pen nerds, unite! take back the night!

You may have noticed (though certainly the misguided companies that e-mail me soliciting product endorsements have not) that I do not run ads on this site. Never have. Sometimes I have used a free service that ran sidebar ads as part of their own business plan (Haloscan comes to mind--I used their service to run my comments section until that company imploded) but overall, I have never accepted money in exchange for ads or endorsements of any kinds. The only kind of endorsements I give--see the last blog entry, for instance--are ones that I do for free, in the spirit of a friend recommending something to a friend.

I know a lot of blogs--in fact, the majority of blogs--run some kind of ads to support themselves, and that is all good and fair. The reason I have chosen not to is multifactorial. First, this is a personal blog which happens to be written by a doctor. Corporate sponsorship is not necessary, nor would it necessarily be appropriate. Secondly, I need to keep things simple, as I have a hard enough time updating this blog as it is without thinking of peripherals like ad content and sidebars. Third, I have a job that pays the bills, and it's not worth it to me to run clutter-y, annoying ads in order to make whatever pittance in ad revenue I could generate.

So please just treat the following is a public service for pen nerds everywhere.

Full disclosure: after I talked about ordering from Jet Pens a few months ago, a representative from the company mailed me an envelope full of samples. I did not solicit the samples nor am I getting kickbacks from Jet Pens, but let it be known that I scroll through that Jet Pens website the way I page through the Ikea catalogue: pure visual porn.

First up, the Pilot Hi-Tec-C Coleto

Jet Pens very kindly sent a pen barrel along with three 0.4mm ink cartridges in the standard red, black and blue, though certainly for those more adventurous of us there are many more colors available. (For instance, a choice between "Orange" and "Apricot Orange." It's the subtle differences.) The pen is easy to use and very standard as multi-barrel pens go--just jam the ink cartridges in, press down what color you want to use, and start diagramming that Krebs cycle, you multicolor pen nerd, you. I had bought a few of the regular Pilot Hi-Tec-Cs to use before, and I did like the pen, although the pen tip was a little scratchy for me (my own fault, 0.4mm is a very fine tip) and the fact that it was a pen with an actual cap rather than a retractable pen drove me crazy.

People seem to rave about the Hi-Tec-C Coleto, as it gets past two of the commonly voiced displeasures about the regular Hi-Tec-C, in that 1.) it's retractable, and 2.) as multi-cartridge pen, the pen barrel itself is thicker and therefore easier to grip. However, two problems with the Coleto that I noticed were that there seemed to be a lot of "wiggle" of the cartridge within the barrel of the pen, to the point that it kind of affected my handwriting. To be fair, it's a very thin cartridge with a needle tip nib, and I do tend to push hard when I write, so perhaps it's operator dependent. However, with my personal writing style, I think I would find it too scratchy and too delicate for heavy use.

Next up, the Sarasa Zebra Clip Gel Ink Pen in Blue-Black with an 0.4mm tip

I'd eyed this pen before, because unlike many of the rarer Japanese or Korean imports (which makes it sound like we're talking about rare anime reel-to-reels or something, but no, WE'RE STILL TALKING ABOUT PENS) this pen is actually available at Staples. My source at Jet Pens also tells me that the clip (it is spring-loaded, which makes it open and close wider than the standard pen clip) has made it popular among nurses. I also liked this pen because it's retractable (cannot emphasize the importance of this feature--I refuse to use a pen at work if it is not retractable) and it has a nice rubber grip which makes it comfortable to hold.

It's a fine pen. It writes smoothly, the gel is nice and non-blobby, it looks like it has a decent ink supply, and didn't skip even after a couple of test drops from a respectable height. (The skipping gel pen is a major pet peeve. I drop my pens a lot, due to, you know, the Earth's gravity; and I cannot tell you how many 0.5mm Pilot G2s I've had in my life that just stopped working despite a full ink cartridge because I dropped them once or twice. HATE.) However, it's nothing special. And at two bucks each, they're fifty cents more than the Uni-ball Signo RT UM-138, which is a gorgeous fine tipped pen, with many of the same properties and (I think) a more handsome design. True, no springy clip, but I have not yet evidenced need for a springy-clip pen in my life to this point, so for my money, I'll stick with the Uni-balls.




(Also impressive about the RT-138s is that one time I had an anesthesia record that I got pretty wet--got sprayed with saline or something. The ink barely smeared. I have rubbed my writing with a latex glove bare seconds after laying down the line, and nary a smudge. That's a good hospital pen, friends.)

OK, one last review: the Pentel Sliccies Gel Ink Multi-Pen

Again, a multi-pen with 0.4mm tip, only the Pentel multi holds two cartridges, not three. The barrel is clear plastic, nothing fancy that you'd use to sign the Declaration of Independence or anything, but cheap enough that you wouldn't cry if you lost it. Easy to use, a large range of colors (in the blue spectrum we have blue, blue black, sky blue, and milk blue...yes, I said milk blue). One benefit of the Sliccies over the Hi-Tec-C is that the ink supply seems a little wetter somehow, which I like--makes the pen glide over the paper easier. However, again, the ink cartridge is small (probably a commonality among most multi-pens, just for mechanical reasons) so I'd be worried about running out of ink constantly. I guess I'm just not a multi-pen kind of person.

Oh, and unrelated to Jet Pens, I got a few of these guys yesterday:

(It's the Pilot Precise V7 RT, in case you don't have your bifocals on.)

I usually don't like writing in a 0.7mm tip, because I prefer a more precise line and anything too thick tends to blob up on me. But I had to write a letter to someone and I knew that if I used my standard 0.38mm pen (I have them in both the Uni-ball Signo RT UM-138 as well as the Pilot G2s, which you can find in 0.38mm at your regular big box office supply store if you look hard enough) then my writing would be too small. The Pilot Precise V7 RT really fit the bill. It's a fatter, wetter line, but great for scrawling larger notes, and makes signing your name feel awesome. The one caveat with this pen is that it does tend to smudge and bleed quite a bit on the wrong kind of paper, or if your writing gets wet, so perhaps more for your correspondence than for writing in the hospital.

I should get a show on NPR where I just talk about pens. And then I could squawk at my co-host in an abrasive Boston accent and make corny Dad-jokes. Oh wait, that's "Car Talk." Still, if anyone has a programming slot on their local public radio station, call me. As demonstrated, I can talk about pens for a long time.

(Idle aside: my dream--and I think it's a stretch, though not impossible--is to be invited to be a guest on "Jordan, Jesse, Go!" Yes, now you know that my self-professed life's goal is to be featured as a one-time guest on a marginally well-known niche comedy podcast. I REACH FOR THE STARS.)

like oprah's book club without the oprah

My youngest sister (she's ten years younger than me, which either makes her very young or me very old, I'll choose the former) is starting medical school in the fall. I think there is a certain futility in giving medical students or pre-medical students advice outside of the purely practical--never pass up a free meal, sleep when you can, that kind of thing--because there are certain things that you will never, ever believe, and certain lessons that you will not be ready to absorb until you've gone through the experience of learning them firsthand. In that sense, medical school is much like that final scene in Oz (as in "The Wizard of Oz," not the HBO series set in prison with all the riots and butt-raping) where the scarecrow asks the Good Witch of the North:


SCARECROW
Then why didn't you tell her before?

GLINDA
Because she wouldn't have believed me. She had to learn it for herself.


Medical students, there are things that I can tell you about medicine, but you'll never believe me. You'll just have to learn them for yourselves. However, let it not be said that I didn't try.

Therefore, I would like to now present to you my list of the five books I think that every student should read before starting medical training, be it for your MD, DO, PA, nursing degree, or what have you. Note that my own book is not among them, though if you would like to read it nonetheless when it comes out, I certainly wouldn't dissuade you.


* * *


1. The Spirit Catches You And You Fall Down (by Anne Fadiman)




The story of a young first-generation Hmong girl with epilepsy, her interface with the American healthcare system, and the catastrophic culture clash that ensued. I read a review that called this a tragedy of Shakespearean proportions, and I think that's pretty much right on the money. I also think this is one of the best books about the medicine I have ever read. Sensitive and beautifully written, this book dares you to choose sides, turns your expectations inside-out, and showed me more than anything that medicine should be treated more like an art than a religion.

I read this book early in my Pediatrics residency (long-time readers remember that I did two years of Peds before switching to Anesthesia) and it completely changed my life. I wish I could say that I remember the lessons from this book every day when I deal with my actual patients, but that's why it bears frequent re-reading; I must have read this book at least ten times in the past five years.

2. And The Band Played On (by Randy Shilts)




I first read this book I think in tenth grade, when I was writing a Social Studies paper about the history of the AIDS epidemic. (Grade on the paper: A minus, but this particular teacher was known for his grade inflation, so it probably was a pretty crappy paper. I do remember printing it out on my dot matrix printer as well, the sound of which always reminded me of sitting in a dentist's office.)

I know that for some people, just reading the subtitle, "Politics, People, and the AIDS Epidemic" is enough to send you to running for the door (or to say that it sounds like something you'd be assigned--read: forced--to read in some college Poli-Sci class), but hear me out. Written more than twenty years ago by Randy Shilts, who I believe since succumbed to the epidemic himself, it is a journalistic work to be sure, but written in such a way that can best be described as cinematic. It's an exciting book to read. It's a tragic book to read. AIDS has been part of our landscape for so long now it's hard to imagine living in a world before we even knew what the disease did, how it was spread, or that it was caused by a virus. The steps in the healthcare process, in the political process, the small acts of craven ignorance and everyday heroism depicted along the way are unforgettable. We live in a world now where AIDS is a household name. Everyone should read about this time not so long ago when it was not.


3. Complications (by Atul Gawande)




I'm pretty sure that by now I don't need to convince anyone that Atul Gawande is a great writer, but let me just say it again. He's a great writer. His writing is more process-oriented than personal, but I think some of the best parts of the book are the personal bits--the part where he talks about his first experience putting in a central line as an intern, the part where he talks about the decision process of choosing a surgeon for his own son, born with a congenital heart defect. Moreover, Gawande highlights his approach to medicine in his own subtitle, "A Surgeon's Notes on an Imperfect Science." Medicine is imperfect. We are imperfect. It is in acknowledging these imperfections and how we strive to be better than we already are that makes the difference.


4. Singular Intimacies (by Danielle Ofri)




I once heard a book editor complain about the glut of doctors who were pedaling around book proposals or manuscripts in various stages of completion about the medical training process. "Every doctor has stories," he said, "but not every doctor can write. The problem is, they don't know that." And I will freely admit to you, I have lived in fear ever since I heard that insider comment that I am yet another in a long line of doctors who has more stories to tell than the talent to tell them.

Danielle Ofri has stories, and she tells them well. This book is basically a memoir of a young doctor in training, starting with her days as a medical student up through her graduation from residency. Most of the chapters (more like vignettes) existed as standalone stories in one for or another; she was widely published in a variety of magazines prior to coming out with her first book, and is now the Editor-in-Chief and co-founder of the Bellevue Literary Review, which is a literary journal that publishes works related to medicine and health.

What strikes me most about Ofri's first book is her fearlessness in admitting her own failures, her own weaknesses, her own moments of doubt throughout the early years of her training. We've all been there, but not everyone can so nakedly capture that feeling that one has as a medical student, an intern, that first night as the senior resident on the floor, of "I-don't-quite-know-what-I'm-doing-but-now-I-have-to-pretend-like-I-do." In a world of medicine being depicted as large-than-life and heroic, her humanizing the scope of medical training is wonderful and refreshing.


5. Walk on Water (by Michael Ruhlman)




I've read this book many, many times, and each time, I can't put it down until I've read it cover-to-cover. Michael Ruhlman is a journalist (I think he may have been a sports writer in a prior incarnation) who spends several months with a team of pediatric cardiothoracic surgeons at the Cleveland Clinic, headed by chief surgeon Roger Mee.

Now, this may be the anesthesiologist in me speaking, but there's nothing I find more distasteful than the "Surgeon as God" narrative, and so I picked up this book with some hesitation. But this book is nothing like that. That is not to say that the surgical skill displayed is not remarkable (it is) or that the scenes in the OR are not heart-pounding (they are), or the stories of the tiniest lives saved not awe-inspiring (they totally are). But the bigger picture of this book is the evolution of medicine, how far we've come in such a short time, where we are now, and how much farther we still have to go when it comes to saving our youngest and sickest patients. It also marvels at the craft of medicine, the skill, and how to be the very, very best at a certain field, it takes more than just hard work and dogged persistence--in some ways, you have to be kind of a freak of nature. Roger Mee is very, very good at what he does, which is pediatric open-heart surgery, and therefore he feels it is his responsibility to do just that, whether he likes it or not.

(As an aside, I have to say that I trained in Pediatrics for two years, and worked in the PICU and NICU where I took care of scores of post-op complex congenital heart patients. However, there were certain passages in the book where Ruhlman, a layperson, discusses the physiology of the Fontan or the challenges of the Norwood, and I understood the surgery in far more clarity than any of the cardiologists or surgeons I'd worked with had ever been able to explain to me. He is a gifted writer, and speaks fluently in the foreign language of medicine. Bravo.)


* * *


There is one theme at the core of all these books, more overt in some than in others, but a central thread in all good medical non-fiction nonetheless. Which brings me back to my original point. If I could give young healthcare professionals one piece of advice, one word to live by, it would be this: humility. Be humble. Yes, all the standard advice still applies: work hard, sweat the details, treat your patients as you'd want your family to be treated--but I think humility is probably the most important quality for a young doctor, for any doctor to have.

Admit when you don't know something. Admit when you've failed. Admit when your goals exceed your reach, when the skills required exceed your experience, but never stop trying to push that limit. Know when to stop, know when to ask for help, and above all, be aware of your own limitations while trying constantly to exceed them. That's the most important thing in medicine. If you think you know everything there is to know, not only will you always be wrong, but you'll wall yourself off against learning anything new. So be humble. Know what it is that is just outside your reach, and spend your entire life trying to get there.

(Any books to add to this list? Let us know in the comments section! For the five I picked here, there's another twenty I left out. What are your favorites?)

because i'm on vacation, that's why i'm updating all of a sudden

You would think (or at least: I would have thought, circa 2007) that having a book come out next year would be something that would be dominating my life right now. But it really isn't. Mostly because I've been working on this thing in one form or another for the better part of three years, and also mostly because the whole book publishing process is very deliberate and protracted, with lots of back and forth and this-department and that-department. Every once in a while I get a package or an e-mail with evidence that things have moved one click ahead (for example, last week I got to see some sample pages to solicit my opinion on things like fonts and stuff--ah, to be at the choosing fonts stage! It's every former high school newspaper editor's dream! I love choosing a good font.) but other than that, the book seems like something very peripheral to my everyday life. Not that's it's not exciting or cool, and not that I'm not dying to see the first bound copy or eagerly awaiting publication, but it just seems...peripheral. And, to be clear, my everyday life consists mainly of taking care of very sick patients, administering anesthesia, getting blood sprayed on me hither and yon, and then coming home, trying to create dinners out of thin air that bear at least a reasonable resemblance to the FDA's food pyramid, bathing two gross sweaty boy kids, wrangling them into their pajamas and then wresting them into bed (read: sitting witness at the bedside until they pass out from exhaustion or verbiage-induced asphyxiation). Rinse, repeat, repeat, repeat.

Where was I? Oh yes, the book.

The book, I think, is in the layout stage now. I don't know what this stage is actually called, but we're past the copyediting stage (aka the part where they send back your manuscript with a billion blue and green pencil marks, erupting Post-it Notes demanding clarification on this or that point--my editor attests that this is the cleanest manuscript she's seen in a while, but if so, I'd hate to see the sloppy ones) and at the typesetting phase, where they take the words and download them into book form. So hopefully, the next time I see this thing, it will at least somewhat resemble the bound and final manuscript, even if it isn't, you know, bound and finalized.

We're also at the early stages of soliciting blurbs. You have to forgive me if I'm not explaining this right, but I'm a neophyte as this, so I'm just explaining this process as I understand it myself, which is to say in a very rudimentary and peripheral way; but blurbs are short recommendations or insights about the book solicited from other writers or notables. Which is to say famous people. I'm sure there are certainly authors who have their share of famous friends, but as I was unfortunately not present at the Algonquin round table, my exposure to the literati past, present and future has been sadly lacking.




We're getting some great blurbs in, and advance attention has been positive, but I would think that when it comes to matter of publicity that more is better, so if you happen to know of any famous people who might be interested in receiving an advanced reviewer's copy of the book, I'm sure the good people at Grand Central Publishing would be more than happy to send one their way. E-mail me, won't you?

Also, yes I am off this week. This is one of the benefits of being in private practice anesthesia--I get more vacation time now, even if I don't really need it. But who am I kidding, I always need it. Did I tell you about that patient I had last week? Well, of course not, because of HIPAA, and me needing to not get fired. But believe me, it was intense.

Famous people who like to blurb books! E-mail me! I love you in advance!

this kid is five years old

I know this is the most trite sentiment in the history of parenting but you have to forgive it because it's true; but one second I had a baby, and the next second, he became a kid.

Cal turned five a couple of weeks ago.

He's not even a preschooler anymore. He starts kindergarten this fall. Which, I think, is no longer considered preschool. He's a schooler. Schoolboy. Whatever.

I could get all sappy and sentimental here about how fast the time is going and how he was just a baby in my arms (I would sing this, of course, and all the while a guy in silhouette would be playing a violin on my roof) but frankly, his birthday was a couple of weeks ago, when I was too busy to write about it, so the sappiness has faded somewhat. It's still weird though. It's like suddenly, my kid became old. Which probably implies some ominous things for me. My telomeres are shortening as we speak!

It's weird, because day to day, I can't quite tell he's getting older, but when I look at his school pictures from last fall, I can see the changes. He's getting thinner. His face is getting longer. Sometimes I still see the baby. But sometimes I can see flashes of him as a teenager, and it's weird. He's going to be a good-looking man, am I right, ladies? I just hope he can get that scowl off his face by then. No one likes a brooder, Cal.

(I am lying. Many people inexplicably like brooders. Exhibit A: Jordan Catalano.)

That's better.

Happy belated birthday, Cal*. Now on to what's next.

* By "Happy belated birthday," I don't mean to say that we didn't actually celebrate his birthday when it happened. Because we did. We even had a birthday party. Nothing says "summer birthday" like a party at the municipal pool! Luckily none of the attendees threw up in the pool afterwards, because I think that the neon orange frosting on the Toy Story cupcakes** would have probably incriminated our group as flagrant disregarders of the "no swimming for 30 minutes after eating" rule.

** No, I didn't make the cupcakes. Because I didn't want anyone to die.