Disappointment (money in medicine)

Depending on many different factors in your life, your view of a medical doctor probably varies wildly from your peers. That's even true among medical students. Find one medical student who thinks that doctors should be enriching the lives of their fellow humans and you'll find another who thinks doctors are just workers found in any other banal profession: lawyers, astronomers, sea captains. Which is what makes fourth year so disgusting: there are people who will graduate with me who have terrible ideas on what it means to be human, have no idea what compassion is, and who will probably continue to drive the healthcare machine in this country over a metaphorical cliff into a rift of soul-crushing, human-endangering failure.

Too hyperbolic? Probably. Let me explain:

It really bothers me that there are people who went to medical school because they had a passion for a certain career, and find themselves sending in applications to programs they know they will be denied from because they are terrible applicants. They lack the grades, the board scores, or something as extracurricular as research. They are not.... competitive.

I think dermatology is stupid. I will pick on derm a lot because eyes creep me out and medical imaging was a great advancement, so I optho and radio will be spared my ire in this discussion. The field of dermatology disgusts me because what do dermatologists know that an oncologist (skin cancers) or a well trained primary care physician (rashes) don't? And yet they somehow get paid more for doing less work. It is an artificially competitive field when you compare it to its value in society. And yet some people legitimately like dermatology. The study of skin. I can't fathom why. But they like it--not because they like that there are no emergencies. Not because they will get paid so well and work so little that they will be able to vacation in the fanciest of places atop beautiful yachts. But because they actually like skin and when they see someone with a rash they legitimately want to help them because they see skin as the most important organ of the body. Good hours and ludicrous paychecks are secondary gains--not the prime objective. The prime objective... is people.

And yet this year there will be at least one--from anecdotal evidence--individual who will in all likelihood not match into the field of dermatology despite a strong conviction that that is what they will want to do for the rest of their lives, simply because there are a lot of jackasses out there who see money as the sole solution to all of their ills and who have done so much better on exams that they can and will crowd out the people who would make the best dermatologists.

The best doctors aren't the ones who test best. The best doctors are the ones who are determined to improve the lives of their patients. Studying well and testing well is not the same as staying up late at night worrying how you can implement better care for your patients. Those are two types of hard workers. But only the latter will actually act selflessly whenever possible and improve the lives of others.

Once we start recognizing that--yes--doctors should be smart but they also need to be enthusiastic and deeply invested in their jobs instead of seeing their jobs as a money making venture we can start really making changes to medical machine for the better. For example... why not pay all doctors the same? No matter the field? Remove the pay gaps and see what happens. That would be a fun experiment. It might improve things.

When I was a first year medical student I had an interesting argument with my cousins--who were and continue to be--more conservative than I am. We were discussing healthcare in socialist societies (read: Northern Europe). They were arguing that when you pay doctors not much more than any other profession, you get doctors who really don't want to work hard because there's no point in working harder if you're just going to make the same amount. I actually think this is absolutely wrong. I think if you remove monetary incentives, only the people who actually want to be physicians will become doctors and they will thus work harder because they will love what they do. I think money is great! I love it. And I miss it when I have to spend it on things. But if I knew I would get the same amount of money whether I was an elementary school teacher or a doctor... well I'd still become a doctor because I am really passionate about being a physician. There are things that being a physician provide you that can't be found in other fields to the same degree. There was, and still continues to be although to much lesser a degree, respect for physicians. There is the sense of accomplishment you get from knowing that you know more than most other people. There is the appreciation you receive from patients who will share with you their most intimate of feelings, fears, concerns. My father is a surgeon. He has had the opportunity to be paid a lot of money many times in his life. But he continues to work in inner city Chicago because he enjoys helping people who wouldn't be able to get such surgeries done, even if he knows he will never get paid for operating on them because they have no money, they have no insurance. There were years when my dad made less money from operating than his malpractice insurance cost. That's right--you can make negative money as a physician. But he never considered quitting. Because he has a love for surgery which I don't understand, but which motivates him to work with little consideration to how much money he will make. More physicians should operate (pun intended) in this manner.

I am not an economist. I do not understand the "economy". I simply acknowledge that economic issues must be way more complicated than they appear. Still, just imagine a world where medical school wasn't any more expensive than an undergraduate education. Imagine a world where it was actually free. The person who loves skin diseases--however weird she may be--goes to medical school, falls in love with the study of dermatology, and in her fourth year decides to apply to some dermatology residency programs. Because there are no extrinsic powers enhancing the appeal of dermatology, only those with an intrinsic interest apply. And because skin is such a specific field, much fewer people apply to it. Perhaps the number of applicants correlates with the number of dermatology resident positions available in the field? Dermatology is no more competitive than any other specialty and everyone medical school graduate gets to work in the field they love. They may still not get into their ideal program, but at least they get to be in the OR, or the community, or in the ER, or in a dark room staring at radiographs all day. Which is what they love and want to do well for the rest of their lives. 

So what are doctors supposed to be? Well paid or hard working? Money is a great reward for hard work. But it's also a great incentive for people who should not be physicians to enter the field.

I've struggled with how I feel about how much physicians get paid. Honestly, being a medical student, being a resident, and being an attending are all difficult and they should be paid well. But now that I have started to see my friends struggle to get interviews when people who have developed reputations for "getting drunk and beating up people" or "saying really racist things in class" are getting a plethora of invites, I have to question how well this system was set up.

And I will continue to question it. Because money shouldn't drive the motivation for anything. Especially something as important as taking care of people.

Money & Politics

So the other day I attended a speech at my medical school entitled "The State of the Medical School Address." I was one of a handful of senior medical students in attendance. The majority of the crowd was a mix of underclassmen--present despite the absence of free food; professors--who looked almost human with their absence of papers and folders and textbooks tucked under their arms; and administrators--eager to be absent from another boring weekday noon meeting.

Overall it was an illuminating presentation. The slides were presented in Prezi, which can make anything look like a Ted Talk, and our school's newly inaugurated Dean, Dr. Tomkoviak, is a psychiatrist so he possessed the appropriate vocabulary and ethos to motivationally interview everyone in attendance--further adding to the Ted Talk vibe. It was nice to hear where our school was going in a suspiciously positive light. But I tried to temper my suspicions with my generally optimistic attitude. It kind of worked, although my cynicism wouldn't completely shut off. Chicago has many highly ranked medical schools and despite being The Chicago Medical School it is hard to stand out and be exceptional. We were also placed on probation by the LCME, as well. Another insult and another reason to wonder if this speech wasn't just a publicity stunt filled with half-truths and full lies.

Our dean talked about what he would be doing as our leader. Essentially he vowed to help everyone work together, allowing the staff and the students to work towards a similar vision of excellence. At times it almost sounded as though he would start telling us that we were "poised to shift paradigms by synergizing our individual strengths" -- it was one of those kind of talks that seemed displaced from the 1980s. I tried not to roll my eyes or laugh. I stayed optimistic.

Finally he mentioned some highlights of the work our administrators were doing for the good of the students, important additions to our school's plan: the creation of more residency programs affiliated with our school and the creation of a 5th year program for those students who fail to match, two wonderful additions for future graduates. He also talked about finding more clinical opportunities for students. All wonderful things. This part of the talk I didn't roll my eyes, I didn't scoff. I was in awe. I was grateful.

But in the end I found two things deeply upsetting. The first was the almost complete omission of our outrageous tuition. At almost 60k a year it's no wonder our school has struggled with diversifying our student population in recent years, a problem which the LCME noticed and used to place us on probation, along with the high debt among graduating students. Our tuition is the most expensive in Illinois--even more than Northwestern's medical school, whose students purportedly are given rental cars to commute to clinical rotations lest they lack a car of their own. A diverse student population is something our school has always been committed to, even from its start in 1912. Something that no other medical school still standing in Illinois today can claim. But how can we ask people--even the most driven among them--to jump into nearly a quarter of a million dollars in debt? That's insane. This shouldn't be happening. And even though, sadly, escalating student debt is not a unique problem to Chicago Medical School, I think students of our school should know exactly why our tuition is so high. What are we paying for? If it's the renovated and lovely cafeteria that closes absurdly early at 2 PM, I hate to say this... but I think we could have made do without. As somebody who's been well briefed about the political corruption in the City of Chicago, I can't believe that any entity with 'Chicago' in its title is free of any monetary mismanagement. Where's our money going? Understandably to hospitals and professors--for our education. For standardized patients and to purchasing online scholarly journals--also for our education. But I can't believe with a class size of almost 200 students (and at 60k a year that's roughly 12 million dollars in revenue), all that money is being used wisely. Where's the waste? What can we do about it?

Which leads me to the way the speech ended and the second thing that ticked me off. During the talk, the dean mentioned a new twitter campaign and offered a prize to a randomly drawn tweeter using the hashtag #CMSPLEDGE. Social  media at its finest! The winner was a medical student. The dean proudly handed her a gift bag and asked her to open it. She pulled out an IPAD mini. To help her with her studies in the evolving world of medical education. A nice symbolic gesture. And a nice gift. Almost as an aside he mentioned: "And to all of you students wondering, I didn't use any of your tuition money to buy this. I paid for that myself." A comment that garnered many laughs. Yet I was outraged. Sure our tuition money didn't go directly into buying gifts. That would be--and the only course I ever failed was accounting so I'm sure I'll mess this up but--that would be some form of money laundering, right? Regardless, it has been proposed that one of the causes for the ever increasing cost of higher education is the money paid to top administrators. Like deans. Like CEOs. Like non-essential and inept staff who don't respond to your emails on time and who belittle you once they finally respond to your originally non-urgent but now emergent requests because it was sitting, neglected, in an inbox for three weeks. Okay, so not so much that last one. But that's an inefficiency all the same. And if the CEO of our university is making $500,000 dollars a year for essentially being a figurehead, I've got to ask if that money would be better used to give eight to ten medical students 100% tuition assistance.

I'm not claiming to know anything about business models or how to run a university. But I do know that in some small way my peers and I helped pay for that IPAD mini and I would much rather have had assistance paying for any number of the many additional fees of medical school few people tell you about.

I love my school. The students represent--in my personal and likely biased opinion--some of the most hardworking and honest medical students you can find in Chicago. And whether or not it was motivated by being placed on probation, I like the way our school keeps thinking up innovative changes to the curricula. Our school has emphasized liberal arts to the long term benefit of every one of its graduates. And I appreciate that. I truly due. But the fact that tuition wasn't addressed heavily tells me that either it was too difficult or too depressing of a topic to put into a motivating speech or that nobody at the top cares about this specific problem. And if tuition isn't seriously addressed, I fear that the quality of the CMS graduate will decline not because of any weaknesses in the school's academics, but because it will be admitting only those students who can look at a quarter million dollar pricetag and not flinch.

Hospital Billing and Insurance

The prompt for this next clinical reflection meeting at school was the following: To what extent are physicians' values and decisions responsible for the cost of health care, and what responsibility do we have to control costs? How cost-conscious have the physicians you have worked with been, and what rolled does financial stewardship have in the professional responsibilities of physicians? 

But like so many other things, I was still angry about dropping $175 at Walgreens the other day for 3 vials of lantus and two boxes of test strips, so I had trouble focusing:

I think it is fundamentally irresponsible to be a physician unaware of the costs of medicine and health care services. That being said, a lot of physicians don't want to worry themselves with the details. Have I ever worked with a physician who seemed to understand how much things cost for patients? Not really. No. But consider this: how many physicians actually have chronic illnesses? How many doctors are on a ton of prescriptions at any one time?

Brainwash 'n Vent

There it was. The truth. Stretched out in front of me like the end of days. And loudness. So much strife and bustle. Everywhere. Cars and the people with their voices and the humming of buildings with their AC units pumping in cold to isolated rooms separated from the world and the streets within the city of Chicago. And the El up ahead a block, three or four stories high with always the same voice alerting passengers and future passengers alike: "Doors opening." Then two bells. Then: "Doors closing." This was my present but less than an hour ago I was in a completely different world. Oppressive silence. The distant sounds of mouses being clicked at other terminals was the only thing to distract the dull buzz that came with inactive listening from taking hold on my ears. Distant, fluorescent lights. Everything controlled. And cold. So cold. That was the world of the United States Medical Licensing Examination Step 2, the second of three licensing exams. And I realized on the streets of Chicago, I could not remember a single question. 355 questions. 9 hours. And I couldn't remember a single thing.

What could possibly be more horrifying?

Step 2 is a serious exam, of course, otherwise, why would we have to pay $580 to take it? If cost equals quality, then Step 2 is a lot more important than the scantrons and blue notebooks I used to use in high school to take advanced placement (AP) exams--which actually helped me take less courses in college, saving me thousands of dollars. I think those cost $25. USMLE tests cost me money to prove that I can be a doctor. I guess if failed enough times, I would have to take a year of medical school again: $50,000. Okay.

AP scores can be dolled out in a simple 1, 2, 3, 4, or 5. Step scores are much much much more complicated. Not always was this so, of course. In the old days, you passed or you failed. Quite simple really. Because we all must be evaluated and found worthy of the MD that will follow our names for the rest of our lives, but do 355 randomly selected and sometimes silly questions mean that we deserve or do not deserve to put our hands on a patient, to share in their suffering, to help and to heal and to comfort and advise? No. They really, honestly shouldn't.

This year the passing score on Step 2 jumped up from 200 to 209. Was this arbitrary? How was this determined? And isn't nine points.... a lot of points? More importantly, if the passing grade was just determined based on how many people passed Step 2--which is the way some courses are run-- wouldn't this imply some kind of insidious ploy to make sure that enough people fail so that the administrators of USMLE can charge some poor soul another $580 and increase revenue? Or does the increased score make everyone feel better that residents are intelligent enough to be able to control and manage possibly dying patients, and the additional money made is just an extra benefit?

How many times have I heard a discouraged patient say something along the lines of, "I know you just see me as money to be made at my expense." Should I also feel the same way, as a medical student, stuck in a world of constant cost with no monetary profit?

Let's assume however, that a lot of thought was made into making it so that 209 was meant to really pick out who would do well as a resident in terms of knowledge. Isn't it possible that there are people who score below 209 who would make good residents because they know how to look up answers on uptodate or even google? And who work hard to make sure that they overcome their deficits? Conversely, couldn't someone with above a 209 simply make the worst resident ever and incur a lot of lawsuits because of they have the worst bedside manner? Or couldn't someone with a +209 score completely slack off for the rest of their career and be unable to provide the standards of care for anyone besides the hypothetical patients he saw before him in paragraphs on a computer screen on test day? I mean statistically, some people who score below 209 will ultimately practice great medicine while people who score above 209 will do absolutely terrible things.

So did I really need to be locked in a room for 9 hours--an amnesia-inducing, cubicle-filled room with no music, no food, no human contact for 9 hours--so that I could answer 355 questions that I would instantly forget and then spend the next three weeks until receiving my score panicking and scratching at my skin, picking at my scabs, and eating antacids like candy because how can you feel like you did well on a test if you can't remember any part of it? Only to find out that I did pass and that I did do well.

All that nervousness and I have to pay $580. Infuriating.

Insulin and Eugenics... I am upset. This is a rant.

As a type 1 diabetic, I am often very angry. Usually this is secondary to hypoglycemia or an ability to eat something because I inadvertently left my insulin at home.

But today I am upset because I am running out of insulin and I only have $600 left in student loans until late February. Why is this a problem? Because as someone with good medical insurance, my doctors have always prescribed me humalog and lantus, which are bloody expensive without a prescription (and are actually still really expensive with a prescription and insurance: $50 each for what I need in a month). But as a medical student I don't have time to go see a doctor to get a prescription to get my bloody f***ing insulin. I am really upset because as I speak I have about enough humalog (lispro, short-acting insulin) to get me through to Monday, after which I guess I'll start employing a poor man's metformin: large amounts of acetaminophen and straight hard liquor. Your liver transaminases skyrocket, but you've effectively bludgeoned your body's best organ so badly that it stops going through with gluconeogenesis. Oh, and a ton of aerobic exercise makes your body more sensitive to the effects of lantus (glargine, long-acting insulin), so I guess I can look forward to dropping a few pant sizes and... cirrhosis. Lots of preventable, freaking cirrhosis.

I don't know what I'm supposed to do. There must be type 1's who are busier than me and have less time to see doctors. And I know there are type 1's who don't have health insurance because this country is absolutely terrible. So how can I get insulin at a reasonable price without having to see a doctor? Because, honestly, I've had diabetes for over ten years and I know my body's personalized ways of dealing with this disease in a way that literally no other health professional could understand. I know the tricks. I know the secrets of my metabolism. My A1c is always under 7.0 and my hypoglycemic events are now well controlled. I know what I'm doing.

SIDENOTE... no wait, MAIN POINT: I think it is absolute bullshit that people need prescriptions for something that their body erroneously stopped producing. Almost everyone else around me is making insulin, but just because my body f***ed up when I was thirteen, I have to spend thousands of dollars on a month's worth of high quality insulin? What kind of justice is that? Answer: it's not. It's wrong. It's condemning people to a constant economical disadvantage on top of the disease they've contracted who's co-morbidities will likely kill them if they don't control the aforementioned disease. In a country where medications aren't regulated to make them fairly priced (hell, I think they should be bloody f***ing free but I realize I'm incredibly biased) and health insurance is severely limited, we are essentially killing off diabetics. I realize that many type 1 diabetics can make it to reproductive age without dying first, but I've seen a 24 year old diabetic with f***ing gastroparesis--that's really severe neuropathy. And now that I've gone through OB-GYN, it becomes apparent that type 1 diabetics with A1c's of 13.6, like this 24 year old, would never be able to carry a healthy child to term. She will likely never produce any children because why? Because our health system is unjust? What sick kind of world is this?

And you know what's worse? The type 1 diabetic population that is under insured and hurting the most is minorities, specifically blacks. And you know what's f***ing insane about that? DIABETES IN AFRICAN POPULATIONS HAS NO DISCERNABLE GENETIC COMPONENT. Whereas caucasian type 1 diabetics usually have some weird HLA inherited predisposition sh*t. And yet, at least in Chicago, those people will be preferentially allowed to live with a disease that could be greatly reduced within the human population if only they were put to the slow and painful death that awaits most uninsured type 1 diabetics.



[edit]: Okay. So I calmed down a little bit. Let me just say that I recognize that a lot of white people don't have health insurance either. But at least in Chicago, economics and race are obnoxiously linked in a way that has already started to upset my psyche. So I'm sorry about that. The truth is, all type 1 diabetics are in an equally unfortunate place in a society where close health maintenance is ludicrously expensive.

And also, I don't think I do a good job of separating my emotion's from the job. Especially other type 1 diabetics so far along. Seeing another black, 24-year-old, type 1 diabetic, laying on a bed in the emergency department, clutching at her stomach and moaning for morphine, secondary to gastroparesis and then her resultant addiction to painkillers, really upset me I guess. I want to help them but I know that it's literally too late because you don't recover from severe autonomic neuropathy. You just suffer until you die. From something completely preventable.

I guess this whole thing bothers me, not just because on the whole diabetics are treated very poorly, but because I'm now a healthcare professional, and I am surrounded by physicians every day, but I don't think I can just ask them to write me a prescription for insulin because I'd rather go to work than call the doctor's office to set up an appointment, then call the dean of student affairs (another physician), and then the clerkship director (also a physician), and then drive to god knows where for a fifteen minute conversation with the doctor to write me a prescription so I can save $350 for something that almost everyone in the world doesn't think about.

It's upsetting. If I had my way, everyone with a type of medical/biochemical deficiency would be able to get whatever they need for next to nothing because that's what equality is. Hypothyroid? You get thyroxine, no problem. Chronically depressed? We'll get you an SSRI or maybe even some SNRI's if you're lucky and need more norepinephrine. Diabetic? We'll get you all the insulin you want. Because giving you anything less than that is a crime.




So this is where I read that Diabetes in blacks and asians is often idiopathic: http://www.aafp.org/afp/1998/1015/p1355.html
Although since I am both caucasian and african, I won't know if I have the idiopathic form until either A) my entire genome gets sequenced (I hear it's only $1000 now!) or B) they look for islet cell antibodies in my serum.

UWorld Blues & A Murderous Rage

Studying for boards is driving me into a murderous rage. It is a combination of self-hatred for not studying more earlier and the incredible disbelief that they want us to know so much.

Also I keep getting diabetic questions wrong on UWORLD, which is probably the most depressing thing. You think you understand the process of something fully only to find there are perverted ways of asking questions that make you question what you once knew as true.

This is hell. I also have normal human being things to worry about, but I'm not paying attention to them anymore. I need to cash checks. I need to move. I need to get a new phone. I haven't checked my blood sugar in three days because I lost my glucometer while trying to pack up my apartment. So that should freak me out. But it doesn't. What makes me chuck the First Aid review book across the room as hard as possible is not the fact that my life has deteriorated to this point where I don't care about my own health and safety. No, it is the realization that I don't know how Rifampin works. I haven't been this angry since I studied carbohydrate metabolism in Biochemistry--a class I was desperately failing. I actually flipped a table when I realized memorizing all the intermediates and enzymes that metamorphose glucose was not going to be enough to do well on the exam.

That's how I feel right now. That I know a lot, but that come test day, everything I know either A) won't be tested or B) won't be enough to answer enough questions correctly.

But I have come way too far to fall apart in the next 12 days and fail Step 1 on June 1st.

12 days.

Compliance & Threats

Currently I am in Clinical Neuroscience. We are being lectured to about sleep disorders, specifically sleep apnea. The guest lecturer appears to be in the range of 40-60 years of age.

Concerning sleep apnea, there is a fairly successful treatment: continuous positive airway therapy (CPAP). Unfortunately, compliance with CPAP is pretty low. Only 46% of patients use the therapy, and of these persons, only 70% use it on a regular basis.

The lecturer urged us to tell our patients: "You're going to die in the most horrific way imaginable then list all the complications of uncontrolled sleep apnea."

This was one of my major complaints for my previous endocrinologist: vague threats. I can understand why doctors would want to do this--it is really frustrating when you're trying to help someone when they're not trying to help themselves. But I wonder if there isn't a better way to tell someone that they're killing themselves. Would this involve asking them about their life goals and how non-compliance will negatively affect these goals? I think it does.

Regardless,

I suppose doctors are among the few people that can tell you--in disturbing and exact details--how you're going to die without you freaking out and calling the cops.

Hassling with the "Need" to Medicate Mental Conditions

I think I'd be a great psychiatrist:

1. I like sitting.

2. Physical exams are my worst competency in clinicals.

3. I have several mental conditions (possibly), but I most definitely have one.

4. I treat people with mental conditions like people.

5. I see people with mental conditions as people.

Now let me elaborate:

In clinical neuroscience we end up watching a lot of patient interviews. One day we saw one with a schizophrenic. Later, me and a group of people got into a discussion, and I was the only one on my side of the argument, which was basically, the person seemed fine and functional enough, and why should we deem him “flawed”?

Yes, he had once been an irritable and a frequent assaulter. But on medication, he seemed talkative—enough, he had moods—enough of them, and he seemed normal—enough.

[One small point, shouldn’t normal be set by the patient? For example, when I was depressed, I knew I didn’t want to be depressed, and I considered the feeling abnormal and I wanted it corrected. But if I have occasional hallucinations that I enjoy, why change that? Or if I have synesthesia? That’s enjoyable. Right? And like, all famous actors have dyslexia. And they talk openly about it and it seems normal now, although you could easily argue it’s not.]

No one agreed with me. "Here," they said, "is a deeply troubled man. He assaulted over 100 patients, nurses, and doctors at his first hospital—etcetera etcetera. He was barely lucid. He wasn’t making sense. He wasn’t talkative."

But these things seemed normal to me. The great variance of human personalities also includes medically treated schizophrenics.

And why are we so eager to eliminate imperfections? Even the term imperfections makes it sound like there’s a one true normal (there isn’t) or that there’s only so many ways a person can be functional (there aren’t). I don’t want to sound like the preachy 2^nd grade teacher you were scared of because they loved diversity thiiiiiiiiiiiiiiiiiiis much, but in all honesty, I hate the idea that mental illness has to always be treated and that we all automatically look down on people with mental illness because society has trained us to fear the abnormal, especially the mentally so. I’m not just saying this because I have a mental illness, but as a person who has known, talked to, interacted with, and dated people with mental illnesses, I say we should all work on the way we see others with DSM-logged disorders.

If you’re born with something, you shouldn’t have to awkwardly try to hide it constantly. And while most mental illnesses aren’t entirely genetic, many of them have a strong genetic component. Even more importantly, if you don’t want to hide it, you shouldn’t be forced to.

Schizophrenia an interesting mental illness. While I haven’t yet studied the topic enough to know if most schizophrenics are violent, I do know that public perception of schizophrenics paints them as violent.

[Side note: There was a great episode of Law & Order: SVU that involved a schizophrenic who appeared to have killed the woman who was in charge of his group home. No one trusted him and he was in a panic for the entire episode. Until the person who murdered the woman murdered him. I rarely cry watching law shows. I bawled.]

Most schizophrenics probably don't want schizophrenia. But what if they don't mind it? Similarly, most people with bipolar disorder I don't want it, but what if they don't mind it? Should we medicate people? And when we do, are we actually doing it to protect others? Or are we just doing it to quiet an imperfection, an imperfection we are holding on with us and projecting onto the larger world? I think this is especially a problem for doctors, who control so much power to change a person's life. Wouldn't it be best to understand what quality of life such a person wants first?

Time "Well" Spent

Today was a relatively difficult day, with me waking up--unwillingly, seriously, my alarm was set for 9:30 and I woke up two hours earlier--in time for my first class. My first class of six. Of course, most of that miscellaneous time was spent making a pie chart for my blog. What is more depressing? The fact that I spent more time in our lecture hall than I spent sleeping? Or the fact that I spent 52% of my day "studying"?

Well regardless I'm proud of myself. I'm not a type A person, so the fact that an entire seven days before my exam I'm already pounding the books... is either a great sign or a desperate call for help. Did no one see me in the library?! Because I was totally there. Totally studying. Totally not an Elora thing to do.

Read Between the Lines

We have a pathology professor--he seems like a nice, funny man--who's voice slowly deteriorates from a standard, older person's grumble to a dying, dehydrated, lip smacking affair. It's his third hour of lecturing. I get it. You need water. I understand this.

WELL THEN GET A DRINK OF WATER.

I should explain. I can't stand several things in this world of a billion annoyances. But the thing that bothers me a lot and is also quite common is hearing. people's. mouths. Mouths are disgusting, disgusting places. In general I can't stand the sound of people eating. This bothers me to no end. I have had to yell at people to stop, I have gotten into so many annoying fights with my little sister who--is an amazing person--but who needs to understand that I simply can't stand listening to other people eating and no, I will not get over it. F*CK that. I AM ACTUALLY ENRAGED RIGHT NOW. Because I am sitting in class and my professor, teaching pathology--an amazing course--keeps making eating sounds over his goddamn microphone. I swear to God I might leave. I want to leave. Maybe I'll put in headphones.

I have put in headphones. I no longer want to pay attention in class, however, and am pretty upset. The only other times I feel this irrationally upset, I am usually PMSing. I know it's irrational, but I am clearly having a physiological response. My breathing is shallower, more rapid--my chest is tightening. I may pass out. 

Worst of all, this is now affecting my note taking. BECAUSE HOLY SHIT, when something doesn't make sense, I get slightly upset. When I am already upset and things don't make sense, I break down.

Medicine is not for the easily incensed.