A busy day in the emergency room

I had a great time in the emergency rooms around Vancouver when I went through my third year rotations. I guess I liked the variety of cases that come through the door, and doing what I think is one of the most fun parts of medicine: diagnosing and stabilizing all sorts of patients until the right experts can take over.

But my 4 weeks of emergency in Vancouver was nothing compared to what I did in a rural rotation during my fourth year. In a small town emergency manned by just one doctor, I suddenly became a useful member on the team. The nurses look to me to take on patients so that I can help with the workflow, seek me out to do procedures “because the student should learn this”, and the doctor place me up front and center for my first cardiac arrest code…

During the day, I sutured a few lacerated fingers (I love suturing no matter how many times I do it… I think it has to do with liking to do small arts and crafts that are fun but not overwhelming), examined a few patients with various ailments, pushed the shock button and zapped a patient out of her multifocal atrial tachycardia, all in a day’s work.

But in the evening, things got more interesting. While I was talking to the ER doc about anaphylaxis, a family member suddenly called out: “we need some help!” I jumped up and rushed to the bedside; I interviewed the frail lady just several minutes ago and thought she just had a partial bowel obstruction, and ordered the standard set of workup.

She looked very different now. Her eyes rolled back, and her muscles started to spasm. Her false teeth came loose and was about to fall into the back of the throat when I threw on a pair of gloves and grabbed it.

“Open her airway,” the ER doc said. “Start bagging her. Call a code!” He turned and called out to the nurses.

I grabbed the bag-valve-mask and the thing fell apart. I clumsily put it back together and starting bagging (providing artificial respiration by pressing air into the lungs with the bag) the patient. I was so focused on my task that when I finally looked up, the family member has been gone, a team is already around the patient, and an ECG was showing ventricular tachycardia (and she is pulseless)- one of the most deadly heart rhythms that means certain death if not corrected in minutes.

“All clear!”

The patient jerked while the shock was delivered. I resumed bagging the patient right away, but almost immediately she started showing signs of life, moving her limbs and spitting out her oral airway. I pulled out the airway and the doctor told me to keep bagging her. After a minute or two, she started breathing on her own and I just held the mask delivering 15L/minute of oxygen over her face, and took in the scene.

A nurse was having difficulty with placing the oxygen pulsimeter, another nurse is placing a large-bore IV, and someone else is fitting a bag of fluids into a pressure cuff. The ER doc was giving orders for interventions and investigations. The patient continued to stabilize, and things finally settled. She was saved from death, for now, but we haven’t figured out what she was dying from.

As a part of tests to find out, we ordered an arterial blood gas. This requires puncturing the artery with a needle to draw arterial blood, to find out about the gases and pH values of blood that the body sees. I had practiced on a classmate more than a year ago, so I was poking my head over a nurse’s shoulder to get a look.

She suddenly asked, “where’s the student?”

“I’m right here behind you.” I said.

“You should be doing this.” She said, matter-of-factly.

“I was thinking ‘I wish I could be doing this'”, I said, which was the truth.

So we switched spots. I struggled at first, but another nurse holding the patient’s hand was steady and patient, and the ER doc gave me some directions, and I got a steady stream of arterial blood from the radial artery. First ABG, success.

The ABG later showed that the patient had plenty of oxygen in her blood, and no other abnormalities. “You bagged her well,” the ER doc said. First time bagging a coding patient, success.

Later on that evening, just as everyone felt they’ve put in a good day, a call came in notifying us that there’s a cardiac arrest patient being rushed in by ambulance.

A team of nurses that make up the trauma team got ready in the trauma bay, and I volunteered to do chest compressions. But the ER doc had something else in mind.

“You will intubate the patient.” He said.

“Alright!” I said, excited.

“Have you intubated before?”

“Only in very controlled settings (in the operating room).” I said

“Well, there will be nothing controlled about this,” he said.

We checked the intubation equipment, and someone pulled up the glidescope. The guidescope is basically a camera that shows the patient’s airway on a screen, which often helps visualizing the trachea into which the tube has to be inserted.

After a few minutes of calm when the whole team waited, the ambulance arrived. A nurse closest to the door took a look, and said quietly: “god, he is 400lb.”

The ambulance crew flew in with the morbidly obese patient, and somehow managed to drag him over to our stretcher. The continued to pound away on his chest until our nurses took over. The team got to work, placing IV’s, defibrillator pads, and I pulled over the glidescope.

“Go?” I asked.

“Go.” The ER doc said. “And 1mg of epinephrine!” He said to the medication nurse.

I opened the man’s mouth. His neck is massive, and his tongue seemed as big as my palm. I couldn’t even fit the glidescope into his mouth, and I think it is at least 2 inches too short for him.

“Let’s use the traditional way,” the ER doc said after he couldn’t get a view either.

I pulled up the laryngoscope, and naturally used my right hand to put his head (which must weigh 8kg) into the sniffing position. I saw the epiglottis, and it was impossible to see the vocal cords.

Thankfully I learned how to use a flick motion with the tube in this suboptimal situation, and I got it in one go.

Unfortunately, despite our best efforts, the patient was too far gone. The ambulance crew has been doing CPR for about 30 minutes before arriving to the emergency, and he was in asystole on arrival. The most likely cause of death is a massive MI, and there is little CPR can do in this situation.

The ER doc called it, and commended on everyone’s efforts. He was especially impressed with my intubation.

“Truly a great job. Things were chaotic, the nurses were doing chest compressions, the man is so obese that even anesthetists would have to try hard.” He said. “You won’t have to do a harder intubation in your life.”

Although the outcome of my first case of cardiac arrest was not successful, I left the emergency room at 2am knowing that I have done as well as what anyone in my situation could have, and that was a good feeling for a medical newbie like me.

And I realized: the more I do in the emergency, the more I like it.

 

At a Honda dealer, feeling like a patient

My 10-year-old Honda has been acting weird lately, like an old, weathered man whose body is starting to fail.

The symptoms that I’ve noticed include: morning gas pedal stiffness (it’s hard to get going when I first start the car), irregular rhythm of the engine (it revs itself like a punk kid at the red light), and spastic jerky movements (it switches gears with big spasms). Some abnormal markers on diagnostic tests also showed up (engine warning light, and a “tcs” light which is a mystic acronym jargon that only the specialists will understand).

I suspect that this constellation of symptoms can actually be attributed to a single cause, or at least commonly occur together as a “sticky gas pedal syndrome”. Like any patient under the age of 60 with a new health concern, I googled the symptoms and found that many others have the same problem. Some suggest that it’s an issue with the throttle able, and offered a website where one can buy a new one, replace it for under $10, and avoid hundreds of dollars of dealership diagnostic and repair fees.

But like a scared patient without a courage to take his health into his own hands, nor any ability to judge the accuracy of such information and advise, I rushed to the Honda dealer as fast I could.


The check in process included an agent asking to see my insurance paper, taking down my contact info, asking me some questions regarding the symptoms my car has, and getting me to wait an hour while the doctors, I mean the technicians do diagnostic tests to figure out the diagnosis. Then I will be called, the diagnosis and treatment options will be explained, I will be confused but too timid to ask questions, and say to them “whatever you think is best, doc.”

The parallelism is striking.

There is a paramount imbalance of knowledge. They know every part of my car, and I barely know how to open its hood. They know how much things cost, which parts last longer, which parts you can get from any repair shop for a fraction of the price they charge. I know nothing. In an hour they can tell me: your engine is toast, you should sell it for parts and buy another, or they can tell me: just the cable getting worn out, it will be $200 total. The most I can do is seek a second opinion with another repair shop, and go through the process again.

In this position, I can only trust that they are legit and at least fair about charging me extra for being the official Honda dealer. They can ask for $200 or $1000, either way I will probably have to pay up. They can be nice and explain things to me, or they can be too busy to slow down. They can do unnecessary tests and cost me a fortune, or they can be judicious and use their experience and judgement.

And I’m just getting my car fixed!

Imagine how scared an powerless you will feel in a big hospital with countless doctors in authoritative white coats rushing about, patients screaming in agony or puking their guts out around you, and never ending ringing of the phone, beeping of unknown medical devices, and calling code-blues overhead, waiting for your loved one to be seen and cared for. The wait, which can be hours, is felt to be even longer because you don’t know how much longer it will be. You don’t know if you can go to the bathroom because you may miss the doctor, you don’t know if it’s safe for your loved one to take a sip of water, and you may not even have an idea what’s wrong with your loved one and if he or she will get better (there is no selling the parts and getting a new car here).

What we as health care professionals can do, is at least be mindful of what our patients and their families are going through. For us, it could be the fifth time being woken up to see someone in the emerge with vague abdominal pain, or yet another patient who doesn’t speak English which makes our job difficult, but for them, we can be their first contact with the medical team after hours of waiting for this very real crisis. It’s easy to forget that and lose patience when the worried family press us for that morphine we said we’d give an hour ago, because it’s up to the nurses to fill our orders. We can say: “talk to your nurse”, or “let me see what I can do for you” and find out what’s holding things up, and perhaps start the IV that the nurse is too busy to get around to do.

Also, we should keep the patients in the loop as much as possible. Update them on what’s going on, what the short term and long term plans are, when they can expect which things to happen, and to check for questions often. Sometimes it seems like our job is to check lab results, check vitals, talk to patients about their pain, bowel, and appetite, and write a progress note. But when I update the patient on an improving lab result that they have been worried about, that could be enough to improve their pain, bowel, appetite, and their day could go so much better.

The hour of diagnostics is up, and they found a dirty throttle body, cleaned it at no cost, and just charged me the diagnostic fee of $75. I’m impressed by their time management, which is more than I can say for many doctors. Of course, patients are not cars, and we can’t always be expected to predict how much time a patient will take as we could for cars. But there are many lessons that we can learn from a good car dealership nevertheless.

Hello Scammer

I posted an ad on Craigslist, as I’ve done many times before, for an iPod touch I wanna sell. Little did I know, I would be running into the first scammer that I personally need to deal with…

The following is the email exchange, with my commentary in italic.

Gmail

32gb iPod touch 4th gen with warantee – $250 (Richmond)
9 messages


Janet <janetscoffy@gmail.com> Sun, Oct 23, 2011 at 6:09 PM
Reply-To: janetscoffy@gmail.com
To: sale-y3khx-2664177043@craigslist.org
** CRAIGSLIST ADVISORY — AVOID SCAMS BY DEALING LOCALLY
** Avoid: wiring money, cross-border deals, work-at-home
** Beware: cashier checks, money orders, escrow, shipping
** More Info: http://www.craigslist.org/about/scams


Still have it for sale??


This message was remailed to you via: sale-y3khx-2664177043@craigslist.org
If this email is a scam or spam please flag it now:
http://www.craigslist.org/flag/?flagCode=31&smtpid=201110240109194B_kzNz94BGT6u-clUcQ4Q


Very legit and similar to what a buyer on Craigslist say. Nothing suspicious yet.

 


Billy  Sun, Oct 23, 2011 at 6:18 PM
To: “janetscoffy@gmail.com” <janetscoffy@gmail.com>
Hi Janet,
Yup. Can we meet tomorrow afternoon at Richmond center?
[Quoted text hidden]

Janet <janetscoffy@gmail.com> Sun, Oct 23, 2011 at 7:25 PM
To: Billy
Thanks for your reply, i really need to buy this and send to my boyfriend schooling in (Newcastle, Wyoming) in U.S.A as a  gift . I will offer you $280.00 CAD so as to close the auction as soon as possible. I will be paying using PayPal because i have a verified account with PayPal. So kindly get back with your PayPal email address so that i can make payment into your PayPal account ASAP. but if you don’t have a PayPal account you can set up an account with them just visit www.paypal.ca the process is just 3- 5minutes, Once payment clears, shipment will be handled by me through my Personal FedEx account, so you don’t have to bother about shipment. Get back to me if my approval is granted and the payment will be made immediately. I would like to see some pictures please.

Thanks.

Janet

[Quoted text hidden]

Here things start to get weird. First of all, WAY too much information with the boyfriend and verified account and instruction to get PayPal and FedEx account… Also, the $280 offer is strange. Why would anyone offer to beat my asking price just to “close the auction”? There are other sellers who are selling at $250, it’s not like mine is a very reduced price. Finally, using PayPal for Craigslist is an automatic red flag. But nothing definitely foul yet.


Billy Sun, Oct 23, 2011 at 8:30 PM
To: Janet <janetscoffy@gmail.com>
Hi Janet,
How should I give you the iPod after your payment clears?
I will hold the iPod for you for $280 no prob. I posted pics on my ad posting http://vancouver.en.craigslist.ca/rch/ele/2664177043.html
Billy
[Quoted text hidden]

Here I was hinting at the hole in her proposal: since she said she would deal with shipping, that means I need to give her the iPod somehow. But why would you pay me extra money by PayPal and then meet me for the iPod? You don’t know how to work an ATM?


Janet <janetscoffy@gmail.com> Mon, Oct 24, 2011 at 5:22 AM
To: Billy
Hey Billy goodmorning to you and how is your night ?? I will be including the shipping fee in the payment I am gonna send to your account and all you need now is to get back to me with your PayPal email address to receive the payment so that I can proceed with the payment…

Billy

[Quoted text hidden]

She did not answer my question. Sounds like she wants me to ship now. And she signed her email with MY NAME. What’s up with that?


Billy  Mon, Oct 24, 2011 at 6:43 AM
To: Janet <janetscoffy@gmail.com>
Ok, it’s xxx@xxx
[Quoted text hidden]

At this point I just want to know how she plans to scam me. Cuz you can’t steal money just by having my PayPal account.


Janet <janetscoffy@gmail.com> Mon, Oct 24, 2011 at 1:08 PM
To: Billy
Great and I will get back to you once I am done with payment and do you also have a cell phone number that I can text you at….Let me know once you do receive an email confirmation from PayPal …Regards

[Quoted text hidden]

Janet <janetscoffy@gmail.com> Mon, Oct 24, 2011 at 1:26 PM
To: Billy
I have just made out the payment online now. Go and check the email  account you used in opening your PayPal  account a payment confirmation message from  PayPal have been sent there check the INBOX or SPAM messages you  should see it there. I will also like you to know that i am having some little problem with my FedEx account as i checked it online now  and i was asked to reactivate it which i can’t do that now as i have  to sort one or two thing out with them. So i am sorry as i won’t be  handling shipment through my FedEx account again. Please get the  postage done to the following address via post office using  (XpressPost via CANADA POST or via PUROLATOR Courier) and ship out the  item asap cos i have told my son to be expecting it. I have also  included $70 extra for Shipping.

Rich Hartinger

C/O Stanley Wooten 701 Salem Ave Lot 1

Wyoming

Newcastle

82701.

Please get back to me when you have posted the item. Thanks and i await your reply

Notice a few hilarious things: 1. she sounded surprised that her FedEx account is suddenly unavailable, although in her last email she already implied that I will do the shipping. 2. Who the hell will get a random seller to send a gift on their behalf? Does she expect me to giftwrap this or write a love letter for her? 3. She threw in more extra money just for fun. And 4. most of all, HER BOYFRIEND IS NOW HER SON.


Billy  Mon, Oct 24, 2011 at 1:34 PM
To: Janet <janetscoffy@gmail.com>
Hi Janet,

The emails I got weren’t from PayPal, so I am afraid I cannot go through with this transaction.
Cheers,
Billy
[Quoted text hidden]

This is what the “PayPal” emails look like:

And:

Basically, she pretends that she already paid me by PayPal, but PayPal needs my shipment confirmation to “clear” the transaction. To encourage me to do it, she paid me $350 magic money that I will never see for a $250 item.

Here‘s what an anti-scam website has to say about this specific operation.

Supposedly there should be a fake threatening email about how she already paid and how I would get in trouble if I don’t ship the iPod, but I haven’t heard back from this scammer. Probably knows it’s a lost battle.

A few final thoughts:

1. I can see how a greedy person not too familiar with PayPal and Craigslist can fall victim to this scam, but you have to be pretty gullible. First fule of online shopping: If it’s too good to be true, it’s because it’s fake. 

2. I still have the iPod for sale. Any takers?

Golden Key UBC gets more activity than EVER

For those of you who don’t know, Golden Key is a society where the invitation-only membership is given to the top 15% of students academically. I made the mistake of joining it in 2nd year, wasting some $70 of registration fee, because of a misplaced sense of accomplishment when I got an invitation that started with “congratulations!”.

Long story short, I have not attended any event or did anything at all with the membership since I signed up. The organization seemed highly pretentious and juvenile at the same time. Pretentious in that the members share a grandiose delusion that they are superior than other students, and juvenile in that people collect points when they attend events. Earn points! I haven’t earned points for good behavior since I was 8 and could earn points for practicing piano. 10 points = 1 sticker. 10 stickers = $10.

Anyway, GK had been largely just a bad memory in the background that spews out an occasional spam about a launch BBQ (the attendance at which will earn you 5 points!), until today, when an unfortunate girl, probably fed up by getting the BBQ spam year after year, replied that she wanted to be removed from the mailinglist. Unbeknown to her, spamming the mailinglist about getting off the mailinglist would set off a chain reaction: people who also wanted to get off the list replied “me too”, and people who were originally patient with these spams got impatient after dozens of these “me too”‘s and wanted to get off, so the “me too” spams grew exponentially. Compounding these are 1) people who think they are smarter spamming the list the ways to properly unsubscribe (and these instructions grew more and more hostile as people continued to spam the list with “me too”‘s, and soon the top 15% of UBC students started to call each other stupid), 2) people who think all of these are funny spamming the list how they thought it was funny and posting cat pictures (no joke), and 3) the “proper way” to unsubscribe actually doesn’t work, so there was another wave of spams telling everyone how it actually doesn’t work.

My solution? Create a filter and make any message with the phrase “golden key” skip my inbox.

But I do think it was pretty funny and had to resist the temptation to spam everyone something witty…

What can I do with all these CDs?

Continuing with the theme of cleaning, I want to talk about one of the many headaches that I believe many of you share, or will share when the same problem inevitably arrives: what do I do with all these dam CDs?!

In the foreground, you can see a slanted pile of what looks like a piece of well-formed poop. This CD poop is the result of years of accumulation of hardware drivers, burned movies that were only played once, outdated music CDs that will make anyone cringe if played ever again… I believe that this CD poop will be even more impressive had not been for the invention of iPods, affordable USB sticks, external harddrives, and wireless home networks.

What should I do with these shiny, pretty pieces of garbage? My mom was about to throw them out, but I saved them from the garbage bag and started to google “used CD diy“.

But this is not even a problem compared to what’s in the background: approx. 200 blank CD-Rs waiting to be used… but for WHAT?

I’m not gonna sit here for 5 minutes to burn 10 songs to the CD and play on my CD-R playback systems; I have iPod and speakers. I’m not gonna burn one movie to one CD and watch it once; I can hook the TV to my computer. I’m for sure not going to backup my files using these CDs… just imagine organizing 600 CDs and trying to find anything in this mountain.

So now I have two buckets of perfectly fine, shiny CDs that I just can’t think of a use for. I don’t want to waste my time and energy trying to sell them on Craigslist (I don’t sell anything below $10 because it’s just not worth my trouble, and blank CDs are worth… wait what? People are actually selling them for tens of dollars?

Well ok. I think I just found out what to do with these outdated tech toys 🙂

But seriously… what are people still doing with these?

Buy my stuff!

*Skip to the bold text below if you don’t want to read my rambling*

After years of living in the same house, it is easy to let things accumulate. Especially things that are sidelined by newer replacements so they are not used anymore, but aren’t broken so they aren’t thrown out either.

This is where Craigslist come in. I don’t know why it took me so long to become acquainted with this one-of-the-most-used site. It’s so much easier to post little things on Craigslist than on eBay, and so much more fitting for my purposes (an Internet garage sale). It only makes sense to sell my things locally; a buyer from the east coast of USA asked me about a $150 stereoset I put on Craigslist, so I looked up the shipping cost and outright told him to give up… it would cost $450 to ship a $150 item!

Anyway, I have had mixed success with my Craigslist ads. I managed to sell a few things, but the time and energy spent to make these dingy dollars are not worth it mathematically. I still do it though, partly because I would hate to throw out perfectly fine items when there are people who could potentially make use of them.

Anyway, tonight I went on facebook and a friend started chatting. I talked about selling stuff on Craigslist, and he got really interested. I think he might just be bored and was curious what my closet held, but that got me thinking: what if more of my friends are like him? What if my friends who aren’t actively looking to buy an iPod touch saw my iPod touch for sale, and thought maybe they could use it?

By selling on Craigslist, I am reaching a wider audience who is looking for the stuff I am selling. But by selling to my friends, I am tapping into the social networking potential. My things aren’t just things to my friends; they are “things that my friends used to treasure”. I bought a set of bicycle pedals off a friend just like that.

Instead of posting dozens of items on my wall individually and risk losing my friends’ respect, though, I will just create a list here.

As a special perk, if you bought anything off the list here, I will give you a surprise gift — a token of thanks for proving that my social networking isn’t all just a big waste of time.

 

Here goes!

Electronics

Cellphones

Computer

MISC

Books

Title: Intro stats

Author: De veaux, velleman, bock

Edition: 3 Institute: UBC (University of British Columbia)

Price: 90.00 ISBN: 9780321500458

Comments: Minimal highlighting, pages and cover like new, has CD Includes the student solutions manual

Title: Human physiology from cell to system

Author: Sherwood

Edition: First Canadian edition

Price: 120.00 ISBN: 9780176441074

Comments: Excellent condition like new. Online access unopened.

Title: Physical chemistry

Author: Ira N. Levine

Edition: 6

Price: 120.00 ISBN: 9780072538625

Comments: Like new! Cover, pages in perfect condition. No writing of any kind.

Title: Landmarks a process reader

Author: Birks

Edition: 2

Price: 20.00

Comments: Slightly worn but no marking of any kind

Title: A short guide to writing about biology

Author: Pechenik

Edition: 6

Price: 10.00

Comments: Bought used but in great condition

Title: The adaptive mind

Author: Lindsay, paulhus, nairne

Edition: 3rd Canadian

Price: 25.00 ISBN: 9780176435752

Comments: Contains chapter 1-8.

Title: Mirror for Humanity (A concise intro to cultural anthropology)

Author: Conrad Phillip Kottak

Edition: 5

Price: 35.00

Comments: Excellent condition. No highlights, markings, or any other damages. Add $10 to get “Windows on the World” by Fedorak.

Title: the little brown handbook

Author: h.ramse fowler, jane aaron, murray mcarthur

Edition: 5th canadian edition

Price: 30.00

Comments: like brand new, no markings at all

Title: Drugs and Behavior – An Introduction to Behavioral Pharmacology

Author: McKim, William A.

Edition: 5

Price: 60.00

Comments: In great condition, no damages.

Title: The Broadview Anthology of Poetry

Author: Rosengarten and Goldrick-Jones

Price: 20.00

Comments: Has some writing, but otherwise in good condition.

Title: Physics for Scientists and Engineers (Vol 1-5)

Author: Randall D. Knight

Edition: 1 Price: 45.00

Comments: Comes in a boxed set. Price is a bargain! 1st ed. is almost identical to 2nd.

Title: ADTs, Data Structures, and Problem Solving with C++

Author: Larry Nyhoff

Edition: 2

Price: 70.00

Comments: Excellent condition, hard cover. No highlighting or any markings.

Title: Physical chemistry for the biosciences

Author: Raymond Chang

Price: 60.00 ISBN: 9781891389337

Comments: Like new. No marking, highlights, etc.

Title: Introduction to Genetic Analysis w/ Solution Megamanual

Author: Griffiths

Edition: 9

Price: 85.00

Contact Person: Billy

Comments: Great condition, no markings.

Title: Exercise Testing and Exercise prescription for special cases

Author: Skinner

Edition: 3

Price: 50.00

Contact Person: Billy

Comments: Excellent condition, no marking at all

Title: How to Think Straight About Psychology

Author: Keith E. Stanovich

Edition: 8

Price: 10.00

Contact Person: Billy

Comments: Great condition

A much needed jog

As a guy with average athletic ability in his class who can only listen in awe when his superhuman classmates talk about running a marathon untrained or biking across the country in a month, I can probably speak to the rest of us who is quite content with finishing the 10k Sun Run.

I woke up quite lazily today to a grey morning, and I had breakfast leisurely, hot cereal with Pulmonary Quiz 2. Then I went back to bed for about 30 minutes to alleviate my pain of scoring 65% despite feeling good about the material. When I woke up for the 2nd time, the sun was out. I remember putting “jogging?” with a question mark on my calendar out of guilt of not doing any meaningful exercise for a week and going out to all-you-can-eat dinners too many times.

But the inertia was strong. I did not overcome my laziness until I went on facebook and saw a picture of a friend flexing his biceps throwing a frisbee. “That’s it!” I remember thinking. Then the question of whether to jog became where to jog to.

I went along my favorite route at UBC: down Westbrook onto NW Marine, then to Spanish Banks. The sun was out. The wind was cool but refreshing. And I instantly felt better about myself as a decent human-being.

When I reached the beach, I relaxed and looked around at the waving forest and small breaking waves. There were people wind surfing, a man with his old dog playing in the water. Blue sky, white clouds. I took a deep breath, satisfied. Spirituality doesn’t have to happen in a church or a temple.

This hour spent jogging probably does more good for me than another hour of studying, not only physically and mentally, but probably academically as well. I can probably study more efficiently or at least more happily. Besides, when that pain in the lower right thorax came back as I was jogging, I wondered: “tall slim male… spontaneous pneumothorax? Was it related to bronchiectasis?” Study, check.