fail if their symptoms don’t improve.  I suppose that most of them don’t need to be seen at all and surely not in an Emergency Department.

In other words I know full well that most of the money with which we hose down the patients is poorly spent and completely ineffectual.  I understand this.  I get it. Thanks for ripping off the scab and rubbing salt in the wound.  You do whatever it takes to get through your day but for my part, it is often necessary to suspend my disbelief and pretend, for sanity’s sake, that every abdominal pain, vague back pain, nebulous headache, and strange constellation of non-specific symptoms is going to pan out; is going to reveal itself to be that one in twenty cases that justifies all of this education, all of the hours, all of the money dumped into my training, and the devastation of my personal life.

Even the Bumper Stickers Suck

Used to be that the most durable object on the planet was a bumper sticker.  So durable that they often outlasted the car.  In fact, you can still see the occasional Clinton-Gore offering, slightly faded but robust, grimly adherent to a lovingly maintained Nissan Sentra.  I mention this because I still see the occasional Obama bumper sticker proudly displayed by the vestiges of those still in abject thrall of the Serpent King Ra-Obama and although it has been less than a year, the stickers are faded, peeling, and look like something printed hastily in some North Korean re-education camp before the entire shift was taken out and shot.

Which is sort of a metaphor for Obamerica, a country that is rapidly turning into a crappy third-rate nursing home where nothing is made, nobody does anything of value, and the only growth industry besides government are breathless special interest groups working hard at the kind of socially conscious jobs beloved of neighborhood organizers, vying for and spending money we borrowed from the Arabs and Chinese to mold another generation of Americans into beggers, whiners, and shrieking social parasites.  The country is kind of peeling at the edges and fading, so to speak.  Even the Russians are laughing at us, completely baffled at our headlong rush into Marxism, statism, socialism, and all of the other -isms that  once, long ago when we were men, we defeated handily.

And the Sun-God hasn’t a clue.

Like I said, even the bumper stickers suck.

18 thoughts on “Anabasis

  1. Congrats on finishing Panda! I hope this journey proves to be worth it in the long run for you.

  2. It sounds like you’re half way to ending it all.

    Before you do, my suggestion is to page through The Myth of Sisyphus. And be sure to pen notes in the margins along the way. That way, you can claim you were being existential writing the shit and nonsense your online commentary exudes. And they all be fooled that all this was just a grand and medically tinted homage to Camus.

    (Go fuck yourself. Existential enough for ya’? -PB)

  3. Wow – totally jaded and you are just finishing residency? Best you move to Texas (with all the other Bush-Cheney lovers)and work with Scalpel in his free standing “ER”.

    (I am not “jaded.” I am just a realist and as I did not just fall off of the cabbage truck, you can stick your condescension up your ass where it will keep your head company (metaphorically, I mean). As if it takes a special degree or some divine insight to recognize that much of what we do in American medicine is ridiculous and expensive. -PB)

  4. I must concede you have one of, if not the most, entertaining yet informative medical blogs on the web but your partisan bickering about Obama being the cause of our continued downward spiral in this country is more reflective of your narrow, unenlightened ideology than anything else.

    It’s really a shame since you are are such an astute observer in some areas and then in the same sentence read like a pamphlet from the Cato Institute.

    I realize you probably lack the time or maybe even the motivation to study history, politics, theology etc but then perhaps you should refrain from commenting on these things as your assessment is embarrassingly off base. For example, Obama leading us towards statism? LMAO. Do you know absolutely anything about the history of this country post-WWII? It’s a bit like saying Khruschev lead the USSR towards Bolshevism. And socialism? are you serious? since the Depression this country’s economy has been helplessly dependent on statist socialism…for the wealthy. Take away the pentagon system of granting contracts to high tech industry, defense contractors and selling arms to nearly every country across the globe, promoting instability and conflict and our economy would collapse like a house of cards.

    So in the end I’d since your fantastic at giving an analysis of the day to day skull drudgery of the medical field but still need quite a bit of work when it comes to the big picture. Best of luck with EM though and I will still continue to enjoy your rants.

    (Are you for real? The difference between my education and yours is that yours was indoctrination in the usual leftist silliness and mine was a classical liberal education that included history, economics, civics, and things that you only know enough about to jerk your knee. Yer’ boy Ra-Obama, for example, in an idiot because all he knows about economics is the same luke-warm Marxist tripe that you know and his plan to stimulate the economy is nothing more than “kicking the can down the road,” essentially printing worthless money to spend on worthless efforts that are not exactly going to generate anything of value and praying he is out of office or re-elected before the bill comes due (in the form of inflation). He is either an idiot or he wants to turn us into the same kind of decaying mammary state that is typical in Europe, a continent that to a country is desperate to find ways to pay for the benefits they promised their people but which no longer can be sustained.

    The French riot at the slightest effort to trim their lavish social welfare benefits. Is this the kind of country you want? A place where everyone has their hand out and nobody is stupid enough to be productive? I weep for you and the change you so richly deserve. Too bad you’re going to destroy everybody else when you get what you have coming to you for being such an idiot. -PB)

  5. Wow,

    I greatly enjoy how you instantly assume how and where I was educated. I’m afraid that you, in fact, are the indoctrinated one, believing that some archaic authoritarian learning style is preferable to another and therefore fosters anything other than indoctrination and misguided faith without any empirical evidence to back that faith up( much like your belief in Christ which you cling to)…I on the other hand am an autodidact who is against all ideologies. My political beliefs can be summarized by espousing people’s right to voluntarily organize for a common purpose and to have self-determination without coercion from government, corporations, or any other autocratic institution…

    And actually I mentioned absolutely nothing about myself in my post.

    I don’t recall resorting to ad hominem attacks against you in my original post. In fact I lauded your contributions in helping me better understand what I’ll being experiencing a couple years from now when I am in your shoes.

    I also never claimed to be an Obama supporter/apologist. Nor did I ever claim to be a Marxist. In fact if you are in favor of the US right’s version of “capitalism” (which is a misnomer if ever there was one) then you are more of a Marxist than I am.

    And as for decaying mammary states in Europe I am pretty certain Sweden, Finland, and Denmark, by most objective measures have a higher standard of living than the US government provides. If one looks at governments from a utilitarian perspective, It would be logical to choose a socialist government to a pseudo-capitalist centrally planned statist economy with upward redistribution of wealth–at least for the majority of citizens.

    To instantly use the right wing heuristic of the French is pathetic albeit convenient for argument which is a flimsy one.

  6. I am not surprised to read the anti-Obama rants on your blog but I feel the vitriol has stepped up as of late. Again this is not surprising – when you are espousing a minority view it’s hard to not find yourself pushed even further from the ‘mainstream’. To paraphrase a talented writer, when you find yourself on the losing side of an election which you cared deeply about, “It’s -supposed- to taste like a poop hot dog.” I suppose you will take about as much comfort as I did from this sentiment about 8 years ago, but I’ll say this – just trust us, we know what we are doing, and in the end you will hopefully see that we were right.

    By the way, welcome back to blogging. And congratulations on the upcoming graduation. It feels like just yesterday that I was first reading your stuff, while you were still at Earl. Time flies.

  7. Regarding PB’s reply to JE on June 4, 2009 7:29 pm:

    JE was stating that the brand of socialism that you’re ascribing has already been around for decades. I did note he wrote nothing in support of Obama nor his policies. And you come back, not with a direct counter to his points (except a response to the lack-of-education silliness), but with name-calling and an attack on the administration’s approach to the economic crisis. Talk about knee-jerk. More likely, it was a quick defensive response to be being called ignorant. My respect for the rationality of your written thoughts declines.

    Silly partisan politics talk here detracts from the quality and purpose of your blog, in my opinion. Of course, it’s your blog on this site, and you can do whatever you want. Still, wouldn’t you think it’d be in poor taste to post personal photos, recipes, and movie reviews? Partisan political opinion? I hope you stick with what people like me read this blog for, and that’s not economic and political opinion, unless it pertains to medicine. I suggest a side link to off-topic posts. But really, I don’t care; it doesn’t bother me. It’s more like coming across an article supporting Mayan-creationism in a supposedly scientific journal. kinda degrades the credibility of everything else.

    (The truth is that if I wrote anything in support of the Sun God, Ra-Obama, you’d be falling all over yourself praising me for my wisdom and open-mindedness. The real problem is that you can’t stand any criticism of The Serpent King as you are either in his thrall or afraid to criticize lest any should think you mean-spirited or, Obama forbid, partisan. Naturally you can and could say anything critical of George Bush or Dick Cheney and win accolades from the wonkatariat with no one ever questioning your motives or your right to say it. I guess you need to scrape the “Dissent is the Highest Form of Patriotism” bumper sticker off of your Prius.

    I suggest you get your own blog and write what you like. I ain’t a public service, this isn’t PBS, and there is no contractual requirement that I sanitize my blog for your protection. -PB)

  8. Seriously? Aren’t you a little over the hill for such sophomoric, rhetorical tactics?

    You tout your classic liberal education, well how about you put it to use. Making a strawman out of every individual who disagrees with you is not only indicative of black & white thinking and a dearth of any capacity for nuance (Piaget might have labeled you psychosocially stagnant), but it really reflects poorly on your status as an educated professional.

    As someone with a degree in social psychology, I find that fact that you are so sharp in one aspect of life an yet so obtunded in another is fascinating. I guess we all have our limitations but serious, for your whole career to be based on the edifice of critical thinking skills and yet for you to be a rabid reactionary in the political arena is the height of irony.

  9. PB: “The truth is that if I wrote anything in support of the Sun God, Ra-Obama, you’d be falling all over yourself…The real problem is that you can’t stand any criticism of The Serpent King…”

    Where was it that I showed disapproval of your criticism to Ra-Obama? I didn’t. nor did I volunteer my political opinions which are irrelevant to the points I attempted to make. I specifically criticized your logic in your off-target reflex to a previous post, and you automatically lumped me in with tree-hugging, chai latte-swigging, Che Guevara T-shirted San Franciscan Ra-bama worshippers. What a simplistic world view. Someone makes a specific criticism, and it’s taken so intensely personal that he’s turned into a whipping boy, oblivious of whatever the specific criticism was. It’s funny because I’m as apolitical as anyone gets, so the real truth is that you’re flat wrong on your assumption. I just like being a smart-ass and poking at arrogance. And regarding my comment that politics detracts from this medicine blog, I’d feel the same way if you spoke glowingly at length about Obama or any politician. Again, I really don’t care what you write and didn’t tell you what to write, and that was clear. ‘Twas only a comment. Now who is it that can’t take criticism?

  10. While I don’t align myself perfectly with PB’s politics, it IS his blog. Which is to say, he can write about whatever the hell he wants. The rest of us have the option to vote on whether we think it’s worthy content via our patronage.

    Thanks for blogging again, Panda. Your writing, even if I disagree with the politics sometimes, is refreshing, amusing, and more often than not, insightful.

  11. “I realize you probably lack the time or maybe even the motivation to study history, politics, theology etc but then perhaps you should refrain from commenting on these things as your assessment is embarrassingly off base.”

    Earth to JE; that was an ad hominem attack.

    “I don’t recall resorting to ad hominem attacks against you in my original post.”

    That’s not surprising given the number of brain cells and electrons you wasted in florid, verbose, condescension.

    “I greatly enjoy how you instantly assume how and where I was educated.”

    JE, that is precisely what you did to PB. You seriously need to remove the beam from your own sarcastic eye.

    “Seriously? Aren’t you a little over the hill for such sophomoric, rhetorical tactics?”

    You mean like this?

    “Making a strawman out of every individual who disagrees with you is not only indicative of black & white thinking and a dearth of any capacity for nuance (Piaget might have labeled you psychosocially stagnant), but it really reflects poorly on your status as an educated professional.”

    Now that is some sophomoric rhetoric.

    JE, I am tempted to tell you to get stuffed, but it is clear that you already have done so.

    thomas chong;

    Why don’t you be a smart-ass and poke at arrogance on your own bandwidth where there is at least a finite probability that somebody might appreciate it?

    JE and thomas chong;

    Please get your own blogs. Oh yeah, AND STAY THERE!

  12. PB MD says it like it is. He does so with great wit and humor.

    Repeatedly, over the years, I have found in this blog precise accounts of exactly what I have seen in this precarious system.

    I have repeatedly been almost shocked by the accuracy and insights of PB MD. I have repeatedly driven to work with my own concerns about the day ahead, considering what I have read here. And I have repeatedly laughed during the day on recognizing PB’s insights into the practices and protocols of the job and system.

    In short, this, in my humble internet opinion, is an excellent, outstanding, unique blog.

    I look forward to reading more.


  13. Regarding JE vs PB

    PB, there you go clinging to your God and your guns and your years spent in two different careers in the real world, which all combine with your education to form a ‘big picture opinion.’ Don’t you know that this pales in comparison to a degree in social psychology?

    JE, you say that you will be ‘in [his] shoes in a couple of years’ which I take to indicate that you have some exposure to medicine as it is practiced rather than as it is esteemed. This experience has validated all of PB’s medical assessments and yet has given him no credibility to comment on any other areas in life (in which he also has experience)–at least as they conflict with autodidactic, unobtunsive social psychology degrees.

    Thou shalt never let the real world interfere with the omnipotence of academia.
    — (I believe this is the Mission statement of the Sun God’s economic team.)

  14. PB: I think you’re wasting your breath replying to those commenters who obviously haven’t passed basic economics. It would probably be best to just continue to tell the rubes to go fuck themselves and leave it at that.

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