Adventures in Awesomeness

Goodbye St. Louis Children's

2011-06-28T04:16:00.000-07:00

Just like every rose has it's thorn and every dawn has it's day, every pediatrics residency has an end, and this is the blog post about mine. It seems like just yesterday I moved to St. Louis to save children and to be hugged by random strangers in the supermarket (see previous blog post). I would say that the time has passed quickly but to be honest the time has passed in drug-aided sleep deprived blur. Its 6:30 in the morning and I'm sitting in the ER with one hour until I walk out of the hospital forever (or until my residency program decides I didn't really graduate).
There she is, a giant concrete Belgian Waffle of top-notch pediatric care. Sometimes I land on top of said Belgian Waffle in a helicopter as sweet as maple syrup. Usually, though, I just ride my bike to work.

It's moments like this when I like to reflect, and when I say reflect I actually mean look back at the last three years on our programs scheduling website to add things up. This is what I came up with.

Past three year stats

In-hospital overnight calls ranging up to 30 hours: 113

Weekend days worked: 126

Night shifts (12-13 hr shifts overnight): 60

Here's the analysis. That's a ton of work. That'll bring you to your knees. It's enough to make a grown man cry (if said grown man were capable of tears as opposed to having the emotional range of a turnip).

After calculating these, I decided to calculate more statistics, and when I say calculate I mean estimate, and when I say estimate, I mean guess blindly at times:

Hot Dogs Consumed, by year

Intern Year: 24

Second Year: 8

Third Year: 0

Mini-tacos consumed, by year (like tacos but smaller and more awesome)

Intern year: 19

Second year: 92

Third year: 211

Here's the graph I made. As you can see, the consumption of hot dogs is inversely proportional to the consumption of of hot dogs. That's a good thing, because if they weren't proportional the graph would look like this:

Broken Knees: 1

Bikes stolen from my apartment while I was asleep in said apartment after having worked overnight call and being really tired: 1

Bikes recovered that had been stolen from my apartment while I was asleep in said apartment after having worked overnight call and being really tired: 0 (zero) (I miss you Bruce, you deserved better).

Times I have said lupus as a possible diagnosis in a large group setting: 62

Number of medically oriented t-shirts I have designed while at work: 22 (including my series of 80s-themed STD-awareness t-shirts)

Number of medically oriented t-shirts I have actually made: 1

Percent of ER shifts I've worked while wearing cowboy boots: 100%

Number of white coats that have been bedazzled by patients: 1

Number of parents or hospital stuff that have independently called me "Doogie": 11

All in all, I can't help but look at these "statistics" and feel a deep feeling of "pride" (I use "quotation marks" to counter-balance the "serious" nature of this last part). In the end, though, a "number" doesn't sum up how great these past few "years" have been. I won't "forget" all the people I've worked with and the kids that I've "met". It's been a great run, but its time to go. I'll see you later, St. Louis. Don't wait up for me.

another arts & crafts night: a study in 21st century imperialism

2011-03-21T07:05:00.000-07:00

I've been on night float again for the past two weeks. As was witnessed in my last blog post about the paper doll show choir, I get bored and do weird things at work, especially at night. During the night, I experience a unique combination of boredom, sleep deprivation, and poorly-controlled Attention-deficit disorder that is equal parts random, creative, and beautiful. So its Sunday night in the hospital. The flu and RSV seasons are winding down and we have a lot of free time. This time, my equally random friend/co-resident Umang was around. The floor she was covering was even slower than mine. So of course, we decide to do what seems to be the only natural thing to do as a a grown man and pediatrician training at one of the best children's hospitals in the nation. We decide that we wanted to do some Arts & Crafts. So first, we take stock of our resources. There is a large, cardboard box from a local sandwich shop in which the Chinese food from the night from before was delivered that I kept. I don't know why I kept it, I just knew at the time that there was something different about the box. Something worth keeping. Something special about that box. And little did we know, that box would change our lives forever.

I can't really figure out how it happened, but before we knew it we were fully occupied with creating a diorama. And not just any diorama -- a diorama of awesomeness. A diorama of truth. A diorama of extreme liberal bias based on pure nonsense. And this is the greatness that was created:
As you can see, this is the diorama. But it ain't you're momma's "shoebox diorama" you made in elementary school with some rocks and plastic dinosaurs that was an excuse to sniff rubber cement. This is a bold, in-your-face diorama for the MTV generation (even though the MTV generation is in its 20-40s and has no reason to care about dioramas). As you can obviously tell, it is the moon. And of course, on the moon you find the Pink Panther, Optimus Prime, and Marvin the Martian. We kind of randomly decided who would be on the moon. But once thewe got midway through, we realized that there was really only one story that could be told. I wrote the story that is on the side panels and reproduced below, but I really think that it wrote itself. And yes, that is an orchestra pit in the front.

In the middle of the 21^st century, earth’s oil and fossil fuel resources had become depleted by 200 years of automobiles, airplanes, pottery kilns, hairdryers and all-night roller disco jams. The earth’s international superpowers and oil conglomerates, led by the Pink Panther, realized that something must be done. After years of suppressing alternative energy technology and research, clean energy was not online. Deciding against clean energy and the resultant drop in oil conglomerate stock prices, they chose to follow the lure oil to the next closest celestial body – the moon. The moon was the perfect resource. It had large untapped oil reserves. It was close enough that the Alaskan oil pipeline, which extended deep into the depths of the Bering Sea, could be moved and extended to create an easy conduit to transport the black gold. But alas! Upon the team’s arrival on the surface of the moon, they found a vast and complex vacation community built by Martians that dwarfed mid-21^st century Boca Raton. The Martians loved the moon for its rocky and cratery beauty and its expansive views of the earth and other cool things in space. The Martians, ages ahead of the earth’s civilizations in clean energy technology and love of planet, didn’t need the oil. They loved the moon for what it was, a large satellite that may or may not have been composed entirely of cheese. This left the earth’s superpowers with a delicate question – what to do with the moon. They could choose to change, to choose life over death, to create rather than to destroy. But to do such would fly in the face of history, years stained by the blood of the oppressed whose only mistake was being native to areas of great resources. But alas! The momentum of years past is too great, and the decision is made to strip the moon of its oil by whatever means necessary. With any such endeavor, a strong showing of military force is necessary to ensure indigenous compliance. The Pink Panther recruits Optimus Prime and his merry band of Autobots who, having defeated Megatron and the Decepticons once and for all, have little left to do besides race NASCAR and scare small children. The Autobots are up to the challenge and accompany the colonizing party, which ironically is headed by The Pink Panther himself after he steps down as Secretary General of the United Nations and his part time job as pitching coach for the New York Mets. And thus we arrive at the our present scene, one that will surely be remembered by mankind, pantherkind, robotkind, and Martiankind alike. Will the Pink Panther purchase the oil with the blood and tears of the Martians? Will Marvin and the Martians allow themselves to be destroyed or will they fight back, martialling together their collective power to protect their homes (and likely moon cheese)? Will Optimus Prime sacrifice his deeply seated robo-ethics to kick some Martian butt? Hard questions require hard answers, and only in searching our own hearts will we ever find the truth.

And now it all makes sense. The lawn chair and tiki bar. The surprised look on Marvin's face as he is frightened for both his lawn chair and moon cheese. The Pink Panther's smug superiority. The Houston Oilers-inspired oil derrick in the background. In all truthfulness, I hope that people will really think about the message and make steps toward a cleaner future. They don't even have to be big steps, or even real steps. You could start with doing a google search of the Toyota Prius. Look up what Arbor day is. Coast down hills in your car. Wear the color green. Admire a tree. Better yet, make your own diorama trying to get people to change. If this diorama leads to another diorama, which leads to another diorama and so forth, imagine what could happen. The world wouldn't be big enough to contain these dioramas. Everybody would be coloring and taping things. Rubber cement would be flying off the shelves. And maybe, just maybe, the world would be a better place.

Like raising a child or being a village, it takes a village. Many people's thoughts, efforts, and managerial duties went into this project, and I would be remiss if I didn't give credit where it is due.

Credits:

Umang: taping skills, obtainer of random supplies from hospital floors, set design
Cheryl: making the chair and tiki bar from nothing, doing medical stuff when necessary to give others protected "craft time", provider of Disney music to listen to during "craft time"
Clay: casting, downloader of things from the internet, coloring, staff writer, cleanup
Michelle the Med Student: team leader, taping the title at the end, general encouragement, asking relevant medical questions to remind us that we were doctors, reminding us of youtful optimism

It was an inspired project and inspiring night. I'm pretty sure I felt just like Van Gogh did at the end of painting Starry Night, if Starry Night had actually been a wicked sweet diorama. And of course, no children were harmed in the making of this diorama. Finally, a few more random pics:

Optimus Prime is ready to mix it up. Turns out, he isn't doing it for the money. He's doing it for the moon cheese. And those craters are in fact paper cups from the cafeteria that I put ketchup and BBQ sauce in.

Poor Marvin, all he wants to do is hang out in his lawnchair and sip virgin strawberry daiquiris while reading the latest issue of The New Yorker. Oh well.

holiday cheer

2010-12-22T07:23:00.000-08:00

Hello. I'm back for my "once-every-three-months" post just in time for the holidays. Lately at work, I've been doing a lot of nightfloat. Nightfloat entails going in to work at 6:15 pm and staying until 7:30 am or 8:30. I'm in the minority because I really enjoy it. I get all the good parts of inpatient pediatrics without any of the rounding. I get to supervise interns, admit patients, and do all the cool medical stuff without the grownup supervision of an attending. This means that I can kind of do whatever I want since its a children hospital (immaturity in the name of relating to patients).

First, I must preface this with the fact that this all really happened. So last night, it was kind of slow. I'd already wandered the hospital trying to help out where I could since my own service was stable.Out of nowhere , all of the sudden, from left field, an overwhelming urge came over me. It was the urge to make chains of connected paper dolls. I don't know where this urge came from. I don't think I've ever made chains of paper dolls before and I hadn't been talking or thinking about it. Like much in my life, it was pure inspiration.

After a quick google-search (my go to search engine for all medical and non-medical queries), I figured out the folding pattern and was on my way. After only one misfire when rather than a long chain, I ended up with four sets of paired dolls, I had completed a chain of eight dolls. Looking at it and wondering what to do next, I realized that there was only thing that I could do -- make a paper-doll show choir.

So there I was at the nurses station, drawing tuxedos on paper dolls. Perhaps more surprising was the outshowing of support I experienced from nurses and other nocturnal doctors. Pretty soon everyone was pitching in. I, of course, made the dolls and drew on them. One nurse created the keyboard player for the choir. Another came up with an outfit for the female members of the choir (though I accessorized them). The intern/doctor I was working with got started on a set complete with risers. It was truly a nighttime hospital miracle. Before we knew it, we had created the greatest paper-doll show choir that I have ever been involved with. Here are a few shots of them in their inaugural performance.

That was a shot of the entire choir, its a pretty big group (8 guys, 8 girls, and Keith, the kind-of-creepy middle-aged piano player). This was from their Christmas program where they did a medley of contemporary and classic Holiday classics, including a 20-minute medley of Michael Buble and Josh Grobin Christmas tunes. Admittedly, that part dragged a little.

This is a good shot of almost the entire choir. A couple girls and a boy got cut off from the shot but lets be honest, they were on the outside of the group which is where the weakest performers get put.
There's a picture of Margoret and Keith. As you can tell, Margoret really doesn't have much star-appeal, thus her place on the end. And Keith, well, Keith isn't actually singing so I'm not sure why his mouth is open and why he looks so happy/creepy. He is a great piano player, especially as he only has about 1.5 octaves to work with.

If you look closely, you can really get a feel for each of the paper doll choir members as an individual person. There hair is what really sets them apart from each other. Their identical and sometimes mirror-image bodies with the exact same skin tone is what doesn't set them apart from each other, in case you were wondering.

That's Kay'te in the front. She's spunky and also the lead singer in a punk rock band. One time her band, "The Crystal Lizards", were playing a concert the same night as a choir performance. Can you believe that? Lets just say there were many zany misunderstandings and half-baked schemes that ensued as she tried to make both performances. Pure Kay'te.

More band pictures. The guy in the back, 3rd from the left, thinks he is Zac Effron. His name is Clint. He is the star wide reciever, pitcher, point guard, left-wing, place kicker, mile-relay anchor, and curler in the school. But he still makes time to write poetry and sing in the show choir. What a guy.

I like this picture for two reasons. One, it really shows off the holiday decorations with the red curtains, green background (patient charts), and reindeer heads. Second, it prominently features Curtis a.k.a. Chops. He thinks he's British but isn't and doesn't realize that most all girls aren't into him or his mutton chops. Margoret has the hots for him, though, but as we established, she lacks star-appeal.

(this is where I was going to put a video of their performance but I couldn't figure out how to with my computer and I lost interest and might come back to later but will probably forget)

So that is an introductory look at the paper-doll show choir. It was really a magical performance. Their voices blended together beautifully (some even said angelically). Their choreography, though, left a little lacking as it seemed pretty stiff. All-in-all, though, they brought their fair share of holiday cheer to the children and staff of St. Louis Childrens. Granted, the kids were asleep since it was 4 am, but I could tell they enjoyed it too.

new love, big decisions

2010-09-25T01:44:00.000-07:00

As all 4 of you out there (doubled the amount of people following the blog, yea!) have realized, I've been kind of distant lately. Not updating the blog, not responding to emails. There has been a lot going on around here. Recently, there have been big changes in the St. Louis-Sontheimer family. Somebody has found love. And that someone is Jake.

Now, to answer the questions that have undoubtedly surfaced. Yes, Jake is a bicycle. Yes, I name my bicycles. Yes, I name many inanimate objects in my possession. No, I don't think that's unhealthy. No, I'm not surprised my life has come to this. Yes, I need to get out more.

Back to the story, one fine summer day at the bike racks, Jake eyes an attractive bike at a distant rack. He admires her from a distance, her sharp angles, powder blue paint and pink handlebar tape. Here he is when I left him with her in the distance.

I really didn't think anything of it at the time as I had a busy day of saving babies on the schedule. After a full day of baby saving (or "the usual" as I call it) I return and realize that Jake has taken matters into his own hands. Here he is "busting a move".

I personally think that they make a cute couple. I'm worried, though, because Jake can be pretty impulsive. Sometimes he wants to dart into traffic or dive off the sidewalk into mud puddles. It's just kind of who he is. As a cyclocross bike, he feels entitled to going where he wants. I worry (as any parent would) that he might take things too far, too fast. What am I going to do if I arrive at the bike rack and the other bike is there waiting for us with this in tow?

I know that all we can do is teach our children well and feed them on our dreams. Don't you ever ask them why, if they told you, you would cry. So just look at them and sigh and know they love you.

The Doc Box saga

2010-03-07T18:58:00.000-08:00

Here in St. Louis Children's Hospital, we have various resources set up to help make work may manageable. One of these resources is something called the doc box. It is essentially a pink vomit basin that holds supplies that we might need, like otoscope tips, tongue depressors and q-tips. Historically these have been a strange assortment of arcane medical equipment. They were very disorganized and of minimal use. Last summer in a residency wide discussion group, a lot of residents said they wanted to standardize what was in the box. In our program, when you need something done and done right, there is only one place to turn -- to Dr. Clay. I spearheaded the Doc Box committee and with amazing results for awhile.

This is the story of the Doc Box committee. The names have not been changed so as to embarass people who look silly in the minutes.

------------------------------------------

DOC BOX COMMITTEE MINUTES
Co-presidents:
Theresa Frey, MD
Clay Sontheimer, MD

Other Members:
none

June 26
First committee meaning. Clay and Theresa began doc box lists, planned timing of filling boxes, made this sheet, tried to recruit Sam Julian and med student unsuccessfully

June 27
Theresa not present, Clay worked more on the sheets and tried to find out where the earwax removers come from

Assignments:
Theresa: come to meetings more
Clay: actually make the boxes

June 29
Clay held an impromptu meeting on his couch while listening to records. Not much was achieved.

June 30
Clay made Dox Boxes for 12W, 8E, 8W, 7E, and 7W. Clay was very pleased with himself and saved the extra supplies for people in Africa. Theresa brought food to the meeting which was greatly appreciated. Discussion was held concerning the coloring scheme for the laminated doc box content cards.

July 1:
Clay was post-call and wasn’t present. Theresa put the Doc Box content cards into the Doc Box

June 30th through July 10: Umang Sood repeatedly states that the doc box should include surgical site marking pens to mark abscess, etc. Clay states that Umang is not a committee member and therefore he cannot entertain the suggestion without going through the proper channels.

July 11: Doc Box committee meeting held at West End Grill and Pub. Umang Sood and Paul Houin officially inducted as members into the doc box. Umang’s previous concerns about lack of surgical site marking pens among the official contents of the doc box is considered. Clay considers the matter but no resolution reached. Clay also had a really good ribeye steak with crab on top (I know, sounds weird). Everyone shared some desert toasted ravioli and chocolate cake. All in all, an excellent committee meeting. Theresa arrived very late to the meeting.

July 16 am: Clay performs a surpise Doc Box check on the 7E Doc Box. He lectures Christa Gaschler about the importance of keeping the box stocked, her responsibility as an intern to keep the box stocked, and teaches her where to obtain the supplies. Christa, working with the charge nurse, stocks the box. Clay commends her on her efforts.

July 16: Kari angrily confronts Clay about the otoscope head in the 7W doc box. Clay calmly points out that the otoscope (including head) is not an official doc box item and officially a doc box contraband item and therefore not under the jurisdiction of the doc box. Kari gets embarrassed and apologizes profusely. Clay forgives her for her oversight and magnaminously helps her by providing a functional otoscope.

August 2: Clay begins checking doc boxes informally. While on 7W, Kyle "KyKy" Schulz (future chief) complains that they have to always get an otoscope tip from the PYXIS and laments the lack of a Doc Box. Clay asks Kyle point blank if 7W has a Doc Box. Kyle says no. Clay says that Kyle is wrong and that there is a Doc Box located in the med room. Clay also says that he is very dissapointed in Kyle, especially since he is going to be a chief and has a responsibility to set a good example. Kyle gets embarrassed. Clay says its OK and they hug it out.

August 4: Clay and Theresa hold a meeting. Theresa is very critical of the typo’s in Clay’s work. Clay says that Theresa is both neither the committee proof-reader nor his mother and to get off his back. Then they eat muffins and make the Doc Box infraction sheet.

Mid-August: Clay performs Doc Box checks and is largely dismayed at the results with a few exceptions. The doc box on 7E was in excellent condition thanks to the tireless efforts of Christa Gaschler and her overbearing senior resident (Clay). 7W was also in good shape. It is unclear if it is from the efforts of the interns or secondary to the fact that nobody knew that the Doc Box (see August 2) existed. The boxes on both sides of the 8th floor are in poor condition receiving multiple citations. Some of the interns were especially hostile despite Clay’s open and friendly teaching about the boxes. Of note, Roseann, Margoret, and Bridget were particularly vehement.

August 26: Jamie Spurrier announces upcoming town hall meeting. Clay and Theresa hold preliminary planning meeeting for the town hall meeting. Theresa was particularly interested in making pie charts. Clay says that pie charts are irrelevent in the current situation. Theresa states that pie charts, and pie itself, is never irrelevent. Clay admits that pie is always relevent.

August 27: Stephanie asks Clay where the doc box for 12 is. Clay says its one foot to her left. Stephanie is surprised. Stephanie then gets angry.

September town hall meeting: Clay arrives early to the meeting to ensure that the doc box committee gets floor time. Doc box committee business is bumped from the meeting to talk about other stuff that Clay doesn't think is near as important as the doc box's. Clay gets upset and feels that his work is all for naught. He contemplates the sad state of the doc box's, despite his loving encouragement and, when needed, sharp correction. He wonders if this is what Moses felt like. He resigns from the doc box committee.

----------------------------------------------

And thus ends the sordid tale of the Doc Box committee. In the end, we learn that idealism is only just that -- idealism. Much like the utopia of John Lennon's "Imagine", some things and places are not of this world and though earnestly sought out, and perhaps briefly obtained, ultimately escape us. In closing, I will quote a poem by Robert Frost, "So Eden sank to grief, and night gives way to day, nothing gold can stay."

My dreams are weird.

2010-02-23T19:18:00.000-08:00

First of all, I'd like to thank the collective internet community for the great outpouring of support for "The Nine Shifts: A triumph: The Clayton Sontheimer Story." I'm glad that my continued search for awesomeness was appreciated. A nurse at the hospital told me that she showed her mom the updates and that her mom would always ask to see what happened next. And a co-worker said her husband, whom I've never met, also was a fan. It truly was a magical time in my life and I'm glad I could share it with lots of people I don't know.

So I'm back in action here in the hospital, no worse for the wear. I'm on call which means, of course, that its time to update the blog. For this entry, I decided to search the archives of my google mail account and pull out past dreams. I used to email a friend of mine about my dreams hoping that she would be able to find some meaning in them. In the end, there was no meaning, only frightening randomness. I think most of these dreams come from mid-2007. As they say, it was a good year for dreams.

1. I had a dream that I was on a bridge with balloons full of almonds floating above and I tried to pole vault high enough to get the balloons but couldn't so I decided to try to build a robot to try to get the balloons.

2: I dreamt that I kept doing yardwork in this big field next to a warehouse where people were shooting guns at each other. I had to do yardwork everyday, and for a few days, I would daily find a sick baby in the field. They were typically pretty bad off -- one had a kidney problem, some were malnourished, and they were all abandoned. Each day I'd turn the baby into the authorities (though I'm not sure exactly who handles babies found in fields). One day I decide that if I find another baby in the field, I'm going to adopt him/her. So that day I'm doing yardwork and I find this baby in the field. The baby is about to die so I jump into action and save the baby's life and then adopt it. I didn't really fill any paper-work out or anything but just kept the baby. It was a little girl and I called her Kris, short for Kristin. All of my family and friends were really supportive of me adopting this kid. My mom came and was helping out and teaching me what to do. I remember having some misgivings as I'm pretty busy and don't know if I should adopt a baby but thought that I'd already made a commitment and was going to stick with it. Also, this all took place during the first day of a conference and I didn't really get to do much since I was busy with yardwork and adopting babies. I also remember thinking that I'll have to figure out how to date women while being a good father in a single-parent home.

3: I'm in a classroom but not the actual teacher. The teacher writes the word pirates on the board. I interrupt and say she wrote it wrong. I proceed to take the dry erase marker and make a skull and cross bones as the dot above the "i". Then, I erase the r and write R really stinking huge while making an "RRRRR" pirate sound. Nobody laughs at all and I get confused because both in my dream and in real life think its a freakin' hilarious joke.

And there you have it, a brief yet harrowing look into my psyche. And its full of almonds and pirates.

The Nine Shifts: Shift 9

2010-01-27T22:04:00.001-08:00

Pre-shift 9: I had a dream that I was at a church meeting and out of nowhere I was awarded the Stanley Tool “Against the Grain” Award for Excellence in Respiratory Care. I felt it a bit ironic at first but happily accept the award. I also dreamt about lupus. Checking my email after waking, I find my friend Jenny has sent me an MP3 of “Eye of the Tiger” in commemoration of Shift 9. I am grateful and listen to it repeatedly. I shadow box as well.

Shift 9: At this point, success seems a foregone conclusion. Nothing short of dismemberment will keep me from completing my shift. I wonder if the greatest accomplishment of The Nine Shifts is that I spent 9 shifts or 108 hours in the children’s ER without coming down with any kind of illness. To wade waist high in gastroenteritis and viral upper respiratory infections and kids spewing forth pure contamination from every bodily orifice without getting a fever. Not even a runny nose. I feel my immune system so strong that I could lick the counter tops in the ER and come away healthy. I decide to not put that theory to the test. I am awarded my diligence with one more shift in the 3-6’s, by far my favorite pod. The ER fates, once my enemy, have now accepted me. No longer trying to destroy me, they give me in parting a final peace offering. They give me ear infections. The bread and butter of outpatient pediatrics. I see more ear infections in my last hours than I did in a month of ER. Every one of my final patients has an ear infection. Whether they came in for fever or diarrhea or cough, they are revealed to have ear infections. Even as it is happening I realize the surrealism of it all. I am surprised to learn that our cafeteria periodically has a Cajun food bar. While a strange thought, I learn the jambalaya has an even stranger taste. In my final moments, I rejoice in the moment. My friend Melissa presents me with a certificate for my achievement. We take commemorative photos of the final moment of victory. The moment is one of completeness. I walk out of the ER like every night before for the past 8 but this time to not return, my victory complete.

Post-shift 9: I ride my bike home in the cold for the last time at 1:30 am. I drink an orange soda and eat a candy bar while watching TV, the sugar and high fructose corn syrup not as sweet as the sense of accomplishment. I fall asleep on the couch watching the Cosby Show.

The Nine Shifts: Shift 8

2010-01-26T10:27:00.001-08:00

Pre-shift 8: Each morning I lay in bed a little longer, putting off the inevitable as long as I can. I have run out of milk for breakfast cereal. I eat my cereal in yogurt. I have also run out of bread and chips. Considering that all I eat is breakfast cereal and peanut butter sandwiches and chips, I am almost completely out of groceries.

Shift 8: I feel strong. I float for the first half of the shift but preferentially take the high acuity patients. I feel at peace in the ER able to lose myself in the work. My first rotation in the ER as an intern was my first real rotation as a doctor. While hardly a great pediatrician now and in fact bordering on incompetence at almost every turn, I was lost, dazed and confused then. I was in fear of what the next patient would bring, always afraid that the next patient would expose me as a fraud. The year-and-a-half that has passed has been good for my knowledge and confidence. We talk how the rotations and months and even years pass quickly but without the feeling of actually learning or progressing. It is times like these that allow me to look at myself and realize that I have grown. I admit a lot of patients. At one point I count and realize that over half of the patients I’ve seen have been admitted. I don’t know if that is good or bad luck. At least it is a change from the feeling of not seeing anything significant. With the last hour of the shift, the fates start to rail against me trying to finally break me in a way the previous 7 shifts haven’t been able to. I treat a girl with altered mental status lasting weeks who has been admitted multiple times at another hospital with countless tests and no diagnosis and a boy with the worst foot odor I’ve ever encountered in a patient under 10. I wear a mask to help mask (pun intended) the smell and say that it is for infection control. I remember that a large reason that I became a pediatrician is for utter disdain and repulsion by the smelly feet of old people. The boy is sadly years ahead of his time. I eat hummus and grapes for dinner. I find it strange that our hospital has hummus and grapes.

Post-shift 8: I ride home in a light snow fortunate that enough hasn’t accumulated to compromise my bike ride. It feels that my only connection to a world outside of the ER, my couch, and the road in between is when I check my mail. It reminds me there are places out there beyond my small sphere now. All I get is junk mail. I fall asleep on the couch watching The Cosby Show.

The Nine Shifts: Shift 7

2010-01-25T10:28:00.001-08:00

Pre-shift 7: The hardest part of the day comes on awaking. It gets better quickly.

Shift 7: I start to shift into survival mode. The physical wear of the shifts isn’t bad but emotional wear of virus after virus starts getting to me. Even though baby after baby is congested but smiling and happy, I feel bad that I don’t have any medicine to offer to cure the common cold. Bulb suctioning and saline drops a poor imitation at a cure. My favorite patient of the day by far is a 16-month girl who is sitting on my lap and drops her pacifier over the railing of the bed. She looks down after it and with the collective frustrations of 16 months lets forth a perfectly pronounced “sh**”. After a moment’s reflection as the pacifier remains yet out of reach, she unloads another five “sh**” in rapid succession. I am extremely happy and fortunate that she cannot see my face, so my huge grin and attempts at holding in laughter go unnoticed by her so I can in no way be accused of encourage her behavior. One of our program’s chief residents Jamie had pizza with a group of residents at π and drops off two pieces as encouragement. Even cold, they are quite possibly the two best slices of pizza I’ve ever had. Despite trying to eat them in secrecy, the smell incites jealously among staff members. Perhaps these shifts have made me selfish because I don’t think at all about sharing. One of my last patients is a teenage boy who overdosed on psychiatric medications. Within 2 hours of this possible suicide attempt with his mouth still blackened by the activated charcoal we made him drink, he is sleeping in bed with his girlfriend lying next to him with a couple of family members sitting in the room. While not usually a policy to let girlfriends lay in bed with patients, in his confused state he was trying to dangerously climb out of bed to sit next to her. This compromise seemed the safest option. It is a lingering image, almost sweet on the surface but ultimately deeply unsettling, love and death and pain and fear all mixed together in violent hues. Now seven shifts complete, my emotions blunted by the hours and work, it is an image now made foreign. I am afraid at times by my lack of emotion.

Post-shift 7: The air is cold but the skies are clear and for the first time during The Nine Shifts I can ride home with my head up and eyes open instead of focused on dodging water puddles. The one mile ride home goes too quickly, I ride a few extra blocks. At 1:30 am Sunday night/Monday morning, there are no cars on the street. I ride down the middle of the road and feel like a kid. I fall asleep on the couch watching The Cosby Show.

The Nine Shifts: Shifts 5 and 6

2010-01-24T10:08:00.000-08:00

Pre-shift 5: I go through my morning ritual at 12:30 pm in order to get to the hospital by 1.

Shift 5: I refer to my halfway point as the hump shift until I realize that sounds kind of weird and inappropriate. Rather than be assigned a POD I am left as the float resident. Free to search out patients wherever they may be, I am also always an intruder, a presence that must be always explained and apologized away. Perhaps the monotony starts to wear at me as the shift goes by in a faceless, nameless blur. Fractures and respiratory distress and vomiting and all over again. Breathing treatments and antibiotics and oral rehydration. I pass out popsicles and anti-vomiting medication with equal nonchalance. While I can remember the fried catfish and popcorn shrimp I ate for dinner, I can’t remember my patients. Maybe that is the cost of efficiency, or at least of proficiency. The cost of ability being that only the failures are memorable. For all the children I’ve seen and treated it is the failures that stay with me the most. It is the ones that I couldn’t save that haunt me. Secretly I am grateful that my passion in medicine comes without as much risk of failure than other specialties. Cancer kills and hearts fail but joints only hurt. I am strangely giddy at the end of the 12 hours.

Post-shift 5: My life seems increasingly redundant and I find monotony even in the quest for greatness. I fall asleep on the couch watching the Cosby show.

Pre-shift 6: I wake up earlier than usual because I am out of deodorant. Rather than sleep until the last possible minute to wake up, I wake up 20 minutes earlier. I remember having a dream that I was married with a newborn son and I was scared when I realized that he had an extra pair of eyes on his stomach and knew this was a very very bad sign and cried for him.

Shift 6: The ER is strangely slow. Or it is overrun by doctors. Or both. I am convinced that I could have either gone home or taken a long nap in the middle of my shift and nobody would have noticed or cared and regret not doing this. My replaceability seems contrary to the greatness I am about to achieve by completing The Nine Shifts. I only saw one patient in my pod the entire day. An intern asks me to supervise her doing a lumbar puncture. I find it funny as I view myself as hardly any more competent than her and am a little secretly glad when an attending agrees to help her. The slow pace of the day illicit a jocular nature among all the doctors. We wonder and joke about the causes for which some of our patients come in. The teenager who comes in because he had a muscle cramp the day before. The boy who comes in because of neck pain cause from playing too much video games. Sometimes I feel I have to wade through too much to find the truly sick. I find it strange sometimes that people come to the hospital seeking my comfort and consolation and expertise. I learn that I love gummi butterflies. I show off my awesome knee high argyle socks – patients and ER staff are all impressed.

Post-shift 6: I ride home in the rain as a cold wind blows. I fall asleep on the couch watching the Cosby show.

The Nine Shifts: Shifts 3 and 4

2010-01-22T10:14:00.000-08:00

Pre-shift 3: I wake up in good spirits. I realize there are two threats to me successfully completing The Nine Shifts. The first is infection. At any time, I could be stricken down with a gastrointestinal virus, pneumonia or any number of maladies I face daily in the ER. The second is laundry. With about 2 hours of waking hours at my apartment, I don’t have time to do my laundry. I have already run out of white socks which are my clear preference for the ER. My feet might feel the effects. I think I have enough underwear. I hope.

Shift 3: I engage in a turf war with nurse practitioners for my POD until I realize that each room they take over is one less patient for me. I feel I’m in a place without time, a place without beginning or end but not in a bad way. As if I had been born of the ER and this is the only life I have or will known. For better or worse, at home. The shift flows by with near mechanical efficiency, a master of my craft. Until I face an 11-year-old girl with abdominal pain that moves and much more attitude than I think an 11-year-old girl should have. For reasons that escape me, she alone undoes the momentum of hours and days and shifts until I am nothing but a sad patchwork of guesses without conviction, actions without emotion. I feel like an El Camino on blocks. Or at least what I think an El Camino on blocks would feel like if granted somehow the ability to feel. At hour 9, I grab a snack and drink from the cafeteria. I guiltily consume a bratwurst with kraut, potato cakes and an orange soda. I don’t eat my chips or my sandwich.

Post-shift 3: I ride home in the fog. It is very creepy. I am overcome by a feeling of déjà vu. I fall asleep on the couch watching the Cosby show.
Pre-shift 4: I listen to “I Get By With a Little Help From My Friends” repeatedly. I realize that I, too, am getting by with a little help from my friends. My friends, in this case, are various legal drugs.

Shift 4: I manage to get assigned the 3-6 POD again and bask in the independence and isolation. The ER is surprisingly less busy than days before, so while other PODs are getting closed down my rooms enjoy a constant flow of patients. I work happily unaware until my POD is invaded by nurse practitioners. I feel that I have been targeted for some reason. They must know that I am on the edge of greatness and are conspiring against me. I try to hold my ground but am ultimately unsuccessful. In shame, I begin to float and see patients wherever they may be. I am sad and wonder if I am uncovering just a small part of a larger conspiracy. I wonder if the entire staff is out to see me fail, if my success would destroy the mystique of the ER. The ER fellow Eric's jesting barbs seem to hold a deeper purpose. I decide to fight back in the only way I know how – to annoy people with random facts about lupus. I raise the question of the possibility of lupus in all patients, not just my own. I find an unlikely accomplice in the overnight ER resident who joins my cause and raises the classic war cry “It might be lupus”. I feel like William Wallace -- even down to the Argyle socks. I am truly my father’s son. With the slower pace of the shift, I steal away at hour 9 for a bacon cheeseburger and fries. I finish my shift strangely giddy, more aware now of my opponent and the stakes.

Post-shift 4: I walk home alone. The rainy weather has been causing muddy scrubs and I couldn’t afford to run out of clean scrubs. I am overcome again with a strange sense of paranoia. The building seem to a be a poor veneer hiding emptiness and deceit. I feel as an accomplice to it all. I shouldn’t think when I’m tired. I fall asleep on the couch watching the Cosby show.

The Nine Shifts: A Triumph: The Clayton Sontheimer Story

2010-01-20T09:47:00.000-08:00

The ER in St. Louis Children's Hopsital is an interesting place. We work twelve hour shifts and usually only work 2 or 3 days in a row. Sometimes we trade days with other residents and work more days in a row to get larger blocks of time off. Usually 5 days in a row is about as much as anyone will do. There are urban myths in the program about people who have worked 7 or 8 days in a row. I recently traded some days with another resident so I could have a couple of days off before going to Dallas for the weekend. I had been working 8 pm to 8 am shifts, so I wanted to try to get my body used to being awake in the day so I wouldn't be useless on my trip. As it turned out, I ended up with 7 straight scheduled days in the ER. These 7 shifts also happened to be the 1 pm to 1 am shift, which is, by public opinion, the worst shift. 12 hours of pure craziness. Never one to settle for average or even impressive, I decided to trade again to total 9 shifts. Based on my research, this will be a record among current residents. This is my story.

The Nine Shifts: A Triumph: The Clayton Sontheimer Story

Author’s note: the experiences and encounters of The Nine Shifts story are all true. Names have been changed when appropriate to protect patient identities.

Glossary:

POD -- a geographic grouping of exam rooms in the ER, residents are assigned a POD and they usually see see all the patients in those rooms. Most of the PODs are grouped closely around the doctor's work station.

EBV -- the virus that causes mono, also known as the kissing disease

H&P -- history and physical

Pre-shift 1: I awake with a strange mix of trepidation, anxiety, and a sense of general awesomeness. I realize that I have all of the tools and talent to overcome any obstacle. Somewhere in the distance, inspirational music plays. I also realize that this will be a bad hair day since the airport stole my hair gel because it might have been a bomb. Sadly, this isn’t the first time that has happened.

Shift 1: I start this experience in self-discovery pod’ing the 30s. Granted, when I came my pod was full so I figured I could relax until people dispo’ed their kids. But no! Jared wants me to see kids out of my pod. My brief foray into the teens is much more medical than I was prepared for – a Kawasaki’s disease and a teenager with fever for 19 days (but not lupus, POOP! ). Finally I get back to my pod, ready to rock. Nothing too out of the ordinary – a couple of psych kids, a non-accidental trauma, a couple of pelvic exams, nothing I can’t handle. The highlight was probably an 11-year-old with ongoing symptoms from EBV about 2 months after infection. At the beginning, I tell him that my goal is to say poop as many times as possible during the H&P. I said I average about 15. We had over twenty in less than five minutes. It progressed to the point where we would greet each other with the word poop. That kid is awesome. At hour 11, I realize that I haven’t eaten so I eat my sandwich. I don’t have time to eat the chips.

Post shift 1: I ride home in the fog. It is very creepy. I fall asleep on the couch watching the Cosby show.

Pre-shift 2: I wake up early as Theresa calls me to ask if I have seen an email she sent me. I then ask who I am talking to. Twice. Then I ask what email. Then I mumble something and go back to bed. On the ride to work, I experience chest tightness. Upon arriving, I realize that I didn’t bring my albuterol. It will be sorely missed.

Shift 2: Like a desperado or ninja, I work alone. Sentenced to toil away in the anonymous depths of the 3-6 pod, I work like a man possessed. Unfortunately, the man possessed has poor balance or sense of self in space. This manifests itself as sometime midshift I run my head into a door frame. No blood. No tears. Only the gritty determination to go on. I deliver a little bit of ER magic. Despite a large volume of patients, I don’t admit a single one. This culminated with me strongly disagreeing with an attending who wanted to admit a kid who was drunk. I totally sent that drunk kid home -- let him be hungover on his own time. As the shift goes on, I realize that my head is pounding worse and worse. I’m not sure if it is a migraine, the start of sinusitis, or symptoms of my concussion. I don’t have time to figure it out. The frustration of knowing that one of my patients from shift 1 came back unsatisfied with my care is cancelled out by the fact that it’s the kid who says poop. I don’t treat him, we only shout poop across hallways at each other. At some point, a radiology technician comes to congratulate me on one of my decisions. I give her a hug. At hour 11, I realize that I haven’t eaten so I eat my sandwich. I don’t have time to eat the chips. At hour 12, I realized that I didn’t use the bathroom the entire shift. I also realize that it isn’t for lack of need but that I blocked out my natural bodily sensations.

Post-shift 2: I ride home in a cold rain. For the first time, I sense my own mortality. I am both frightened and amazed by it. I take a couple of puffs of albuterol. I feel my lungs open in sweet, sweet, ectasy. I cherish the rich night air filling my lungs. I fall asleep on the couch watching the Cosby show.

Will Clay succeed in his quest for awesomeness? Will he be overcome by insanity or illness? Will he ever get to eat his chips? Will he ever be able to fall asleep in his bed again? Stay tuned for more updates on The Nine Shifts: A Triumph: The Clayton Sontheimer Story.

Online tarot reading = eerily accurate

2010-01-10T04:10:00.000-08:00

2010, so much like 2009, but colder. At least in St. Louis.

So it's about 6 in the morning and I've been here in the Children's ER for about 10 hours now. Despite an seeing an unsettling amount of head traumas this shift, I've had the chance to reflect on my life. I realize that my life is missing direction. Direction not to be provided by jobs or purpose or anything. Direction that can only be provided by internet tarot readings. Fortunately, in the medical marvel that is the St. Louis Children's Emergency Room we have computers with internet, thus providing quick and easy access to internet tarot readings.

I will share excerpts from my internet tarot reading. I've got to say, though, that before this I wasn't much of a believer in tarot readings, let alone internet tarot readings, let alone free internet tarot readings. For those of you who know me well (shout out to my 3 blogspot follows -- up 50% from last post! Holler!), this internet tarot reading is eerily accurate. I think I got goosebumps and/or chills when I first read the results. It's like someone looked past the disheveled and unkempt exterior and looked to the very core of me. Here it is.

For the internet tarot site to work, you have to ask it a question. So I asked the question on everyone's mind.

OK, so that isn't too helpful, just a bunch of cards. But when you see what the cards mean? Eerie.

The significator is the card you have chosen to embody your presence and the focus of the reading. Dr. John (The Magus) Mastery over word, mind, and matter. The ability to turn ideas into actions, handle problems, and control one's life. The initiation of new projects, great works, or a new way of life. Eloquent and moving communication. Arcane and eldritch technologies.

Not only does it call me doctor, but it uses my middle name. And it totally nails my presence. Mastery over word, mind, and matter? Eloquent and moving communication? Spot on. Apparently, Dr. John (like Dr. Clay) looks like a party animal with his workout ball of fire.

The card at the top left represents how you see yourself. Rada Mambo (Queen of Swords), when reversed. The dark essence of air behaving as water, such as a cold rain. A person gifted with both keen logic and natural intuition, giving them uncanny powers of perception and insight. One who easily sees the weakness in any argument and savages friend and foe alike with biting sarcasm. Dry and vicious wit covering a hollow sense of isolation and dissatisfaction with life.

Yes. Who hasn't felt amazed by my perception and insight? Who hasn't felt savaged by my sarcasm? Who hasn't sensed the depth of my isolation and dissatisfaction with life? Oh wait, that's kind of sad...

The card in the lower right represents what your partner feels about you. Legba (Six of Swords), when reversed. Conceit and intellectual pride. Being stuck in a problem with has no apparent solution. Frustration and anxiety that are left unsettled. Travel and exploration are delayed.

Granted I don't have a girlfriend or a wife, so I will apply this to people I've dated or who have wanted to date me (grand total of both, 4 1/2).

The card in the center represents the present status or challenge of the relationship. Congo Hounsis (Page of Cups), when reversed. The dark essence of water behaving as earth, such as a wellspring. An unexpected new relationship that is childish and foolish. An idle dreamer oblivious to the realities of the world. Moodiness, sad reflection, and retreat from society. Seduction and deception in personal and business relationships.

Wow. It is now clear why my relationships fail: childish and foolish. Moodiness. Sad reflection. And retreat from society. Ironically, this entire post has ended as a sad reflection. And when I get off work, I'm going to go home and go to sleep until my shift tonight (or "retreat from society").

In the end, I think there are valuable life lessons to be learned from this experience. The internet is a wonderful thing. Internet tarot readings can be incredibly accurate. Clay shouldn't be allowed internet access at work.

I'm back. And I think my shoes are racist.

2009-10-25T19:54:00.000-07:00

Hopefully my followers (2, oh yea!) weren't too worried about me during my absence. My blogging privileges weren't revoked due to the provocative nature of the Argyle socks post or to the mysticism of my amateur palm reading. I didn't fall down a well either (remember Baby Jessica? ah the memories). Suffice to say, I'm back and I'm ready to blog. Hopefully over the next few weeks I'll be rolling out some awesomeness truly befitting a place in the adventures in awesomeness.

So first my first post, I will share a harsh realization I learned about my footwear recently. After a busy day at work saving children's lives, one of the first things I do upon arriving home to unwind from all the child life saving is take off my shoes. Rather than their appointed place in the closet, my shoes prefer to hang out in the middle of my bedroom. Here is an example:
The shoes (and the slippers) are obviously having a grand time. At the bottom of the pic, the clogs, shoes and slippers are chilling, probably talking about something really trendy and awesome. The cordovan colored shoes at the top are branching out and spending some time with my dirty clothes. All is well, you would think. But no! Trouble is afoot! Pun intended.

The white shoes are off by themselves. Not only that, but they are hanging out in a pile of trash. Well, not actually trash but stationary and such. Now I'm not pointing fingers because as everybody knows it takes two to tango and throwing stones in glass houses is a bad idea (but would you really even throw stones in a normal house, seems like unseemly behavior).

But you start to get a feel for who is doing whom wrong in this one. Granted this is just a glimpse in time, a snapshot if you will, but it sure seems that the Converse is looking longingly over at the other group of shoes. Anyone who has been picked last for kickball (not that I was, I was awesome at kickball) or any other sport or not gotten asked to the dance or had a slushee thrown in their face by the cool kids knows exactly how that shoe feels. And what's worse, the doc marten has completely turned his back on the Converse. Man, that's cold.

So in conclusion, I hope that we all can all learn some valuable life lessons. Hopefully this inspires to look beyond ourselves and our circle of friends to those around us. Maybe there is a Converse trying to get our attention or maybe a Nike running shoe has to sleep in a pile of trash because we won't acknowledge him. Me, I envision a world where all shoes whether sandals or penny loafers, boots or some other random type of shoe, can live together in peace and harmony.

oh the possibilities

2009-06-26T20:52:00.001-07:00

Has any of the two readers of this blog noticed that many of my best (or at least funniest by my defintion) are created late at night? Well, its true. And surprisingly enough, they happen to be late at night while I'm at the hospital. I'm not trying to debunk or demyth the ideal of a resident physician. The truth is that when I'm on call I spend a lot of time waiting for things. Waiting for patients to come, waiting for lab results to pop up on the computer, waiting until its a respectable enough time to go to bed. So in this waiting I entertain myself in various ways. Sometimes I read about patients. Sometimes I read about diseases. But mostly, I picture myself with facial hair. Tonight has been no different as I've deeply and meaningfully contemplated facial hair. Rather than idle thought, I decided to create fairly accurate images of what I would look like with different types of facial here. And here they are.

First, we have the simple goate'. And yes, that is in fact a picture of me. I took it of myself for residency applications. And yes, I'm smiling because I'm not wearing pants.

Simple, classy, and a little understated. And yes, this is my natural facial hair color -- bridging that beautiful hue between neon and jack-o-lantern orange. I think I need some cool, thick framed glasses though for the full effect.

Next up, the full goatee.

Honestly, I'm worried a little bit about getting chunks of food stuck in that beard. Its kind of weird, too, how I have facial hair growing out of my upper lip. That's just the way it grows though.

Next up is something a bit more "hipster"

Nothing says trendy like mutton chops and a razor-tipped goatee. Its kind of like an inverted, orange Christmas tree. Which makes it awesome.

For the fans of classic facial hair, here is a little treat named "the rollie fingers" after the great relief pitcher of the same name (and great is in reference to his 'stache).

A little comical, a little sinister, a lot of awesome.

Next up, the full beard. I've been listening to a lot of "indie folk" music lately, so I think I really need to look the part. And looking the part entails wearing plaid shirts (usually with pearl snaps) and growing a beard.

I think that it looks pretty good though. Kind of like a young Harrison Ford in "The Fugitive" before he became a fugitive and had to blend in. So it would be a good fit for me since I'm a doctor and will at some point in my life inevitably blame a one-armed or similarly de-appendaged man for some crime.

Fu-manchu. Enough said.

And lastly, the chin-strap.

I think for this to work, I need to get roid-ed up and get a tribal tattoo on my upper bicep and some large tattoo on my upper back. Of course, that is my ultimate goal in life, but you can't just jump to that...

There were some other possibilities. Some other variants didn't make the list, including "the adolf", "the pedophile", "the creepy-uncle", etc.

nephews and niece

2009-05-31T10:47:00.001-07:00

I'm finishing up my vacation and starting back at work tomorrow. I sepnt most of ht evacation in Utah. Since getting back to the STL, I've been going through the pictures I took and trying to find keepers. Here's some of my awesome nephews and niece.

So that's Troy. He rocks.

And that's Sabrina. Hopefully her mom won't get ticked off that Sabrina (or "Beanie") has a dirty face. Sabrina is a free spirit. Her dirty face doesn't reflect on her parents' parenting skills.

And Colt. Colt is like a cow -- he eats almost constantly. As you can tell from the pictures, I don't really like posed pictures or pics of kids smiling. But that's me.

fun with black and white

2009-05-10T13:31:00.000-07:00

Another picture post. Good times. So I've been messing around on the computer with black and white. Mostly, I'm going through old photos I've taken and finding the ones that are more interesting/dramatic in B&W. Most of the pictures of people that I've taken fall into that category. It makes sense when you consider that I stink at taking pictures of people.

So here's the arch. In color the picture is kind of boring. And by "kind of" I mean "really".

Another arch shot. Got to represent the STL.

Here's a bridge across the Mississippi. I cropped out a ton of bridge but wished I had a bit more river to work with.

This is my bedroom. I was messing around with the wide angle. I didn't rearrange anything -- everything is in its natural position (including random bike wheel).

My buddy Sam from when we went on vacation last fall. I kind of like how his camera blocked out his eyes. Also of note, my camera is so much bigger than his.

Doesn't he look pensive? It's no wonder everyone wants to date him. He's got the whole angst thing going on which is only magnified, I think, by the B&W.

OK, so I didn't take this one. I included is mostly because I think the B&W makes the mullet look awesome. Nothing better than the open water and the wind in your hair (or mullet).

And last but not least, and awkward self-portrait. If you squint (and use your imagination), you might just see a bit of facial hair.

a low-down dirty shame OR the saddest sight ever

2009-05-03T18:09:00.000-07:00

I was walking out of my neighborhood Staples with my xerox copies in hand when I came across a sight so wanton and deplorable, so deprave and perverse, that it shook me to my very core. Part of me cried out to flee from such a scene, but I found myself strangely drawn in. I could not shake my eyes from the mindless destruction that I faced. I grabbed my camera phone and took pictures in the hope that the images might stir something inside all of you so that such wickedness, which should rightly be abhorred, might not be repeated. I warn you, these images might be too graphic for those of a weaker constitution.

This is the scene from further out. This encompasses it in all of its horrific horribleness.

Moving closer in to the grouping on the left. Can you see the golden spongy goodness laying battered and destroyed on the cold, hard, unforgiving cement?

And look here below, the creamy goodness lying inside a warm blanket of cake, beckoning the faithful to a heavenly center. But instead of its near-divine purpose, it lies cast aside and disregarded. And again, Eden sinks to grief.
In case you haven't yet realized what this heavenly creation is, it is in fact a twinkie. My natural inclination when facing such travesty is to try to make sense of what happened, for it is only in learning from history that we can ever hope to unrepeat it. I submit my graphical recreation of what happened here. We start with our main player, Twinkie the Kid.

Through forces unknown, Twinkie the Kid finds himself in a free fall, from heaven to earth.

Now in his fallen state, he finds himself subjected to the heartless will of the boot.

Now I can't be sure exactly how it all happened. Rather than a combat boot, Twinkie the Kid could have fallen victim to a wandering cowboy (no doubt wearing a hat black as night).

As dark as these time are, maybe in fact it was not a wandering cowboy but in fact a skeleton who happened across the fallen twinkie.

The exact details remain dark and hidden. So there it is. I leave it to you to struggle to find meaning in all this, whether you view these events as an allegory to the state of fallen man, or a manifestation of the chaos of existence, or whether this in fact has no meaning and only serves to expand the outer limits of this nihilistic void in which we find ourselves. Me, I will weep with the tears saved only for the innocent. Do not cry for spilled milk, but cry with me, brothers and sisters, for the twinkie now departed.

Palm Reading 101

2009-04-25T20:38:00.000-07:00

So its Saturday night and I'm at work. It has been kind of slow today (already took a nap and watched the Cardinals game). So tonight, I thought I'd do something productive and learn how to read my palm. Being the traditionalist that I am, I wanted to go to a reliable and trusted source: http://www.wikihow.com/Read-Palms

The whole experience has been quite informative and enriching, so I thought I'd share.

So that's my palm.

And that's my palm with my lines marked with the magic of computers (go microsoft Paint)

And here's the line by line breakdown:

Heart:

content with love life

freely expresses love and feeling

suffered some emotional trauma

Head:

creativity

short attention span

Life:

energy

vitality

Fate:

self made individual

develops aspirations early on

Hand shape: FIRE

spontaneous, enthusiastic and optimistic

sometimes egoistic, impulsive, and insensitive

do things boldly and instinctively

So that's me according to my palm. While I'm not exactly sure what emotional trauma I suffered, I'm sure it happened

argyle socks

2009-04-12T18:52:00.000-07:00

As many of you know, I am a man of many passions. And by passions, I mean strange obsessions. One of these "passions" is Argyle socks (like I said, strange obsessino). Argyle socks are, in my opinion, the coolest things ever. Definitely the coolest type of socks every made. I own quite a few pairs of Argyle socks and count them as some of my dearest possessions. Tonight I decided to chronicle my love of these socks through photography. Here are all my pairs.

So I was recently on service in the NICU for a month. My team consisted of me, Phoebe (another resident), Dr. Saunders (our attending/boss) and Kevin (a NICU fellow). Early on, we learned that Phoebe and I shared to some extent a love of argyle socks. I would even talk about my socks on rounds. Then one day Phoebe and Dr. Saunders both wear argyle socks to work. But alas! I was on call and had worn normal, white ankle socks. However, I had forgotten my ID badge at home. I either had to beg people to let me in to the NICU or call rooms for 30 hours, pretend to be Phoebe and use her ID, or go home and get my ID. I opted for going home. While I was home, though, I did pick up a pair of Argyle socks to complete the team. Here we are.

That's a lot of Argyle. Here is the sock by sock breakdown.

Don't worry, Phoebe actually does have two feet. I'm not sure where her other foot went cause I'm pretty sure it was there at work. So the moral of the story is that Argyle socks rock. On a side note, I want to make a sock puppet for work but it would be too difficult to pick a sock to say goodbye to.

pictures

2009-03-29T19:28:00.001-07:00

So it turns out I don't have too much to say about my life, so I'll keep posting pictures.

Unfortunately the words aren't 100% parallel to the box. I wasn't sure if, in the end, I wanted St. Louis straight or the edges. I opted for the box as it forms a frame.

Some place was going to through renovation and had a bunch of newspaper in the window with the cool colored signs.

I eat burgers here a lot.

Yea graffiti.

I like this one. Its in front of a place called Dressel's. Its a giant dragon.

more pics

2009-03-15T18:10:00.000-07:00

So I wandered around my neighborhood again yesterday taking pictures. I've got some good ones that I'll post in batches over the next few days (motivation to keep checking back). This first batch is of a bunch of tables at a place called Wildflower. None of the bars have their patios open yet -- all the tables at this particular one and all pushed together, thus facilitating the pictures. I climbed up on some concrete thing to take these. And while I did touch up the colors a bit, I think that my sense of composition and depth still legitimize me as a [amateur] photographer.

I'm not sure what those math equations mean. I'm about 14 years removed from my last math class.

I think the tree branch shadow is kind of eerie in a good way.

recent news

2009-03-12T20:35:00.000-07:00

So I have some updates. First of all, the t-shirt I designed came in. This is a picture of me wearing it.

Notice how smooth my arms look. Sweet. For those of you not in the medical field, prn is an abbreviation we use when writing prescriptions. It means "as needed", like for a pain med or something of the sort. Essentially, it makes the shirt totally awesome. This shirt represents the first phase in my grand plan for either world domination or financial security. The main idea is that the "hugs prn" phrase will spread across the country from children's hospital to children's hospital with various editions of shirts until at last I take over the world (with the proceeds going to charity).

Next up is a portrait drawn by one of my patients. He was my patient last weekend. We sent him home on Sunday with the diagnosis of "viral syndrome" but he hasn't really gotten better. So he came back into the hospital on Tuesday and is getting all kinds of crazy tests done. Everything is still negative, which is good. Anyway, he drew a picture of me.

I think that it looks just like me, Dr. Clay. I go by Dr. Clay to patients and families. Definitely easier to say and remember and Dr. Sontheimer and it doesn't make me feel like an old academic dermatologist either (not that there's anything wrong with that). So that's me right now.

More pictures -- saint louis in february

2009-02-22T17:51:00.000-08:00

So here are some pictures I recently took. I just got a wide-angle lens for my camera so I walked around my neighborhood taking pictures of things on my day off saturday. I like to walk around and take myself too seriously.

This is a clock at an intersection leading into a neighborhood. I jumped up on some scaffolding to take the picture. Kind of abstract or something.

About a half-block from my house is this theater. It is a real small place with my favorite pub attached (desert toasted ravioli) on the side. I've been meaning to go see a show but as many of you may know, I'm lazy and cheap.

This (and the next one) are shots of a local hardware store. I like to take pictures of signs. I'm not sure why, but I do.

So I live across the street from a giant catholic cathedral. On the side is this statue of an angel blessing some kids.

So this is just a wall with some dead vines on it. I don't know why I like the picture, but I do.

Photo Entry -- New England Oct '08

2009-02-22T17:39:00.000-08:00

So I'm going to post some pictures that I'd taken. This set is a few from when my buddy Sam and I went up to Boston and the surrounding area in October of last fall.

T-shirt Ideas

2009-01-25T11:55:00.001-08:00

Awhile back, I decided that my class of pediatrics interns needed an official t-shirt. Being the go-getter that I am, I finally got around to making the t-shirt about 2 months later. During the design process, I created several other great medically oriented shirts that, unfortunately, did not make the cut. Here are a few of them.

For everybody's favorite hapless doc.

Is New York City really popular still? I hope so.

Yea, kind of lame.

Seriously. Not even close to accurate.

I blame Grey's Anatomy. Unfortunately, this isn't reason enough for my student loans to go away, so I'm stuck in medicine.

Seeing an old friend

2009-01-09T03:12:00.001-08:00

The combination of short daylight hours, long days at work, vacation, and weather have made it so that I haven't seen the sun in St. Louis in probably over a month. Really. So I was pleasantly surprised to see the sun on my way to the clinic today. I almost didn't recognize it.

There it is -- the sun. Beautiful.

And there's me with really short hair and sunglasses on. As you can tell from the skin tone, I'm not making up the whole not-seeing-the-sun thing.

life changing decisions

2009-01-04T19:34:00.000-08:00

So here I am at work with a little time to kill before the next kid comes (seizures, ooohhhh). I decide to get some dinner at the cafeteria and faced some pretty tough decisions. Hamburger? Chicken strips? Bratwurst with kraut? Yes, our cafeteria has brats with kraut and I'm pretty sure that the ones I just saw at 9:30 pm were the same ones I saw at lunch. So I decided on chicken fried steak. And there it is.

Beautiful, isn't it? Actually the cafeteria came through and it wasn't too bad. With the gravy, it had just the right amount of pepper to ofset the pure thick graviness of the gravy.

And to top it off, I had a pretzel. Another impressive bit of salty deliciousness. The yellow stuff was cheese. I think. Don't hold me to that, though. I think that I really captured the essence here. I think that one can really appreciate the symbolism -- of how post-industrial America contributes and even makes more pressing the inherent question of self-identity that we all face. Come on, who hasn't felt that socieities pressures don't chip away at one's one identity, ultimately leaving us feeling twisted upon ourselves? Also, the cheese is really lumpy. I think the picture shows that, too.

So I think its safe to say that it was a successful dinner -- I satisfied both my physical hunger and my inner hunger for meaning in the face of existential uncertainties. Good times.

(I probably shouldn't post when I'm kind of sleep, sorry)

Rolling mid-west style

2008-06-13T13:34:00.000-07:00

Due to popular demand, I have returned to my dear, beloved blog. I'm sure everyone has been checking pretty constantly over the past year, desperate for news about C.J. Especially after that last post -- how did the summer vacation go?

OK, major updates:

1. I'm a doctor
2. I live in St. Louis

And that's pretty much it. Over the coming months I will be sure to post pictures and stuff about the transition to a new city and new job (i.e. the transition from medical student to doctor).

For now, I will share an experience from a recent trip to the grocery store. So I went to the near-by grocery store to get some of the necessities (soda, cereal, milk). So my local grocery store is pretty diverse. I'm rolling down the soda aisle stocking up on DP when an somewhat elderly black lady asks if I could pick up a 12-pack of Sprite for her. I do and place it on the bottom of her cart. Then she asks if I can grab a 12-pack of lemonade for her. I oblige. Then some Indian lady comes up and slips her some money. The indian lady walks away. The black lady gets kind of weepy and says the other lady just bought her groceries and asks if I would give her a hug. I give her a hug. Then I walk away.

My summer vacation

2007-06-25T16:09:00.000-07:00

With all this crazy tecnology and what not, I figured I too would dabble in the realm of blogging. Who wouldn't want to read about me, right? As I envision it, this will be the perfect setting to keep people posted on the most important and awesome events in my life. That probably means I'll just talk a lot about work and bicycles. But I'm sure to post some sweet pictures...

This week seemed like the perfect time to start as I have just started my summer vacation. In this case, summer vacation is a largely relative term. Today (Monday) I worked in the hospital, and on Friday I have a mega-huge test that will make or break my grade for internal medicine. I was fortunate enough to get Tuesday, Wednesday and Thursday off. I was really only supposed to get Thursday off but lucked out. So I consider this week to be my summer vacation. Rather than go the beach or mountains or Europe, I've decided to spend my summer vacation studying for my test on Friday.