A Denial, A Denial, A Denial...

...and with these words, Kurt Cobain's voice trails off, the guitar fades, and five minutes and one second of adrenaline pumping, teenage-angst invoking, era-defining grunge comes to an end, leaving behind memories of youth and vitality.

It finally happened. The day I feared and hoped would never come suddenly sucker-punched me forcing sanguine reality to trickle from my lips. My joints seem creakier. My back aches. Has it really been 17 years since that song first rocked me out of the comfortable world of Oldies 92.9?

Today, I heard Nirvana's Smells Like Teen Spirit played on a classic rock station. A...CLASSIC...ROCK...STATION. Pardon me if I overreact a bit. The music of my youth has now been deemed classic rock. OH SAY IT AIN'T SO (oh crap, I bet that song's next). Nirvana isn't classic rock. Led Zeppelin is classic rock. Aerosmith is classic rock. WHAT HAPPENED HERE?!?

I hope you realize that Smells Like Teen Spirit was more than just another overly distorted grunge song. That was it, that was us. It defined my generation. It was the collective consciousness of my teen years. And now.... relegated to the past.

Maybe if I crawl into bed and forget that today ever happened it will all go away. Because let's face it... with the lights out, it's less dangerous.



"Here we are now. Entertain us."

Rock Around The Clock *UPDATE*

It turns out that the people at the hospital have a soul after all and let us go home at 5 pm on Saturday rather than staying through the night. Although, I'm not sure this will be standard practice.

Rock Around The Clock

It's been a busy exciting week for me filled with a lot of lessons, both in medicine and life. So now that it's Friday, I can sit back, relax, and enjoy the... 12 hours I get off before I have to be back at Mary Immaculate Hospital (MIH) for 24 hours of in-hospital call. Pardon me whilst I jump for joy! *jump*

Part of being a medical student is being on-call. There are two kinds of call in IM at MIH. The first is during the week and is called short-call. This is where you stay beyond the end of your shift until 9 om. Then there's weekend call. Weekend call begins Saturday morning at 8 am and doesn't end until Sunday morning at 7 am. Pardon me whilst I leap for joy! *leap*

While on call, I'm responsible for helping the resident on call follow the patients throughout the night... you heard me, aaaaaallllll through the night. Pardon me whilst I skip for joy! *skip*

5 am will arrive all too soon. Goodnight, and see you on Sunday.

Ain't Nuthing But A "NG" Thang

What an exciting day to be on the wards for Nareg. From the beginning, I knew this was to be a particularly busy day, as Tuesdays we have Grand Rounds, which is essentially a presentation of a particular topic of medicine by an attending in her or his respective field. Add to that our regularly scheduled meetings with the Chief Resident and the Attending and basically, the morning was jam-packed.

I knew one thing... I wasn't leaving the hospital today until I had spoken with and taken a History and Physical (H&P) of a patient on our floor. I figured, this rotation had gone on far too long with me not having any patient contact, and I was set to rectify that. BOOOOOOOOOOY, Did I ever!

In between sign in and Grand Rounds, I stood in our little med-student hang-out with my colleagues. All of a sudden, the PGY 2 (remember? the second year resident?) came in looking for a volunteer to place a nasogastric (NG) tube in a patient. In one of my bolder and more courageous moments, I volunteered to take on the challenge (much to the approval of my intern). Now, an NG tube is more or less a basic procedure, nothing to get all excited about. But you'll notice... I called it a procedure... like real doctor stuff! Excitement fills the air!

For those who are interested in what an NG tube is, read on. For those disgusted by the idea of any medical procedure, disregard the rest of this paragraph. An NG tube is a method of providing nutrition to a patient that is otherwise unable to eat or drink. A tube is passed through the nose, the pharynx (the little space that causes you to have milk come out of your nose when you laugh), down the esophagus, and into the stomach, hence - Naso (nose), Gastric (stomach). This tube can then deliver nutrition directly into a patient's GI tract.

Under the supervision of the PGY 2, I was able to get the NG tube down. It actually proved to be rather easy, easier than I had expected. It was a good feeling to finally be getting some kind of clinical experience. Empowered by my sense of accomplishment, I set off to do my first H&P. The most intimidating thing is to be sitting across from a patient in your stupid little short white coat, realizing that you actually don't know anything, and setting off to interview this person about why they're in the hospital. It also doesn't help that, no matter how many times you introduce yourself as "a medical student", they still call you doctor. Forgive me while I throw up a little in my mouth. That's just too huge to handle.

The interview went rather well, but took WAAAAY too long. Of course, there were about a million things that I forgot to ask and do that only came to me on the way home. Nonetheless, I was happy that I was able to devote that much time to a patient who just wanted someone to talk to. (Expect comments on the current status of health care soon). Look out people, a new Dr. Kalamkarian (in training) is coming up in the world!

Harvester of Joy

Early October every year brings the closing of the harvest for grapes in the central valley of California. With the end of the harvest comes a celebration of that harvest, a festival to be thankful for another fruitful year and a chance to celebrate the wonder of nature's bounty with close friends and family.

Mesereh: On the surface, a simple transformation of fruit to preserve. Look below the bubbling surface and you'll see the spiritual and emotional connection to land, people, and ancestors. An opportunity to carry out a tradition handed down for generations.

The gist of Mesereh is to harvest grapes - a fruit that eventually spoils - and turn it into molasses - a product that can hold on to the benefits of the fruit for the coming year.

Friday, October 3
8 pm - A pit is dug and a fire is lit at the bottom of said pit. This fire will continue to burn throughout the night with careful tending by the primary orchestrator of the proceedings, Mr. Raffi Santikian. Tomorrow, this pit will serve as a slow-roaster for the various meats that will be served at the party.

9 pm - A flagpole is erected and the American and Armenian flags are proudly hoisted at the entrance to the premises.

For the remainder of the night, the house is abuzz with preparations for the following night.

Saturday, October 4
6 am - A trumpet call awakens the participants from slumber.

6:30 am - The fire in the pit has become embers, but the surrounding earth has absorbed all the heat from the previous night and is set to receive the aluminum containers full of tri-tip steak and turkey for slow-cooking.

7-9 am - A flat-bed truck is loaded with the workers (family and friends) to make the short trip to the adjacent vineyards. The objective is to collect as many bunches of grapes as the grapevines will yield.

9:30 am - Towards the end of the harvesting period, a mini war inevitably breaks out between the workers. Sniper-bullet grapes fly from one end of the field to another. Grape-bunch bombs fly from row to row, finding innocent and combatant targets alike. Heinous run-by-frutings are aimed at unwilling participants. Suddenly, even those who had shied away from getting too dirty find themselves in the crossfire, and few make it back home clean.

10 am - The grapes and workers find themselves back at headquarters. The grapes are unloaded and dumped into an elevated converted bathtub for a prelimenary wash.

10:30am-12 pm - The now washed grapes are removed from the converted bathtub, which becomes the stomping area. Grapes are filled into burlap sacs. After sprinkling lime (The chemical, not the fruti) in with the grapes, the bags are tied off, and placed in the stomping area. The fun begins shortly thereafter. Two members of the crew step in with the grapes and begin stepping on them, literally stomping the juice out of the grapes. The juice flows out of the bags, and down the drain, into a waiting bucket. The process is continued, and often the stomping crew changes shifts to allow all to partake in the fun.

12-3 pm - The resulting liquid is emptied into a large container, where it will remain for a few hours. During this time a fire is lit underneath the juice container and the juice is brought to a simmer. This begins the next stage of purification. The heat will cause the lime to grab any impurities (see feet in paragraph previous) and bring it to the surface. These impurities can easily be skimmed off the surface.

3-4 pm - The juice is pulled off the fire into buckets and allowed to rest, ushering in the final stage of purification. During this time, all remaining impurities settle out to the bottom. The supernatant liquid is then poured back into the container, and the heat is resumed.

Under extreme heat, the water from the grape juice will slowly evaporate, leaving behind the sugar and vitamins of the grape, slowly converting it to molasses. The final indicator that the molasses is ready is a fine foam that appears at the surface of the liquid. As onlookers wait in anticipation with occasional cries of "PRPOOR!", the armenian word for foam, those who preside use a dried, hollowed-out gourd to scoop out the liquid and let it fall back into the container, causing turbulence that hastens the arrival of prpoor. When the prpoor is ready, it is scooped off the surface and served to guests who use a fresh bay leaf to enjoy the decadently sweet foamy treat.

The entire scene is generally filled with singing, dancing, and a drum procession, all meant to celebrate the arrival of prpoor and to rejoice in the year's harvest. It is a surreal experience, when in that moment, one steps back and looks around at the glowing faces. The beat of the drum is in sync with the heartbeat of the ancestors to whom Mesereh was more than just a party, it was a way of life. The dancers, arranged in a line from old to young, reflect the celebrations of old. The voices raised in unison momentarily drown out the ugliness of the world that surrounds the participants. And all that's left, all that matters, is prpoor.

F-Town Nareg's Back Again

23 days in NY has been enough. I love my new adopted city, but I need a dose of Cali, and this is the weekend to do it.
This weekend is Mesereh at the Santikian's home, and, having missed the last two years, I cannot justify missing this year. This gives me a chance to not only be part of an event that I love, but to also see the family, excluding of course the traveling parents.
It's a great break from the hum-drum life of the medical student, and I'm sure it will refresh mind, body, and, most importantly, soul. More updates about my weekend to come.

So Low The Sky's All I See

The lessons began from the very first sign-in session. We sat comfortably at the table of the conference room when we were told that the table is reserved for the residents, and that the students were supposed to take seats around the edge of the room. Ahhh, the hierarchy, the pecking order, the totem pole. Here’s how it works

At the bottom there’s us – the medical students. We wear the short coats. We know nothing. We smile, act polite, and do as we’re told.

Next up are the interns. These are the first year residents. They are directly responsible for patient care and also for assigning duties to the medical students. There are about 4-5 interns per floor, and each one is responsible for two medical students.

Next up is the second year, followed by the third year residents. There is one second year per floor and they are supervising the interns, rounding with their patients, checking on their work, and making sure the students are being taught properly.

The entire department of medicine is led by the chief resident, who is a third year responsible for all the residents. He arranges the schedules, assigns students, and generally makes sure the residents are doing their jobs. He is also responsible for presenting the core curriculum to residents and students by way of lectures and such.

The highest level in the hierarchy is the attending. These are the doctors who have long since finished their residencies and are basically practicing physicians in the hospital. Each floor is assigned an attending physician who is responsible for all residents and students on the floor.

My group is particularly lucky, because our attending is semi-retired, and mainly focuses on medical education rather than patient care, so we get his complete attention. He has a lot of experience and I think we stand to learn a lot from him.

Life On The Fourth Floor

Third year of medical school is about doing rotations through the five core clinical disciplines of medicine: Internal Medicine, Surgery, OB/GYN, Pediatrics, and Psychiatry.

This week began my first core clinical rotation, Internal Medicine. After two days of pointless orientations that brought me no closer to understanding what exactly my responsibilities are, I began work at Caritas – Mary Immaculate Hospital in Queens. I was assigned to my attending Dr. Sossi and my intern Dr. Kumar on the fourth floor of the hospital.

The first day was a real Charlie Foxtrot since it was also the resident’s first day at the hospital. The second wasn’t much better. I have yet to see a patient of my own, and I can’t say that I’ve learned anything in particular. If teaching was confusing in Basic Sciences, then it is nothing short of haphazard in the hospital. Things get thrown at you from all over the spectrum of medicine, with no rhyme or reason. I suppose it is my responsibility to take everything I heard during the day on the floor, and organize it into some sort of study schedule.

So far, the day entails trying to keep up with the list of patients, making sure that the list is constantly up-to-date with labs, medications, radiographic studies, etc. We are also responsible for a daily check of the patients’ vitals and general status. Occasionally we follow the intern into a patient room and observe him examine and talk to the patient, but mostly, we’re chasing after paperwork.

The schedule is mostly filled with meetings, lectures, and rounds, so we’re often dropping everything we’re doing and running to the next thing. It’s kind of disjointed but I guess part of the lesson is to be able to juggle a hundred things at once and still be flexible enough to go with the flow.

We’ll see how this all works out.