Third year rotations question

[redrosesfi]

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[Law2Doc]

I have a quick question about 3rd year rotations. Just curious, do you have to perform procedures as part of your rotation requirement? As I understand it, a med student goes through the different rotations and primarily observes. Please correct me if I am wrong. Thanks.

You are wrong about primarily observing. It's a hands on profession. You will get very good at physical examination, looking in eyes, ears, throats. You will be doing digital rectal exams, speculum exams, putting in NG tubes, drawing blood, putting in Foley catheters. You will put in sutures, Change dressings, remove skin staples, do a lot of retraction in the OR. You might get to do an LP, paracentesis, I&D, maybe a central line. You might get to participate in a Code. Plan to roll up your sleeves and get dirty.

 

[Abider]

You are wrong about primarily observing. It's a hands on profession. You will get very good at physical examination, looking in eyes, ears, throats. You will be doing digital rectal exams, speculum exams, putting in NG tubes, drawing blood, putting in Foley catheters. You will put in sutures, Change dressings, remove skin staples, do a lot of retraction in the OR. You might get to do an LP, paracentesis, I&D, maybe a central line. You might get to participate in a Code. Plan to roll up your sleeves and get dirty.

Sure. But there's also quite a bit of spectating. Watching an aortic bifemoral bypass for hours isnt even that hands on for junior residents. There's just a lot of stuff that your not going to be doing. Starting an IV on an obtunded senile patient sure, anyone who "matters " not so much. And a lot of other stuff that like a school play. They tell you to do it, but it's not like it makes a difference because they've already done it. We're just making believe until we're grown ups.

I'm still learning a lot. Sometimes doing, definitely lots of physical exam practice. But even watching and listening you're picking up tons. Learning the language.

But it's just a shock how long it takes to learn. And that I'm perfectly happy to earn the trust to be DOING instead of being given it. Even if it does feel useless to go work hard to organize some information that the team already has but is waiting for me to baby talk it to them.

So be prepared for this. And keep telling yourself to get good at it for you and your future patients despite its current lack of utility to anyone. This is my 515 am mantra.

 

[eablackwell]

How much you do often depends on a couple things 1) How proactive you are 2) The doctor/residents you're working under.

I'm a 2nd year, but our school does ER and Family Medicine rotations from basically day 1. I've already performed CPR a few times, assisted with a central line, completed God only knows how many physicals and well-woman visits, and assisted in several surgeries (I worked with a gyn oncologist over the summer). Many of my 3rd and 4th year pals have had very hands-on experiences as well, especially in their core rotations. However, I know many who complain that they don't do much but stand around. I notice many of those people are a little too soft-spoken. You don't want to be a pushy jerk on rotations, but make sure you let your superiors know you want to do as much as possible. 😉

 

[Abider]

How much you do often depends on a couple things 1) How proactive you are 2) The doctor/residents you're working under.

I'm a 2nd year, but our school does ER and Family Medicine rotations from basically day 1. I've already performed CPR a few times, assisted with a central line, completed God only knows how many physicals and well-woman visits, and assisted in several surgeries (I worked with a gyn oncologist over the summer). Many of my 3rd and 4th year pals have had very hands-on experiences as well, especially in their core rotations. However, I know many who complain that they don't do much but stand around. I notice many of those people are a little too soft-spoken. You don't want to be a pushy jerk on rotations, but make sure you let your superiors know you want to do as much as possible. 😉

To an extent yes, I agree. But there's also room for a little more honor, chivalry, and collaborative deference. Instead of 5 med student gunners on an island who leaves having done what. Proactive and being a douche are opposites on a fine line.

I try to get my reps on suturing patients under anesthesia--they're quite a bit more agreeable as such--but if there's a procedure that would be a great experience for a budding surgeon, I give them the open lane and keep working on what I need from the rotation--clinical management and monitoring practice pre- and post-op.

Will this effect my chance at honoring. Maybe, probably. But I like myself while I'm learning.

Choices....

 

[Law2Doc]

To an extent yes, I agree. But there's also room for a little more honor, chivalry, and collaborative deference. Instead of 5 med student gunners on an island who leaves having done what. Proactive and being a douche are opposites on a fine line.

I try to get my reps on suturing patients under anesthesia--they're quite a bit more agreeable as such--but if there's a procedure that would be a great experience for a budding surgeon, I give them the open lane and keep working on what I need from the rotation--clinical management and monitoring practice pre- and post-op.

Will this effect my chance at honoring. Maybe, probably. But I like myself while I'm learning.

Choices....

Well, as a resident, the only way we can really tell someone is interested is if they jump all over every opportunity thrown their way with a flourish. We can't distinguish "chivalry" from disinterest, so if I ask two med students if one wants to do X procedure and one declines I have to think the decliner is less interested and this will be reflected in evaluations. As a med student, the answer should always be to enthusiastically say "yes" without hesitation and start rolling up your sleeves. Leave it to the residents to even out opportunities -- that's not your job. Never "give an open lane". You take the opportunity, and the resident will see to it that the other person, if he's interested, gets the next. Thats part of his role in the process. But if you work this out at the med student level, it makes it harder for us to figure out whether someone is interested or simply drew the short straw. There's actually a form of gunnerism where one med student offers up the unsavory tasks to his peers (eg. I'll let Steve do this DRE -- I already did one). So no, don't do this -- it hurts your evaluation and limits your learning opportunities. If both if you are interested, the only way it works itself out is if everybody jumps on every opportunity. Don't try and add a layer of rules (chivalry, honor) on a game that already has rules.

 

[Abider]

Well, as a resident, the only way we can really tell someone is interested is if they jump all over every opportunity thrown their way with a flourish. We can't distinguish "chivalry" from disinterest, so if I ask two med students if one wants to do X procedure and one declines I have to think the decliner is less interested and this will be reflected in evaluations. As a med student, the answer should always be to enthusiastically say "yes" without hesitation and start rolling up your sleeves. Leave it to the residents to even out opportunities -- that's not your job. Never "give an open lane". You take the opportunity, and the resident will see to it that the other person, if he's interested, gets the next. Thats part of his role in the process. But if you work this out at the med student level, it makes it harder for us to figure out whether someone is interested or simply drew the short straw. There's actually a form of gunnerism where one med student offers up the unsavory tasks to his peers (eg. I'll let Steve do this DRE -- I already did one). So no, don't do this -- it hurts your evaluation and limits your learning opportunities. If both if you are interested, the only way it works itself out is if everybody jumps on every opportunity. Don't try and add a layer of rules (chivalry, honor) on a game that already has rules.

Fair enough, I see your point. But I'm not going to be throwing elbows to prove enthusiasm, not for you, not for anyone. I would like to learn as much as possible, but proving that, to every long coat that passes is not going to happen. Grade me accordingly.

 

[Law2Doc]

... Grade me accordingly.

We do. But actions and enthusiasm are usually all we have to go on. We positively regard that med student who jumps all over every hands-on task, and have no way of knowing how his peers think of his enthusiasm. Nor care. I get that how you are perceived by your peers matters, at least in the short term. But the folks who get Honors in procedural fields tend to be on the more aggressive end of the spectrum, and that's part if the game of how you honor one of those rotations -- by navigating the delicate balance of snagging every opportunity thats up for grabs but not coming off as a total jerk about it.

 

[Abider]

We do. But actions and enthusiasm are usually all we have to go on. We positively regard that med student who jumps all over every hands-on task, and have no way of knowing how his peers think of his enthusiasm. Nor care. I get that how you are perceived by your peers matters, at least in the short term. But the folks who get Honors in procedural fields tend to be on the more aggressive end of the spectrum, and that's part if the game of how you honor one of those rotations -- by navigating the delicate balance of snagging every opportunity thats up for grabs but not coming off as a total jerk about it.

Sure, I get it.

But it's my skin I'm livin in. I like a good home.

The people who I sense aren't going to rate me well are the same bunch who are aggressive and manipulative to the point that they don't even know when their faking it. Medicine is deep in this personality type.

The irony of the fact that they probably faked it to honor in my chosen specialty only to disparage it and the fact that I have a natural interest and curiosity and respect about theirs is lost in the grading scheme. But not to me. I take the experience of watching this surgeon perform a gastric bypass with elemental grace with me.

This is the phase where I am building my style of practice and being.

The fact that I know the janitor intimately is confusing to my more gunnerish colleagues. They don't see the utility. But they will jump and wag and beg at something they're not even interested in. Enjoy their nose in your crack.

If it means I can only honor the specialties that I'm trying to get into, then so be it.

 

[Scottish Chap]

Sure, I get it.

But it's my skin I'm livin in. I like a good home.

The people who I sense aren't going to rate me well are the same bunch who are aggressive and manipulative to the point that they don't even know when their faking it. Medicine is deep in this personality type.

The irony of the fact that they probably faked it to honor in my chosen specialty only to disparage it and the fact that I have a natural interest and curiosity and respect about theirs is lost in the grading scheme. But not to me. I take the experience of watching this surgeon perform a gastric bypass with elemental grace with me.

This is the phase where I am building my style of practice and being.

The fact that I know the janitor intimately is confusing to my more gunnerish colleagues. They don't see the utility. But they will jump and wag and beg at something they're not even interested in. Enjoy their nose in your crack.

If it means I can only honor the specialties that I'm trying to get into, then so be it.

You have integrity. I admire that. Just don't shoot yourself in the foot. Trust me when I say that residents and fellows don't spend much time thinking about medical students and their motivation for doing things. We have too much responsibility, and competing demands for our attention (patient care), to be vindictive, but I see some red flags in your thinking as expressed here.

I will echo what was said above by another doctor--I always, always remember the medical students who are most proactive. Evaluators (residents, fellows) can usually sense the 'gunner' medical students and they often annoy us. Similarly, the self-righteous or standoffish medical students can be annoying and this, sadly, is usually what you remember best when you're given their evaluation form at the end of a rotation. There are ways you can be tastefully proactive and available without being a gunner. When I have evaluated medical students who like to let others 'steal the limelight', I always asked them why they were not more proactive, and 100% of the time such a student would tell me I was not the first to say this to them at the end of a rotation. Everything you do (or not do) is reflected in your evaluation.

Playing the game in medicine is actually important to a certain extent--and you can do this while still being true to yourself. Winning honors in as many classes outside of your specialty of interest is really important (plenty of medical students do), or you just might find yourself unmatched, or in a program you are not 100% happy with. Never assume anything is a sure bet in this career.

 

[Abider]

You have integrity. I admire that. Just don't shoot yourself in the foot. Trust me when I say that residents and fellows don't spend much time thinking about medical students and their motivation for doing things. We have too much responsibility, and competing demands for our attention (patient care), to be vindictive, but I see some red flags in your thinking as expressed here.

I will echo what was said above by another doctor--I always, always remember the medical students who are most proactive. Evaluators (residents, fellows) can usually sense the 'gunner' medical students and they often annoy us. Similarly, the self-righteous or standoffish medical students can be annoying and this, sadly, is usually what you remember best when you're given their evaluation form at the end of a rotation. There are ways you can be tastefully proactive and available without being a gunner. When I have evaluated medical students who like to let others 'steal the limelight', I always asked them why they were not more proactive, and 100% of the time such a student would tell me I was not the first to say this to them at the end of a rotation. Everything you do (or not do) is reflected in your evaluation.

Playing the game in medicine is actually important to a certain extent--and you can do this while still being true to yourself. Winning honors in as many classes outside of your specialty of interest is really important (plenty of medical students do), or you just might find yourself unmatched, or in a program you are not 100% happy with. Never assume anything is a sure bet in this career.

Noted, and perhaps why I'm persisting in the conversation--because I can sense the impressions being formed already. And am coming to terms with the games being played.

Some of us find the limelight contest repulsive. I do and will look for ways to help. I'm not standoffish at all. But I refuse to do things that make my colleagues look bad. And to undercut them. What I'm talking about are all the things that you don't have time to notice. That if I did just to get close to all the right people at just the right times with the right song and dance, then I would feel disgusting to myself in out competing my colleagues for airtime.

Admittedly, I have no answer to this, and the margin of succes in the clerkship game. I want to do well. But I also want something that reflects me. I like teamwork, being supportive instead of competitive, and making people feel good. I can't do that worrying only about my "winning" impression on every one. Which is the vibe that seems to be rewarded. Hence my concern.

 

[Law2Doc]

Noted, and perhaps why I'm persisting in the conversation--because I can sense the impressions being formed already. And am coming to terms with the games being played.

Some of us find the limelight contest repulsive. I do and will look for ways to help. I'm not standoffish at all. But I refuse to do things that make my colleagues look bad. And to undercut them. What I'm talking about are all the things that you don't have time to notice. That if I did just to get close to all the right people at just the right times with the right song and dance, then I would feel disgusting to myself in out competing my colleagues for airtime.

Admittedly, I have no answer to this, and the margin of succes in the clerkship game. I want to do well. But I also want something that reflects me. I like teamwork, being supportive instead of competitive, and making people feel good. I can't do that worrying only about my "winning" impression on every one. Which is the vibe that seems to be rewarded. Hence my concern.

When a resident asks "anyone want to do a X procedure" it's not undercutting your fellow classmates to say yes. Nor is it acting gunnerish. Not jumping up and grabbing opportunities is more memorable than the other extreme. As Scottish Chap indicated, we aren't going to think too hard about med students, so you ave to come across as enthusiastic, period. That's the game. We aren't asking you to stick it to your peers, just jump all over the things we offer up. It's up to us to make sure that everyone who wants it gets a turn, not you guys. But you ave to be proactive or we will assumed you are disinterested.

 

[gyngyn]

Agreed. The coin of the realm is what you contribute. When scut was prevalent, med students were a valued member of the team. Now, all a student can contribute is enthusiasm; in return he will be taught, and his eval will reflect what he contributed.

 

[Abider]

Ok all, thanks, clear and easy enough. Want to do stuff.

 

[45408]

Some of us find the limelight contest repulsive. I do and will look for ways to help. I'm not standoffish at all. But I refuse to do things that make my colleagues look bad. And to undercut them.

The best students are able to do all of these things at the same time. Note: I was not one of the best. I tried, but I couldn't always pull it off. I did have some classmates that somehow were always friendly, willing to help, read all the time, did well with residents/patients/multiple choice tests, and still had families. Interestingly enough, most of them were Mormon...

 

[QofQuimica]

Impressing residents or backstabbing classmates aside, I would argue that you should do as much as you can on all rotations, and *especially* on the ones in specialties you know you won't go into. Think about it this way: you'll never get another opportunity to have those experiences again. So if you're not going to go into surgery, scrub in as much as possible. Suture, staple, see and do whatever they'll let you see and do. Once your rotation is over, the only way you can ever do those things again is if you go to the pain and trouble of retraining in a different specialty.

We talk a lot on this forum about how we will regret the things we don't do more than the things we do. Don't regret not having gotten the most out of your surgery rotation while you still have the chance.

 

[abolt18]

Impressing residents or backstabbing classmates aside, I would argue that you should do as much as you can on all rotations, and *especially* on the ones in specialties you know you won't go into. Think about it this way: you'll never get another opportunity to have those experiences again. So if you're not going to go into surgery, scrub in as much as possible. Suture, staple, see and do whatever they'll let you see and do. Once your rotation is over, the only way you can ever do those things again is if you go to the pain and trouble of retraining in a different specialty.

We talk a lot on this forum about how we will regret the things we don't do more than the things we do. Don't regret not having gotten the most out of your surgery rotation while you still have the chance.

Thank you. I feel this is the most helpful statement for me of this whole thread. Great perspective!

 

[Law2Doc]

Impressing residents or backstabbing classmates aside, I would argue that you should do as much as you can on all rotations, and *especially* on the ones in specialties you know you won't go into. Think about it this way: you'll never get another opportunity to have those experiences again. So if you're not going to go into surgery, scrub in as much as possible. Suture, staple, see and do whatever they'll let you see and do. Once your rotation is over, the only way you can ever do those things again is if you go to the pain and trouble of retraining in a different specialty.

We talk a lot on this forum about how we will regret the things we don't do more than the things we do. Don't regret not having gotten the most out of your surgery rotation while you still have the chance.

Agreed. Look at your rotations like taking a vacation someplace cool. You can have an amazing trip even if it's someplace you just enjoy visiting once but would never want to live there. And you'll forever be able to tell the stories at dinner parties of how you delivered a baby or held someone's necrotic gallbladder in your hands, or stuck a really big needle into someones spinal canal. Plus, it helps in any field to be able to tell your patients, from first hand experience, what's going to happen when you refer them for X procedure.

 

[45408]

Plus, it helps in any field to be able to tell your patients, from first hand experience, what's going to happen when you refer them for X procedure.

Very much so. I think patients would never be referred to certain highly invasive and complicated procedures if the provider knew what they entailed. It also makes you look pretty silly if the patient knows more about a procedure than you do.

It also helps a lot when you're working up a patient with a vague complaint that may or may not be related to something a surgeon had done. We once got a terrible consult regarding an endovascular aneurysm repair from a newly graduated ED physician who had no idea what he was working up, but he (incorrectly) assumed it was due to something we had done. It had nothing to do with us, but we basically did the entire work-up for him...

 

[jl lin]

Sure. But there's also quite a bit of spectating. Watching an aortic bifemoral bypass for hours isnt even that hands on for junior residents. There's just a lot of stuff that your not going to be doing. Starting an IV on an obtunded senile patient sure, anyone who "matters " not so much. And a lot of other stuff that like a school play. They tell you to do it, but it's not like it makes a difference because they've already done it. We're just making believe until we're grown ups.

I'm still learning a lot. Sometimes doing, definitely lots of physical exam practice. But even watching and listening you're picking up tons. Learning the language.

But it's just a shock how long it takes to learn. And that I'm perfectly happy to earn the trust to be DOING instead of being given it. Even if it does feel useless to go work hard to organize some information that the team already has but is waiting for me to baby talk it to them.

So be prepared for this. And keep telling yourself to get good at it for you and your future patients despite its current lack of utility to anyone. This is my 515 am mantra.

OK. You're the one in med school, and I see your point. I would be lying, however, if I didn't say that your comment, "Starting an IV on an obtunded senile patient sure, anyone who "matters " not so much. "

Yikes. I'm sure you didn't mean that the way it came off. Ummm, lol, Lots of obtunded, senile patients matter. I mean, one way or the other, they all do.

 

[Abider]

OK. You're the one in med school, and I see your point. I would be lying, however, if I didn't say that your comment, "Starting an IV on an obtunded senile patient sure, anyone who "matters " not so much. "

Yikes. I'm sure you didn't mean that the way it came off. Ummm, lol, Lots of obtunded, senile patients matter. I mean, one way or the other, they all do.

Dont be ridiculous. What do you hear in this conversation besides the shark and the orca telling the little penguin to swim fast. And you fault me for citing a cynical flash of oceanic law.

I doggedly regard the power of the Dark Side and risk being a patsy and whiner and cynic...and now apparently a mediocritist.

I didn't write the law that says it's ok for students to medically experiment learning skills on patients who are indigent and unconscious. But not on the senator's mother. I swim fast. Try not to be breakfast. And note with passing regret some of the things you're attempting to be shocked at.

Which as an experienced nurse, I find hard to take seriously.

 

[jl lin]

Dont be ridiculous. What do you hear in this conversation besides the shark and the orca telling the little penguin to swim fast. And you fault me for citing a cynical flash of oceanic law.

I doggedly regard the power of the Dark Side and risk being a patsy and whiner and cynic.

I didn't write the law that says is ok for students to medically experiment learning skills on patients who are indigent and unconscious. But not on the senator's mother. I swim fast. Try not to be breakfast. And note with passing regret some of th things you're attempting to be shocked at.

Which as a experienced nurse, I find hard to take seriously.

LOL. Hoping, once again, you aren't being serious. No need. No worries. I figured better of you, which is why I phrased it the way I did. 🙂

Besides that, honestly, I'm not sure what you mean by last comment. . . shrug. Yes, seen such things. . .don't care for them. I think it will be different after you graduate. Stuff will get thrown at you right and left, and those former "rules" as you call them won't matter so much anymore. But people also have to get that it's not so much like the old days. By that I mean that consumer-driven healthcare is here to say. So, for example, a resident or even fellow may not get 7 chances to get a line in a baby. It's family-centered care. Families are right there in your face, and IDK, I kind of think it's often a good thing. I try to walk in the shoes of those moms and dads. It sucks watching your kid get tortured--even if in the end it's going to help him or her. And now the pt-centered and family-centered approach is moving to all areas. So I mean I do hear what you are saying, but it's not like it used to be for MS and residents, b/c the pts as consumers have to be considered as partners in the process. Except, it's hard to watch, but in many cases, the kind of thing you are talking about still goes on in the VA hospitals, or as you imply, the indigent drunk or the homeless or forgotten aged obtunded persons.

Just looked weird the way you wrote it. I like VIPs, but I like all the other folks too--even if some of them can be a major p i t a.

It's like some things that can bother you a bit. . .like superficial crap. Like referring to pt's as cases, although it can be easy to fall into that trap, but it's good to be cognizant of it. Whether a RN, or if fortunate enough to become a doc, I have been on the patient side of things, and I have been there for loved ones and others on the patient side of things. So, I'm a little sensitive about it. . .but again, didn't really believed you thought that way. . .least hoped not. Believe it or not, some people, nurses or docs or whatever do. Makes me sad. As you have suggested, what you stated is more of a reflection of the process, not necessarily you. I don't think most are not thinking concretely about it. I mean they just want to learn and do their thing. But I often think of that movie, The Doctor, with William Hurt. Empathy matters, even while playing the game. That's my take. . .IDK, maybe some feel differently.

Also, good luck in stepping up during clinical rotations. I get what you are saying about stepping on toes or not looking like a team player. Tough to juggle.

🙂

 

[Abider]

LOL. Hoping, once again, you aren't being serious. No need. No worries. I figured better of you, which is why I phrased it the way I did. 🙂

Besides that, honestly, I'm not sure what you mean by last comment. . . shrug. Yes, seen such things. . .don't care for them. I think it will be different after you graduate. Stuff will get thrown at you right and left, and those former "rules" as you call them won't matter so much anymore. But people also have to get that it's not so much like the old days. By that I mean that consumer-driven healthcare is here to say. So, for example, a resident or even fellow may not get 7 chances to get a line in a baby. It's family-centered care. Families are right there in your face, and IDK, I kind of think it's often a good thing. I try to walk in the shoes of those moms and dads. It sucks watching your kid get tortured--even if in the end it's going to help him or her. And now the pt-centered and family-centered approach is moving to all areas. So I mean I do hear what you are saying, but it's not like it used to be for MS and residents, b/c the pts as consumers have to be considered as partners in the process. Except, it's hard to watch, but in many cases, the kind of thing you are talking about still goes on in the VA hospitals, or as you imply, the indigent drunk or the homeless or forgotten aged obtunded persons.

Just looked weird the way you wrote it. I like VIPs, but I like all the other folks too--even if some of them can be a major p i t a.

It's like some things that can bother you a bit. . .like superficial crap. Like referring to pt's as cases, although it can be easy to fall into that trap, but it's good to be cognizant of it. Whether a RN, or if fortunate enough to become a doc, I have been on the patient side of things, and I have been there for loved ones and others on the patient side of things. So, I'm a little sensitive about it. . .but again, didn't really believed you thought that way. . .least hoped not. Believe it or not, some people, nurses or docs or whatever do. Makes me sad.

Also, good luck in stepping up during clinical rotations. I get what you are saying about stepping on toes or not looking like a team player. Tough to juggle.

🙂

Yeah, I mean. There's a necessary evil to all of this. Somebody gave me their body so me and my anatomy tank mates could pulverize it into scraps of this and that.

But....Tibetan monks feed theirs to the buzzards.

Likewise, my patients, mostly the poorest of the poor, make sacrifices for me to learn medicine on them. If my supervisors are diligent then hopefully without egregious harm.

I try to honor their sacrifice. But, everything now is for the first time....(why is some 80's hair band ringing through my head.....Feels like the first time...) But..yeah, what can you do man. There's no way I'd be doing that on hospital VIP's. Thems just the facts. It's not my sensibilities that determine the status and safety and thus the opportunity to learn.

Like these docs have said to me, you swing at what they offer you. Thought is a complication in some real sense in that moment.

I'm just more honest about the ugly than most. And of course am learning to survive. And thus to mitigate my hesitation and misplaced southern manners.

 

[Law2Doc]

...What do you hear in this conversation besides the shark and the orca telling the little penguin to swim fast...

as someone a bit higher up on the food chain, I enjoyed this metaphor.

 

[jl lin]

Yeah, I mean. There's a necessary evil to all of this. Somebody gave me their body so me and my anatomy tank mates could pulverize it into scraps of this and that.

But....Tibetan monks feed theirs to the buzzards.

Likewise, my patients, mostly the poorest of the poor, make sacrifices for me to learn medicine on them. If my supervisors are diligent then hopefully without egregious harm.

I try to honor their sacrifice. But, everything now is for the first time....(why is some 80's hair band ringing through my head.....Feels like the first time...) But..yeah, what can you do man. There's no way I'd be doing that on hospital VIP's. Thems just the facts. It's not my sensibilities that determine the status and safety and thus the opportunity to learn.

Like my these docs have said to me, you swing at what they offer you. Thought is a complication in some real sense in that moment.

I'm just more honest about the ugly than most.

Get that. Don't hate the gamer, hate the game???? LOL

Course don't mean that literally--at least not as badly as it may sound. It's hard; it's just going to be. All of it is hard. Weighing benefits over risks, which is done all the time in medicine and healthcare can be brutal. I mean it's the nature of the beast.

 

[Abider]

as someone a bit higher up on the food chain, I enjoyed this metaphor.

Cool, orca. I'm glad you enjoy the sight of my penguin @ss flying out the water, hoping for a solid ice landing.

 

[jl lin]

Cool, orca. I'm glad you enjoy the sight of my penguin @ss flying out the water, hoping for a solid ice landing.

You make the "seas" sound frigid. Guess you have to watch out for the warm spots too.