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Do you care if wild animals needlessly suffer and die during wintertime? If so, see www.shelteranimals.org.

Even more ER questions

Part 2

Getting into medical school:  do looks matter?
Q:  Will physical appearance affect my chance of getting into medical school?  Rachel

A:  Grades and MCAT scores are the foremost criteria for acceptance, but keep in mind that it's still a group of humans who will decide whether or not you're accepted.  If you don't think humans can be powerfully swayed by appearance, then you don't know people very well!

By the way, note that I did not say your chance of acceptance is heightened if you're beautiful.  Depending on who interviews you and who sees the picture affixed to your application, you may be better off if you're unattractive.  It's no secret that women can be intensely jealous of more attractive women (incidentally, I discussed a couple of these cases in my ER book in which jealous women took physical steps to ruin the appearance of beautiful women).  Do you think this only affects mentally unbalanced young women who are gang members?  Not quite.  I've seen this bias against attractive women even in female physicians who are members of the faulty at prestigious medical schools — people who some day might decide if you get in medical school.  So, if you know you're going to be interviewed by a woman, you're probably shooting yourself in the foot if you do what most people do for that important day, which is to maximally accentuate their appearance.  My advice?  Look like an asexual bookworm.  Wear glasses instead of contacts.  Have big boobs?  Hide them.  Great legs?  Cover 'em up.  Makeup?  Forget about it!  Get your hair done?  No way — you're too busy to dwell on such frivolity!

On the other hand, if your interviewer is a male, you should do the exact opposite, but don't overtly flaunt your sexuality.  Remember:  he's a man, so leave that to his predictable imagination.  The key is to look like someone he'd likely want to date.  For most doctors, that is someone who is very attractive, but whose dress and mannerisms are relatively conservative.  Anyone who is smart enough to apply to medical school probably doesn't need to be told not to dress and act like a harlot, but just in case, don't.

On to your application photo.  It's virtually certain that both men and women will see your picture and collectively determine whether or not you're "in."  Hence, for the photo you must take a middle-of-the-road approach.  Above all else, try to look both friendly, compassionate, and intelligent, yet serious and sincere.  Don't just do what most people reflexively do, which is to use the photo in which they look most attractive.  If your countenance looks even a bit daffy, flip, or impudent, don't use that picture!

Endocrine problems don't belong in the ER?
Q:  Dear Doc, Great web site by the way. It seems to me that if you go to the ER, the moment you announce you have multiple endocrine problems, you get 'bumped' or fobbed off regardless of whatever current crisis brought you to the ER. By this, I mean everything gets ascribed to your thyroid, adrenal, diabetic condition even though no one actually checks levels to assess the current status of such disease processes. Why is this and isn't it potentially dangerous to simply assume new problems are related?  Cheers, Jayne

A:  Yes, that's potentially dangerous.  Why do they do it?  Some people who go into the field of emergency medicine are constitutionally predisposed to not think very deeply.  Their credo seems to be, "Superficial is better."  If a problem isn't superficial, they often try to make it that way by ignoring all the complexities that their brains are not very fond of.

Q:  Wow! I'm impressed with the speed of your response. I wasn't honestly expecting one. We could use some more decent ER doctors here (Sydney, Australia)  if you ever fancy a relocation! I could talk sand, sea, surf....not forgetting sun, good food, good fine........  (interjection from Pezzi:  Ah, my imagination is running wild!)

Anyway, thank you for taking the time to answer my question. It's been explained to me here that endocrine problems do not belong in the ER and that evidence of any such history will almost automatically warrant dismissal of presenting problems. Quite a worry to know that's the case on the rare occasion you might need to go to the ER. Such a recent episode put me into adrenal crisis when I was given a 5-day high dose, fast taper course of prednisone just to temporary fix me up and get me out of the ER. So guess where I ended back! Thanks again, Jayne

A:  Endocrine problems can be just as serious as cardiovascular problems, surgical problems, neurological problems, obstetric problems, and other problems that cause people to go to the ER.  Therefore, I cannot understand their rationale for saying that "endocrine problems do not belong in the ER."  Frankly, that's ridiculous, and I've never heard any ER personnel voice that sentiment.  My guess is that they're lazy, or burned out, or uncaring — or all three.  I've done my share of griping about patients who come to the ER for silly reasons (such as trying to get a date — difficult to believe, but it's true), but that is an entirely different problem.

> . . . if you ever fancy a relocation! I could talk sand, sea, surf....not forgetting sun, good food, good fine........

Well, I live near one of Michigan's Great Lakes, so if you ever want to see hundreds of miles of breathtaking beaches, spectacular forests, beautiful sand dunes, and captivating streams, look me up!  :-)

Passive-aggressive behavior by an ambulance crew
Q:  I called 911 during an asthma attack, but they forced me to walk to the ambulance and argued with me about my use of inhalers.  They drove at regular speed, without a siren, and gave me no oxygen to discourage me from calling them again, I guess.

At that time, I couldn't speak, and I had difficulty walking.  They told me to walk to the ER treatment room, but I didn't think I could make it.  I asked to be transferred to another hospital.  His response was, "You do that and next time you call, I will have you arrested."  Eventually, I was left in a wheelchair by myself, and had to treat myself with my inhalers.  I contacted the health department, fire chief, and chief of emergency medicine, but I've yet to hear from the last two.  What would you do?  Joan

A:  It sounds like you've encountered healthcare providers who aren't very compassionate and caring — or smart.  Dealing with such people can be difficult, especially when you're having an asthma attack!  My best suggestion is to get a peak flow meter (which all asthmatics should have), and if anyone questions (overtly or tacitly) the legitimacy of your presentation, just tell them, "My peak flow is only ________."  Faced with such objective evidence, they'll have no choice but to give you the treatment you deserve.  If they still act like jerks, write a complaint letter and cite all the facts, including your peak flow.

Good luck and keep me posted.

Choosing a pre-med major
Conquering math anxiety
Study tips
How to raise your IQ

Q:  Dear Dr. Pezzi, my name is Ashley and I will be a freshman at Texas Tech University in the fall.  I wanted to ask your advice on what I should major in:  biochemistry, cell & molecular biology, or microbiology?  Another thing is, I am horrible at math.  I've never been good at it . . . is it a requirement to have calculus?  Also, I have one more question and I'll leave you alone : )  I have bad study habits and I want to prepare myself so in the fall I will be focused.  Do you have any advice on that?  By the way I LOVE your website!  Sincerely, Ashley

A:  Dear Ashley,

What a pretty name you have! :-) And thank you for the compliment on my web site.

> I wanted to ask your advice on what I should major in:  biochemistry, cell & molecular biology, or microbiology?

Any of those are good pre-medical majors. To choose one, I'd read at least one book on each subject, not so much to memorize the material but to answer the questions, "Am I truly interested in this subject? Can I see myself enjoying this for four years?"

Secondly, I think all pre-med students should choose a major that gives them a marketable skill so they're readily employable in case they're not accepted into medical school. With that in mind, the most common pre-med major, zoology (a.k.a., animal biology), is a poor choice in this regard. I've never seen a want ad requesting a zoologist. The majors you specified are more focused and definitely more marketable. Could you get a job as a biochemist or microbiologist? Easily.

> Another thing is, I am horrible at math.  I've never been good at it . . . is it a requirement to have calculus?

Generally, yes. However, don't panic. I HATED math, so much so that I'd often have a beer before doing my math homework. I'm not much of a drinker, and after a beer I didn't care what I did . . . it definitely quelled my math anxiety, and I took three math classes in a row without missing any exam questions. Many people have math anxiety, which is analogous to stage fright. Have you ever heard of using the beta-blocker Inderal (propranolol) to reduce stage fright? I suppose it could also be used to reduce math anxiety, which impedes the math performance of anyone who gets tense whenever they anticipate doing math. I now use math (primarily if I'm inventing something or making something) without any anxiety whatsoever, and without using any booze! :-) That response is typical for mitigation of stage fright (or math anxiety) effected by Inderal, or beer — as I crudely used (not having any knowledge at the time of what I was doing, but I did stumble upon a reasonably effective substitute). Once the Inderal/beer achieves its effect of suppressing the response of the sympathetic nervous system, your brain learns to tolerate further exposure to the once-noxious stimulus without manifesting sympathetic effects in the future even if Inderal or beer (or whatever) is not used. The sympathetic nervous system activates the "fight or flight" response, which is great for fighting or fleeing, not doing math problems! Hence, sympathetic arousal can cloud thinking, and make math seem harder than it really is. In comparison to some subjects (e.g., advanced genetics), math is very straightforward.

> I have bad study habits and I want to prepare myself so in the fall I will be focused.  Do you have any advice on that?

I had the same problem. My concentration used to be terrible. I'd read four or five sentences, then daydream about snowmobiles. A half-hour later, I'd chastise myself and resume studying. After another few sentences, I'd daydream about some woman. Fifteen minutes later, I'd snap out of it and read another few sentences . . . and that's how my day would go, on and on. Believe it or not, my study skills reached their nadir in medical school, probably because I was subconsciously rebelling at the lack of fun time. In any case, someone suggested that I try caffeine to enhance my concentration, and it worked incredibly well, probably because I was a virgin to caffeine (which is why I exhort prospective doctors to not use caffeine until they really need it, which is during medical school). In med school I had no math anxiety (since we had virtually no math, and my math anxiety was history by then). Different situation, different drug. Hence, instead of beer, I used caffeine. It worked great and I ended up acing medical school. Now, even if I don't use caffeine, I still have fantastic concentration. Can you see a pattern developing here? Using a drug to deal with a study-related problem. Drug suppresses problem. Brain programs itself to think or act correctly. Drug is no longer needed, and the problem is gone. Inderal® (propranolol) is sometimes temporarily used this way to overcome situational anxiety or performance anxiety such as stage fright. Propranolol can improve the performance of musicians, speech delivery, and even change aggressive Type A behavior into more tranquil Type B behavior. Some doctors take it before Grand Rounds presentations.

Here is another tip for academic success:  study ahead of time. Don't wait until you're in a class to begin studying that material. Some professors are excellent teachers who present information in a lucid manner, but some are not. For example, I studied physics in my free time before I took a physics class, and I was very glad I did that when I enrolled in a class taught by a professor who had a knack for making even simple things complex. I knew virtually everything he said before he said it, and when he'd do a 20-step physics problem, I could immediately think of a way to do what he was doing in a simpler, more direct way. At the time, I recall thinking that I was glad I'd studied ahead of time, because his explanations were generally so nebulous that I'd often otherwise be lost.

Even if you are fortunate enough to have all great teachers, you still should engage in a program of independent study. If you want to maximally develop your mind and become an excellent physician, you should realize that universities are just an adjunct to learning. Most people make the mistake of relying on college classes to educate them. That's a recipe for being average. If you want to truly excel, you must do a lot of learning on your own. It isn't realistic to expect a few dozen college classes to enable you to "be all you can be," as the old Army recruiting slogan said.

I'm also a proponent of hands-on education. I have nothing against so-called "book learning," but people who rely on that often have such a foggy intuitive grasp of the material that they have a difficult time applying that knowledge to practical problems in the real world. For example, when you study magnetic fields in physics, don't think your day is done when you've read all your homework on that subject — get out some magnets and play with them!

This need for independent study is especially crucial during and immediately following high school. Despite their occasional flaws in elucidating information, college professors are generally very bright or even brilliant people. The same cannot be said for high school teachers. I think high school teachers are often better than college profs at explaining things, but in terms of raw brainpower, there is no comparison. Yes, some high school teachers are quite smart, but, statistically speaking, people who major in education in college (and hence go on to become elementary, intermediate, or high school teachers) have the lowest test scores on standardized measures of brainpower. I recently went on a date with a teacher who somehow possessed a masters degree, but she was such a dull person that I was horrified by the prospect that her insipid intellect was shaping our next generation.

After years of exposure to mediocre intellects, it is no wonder that many high school students are poorly prepared for the "big leagues," a.k.a., college and especially medical school. That brings me to my next tip:  there is no substitute for exposure to first-rate minds. I enjoy interacting with such people not just for the sheer joy of the intellectual stimulation they provide, but also because they can teach me things and expand my intellectual horizons. If you aren't fortunate enough to have such people as friends, you can always read books by exceptionally intelligent people. As I mentioned elsewhere in my web site, by exposing myself to such people, I learned to think as they thought in a process I term "cognitive mirroring." It's important to note that this was an eclectic process, not a non-selective adoption of all their cognitive paths. Thus, I'd cull the best of what they had to offer, and learn how to think as they thought when presented with a situation for which that was the best approach. In my opinion, too many people rely on others just as information resources who feed their memory banks, failing to distill more general lessons of how those people think. As a result, during their education, most people memorize many new facts, but never substantially expand their repertoire of cognition, or their palette of how they think and reason. Brainpower is infectious, and if you exposure yourself to enough of it, some is bound to rub off on you. However, don't make this a passive process. Actively seek out brilliant people, and consciously adopt their best cognitive processes which you can employ in the future whenever a situation arises for which that is the best approach. If you do this, during your education you will not only become more knowledgeable, you will also raise your IQ. I don't think IQ is a static attribute, but rather one that is readily amenable to change.

Most people forget most of what they learn, so traditional education (which is primarily the acquisition of new information) has an ephemeral primary benefit. Yes, a student might sound like a rocket scientist on test day when he or she is brimming with facts, but what great lessons remain 5, 10, 15, 20 or more years later? Most of the value of that education just evaporates as those lessons fade. However, if educators focused more on truly learning how to think (as opposed to what to think), those lessons last a lifetime, conferring an enduring cognitive advantage.

If computer engineers made the same error as most educators, they would focus on improving computer memory (more RAM, bigger hard drive, etc.) but give short shrift to the processor—the “brains” of the computer. Memory and what is stored in it is important, yet how information is used in a computer or brain is even more crucial.

What do I think of Gifted Hands?
Q:  Have you ever read the book Gifted Hands, by Ben Carson, who's the head of neurosurgery at John Hopkins hospital?  It wasn't on your book review page.  Amy

A:  No, I never read it. I've skimmed through it a few times at the bookstore, but I was repulsed by the shamelessly self-aggrandizing title. Skilled Hands would be OK, but Gifted? I bet I have better hand coordination than he does, and I've never proclaimed to the world that I have gifted hands. I soldered dozens of wires to individual parallel traces on a printed circuit board about a quarter inch wide . . . and I did that without the aid of an operating microscope. I've made a copying machine, the parts of which were machined to less than one ten-thousandth of an inch. And I've done beautiful cosmetic surgery, so precise that when I was finished, only the sutures were visible — no wound could be seen. Considering that the human eye can easily see something as wide as the edge of paper, creating an imperceptible wound is almost unbelievable. Surely that is more precise work than carving away at a brain tumor. Yes, neurosurgery has always had a certain dramatic air about it, and neurosurgeons have capitalized on this and anointed themselves to be the cream of the crop, but I contend that being an ER doctor in a busy emergency room is a far more challenging job. Anyone who can do the latter is more worthy of adulation than neurosurgeons who can spend hours trying to be meticulous. We have seconds. And I can still do it better.
UPDATE: Dr. Carson is no egomaniac, so why the self-aggrandizing title? Publisher hype?

The most difficult aspects of being an ER doctor
Q:  What is the most difficult aspect of being an ER doctor — running a code?  Thank you, Stacey

A:  With occasional exceptions (running multiple codes at the same time, or coding a person whose cardiac rhythm changes to a new pattern every few seconds), running a code is straightforward enough so that elementary school children could be taught how to do it.  It isn't rocket science.  Hence, I've always been amused by how intimidated people are when they take the ACLS (Advanced Cardiac Life Support) course, which teaches the fundamentals of emergency cardiac care to physicians, medical students, nurses, and paramedics.  Codes can be dramatic events, so this often precipitates anxiety in people who participate in the ACLS class or in subsequent real codes.  A bit of anxiety can facilitate mental sharpness, but I've seen too many people fall apart during a code that it is obvious to me that they're experiencing enough anxiety to cloud their judgment.  This induction of anxiety is such a pervasive problem that I think the American Heart Association brass (which runs the ACLS program) is remiss for not addressing this issue.  I wouldn't be surprised if they subconsciously enjoy this intimidation, because it feeds into their sense of self-importance.

In my opinion, here are some of the most difficult aspects of being an ER doctor:

  • Working nights, weekends, holidays, and having your shift change three times in a week and sometimes twice in a day.  Need I say more?
  • Working for people who think nothing of forcing a night-shift worker to attend a meeting at 1 PM, which is right in the middle of his sleep time.  If you ask a day-shift worker to attend a meeting at 3 AM, he'd rightfully tell you that you're nuts.  However, ER docs are expected to be immune to the normal human needs for sleep.
  • Being so rushed that you can't possibly take care of all your patients, and then having another dozen patients arrive by ambulance who are comatose, seizing, having a heart attack, bleeding profusely, or lacking vital signs.  If you crave stress, you'll love this job.
  • Being sued for malpractice even when you took excellent care of a patient.  Back in my naive days, I once assumed that the only docs who were sued for malpractice were doctors who made errors.  Unfortunately, the real world doesn't work that way.  Doctors have something that some patients and all attorneys want:  money, and they're not about to let facts get in their way of pursuing that loot.  So they sue, even in cases in which the doctor took perfect care of a patient (here's a case I was involved in that's an example of this), knowing that they may dupe some jury or at least scare the doctor's insurance company into settling a case because they're afraid that some jury will listen to the hot-air rhetoric and unsubstantiated allegations of the plaintiff's attorney, not the facts of the case.  Most people are decent folks who would never sue a doctor unless they were truly injured by him, but there are enough litigious people in our society so as to make the practice of emergency medicine a real crapshoot.  The United States is literally suffused with attorneys, and there are so many bloodsuckers out there that they'll take on cases without any legal merit just because they know how to milk the system.  I've berated physicians in the past for being pusillanimous wimps who don't respond to provocations that no normal person would overlook, but even these primarily weak-kneed folks are now so livid about this situation that they're talking about a nationwide strike.  ER docs have let themselves be slapped around like 98-pound weaklings, but the days of their placidity are almost over.  The combination of declining income and skyrocketing insurance premiums has created a "perfect storm."  Something's got to give, and it will.
  • Being subject to slavery.  No, I'm not being facetious.  I discuss this subject elsewhere in my web site, where I point out that the US government legally obligates ER docs to take care of anyone who walks in the ER, even if they can't pay.  I'm not opposed to helping people who have a legitimate emergency, but I resent that the government takes advantage of me because I'm an ER doc and holds a gun to my head, forcing me to see anyone who strolls in the ER, even if it is for some ludicrous reason (e.g., are my boobs big enough to satisfy my boyfriend? [how would I know?], is my vagina tight enough?, how can I get a date tonight?, how can I convince my ex-fianc้e that she should marry me?, do I have bad breath? and thousands of other "this AIN'T an emergency" situations).  This is just as ridiculous as forcing restaurateurs to feed people even if they aren't hungry and certainly don't need food, or forcing landlords to provide a free home to people "or else."  Besides ER docs, who will put up with such a forced confiscation of their labor?  If being forced to work without remuneration doesn't offend your sensibilities and smack of slavery (working without pay, and not having the right to refuse it), please show up for work (without pay) at my house next Saturday morning at 8 AM.  At least I'll thank you, and give you the best homemade cinnamon rolls you've ever tasted!  :-)
  • Being in unique circumstances that were never addressed in training or a textbook (curiously, many ER textbooks seem to have been written by folks who live in sterilized worlds in which wacky things never crop up).  You'd be surprised by how often this happens.  Every time I smugly (and prematurely) thought that I'd seen it all, I'd soon be in a situation that I had never experienced, read about, or even imagined was possible.  The ER is a magnet for unusual events, and given that humans seem to have an infinite capacity for becoming involved in bizarre situations, there seems to be no limit to what an ER doc might face on any given shift.
  • Constantly needing to project professional feelings of warmth, caring, compassion, and understanding to people you'd really rather exterminate than help.  Unless you've worked in an ER, you have no idea of how vile and antagonistic some people can be.  Thus, I can understand (but not condone) how some ER personnel "lose it" and attack patients either verbally or physically.  As you might imagine, the physical assaults are much more dramatic, and if I had a videotape of some of these melees, I could retire by selling it to the tabloids or the Fox Network, who'd no doubt love to air a show entitled "ER Personnel Gone Wild."  Given that some people are willing to risk their careers for the satisfaction of pummeling some jerk for a minute, you can probably imagine that the provocation was extreme.  Now here's a tip for prospective ER doctors:  learn to "lose it," but in a controlled fashion.  In other words, learn to bend before you break. Here's an example.  One night in the ER, I had a patient who said "Fuck you" to everything I said.  Now my job was to take care of this jerk, not be a punching bag and on the receiving end of his profanity.  I tried all the usual measures, to no avail.  I could have kept up with the same old ineffectual measures, but I was in a busy ER and didn't have the luxury of gradually coaxing this man back on the path to normalcy.  So rather than abnegate my responsibility to do everything I could to take care of him, I had a gut feeling that I could truncate his lack of cooperation if I returned his profanity tit for tat.  Here is how our conversation went from that point on.

Dr. Pezzi:  Mr. Jones, I need to know where you hurt.
Patient:  Fuck you!
Dr. Pezzi:  Fuck you, too.
Patient:  (patient raises his eyebrows, and momentarily stunned into silence) Hey, you're not supposed to say that — you're the doctor!
Dr. Pezzi:  Yes, and I can't take care of you if you answer every question with "fuck you" or if you threaten to hit me every time I get within the range of your fists. (This was at a hospital that lacked a security guard and run by an administrator so brain-dead that he instituted a policy that patients could be restrained only if a quorum of at least five personnel were present to attempt a restraint, even though we NEVER had five personnel working the night shift, when patients are most likely to require restraint!)  So if I have to be a jerk to take care of you, just remember that I can be a bigger jerk than you.  If you fight me, you won't win, and you'll go to jail.  Now where do you hurt?
Patient:  My knee hurts . . . .

Thereafter, this patient was totally cooperative, and I took care of him without wasting any more time that should have gone to other patients.  I agree that it's unprofessional to swear at a patient, but when you're in the trenches (working in the ER), you often don't have the luxury of steadfastly seeking an optimal outcome from the standpoint of decorum; you must often choose between looking good or doing what is best for that patient and the other patients in the ER.  I know ER docs who just walk away from such patients.  Do they swear?  No, but are they really better doctors?  What if that patient had a bleed in his brain, a metabolic or drug toxicity, or some other serious problem?  If the doc walks away and comes back later, it may be too late.  I'll risk uttering a few trite words of profanity if it helps me do a better job.  Yet will you ever see any textbook author (remember, those guys who live in sterilized worlds) giving you the OK to do what I did, or to suggest a better solution?  Nope.  They confine their brilliance to situations that have easy solutions.  Rather than guide you in how to respond to situations in which there is no perfect outcome, but merely the choice of an undesirable outcome or a less desirable outcome, they'll just keep mum on the subject.  They can't tarnish their perfect image with solutions to problems that lack a perfect answer.  By the way, this cowardice isn't evident just in dealing with recalcitrant ER patients, it is evident in what they write about other subjects, too.  By avoiding the difficult subjects, they can continue their pompous self-deception that they're know-it-all sages, while leaving practicing ER docs to figure out, on the fly, how to deal with an imperfect world.

Who pays ER docs?
How long are shifts?

Q:  How are ER doctors paid?  By the hour?  By the shift?  How long is a typical shift?  Amy

A:  ER physicians are usually employed by a group that has a contract with the hospital to staff its ER with physicians. Occasionally, however, ER docs work directly for the hospital.

A shift for an attending ER doc is usually 8 to 12 hours, but sometimes as much as 24.  However, ER docs often work a few hours of unpaid overtime after every shift just to catch up on their paperwork, and to complete patient care.  I've worked some extreme periods of overtime.  Here's an example.  After being up the entire day, I went to work in the ER for the 12-hour night shift.  The day shift physician who was due to relieve me never showed up, so I worked another 8+ hours until a replacement could be found.  This was in a very busy ER on a very busy day, so I was exhausted by this 20-hour shift.  In slow ERs (which are increasingly rare), docs can rest or even sleep during their shifts, so 24 hours can be tolerable.  At my ER, though, the pace was so frantic that my lunches would often consist of sucking down a can of Ensure in five seconds.

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

You will have sex about 10,000 times during your life.

Doesn't it make sense to read a book that can maximize your enjoyment, and the enjoyment you give to your partner?

Cast away your preconceptions of sex books as being a rehash of things you already know and hence a waste of time.  By reading this book, you will learn many things that Dr. Ruth and other sexologists have never considered.

The Science of Sex
Enhancing Sexual Pleasure, Performance, Attraction, and Desire

by Kevin Pezzi, MD

Available in printed and Adobe Acrobat e-book versions (will display on any computer)

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Contact with residents and medical students?
Q:  If I worked at a teaching hospital, how much would I interact/oversee residents and medical students?  Amy

A:  That depends on the hospital. If there are many residents at the hospital, the ER will almost always have one or more residents working in the ER. However, hospitals with fewer residents often have many shifts without residents in the ER. From my standpoint as an attending, the only residents who can "pull their weight" in the ER are ER residents. Other residents -- in medicine, surgery, and whatnot -- often increase the burden on the ER attending because their ability to take care of things on their own is limited, and they require a lot of instruction. Sometimes they create problems that I'd need to mop up. For example, one medical resident assured me he knew how to suture, so I let him suture a patient's cut. When he finished, he proudly announced that to me, and I went to check on his work. When I saw the patient, I was horrified -- it looked as if the patient was sewn by a seven-year-old child! I had to remove all his sutures, and sew the wound all over again.

Sleep deprivation during residency
Q:  Well, here I am, sitting at the hospital on my lunch break, munching a cookie.  I don't have to be anywhere for another hour, so I thought "Hey, why not write Kevin Pezzi?"

I just had a most interesting conversation with one of the lovely ladies I work with.  Her daughter is just finishing her last year of residency as an ER doc (she's a DO, however).  She said (somewhat surprisingly) that her daughter's experience was almost exactly like those of residents on the show ER, which I thought was odd, since most doctors (or least those I've come in contact with) would never dare admit such a thing.  Then again, I live in a relatively quiet suburb, so there's not much action.  Your thoughts?  Amy

A:  I don't watch ER enough to know what she is referring to.  Is it the drama?  The romance?  The medical stuff?  The nonstop action?

Amy responds:  Hardly.  Most episodes of ER only have one or two critical patients, unless there's been some big accident or something.

I think she was referring to the fact that interns/residents/med students are tortured by the nurses and attendings.  Also, residents aren't allowed much sleep, which I can vouch for.  I volunteer in the hospital gift shop on mornings and I can't tell you how many really tired residents come crawling in, buying big bottles of Coke.  If it weren't a hospital, I'd think they were drunk.

Oh, that reminds me.  A friend of mine gave me a printout of a web page she'd found; it claimed that a person who has gone without sleep for 36 hours has the same mental and physical abilities as a person with a BAC (b
lood alcohol concentration) of 0.10 (the legal limit of intoxication in many states).  That seems rather exaggerated, as I have gone without sleep for periods longer than that and could still function (almost) normally.  Then again, I'm an unusual person.  Amy

A:  Excellent point. Ironically, a resident who had even one alcoholic drink at lunch would be fired or severely reprimanded, even if this did not appreciably affect his performance, and his superiors would forever view him as a leper because he did something unprofessional that might endanger a patient. On the other hand, supervising physicians would not give a second's thought to a sleep-deprived resident with far greater mental impairment. In fact, this sleep deprivation is often viewed almost as a badge of honor. Thus, while the profession of medicine claims to act in the best interests of patients, the fact that sleep deprivation and its consequent mental impairment have been ignored for so long is proof to me that collectively physicians feel a greater need to do things to assuage their need for masochistic self-destruction rather than doing things to improve patient care.

I'm tired of hearing the same old tired excuses for the perpetuation of the 36-hour on-call shifts and workweeks of 110 or more hours. The two most common justifications for it are that doctors need to learn to tolerate sleep deprivation, and that doctors need to be with patients for long stretches to learn the natural course of acute diseases and how to manage them. I'll now discuss why these excuses are baloney.

"Doctors need to learn to tolerate sleep deprivation." This is something that can't be taught. A person either possesses this ability, or not. In fact, chronic sleep deprivation often wears a person down so much that he or she is less functional in the future when in a sleep-deprived state. Then there are the ancillary consequences of sleep deprivation, such as when a doctor finds chronic sleep deprivation to be so noxious that he'll take extreme measures to not suffer from it in the future. A case in point:  me. I purposely chose to not have children, because I couldn't stand the risk of having a cranky baby who'd keep me up at night. I've seen parents in the ER who were so sleep-deprived that they looked as if every ounce of joy had been sucked out of their lives. I could sympathize with what they were going through. Yes, I know all children don't cause their parents to lose much sleep, but there is no way to know in advance if I'd have such a child. In other respects, I very much wanted to have kids, and if I could magically have a child old enough to be past the "cranky baby" years, I'd love it. But, as much as I love kids, I can't bear the thought of doing something that might give me a few more years of sleep deprivation. Unless you've endured chronic, severe sleep deprivation (as I have), you have no idea of just how unpleasant it can be.

If the ability to tolerate sleep deprivation were truly important, medical schools would administer the MCAT exam to people who'd been kept awake for 36 hours in a row ten times per month for the last several months.

"Doctors need to be with patients for long stretches to learn the natural course of acute diseases and how to manage them." More hogwash. I was so tired by those 36-hour shifts and 110-hour workweeks that my ability to learn was somewhat less than that of a nematode. Learning isn't the reason behind such forced labor -- it's getting cheap labor to staff the hospital, and because the medical profession wishes to inculcate its long tradition of masochism on the next generation of physicians.

A break between high school and college?  Between college and medical school?
Q:  What do you think of students taking a year off between high school and college? Or between college and medical school? (If they do something constructive, of course.)  Amy

A:  I think it is a good idea to take a break before college. I did it myself. After getting out of high school, I just didn't feel like jumping into college, so in addition to mowing lawns, I worked as a winder (I wound the coils on large industrial transformers), then worked in a plant making roof and floor trusses for homes. In my spare time I studied physics.

Unless you're a lot more disciplined than I am (and you probably are, Amy!), I advise against taking a break between college and medical school.  Once you get a taste of the real world, it is more difficult to tolerate the insular world of medical school in which you're expected to eat, breath, and sleep nothing but medicine.  Hobbies?  Family?  Friends?  Watching TV?  Listening to music?  Exercising?  Sleeping?  Forget them!

Between studying and working multiple jobs, I was so busy in college that I had virtually no time for fun, so acclimating to the inhuman demands of medical school was less of a shock than it may have otherwise been.  Now that I enjoy my free time with snowmobiling, riding my Sea-doo, reading, inventing, cooking, shopping, dating (on those rare occasions when I find someone worthwhile to date -- believe me, northern Michigan is a veritable hinterland when it comes to dating!) and other pleasant activities, giving up those activities so I could study 100+ hours per week would be sheer torture.

In my medical school, we had several older students with Ph.D's in pharmacology, biochemistry, and whatnot.  I never had a class in pharmacology or biochemistry in college, but I beat them in medical school, even in units involving pharmacology or biochemistry.  Surely they must have been more knowledgeable than I was about those subjects, but they'd tasted the real world -- and having sampled it, they couldn't begin to compete with someone like me, who had a maniacal focus.  In those days, I thought it was a thrill to buy a new pen or pad of paper . . . so you can see that I wasn't distracted by many outside interests!

Should she pursue her dream of going to medical school?
Q:  Hello, my name is Sara. From what I am going to tell you about myself, I want to know your opinion about whether I should seriously consider a career in medicine.

I'm 15 and not exactly getting the best grades.  I go to a Connecticut trade school.  When I started high school I thought I'd spend the rest of my life being an electro-mechanical technician, but I realized that I would love to become a doctor, maybe being a neurosurgeon, plastic surgeon, or general surgeon. Next year I will be a junior. Colleges usually don't accept students who have less than a B- average. I know that I'm smart -- I'm just lazy and now I've realized that I may have screwed up any chance of going to college.  My freshman and sophomore grades were primarily C's and sometimes less.  I guess I'm just lazy.  I'm really good at math and science, though.  If you get a chance, please reply ... it doesn't matter if it is 3 months from now -- hey, I just am not getting much help from anyone with the matter.  Sincerely, Sara

A:  First, medical school is very difficult. It will no doubt be somewhat less challenging in the future as the average medical student aptitude drops (for reasons I discuss elsewhere on my web site). However, it will never be easy, and it will always be significantly more challenging than an undergraduate college education. Hence, I think that before someone invests a lot of time, money, and emotional involvement thinking of a medical career, he or she should assess the likelihood of succeeding in that dream.

When I was your age, I had the same problem you did. I was lazy, or at least not interested in even trying in school. Consequently, my grades were decidedly unimpressive. I knew I could do better if I tried, but at that age I felt so insulated from the real world that riding my motorcycle and skipping school meant more to me than applying myself to get into college. While I knew I was smarter than what my grades may have indicated, since I'd never really tried, I had no idea if I was doctor material or not. I thought I might be, but I had some serious doubts. If anyone told me that I'd one day graduate in the top 1% of my class in medical school, I would have wondered if that person was smoking dope. Hence, my point is this:  until you fully apply yourself, you have no idea just how smart and capable you are. I surprised the heck out of myself, but I'm not unique in this regard. I think most people are far smarter and far more capable than they think they are, but they harbor so many self-doubts and bad study habits that they fall far short of their true potential.

Therefore, you should assess the likelihood of your succeeding in medicine, but you cannot begin to do that until you fully apply yourself. Obviously, that is step one. If the grades you receive are reasonably encouraging, the next thing you should do is to do everything you can to expand your brainpower (I discuss this elsewhere on my web site). IQ is not fixed; it can be increased, sometimes significantly. In addition to my other tips on enhancing brainpower, I think one of the best ways to expand your intellectual capacity is to invent new things or processes. By its very nature, inventing involves conceiving of a solution to a problem that no one else has yet envisioned. Given the collective brainpower that has preceded you in the history of the world, this may seem to be an insurmountable problem, but it is not. Even though our society is fairly advanced, there is room for improvement just about everywhere. I'm always inventing, sometimes thinking of 15 new things per day. Most people are far more creative than they think they are, but they're so imbued with self-doubt that they reflexively dismiss their ideas. A bit of self-confidence would do wonders in unleashing that creativity.

Our culture does little to encourage true creativity. Accordingly, most people have not benefited from the brainpower expansion that is engendered by always being on the lookout for new and better ways to do things. Aside from the obvious tangible and ancillary rewards of inventing, I think inventing is one of the most enjoyable things in life, and I think our educational establishment is remiss for not doing more to encourage creativity. In school, I was rewarded for memorizing and regurgitating information, not being creative. Ergo, it is likely that the impetus for your creativity will come from a source other than your teachers. My start in inventing was kindled by a chance event. When I was 8 years old, I watched my Dad make a shelf under the stairway to our basement. My Dad asked me how he could support the back of the shelf. The answer was utterly obvious, and I explained how he should nail a block of wood under the shelf. While he was effusively praising me, I realized he could have figured that out on his own (he was a carpenter in his younger days!), and I felt a bit self-conscious receiving praise for something so easy. In any case, that event was a form of positive reinforcement that triggered a link in my mind between inventing and feeling good. I don't obtain the same pleasure from other intellectual pursuits, such as acing exams. Hence, I credit the process of inventing as being one of the key elements in making me smart enough to succeed even in things that don't interest me. When I was in sixth grade, my teacher denigrated me for being "slow," so I wasn't born with exceptional aptitude. I stumbled on ways of enhancing brainpower, and they worked wonders for me. They can do the same for you.

Review of
TRUE Emergency Room Stories
by Kevin Pezzi, M.D.

Book info  Ordering info

Now available as a free e-book download

What really goes on in emergency rooms?  If you're a fan of the television show ER, you might think that you know.  Not so, asserts Kevin Pezzi, M.D., an ER doctor and author of True Emergency Room Stories.  Pezzi says the show ER only scratches the surface; the truth is far more interesting — and bizarre.  So bizarre, in fact, that the cases could shock even an experienced ER physician.  "I'm now a firm believer in the saying that truth is stranger than fiction," he says.  "I don't think that anyone could dream up such unusual stories."

Pezzi's book is packed with nothing but unusual stories.  There are no "the patient's in v-tach, shock 'em with 200 J and give 'em 100 mg of lidocaine, stat" type of cases.  While such cases are a mainstay of the show ER, Dr. Pezzi believes that they quickly become repetitious.  Instead, he presents an amazing collection of true stories.  The book begins with a story of how he may have saved Michael Jackson's life by averting an assassination attempt by a person who claimed to be a Cosmopolitan cover model, and ends with an interesting tale of how he was propositioned on a beach by a relative of a recent ER patient.  In between, he recounts stories of unusual murders and other crimes, truly odd reasons for dialing 911, unfathomable reasons for visiting the ER, and people with an extraordinary affinity for their pets.  Then there's a shocking end to a pregnancy, a twisted tale of revenge that would be a spellbinding plot for a movie, and the story of a man who attempted to remove his liver at home.

In this book, you'll accompany Dr. Pezzi as he meets the world's unluckiest man and woman, deals with people who have strange requests, and attends to a bride whose genetic disorder wasn't discovered until her wedding night.  There is also the story of the man who didn't know that he had been shot in the head, and the case of the pit bull who picked on the wrong person.

True Emergency Room Stories has something for everyone.  Besides the strange cases, readers will be captivated by dozens of incredible, tragic, humorous, steamy, heartwarming, thought-provoking, and poignant tales.

The family room
Q:  I am fourteen and interested in the science of the ER.  Do ER physicians have somewhere to go after they lose a close patient or family member if they take it hard?  Thanks, Josh

A:  Yes, there is such a room, but it's not intended as a place for ER docs to grieve. Emergency departments typically include a room called the "family room" that is reserved for breaking bad news to the relatives of patients. That room is usually not in the ER treatment or waiting room areas, so others won't be disturbed by the agonizing sounds that emanate from it.

Interpreter gets attached to patients; is it OK to contact them afterwards?
Q:  I've been working as an interpreter for about 4 weeks in emergency rooms in Columbus, Ohio. I'm having a very difficult time dealing with the pain of people and with "letting them go" after the patients go home. I feel like I want to know how they are doing, I want to call them and learn more about them...in other words I get attached. I usually spend 3 to 5 hours with the patient. I sit with them through the whole ordeal and I get to know them. I never got in contact with any of them because I feel that I shouldn't. How do I deal with this feeling? How can I separate myself from them so I don't feel their pain? If you know of any books I can read about this I'll appreciate it if you let me know the names. Thank you.  Norma

A:  I think your desire to contact them shows that you are a caring person who is genuinely interested in them. Therefore, I don't think this is something you should suppress. Why not contact them? I think most patients would be thrilled that someone cares.

Better ER docs?  Men or women?
Who is more competent?  Men or women?
Pezzi's rebuke to a male-bashing woman, and its surprising ending

Q:  In general, who makes better ER docs:  men or women?  Thanks, Stephanie

A:  A few days ago I watched a documentary which claimed that there are definite differences in the brains of women and men.  One of the differences discussed was that women excel at multitasking; that is, doing many things at once, rather than serially attending to problems.  From a teleological perspective, I suppose the facility in multitasking is especially beneficial to women because women typically assume more of a hands-on role in childrearing, and children have an amazing ability to create multiple simultaneous demands.  Hence, with this innate attribute, women theoretically have an easier time adapting to the helter-skelter conditions often present in emergency rooms.  I've known some female emergency room docs who seemed to weather the demands of the ER quite well, but I've seen even more men who are equally adept — probably because there are many more male ER doctors.

Personally, I don't like multitasking, unless it is something that I'm doing of my own volition — such as when I'm exercising, watching a videotape, and working on one computer while I'm using another computer to print out something.  Given a choice, I'd much rather focus all my attention on one patient before going on to the next problem, but that isn't often possible unless the ER is very slow.  So, while I don't like multitasking and I doubt that I was born with much of an ability to do it, I've trained myself to do it fairly well.  I could perform surgery on a patient while talking to the doctor of another patient on the telephone (I'd have a nurse or tech hold the phone in place) while listening to someone else give a report on an incoming trauma patient.  My dream job?  Hell no!  My idea of ER nirvana is when I'd wave goodbye to one patient — the last patient in the ER — while watching another patient approach the triage desk.  Then I'd be able to expedite that patient's treatment.  I'd personally triage the patient (relieving the triage nurse so she or he could take a break), then whisk the patient back to the ER, complete the H&P (history and physical exam), and order the necessary tests and treatment . . . all before a typical patient could finish reading the first of many magazine articles in the waiting room.

Bottom line?  While women may possess more of an inherent ability to multitask, I think the human brain is sufficiently plastic that we can adapt to a remarkable variety of circumstances.  Thus, I don't think that women are necessarily superior ER docs.  In fact, the best ER physicians I've known are men, but this may just reflect the fact that most ER docs are men.

Follow-up from Stephanie:  Thank you for answering my question.  I am writing a term paper for college in which my thesis is that women are more competent than men  — not just better ER doctors, but I asked you that because you're an ER doc.  Thanks again, Stephanie

Response from Pezzi:  What makes you think that women are more competent than men?  If you are discussing competence in a general sense, I think that there is more evidence to substantiate the notion that men are more competent because men often possess a wider range of skills and documented abilities.  I hate to mention this, because most of my readers are women, and I'd rather not provoke their ire by saying something that smacks of political incorrectness.  But you fired the first shot over the bow, so to speak, so if you want my opinion, you have it.

Follow-up from Stephanie:  Men are more competent?  Ha!

Response from Pezzi:  If you want to sway my opinion, you'll have to think of a more compelling argument than to just use the interjection "ha."

Follow-up from Stephanie:  You want facts?  Take me, for example.  I have a 3.7 grade point average, I write poetry and songs, I can play the flute, I'm an ice skater, and I can paint quite well.  Show me a more diversified man!

Response from Pezzi: OK, I will.  Me.

Follow-up from Stephanie:  You?  You're an ER doc, but let me guess . . . in your spare time you probably golf and watch sports on television.  Wow, I'm impressed.  You're very diversified.  I hope you can tell that my response is dripping with sarcasm.  I'm sick of men who don't realize that women are generally far more competent.  In our society, men usually work, take out the trash, and mow the lawn.  Women do everything else.  I've never known any man who possesses the range of competency that women usually have.  Yet what does our society do?  It glorifies men!  I could scream!!!!

Response from Pezzi:  Forget to take your Prozac, or maybe your Haldol?  Sheesh!  What planet are you living on?  You've never known any man who can do more than take out the trash and mow the lawn?  Does the phrase "living in an insular world" mean anything to you?  Yes, there are men who substantiate your stereotype, but there are also women who possess an amazing absence of competency who get through life by smiling at men, plying their other coquettish guiles, and spreading their legs three times per week.  Many insects manifest a more impressive range of skills!

Follow-up from Stephanie:  Women are superior, but you're just too stupid to realize it!  Oh, and by the way, when I asked you to show me a more diversified man, you mentioned yourself, but you never substantiated that claim in any way.  No doubt because you can't substantiate it!  Typical man . . . all hype.  Now do you see why this issue pisses me off so much?

Response from Pezzi:  No, I don't, but it does make me wonder if you've ever been laid.  Speaking purely as a doctor, of course.

Follow-up from Stephanie:  See?  I proved my point.  Whenever I ask for substantiation of your claim about your supposed competence, you change the subject!  Ha-ha, I gotcha, doc!  You can run, but you can't hide!

Response from Pezzi:  But I'd like to, at least from you.  OK, you asked for it.  My college GPA was 3.94 — and that was before the days of grade inflation, and in a course load consisting primarily of chemistry, organic chemistry, physics, biology, engineering, and other challenging science classes, while working two jobs, one of which involved a three-hour commute.  My grades and MCAT scores were high enough that I was accepted into medical school before I finished college, whereas almost everyone else must first obtain a baccalaureate.  In medical school, I graduated second in a class of 256 students — and, incidentally, the top person was not a woman.  I've written several books — and a few songs and poems, especially if I'm enamored by some pulchritudinous woman, particularly if she doesn't have a chip on her shoulder.  :-)   I can't play the flute, but I played the electronic organ when I was a child, and I've sung to an audience of millions on the radio.  I can make just about anything, from a robot that mowed my lawn (by the way, the current robotic lawn mowers are Stone Age compared to mine.  They just wander aimlessly, while mine mowed in perfectly straight rows, knew just where every row was, turned itself around at just the right time, had a variety of accident-avoidance sensors, could compensate for the growth of trees, and turned itself off as soon as the job was through), to a wide range of medical devices, new tools, innovative household gadgets, and hundreds of other inventions.  I developed a new technique of fractional multiplication and two ways to achieve radar transparency.  I can't paint or draw very well, but I can produce beautifully hand-carved doors, cupolas, or sheds, and do just about every task involved in building a house from felling the trees on the building site with a chainsaw, to rough carpentry, finish carpentry, building countertops and trusses, laying tile and carpet, doing electrical and plumbing work, etc.  I can perform surgery so well that nurses who wanted cosmetic surgery would sometimes have me do it, rather than a plastic surgeon.  I can cook, bake, sew, and clean better than any woman I've met.  (And I love to shop!  :-)  I can make custom candy bars that look as if they were made in a factory.  I know as much about Nikola Tesla as I do about Thomas Edison, and I know all the words to the national anthem (judging from Sean Hannity's "Man on the Street" interviews, most people don't know what comes after "I pledge allegiance to the flag . . .").  The other day I heard Dave Barber, probably the most engaging and provocative talk show host in this state, ask a military cadet if he knew the Caisson Song, which should be something every cadet is familiar with.  The cadet didn't have a clue, but I knew the words ("Over hill, over dale, we have hit the dusty trail, and those caissons go rolling along . . .") because I heard that song when I was a kid, and the words stuck with me.  I also still remember our telephone number when I was three years old.  I know more about nutrition than your family doctor and school nutritionist combined, and I know more about sex than Dr. Ruth.  (Want proof?)  I know how to make babies smile, even when they're indifferent to their parents.  I know how to raise a cat so that it is perennially playful.  I figured out just what caused cellulite, when other supposed "experts" were incorrectly asseverating that it was caused by "toxins."  I know how to lose weight without dieting, drugs, herbs, exercise, or surgery.  I thought of ways to get rid of wrinkles that don't require lasers and thousands of dollars.  I knew how to transform my body (which was once disgusting) into something that would not look out of place on the cover of a magazine (most doctors think they know how to get in shape, but why are they so fat?).  I made a motorized toboggan.  Why?  Because I thought it'd be fun.  It was.  I also made a radio-controlled snowmobile — and not from a kit, either.  From scratch.  I also made a copying machine . . . also from scratch.  I know how to make a combination lock whose combination cannot be forgotten by its owner, even if he has Alzheimer's disease.  I know how to make devices that make it safer for people with chronic medical problems (such as diabetes, seizures, or heart disease) to live alone.  I've made EKG circuits that cost less than an order of fries at McDonald's.  I figured out how to make a ROM (Read-Only Memory) chip behave as if it were a complete computer.  I also thought of a way to make a printhead out of scraps costing less than a penny.  I can make craft items fancier than those produced by people who do that professionally.  I can take a lawn mower that doesn't run and make it more powerful than the day it came out of the factory.  I can take those ubiquitous free CD's from AOL and turn them into an engine, fan, or pump (when I have the time, I'll post a page showing pictures of these gizmos.)  I thought of a simple device that could reduce ohmic losses of electricity, and thereby save people money on their electrical bills (people of California, what are you waiting for?).  I thought of a new type of wheel that is unlike any wheel you've ever seen before, even in science fiction movies.  It will do things that are impossible with conventional wheels.  I've invented things that would terrorize terrorists and make burglars wish they'd chosen an honest way to make a living.  I also invented a device that would trick rapists and other thugs into killing themselves.  Yes, I can do more than operate a remote control, drag trash to the curb once per week, and mow the lawn.

Follow-up from Stephanie:  You're a typical man . . . you love to brag!

Response from Pezzi:  If I wanted to brag, I'd mention all my accomplishments, not the 5% that I just did.  Incidentally, you're the one who asked for it by demanding that I substantiate my claim that I'm more diversified than the knuckle-dragging stereotype of men you seem to possess.  Before you continue denigrating men, perhaps you should take a dispassionate look at the world around you.

Follow-up from Stephanie:  What do you mean?

Response from Pezzi:  Transistors.  Integrated circuits.  The internal combustion engine.  The automobile.  Jet engines.  Rockets.  Gunpowder.  The Internet.  Television.  The telephone.  Fax machines.  The electric light.  Electric motors.  Air conditioning.  The copying machine.  And something that no doubt is near and dear to your heart, the vibrator.  What do all these inventions have in common?  They were all invented by men.  The world we live in is one that we've created by innumerable inventions, 99% of which were conceived by men.  I'm sure you won't mention this fact in your paper, since it doesn't mesh with your image of men.

Follow-up from Stephanie:  So you hate women?

Response from Pezzi:  No, I don't.  What makes you think that?  Most of my friends are women, probably because I can see that many of them have a lot more to offer than sex.  However, I clearly think you're off base by trying to diminish the value of what men do.  Judging by the facts, we've done a lot.  Isn't college supposed to be about expanding your horizons, rather than perpetuating your biases?  If so, you're doing an abysmal job.  In my opinion, instead of belittling men by alleging that we lack general competency, your paper should explore the complementary attributes of men and women.  In other words, what we "bring to the table," to put it colloquially.

Follow-up from Stephanie:  Such as?

Response from Pezzi:  I'll give you an example.  The people who purchased my first home also bought my lawn tractor.  When I unpacked at my new home, I discovered that my movers packed the tire chains to the mower, so I stopped by one day to drop them off.  She invited me in to see how she'd decorated the home, and I was amazed.  The house looked so different, I found it difficult to believe it was the same house.  She'd decorated it in a way that was so warm, inviting, and homey — something that no man I've seen could do.  The ability to create a cozy home is valuable, though often taken for granted . . . except by me.  I don't think the differences between the sexes should be decried; I think they should be relished.  Men and women are complementary, in its truest sense.  Not rivals or competitors.  Partners, each of whom adds something special.

Follow-up from Stephanie:  Ha-ha, I did trick you!  I didn't believe everything I said, but I thought by assuming such a radical viewpoint, I could goad you into giving me some good points to use in my paper!  I incorporated them, and I got an "A."  Thanks, doc!  :-)

Update:  About a year after I answered the above question, I received an e-mail from a woman who wanted to know why women don't accomplish much, even though they're as smart as men.  My response to her was more comprehensive than the above answer, and I touched on topics that everyone should be discussing.

What amazed me?
Q:  Can you give me an example of something that you thought was amazing in the ER?  Carla

A:  I can think of many such things, but here is one that never ceased to amaze me:  the rapidity and fluency of speech exhibited by some manic people.  Imagine someone speaking a tad faster than an average auctioneer, who could discuss (whether anyone was listening or not) some surprisingly incisive topics, on and on for hours.  The nexus between these topics is often tenuous, which leads many people to think that such manic speech is just babbling.  Sometimes it is, but it is also sometimes incisive, as I just mentioned.  The most trenchant patient I had was a man in Flint, Michigan who impressed me with his ability, sans lithium, to make observations and analyses in a remarkably keen way.

Even more ER questions! Part 1

Even more ER questions! Part 3

Organize your garage beautifully.

If you want a beautiful garage that is easy to keep organized, see the GarageScapes web site:  www.GarageScapes.com.


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