Enemy of Mankind

Why, oh why, is it impossible for us to do all of our grocery shopping in all of one place? I live within walking distance of both a Trader Joe's and a Stop 'N' Shop. The produce and refrigerator section at TJ's, I've discovered, is not reliable, and 95% of the stock at SNS is loaded with high fructose corn syrup and other unnatural chemicals.

I was shopping at SNS this afternoon, and I passed the peanut butter, which reminded me that I needed to get some. I usually get the all natural peanut butter at TJ's, but in my laziness, I didn't want to make two stops. So I perused the selection at SNS. I settled on Skippy Reduced Fat Creamy Peanut Butter, with 25% less fat. This stuff is EVIL. It neither tastes like peanut, nor is it creamy. What they took away in fat, they replaced with loads of sugar and corn syrup, masking whatever peanuty taste that used to exist in the product. There's so much sugar that the texture is almost grainy, making me think of that jar of honey that sits too long in one's cupboard.

Culinary recommendation of the day:

AVOID Skippy Reduced Fat Creamy Peanut Butter.

I'm going back to Natural.

Axis of Quasi-Evil

This is my list of individuals and businesses that I am sure exist solely to prevent me from accomplishing my personal goals.

Brookline Booksmith: One goal of mine is to remove the clutter from home. This clutter is mostly piles of unread medical journals and, increasingly, books I've finished reading. I don't have that much shelf space around here to store all these books, so I've decided to donate used books to a small store around the corner which helps fund the Women's Studies Research Center at Brandeis University. And I've decided to put a stop to me purchasing more books and instead exploring the extensive Boston Public Library System. But then Brookline Booksmith has to go and open up a 'Used Books' section in their basement. On top of all that, they have a bunch of sale books in the regular part of the store for 50-60% off list price. My last visit there, I found 4 discounted books that were on my 'To-Read' List. And I bought each of them. Therefore: Brookline Booksmith is in the Axis of Quasi-Evil for wrecking my budget and the orderliness of my home.

Anna's Taqueria: Included in the AQE for their cheap, delicious, waistline-bulging burritos.

Gourmet India: These people are in the AQE for their Indian curry buffet, loaded with ghee. Now my coronaries are clogged with this:

Across-the-hall neighbor: Every other Sunday or so, this stinky fish smell invades my apartment because my across-the-hall neighbor cooks it. I spend most of my Sunday now trying to fumigate the odor from my home. AQE-listed for making me waste time on this chore.

Next-door neighbor: for late-night techno and making me lose out on sleep. I don't hate techno, I've been known to listen to a couple of techno tunes, but I certainly don't need that driving bass beat to put me to bed at night. Come to think of it, I've never even met this person. I don't even know what he looks like. How sad is that? I've talked more to people I've merely met online and I've not ever said one word to whoever lives right next to me. Perhaps I should use this opportunity to not only introduce myself but also familiarize him or her with the Chopin Nocturnes.

*******

Music recommendation for today's post

On the Transmigration of Souls, by John Adams. Commissioned by the New York Philharmonic in memory of the heroes and victims of September 11, 2001, this piece by the minimalist composer John Adams is haunting, moving, and heart-wrenching. The work begins with a child's voice intoning the word "missing" repeatedly. Gradually, other voices join in the chant, including the reading of victim's names by friends and family members, superimposed over a children's chorus, an adult chorus, and symphony orchestra. Often, the spoken words give a more personal description, such as "Jeff was my uncle" or "brown hair, brown eyes" or "I miss him so much." Some of the phrases are taken from the 'Missing' posters that were put up around the World Trade Center Site after the attack, evoking the emotions, hustle, and bustle of the city. Towards the middle of the piece, the choruses and instruments crescendo eventually drowning out the voices. The crescendo fades away and we hear the return of the sounds of the city and the voices of mothers who lost their children reciting more names. The last words we hear are a woman saying: "I love you."

This piece really brought back many of the emotions I felt during those days and weeks after September 11, 2001, something I'd forgotten with time. Having lost a friend on that day, I was looking for a way to reach back and revisit those feelings of loss and vulnerability, to remember her. On the Transmigration of Souls did that for me. Unfortunately, my words don't do this work any justice. Try to listen to it at least once. A powerful tribute.

Lardo Reprise

As if anyone should have yet another reason to not be overweight, a Swedish study gives us this:

Increased BMI Correlated with Dementia Risk in Men (abstract)

Here are the depressing numbers:

• BMI between 22.50 and 25.00 carries with it a 1.73 increase in hazard ratio.
• BMI between 25.00 and 27.49: a 1.93 increase
• BMI between 27.50 and 29.99: 2.30 increase
• BMI over 30.00: 2.54 increase
• no elevated risk in men with BMI's below 20.00

Okay, I'm all for being healthy (to date, the goal is to keep your BMI between 18.5 and 25.0 for optimal health), but for me to get a BMI below 20 would require me to lose all body fat and lop off both legs at the hip.

Epiphany Symphony - III. Lardo

III. Lardo - Costruzione in pieno dei perdenti

ivory towers
erected for learning Truth
merely a façade

hidden from the light
slowed growth, decay creeps along
foundation crumbling

Imagine what the academic world would be, if they actually had to go out and do a hard sell on people to actually consider attending graduate school. I get the impression that, as in professional sports, academia doesn't have to spend a large portion of its budget on advertising - sports get an entire section of the newspaper to talk about their product, presumably for free, and they only have to hand out a couple of press passes every game, maybe put out a decent food spread for the journalists, who then create a stir for the adoring public. Support, both financial and emotional, for the local team is almost genetic, handed down from parent to child.

Similarly, the world of academia rides on the notion that Education is the be all and end all for upward mobility in today's society. They dangle the PhD carrot out there, and people come running. However, in my opinion, the PhD degree doesn't hold the same luster it once did. Perhaps due to oversaturation of the scientific community, jobs for freshly trained PhD's are harder to come by. The biotechnology industry seems to be showing signs of saturation, too, so that area hasn't been quite the haven for freshly graduated trainees. While unemployment of PhD's is relatively low, I believe that this is partially because more people are spending longer periods of time in postdoctoral positions. Before getting that first academic position, newcomers to the market are forced to take two, three, or even four postdoctoral positions - each lasting up to three years of training.

You'd think that the academic world would have the foresight to deal with the demands in the work force, but the sad truth is that, at least at BUSM, the graduate student office has precious little information about their graduates and where they end up. But no, I've discovered their philosophy. So, are you ready? It's time for..................

LESSON IN LIFE #2
(Upper Management Psychology)

There is no 'problem' as long as you never acknowledge its existence.

With this approach, the graduate student office is able to ignore such issues as:

1. Mental or emotional well-being of the graduate student.
2. Fallibility of the graduate student advisor.
   
3. Job placement of their graduate students.
4. Graduate student health insurance of a quality equivalent to their medical student counterparts.
   

Rather than worry whether their graduates are finding jobs once they leave here, they choose to blindly forge ahead, building more lab space, and thinking about taking on MORE graduate students. Why? Because the sad truth is that the graduate student is cheap labor to them. The stipend is less than the salary of a technician, the health benefits are cheaper, plus the student will probably stay around longer than the technician (I think the average turnover of a lab technician position is around 2 years). In the end, students put in their time and their effort, and they're awarded with the PhD.

But is the degree worth it any more? I've already mentioned the bleak employment opportunities awaiting these people. The department pays for graduate student tuition, I believe to be an artificial benefit. Money gets transferred from the department coffers to the medical school, which redistributes it amongst the departments - pretty much amounts to you moving coins from one pocket to the other.

How about the quality of the degree itself? Requirements for awarding a PhD in the biomedical sciences are surprisingly subjective. Some people are awarded with less work, some with more, and some are awarded the PhD just so they get out of the primary investigator's hair.

Is graduate education totally useless? I'd say no, but it definitely needs some retooling, while taking into account the job market for the graduates. Anything less is irresponsible.

Coming soon: a portrait of Hank the Surly Penguin

Tribute

Change your thoughts, and you change the world.

- Norman Vincent Peale

I'm stealing a page out of my friend Dave's book, and creating a post just listing a positive thing in my day. So, Dasro, this post is dedicated to you.

Today, I performed a simple act - simple, but very significant. One of those significant events that just seemed a long way off, and seemed so improbable, that focusing on it daily would have been painful and counterproductive. Yet having it in the back of my mind was reason enough to get out of bed and into lab every morning. Friends, I'm speaking of finally turning in that letter of intent that I wrote several days ago to our beloved Registrar.

The Peale quote above certainly applies here. Armed with the knowledge that I'll soon be learning medicine in the clinic, my thoughts have been more positive, and my demeanor has been energized with hopeful energy.

So, to summarize - good thing for the day: Another Step Towards Moving On.

Update: Good thing of the day #2 - IT'S A GOOD-THING-OF-THE-DAY ORGY!!!

I just entered my preferred schedule of third year clinical clerkships. This is kind of an important issue as it has been almost five years since I really studied anything remotely related to medicine. MD/PhD students have to consider this fact when we consider the third year schedule - we'll be compared with the regular MD students who will have this information much more fresh in their minds. I solicited advice from three people (special thanks to Kris, Becca, and Dave) and got so much helpful information. Kris and Becca gave me the scoops on where the best clerkships would be, while Dave gave me some more empirical advice on scheduling. Basically, Dave thinks I should do my harder rotations when I have more energy and my easier rotations when I tend to feel burnt out. Sooooooo....my ideal schedule would be:

1. Surgery, 10½ weeks - this would be July through September; a tough rotation, but might give me the best chance to compete with my peers as we're all equally in the dark about anatomy at this point. Although this is my chance to make Daddy proud. I can't mess up this one. Oh, good. More pressure.
   
2. Internal Medicine, 11 weeks - October up to Christmas; this will be really tough, as the critical 2nd year course 'Biology of Disease' will have been five years ago in my past
   
3. Family Medicine, 6 weeks - End of December through January; my biorhythms are lowest in the winter months - this will be my first 'easier' rotation
4. Pediatrics, 6 weeks - February through March; well, I like working with newborns and young kids...can I stand dealing with the teens?
   
5. Psychiatry, 6 weeks - April to mid-May; "I'm not only a student, I'm also a client."
   
6. Obstetrics and Gynecology, 6 weeks - mid-May through June; hopefully I'll be full of pep for this one, another intense clerkship

I have to admit that I didn't think too hard about this scheduling stuff. There's no data that shows that the order of our rotations really matters in our performance. Plus, hoping for this schedule is wishful thinking. There will be 165 medical students doing third year clerkships, and they have to divide the class up to fit everybody into limited clinical space. So this scheduling thing basically turns into a lottery. With my luck, I'll get choice #165 and have the 'nightmare schedule.' However, due to the fact that I've spent so little time really worrying about it, I recognize no nightmare schedule. HOORAY FOR IGNORANCE! Anyway, I could get a bad schedule, and I'll still laugh out loud because I know I WON'T BE IN LAB.

To summarize - good thing for the day #2: I put in for my third-year clerkship schedule. I'm on my way!

Epiphany Symphony - II. Andante

II. Andante - Maturità in ritardo

nearing middle age
the perennial student
a dateless wonder

longing for oblivion
I am one with solitude

fear paralyzes
inward focus finds solace
eternally one

The medical school curriculum is such that the more you study, the more you learn about yourself - how the systems in the human body work, how we're born, how we die, and how we think. One topic that jumped out at me during our first year in Psychiatry was the Heuristic Stages of Development of Harry Stack Sullivan. In short, the stages are separated by changes in type of thinking and approach to interpersonal relationships. Each stage has an associated goal. Failure at any stage leads to isolation in later life. A summary of the stages and the goals as far as I can remember:

1. Infancy - goal: develop orientation to the world - lasts from birth until the onset of articulate speech
   
2. Childhood - goal: ? - lasts until appearance of need for playmates
3. Juvenile Era - goal: develop logic, rules of causality - lasts until
4. Preadolescence - goal: develop relationship with individual of one's own sex - lasts until interest switches over to that of the opposite sex
5. Early Adolescence - goal: dealing with feelings of lust, security
6. Late Adolescence - goal: combine friendship needs with sexual needs (I think most men struggle here)
7. Adulthood - goal: establish relationship of love with some other person. It is this relationship from which the individual will derive the most satisfaction in life.
   

When I read that, some little voice nags at me saying I tripped up somewhere. I worry that I'm too used to being single, as if incorporating another person in my life would totally mess up my schedule right now. I've achieved full equilibrium in my life, you know, balancing school with, um, sitting at home with my XBox.

Plus all these blissfully happy couples I know have been totally useless. Or perhaps you all think I'm not worthy. That's IT!!!! You know what? Screw you, too. You can keep your Valentine's Days and your anniversaries and your 'Oh, we're so happy' attitudes and your kissing under the mistletoe and oh-so-great lack of dateless New Year's Eves and...

Actually, no, I'm not bitter. My oneness is really all my fault. I recognize the fact that I'm alone due to my insurmountable ineptitude - bad timing, forgetting English on the approach, 'Smooth' is NOT my middle name, etc. - and, on top of that, given my feelings about where I spend the bulk of my time, I'm not exactly the most fun to be around nowadays. I definitely need a change of scenery. Not to mention an incredible shyness and lack of confidence - insecurities that were going to disappear by getting that oh-so-important MD/PhD degree. Come to think of it, I haven't really tried that...using the 'Hey, wanna date a honest-to-God real MD/PhD?' pick-up line. I hear it works gangbusters.

Um, go away. I'm talking to my blog. And the penguin.

Postcards from Mikey

I always thought that letter-writing was for individuals that were too caught up in themselves to realize that no one cared about their opinions. I snickered at the suggestion by my grade school teachers that we should write to the newspaper or to our elected officials. I always thought that it would be an exercise in futility - would my letter ever actually be read by the person it was addressed to? If so, wasn't my opinion destined for the circular file?

Well, all grown up now - well, at least semi-grown up if not from a maturity standpoint - I've changed my mind. I've decided that letter-writing is cool. If only because I've now become one of those self-absorbed individuals who thinks my opinion actually matters. Better yet, I find that writing these things and mailing them out is worth the time therapeutically. I wrote the following to the Education Department of the United States Government:

Please forward to Secretary of Education Margaret Spellings.

Dear Ms. Spellings

First of all, let me commend you for taking such a brave stance in the values that are taught to our nation's children. Your crusade against the children's program 'Postcards from Buster' has shown the country that there is truly a movement in the media to foster acceptance towards hateful alternative lifestyles.

Unfortunately, another piece of media propaganda has been released for public view, and there are none to be seen that will fight it. Ms. Spellings, I'm speaking of the beloved Winnie the Pooh, which has now been bastardized into a character that stands for gay propaganda. 'Pooh's Heffalump Movie' has just been released into theaters, and, while I understand that this film has not been shown on public television, I've no other recourse than to contact you, our heroic crusader, to fight this movie. Because the 'Focus on Family' organization has given its blessings to this 'family' movie (Focus on Family review here), people like you and I are alone in pointing out the evil message that is the centerpiece of the cartoon.

Let me point out the following:

1. Heffalumps have been these mysterious unseen creatures in the Pooh books. Until now. The supposed message for youngsters in this movie is one of tolerance. That Heffalumps have lived in the 'other' woods elsewhere. Only NOW are they discovered. What does this sound like to you? That's right, it sounds like COMING OUT OF THE CLOSET. That's what the GAYS DO.
2. I've attached a photo file from the movie. Look at the 'Heffalumps.' What is that on their heads? Hair? I think not. That's alternative GAY fashion. Yet another blatant hint that these creatures are cartoon representatives of the GAY community. Perhaps that gay heffalump is pictured with its gay offspring. That would be crime enough, but perhaps that smaller heffalump isn't its offspring but its younger gay LOVER! This shows how gays corrupt the youth in our society.
   
3. Where is the Heffalump on the left of the picture putting his trunk, exactly? He's sticking his proboscis up Roo's rump! And Roo is enjoying it. I'm absolutely appalled the MPAA didn't put on the 'X' rating stamp for this scene alone! THIS IS SHOWING OUR CHILDREN THAT GAY SEX IS ACCEPTABLE!
   

Ms. Spellings, please alert parents to the harm this film will do to our children. Reject this evil message of tolerance immediately.

Yours in Christ,
Michael

Perhaps this little bit of correspondence will backfire, and my likeness will be put into press as the posterboy of the anti-homosexual lifestyle crusade. Let's hope not, but I've little faith in the religious conservative's ability to appreciate sarcasm.

*******

Another reason to avoid letter-writing is the huge waste of paper. Paper is my enemy. If you look around me in lab, I'm surrounded by paper. Piles of journal articles to be read, raw data, scores of little post-it-sized notes reminding me of things to do, of experiment recipes, some rudimentary math, primer sequences, and meeting reminders. I personally must be responsible for the decimation of at least one medium-sized forest.

However, I had to write the following letter, and, I must confess, the sacrifice of the aforementioned forest was worth it for this cause:

## Xxxxx Road, Apt. ##
Brookline, MA 02446
February 15, 2005



Ellen DxXxxxx
Office of Registrar
### Albany St., A-414
Boston, MA 02118

Dear Ms. DxXxxxx,

I am currently in the graduate school portion of the MD/PhD program at BUSM. My original class was that which graduated in 2002. Please consider this letter as official notification that I will ENTHUSIASTICALLY join the 3rd year class this summer, starting in June 2005. I mean, the idea gets me so excited that I'm going to go take a cold shower right now. So GO AHEAD, BABY! TYPE IN MY NAME RIGHT NOW INTO THAT DATABASE YOU HOT MAMA OF AN ADMINISTRATOR. STROKE THOSE KEYS. HARDER! FASTER! SAY MY NAME! SAY MY NAME!

Whew! Smoke?

Sincerely,



Michael

Yeah. I think that got my point across.

Epiphany Symphony - I. Adagio

I. Adagio - Verità dolorosa

sanity fades 'way
like water off hot pavement
an unforeseen fate

I am but a slave
false prophets were my beacon
how did I not see?

I feel my life draining away. I'm going to lose it whether I work myself until burnout trying to finish by the summer, or, even worse, I'm stuck with another year of graduate school.

Each day I spend here is a reminder of how bad an idea graduate school was for me. Why did I do it? Hindsight is 20/20, but only if you're being honest with yourself. Sure, there are some positive reasons for getting the MD/PhD combined degree, which I used to justify the decision. They are the following:

1. financial aid - decreased medical tuition and financial support while pursuing the graduate degree
2. professional status - theoretically, MD/PhD's are given a small boost when applying for residencies, as pursuing the degree and investing so much time in the endeavor is indicative of how committed the individual is to academic medicine and how much better trained he or she is in the scientific method
3. scientific training - one generalization that exists is the notion that MD/PhD trainees inherently have a better aptitude for science than their MD counterparts. In truth this depends on the individual, as you might expect. MD's who decide to do science later in their careers are perfectly capable of performing good science if they choose.

Looking back, I think these were only minor factors in my decision. I think the most driving force in choosing to do the MD/PhD was ego. I used to think that getting that MD degree was finally going to give me that feeling of self-worth I'd been craving for so long. And given the opportunity for another degree on top of that...wow! Michael Liang, MD, PhD - three extra letters! Can't you just hear the reverb when you say that out loud? This guy must be smart and hard-working and dedicated and talented! My parents can finally go around and brag about me to all their friends and colleagues!

I've been in academia most of my life, and always on the bottom. Getting that combined degree was my ticket to climbing that academic ladder so I could be one of the big boys on the top rung. I drank the Academic Kool-Aid. Hard. After almost five years in the system, though, my eyes are finally wide open.

What strikes hardest is the fact that so many people from my past, while encouraging, questioned whether I was making the right career move:

• Dean S, doctoral candidate, The Pennsylvania State University, 1992: "If I had to do it over again, I wouldn't have gone for my PhD."
  
• Anne G PhD, The Pennsylvania State University, 1993: "Don't do the MD/PhD."
• Chris T MD, PhD, National Cancer Institute, 1996: "If you're sure it's the right move for you...."
  
• Uncle Ron, New York, New York, 1996: "You haven't convinced me that you really want to do this. Are you sure you want to go to graduate school?"
• Alex C, Boston, MA, 1998: "I think you're crazy."
  
• Jeffrey F MD, Stoneham, MA, 1999: "You're MD/PhD??? Uh, you seem more like a clinical guy to me..."

Perhaps if I had actually listened to these people, actually listened, I wouldn't have taken this path. But perhaps I wouldn't have truly known that academia isn't for me until I took the time to jump through the hoops. But I've been unhappy in graduate school for the longest time, regardless of who I've worked for. Graduate students seem to accept the notion that they're supposed to be miserable. I now recognize that has been my brain trying to tell me that I don't belong here, short of pulling up its nervous tendrils and wrapping them around my neck to strangle me.

My choice has turned into a costly, 5-year mistake. And counting.

Plus I'm starting to notice signs of psychosis in my behavior. Talking to myself, for example. Every time I mutter something to myself, Hank the Surly Penguin gives me a funny look. I give him a fresh sardine, so he stops bothering me.

Epiphany Symphony

I. Adagio - Verità dolorosa

sanity fades 'way
like water off hot pavement
an unforeseen fate

I am but a slave
false prophets were my beacon
how did I not see?

II. Andante - Maturità in ritardo

nearing middle age
the perennial student
a dateless wonder

longing for oblivion
I am one with solitude

fear paralyzes
inward focus finds solace
eternally one

III. Lardo - Costruzione in pieno dei perdenti

ivory towers
erected for learning Truth
merely a façade

hidden from the light
slowed growth, decay creeps along
foundation crumbling

IV. Psycho - Accecato da scienza

science
poking probing proposing posing
vanity insanity inanity profanity
gathering blathering bleating bleeding
vying sighing lying dying
schmience

Sidebar

I've made some changes to the links in my sidebar.

• Is this Kinjo? is Bracken's blog. Other than the fact that he's married to Heather, who started graduate school at the same time I did, it has relatively very little to do with graduate school. But I guarantee it will be a good read.
• Piled Higher and Deeper has been one of my links since the conception of my blog. A comic strip about graduate school life, the creator manages to capture the essence of the academic world.
• Seek the Truth. Behold the Truth. Reveal the Truth. Straight Talk about Graduate School is a detailed and, more importantly, honest discussion about graduate school life. A very worthwhile read.
• THINGS I HATE ABOUT MY FLATMATE has absolutely nothing to do with graduate school. Or academia. But it made me laugh. So it gets space in the sidebar.
• Vik's link is gone. A fellow student in the MD/PhD program, Vik has been through much of the same stuff I have. But his site hasn't been updated in three months. It's got potential, though.
  

Blink Blink

To the tune of The Playmakers' Beep Beep (Little Nash Rambler)

While typing on my Inspiron, what to my surprise.
The little cursor was watching me, with two beady eyes.
The cursor leered sardonically as he flashed first on then off (blink blink).
I'll show him that my prose is not that at which one can scoff.

Chorus (slowly):
Blink Blink (blink blink),
Blink Blink (blink blink),
Cursor goes blink blink blink (blink blink).

I racked my mind for words to write and wipe that smile from the screen.
But the cursor simply rolled its eyes and then it started to preen.
I muttered, "Subject - verb - direct object..." and the cursor snidely coughed (blink blink).
I'll show him that my prose is not that at which one can scoff.

Chorus (faster)

I timidly typed my first few words to jolt that line into place,
but the text was awful gibberish, and I had to hit backspace.
I cleared my room of all distractions, of all earthly joys.
I then cursed Science for always speaking in the passive voice.

Chorus (even faster)

Now I'm typing furiously, I've certainly built a pace.
But I'm playing Tetris, and BAH! only good for tenth place.
The cursor merely shook its head, and held its nose aloft.
I'll show him that my prose is not that at which one can scoff.

Chorus (so fast you're breathless)

Now I'm typing as fast as I can, my fingers really move;
I look to the snotty line, and wait for him to approve.
The cursor laughed haughtily, and stated with a mouthful of scorn:
"Give it up, jagoff, you might as well surf internet porn!"

The Write Stuff

Using the mind to look for reality is delusion. Not using the mind to look for reality is awareness. Freeing oneself from words is liberation.

-Bodhidharma

I'm spending less time working in lab and more time trying to put the data onto paper in some coherent order, suitable enough for presentation to my thesis committee. I've actually told myself that I'd get down to this several times in the last few months. I'm finally getting serious about it now, but it feels like it's late in the game. I sit in front of the computer, but the words won't come.

I've reorganized my desk, and cleaned out the office, but the page remains empty.

I've booted the infernal machine (read: XBox) out of the house, but the words won't come.

The words won't come.