Dear BarBri

You are kinda two faced!
On the one hand, I am happy that you are giving me structure and encouraging me to be "mediocre," Steve Rubin, the regional director, just gave us his home phone number (I totally bet it's his separate line) and I bet I will find a reason to call him at least once this summer :). Unless I forget!
On the other hand, you are freaking me out! Go to class for 3 1/2 -4 hours, study for 6-9 hours extra each day - umm that's already 9 + 4 = 13 - that's like 9 - 10 including breaks - no way Jose. Yeah, I want my money's worth, but not that much worth! Also, I can't believe how incompetent some of you are! I had a note in my file saying "enroll this student into the NY Mini Review" - it's good I checked "My Account" because guess what? no one enrolled me! And when I called to ask about it, the girl said "Yes, there is a note we have to enroll you, but it's not our job to look through student accounts to see who we should enroll." OKAY, sure, except NO ONE told me I should call you! I don't mind calling! Also, I was promised free shipping of all the books, given that I broke my ankle and I can't carry heavy stuff, NOPE. Promised one day, took back the next. WTF? W/ever. And the website is NOT intuitive, so really work on that.

And my last gripe with everything is that WHY should there be so many broken foot/leg questions? Every assault and every accident and every products liability and every medical malpractice DOES NOT INVOLVE BROKEN LEGS! I hate hate hate reading about it. Especially since my own MD was so negligent!

So yes, the Bar time has come. Time to do the mini-review...

I have also started going to some sample sales. I like that a lot better than those on line things b/c I can try stuff on, which is a great plus. I also have stuck to my mantra of "Don't love it, don't get it." Even if it's $15, or $10, doesn't matter. I now look at things and ask myself: Will I wear this a year from now? Two years from now? How often will I wear this? I am not talking about everything, of course. I need basic t-shirts and basic every day knits and I don't want to spend money on those b/c they are just not meant to last long. They are fun & cheap Daffy's summer pieces. I realize that I have stuff in my closet that I have bought that I don't love. I wear it but it's blah. I think my clothes should make me happy and I should love them and love wearing them. Otherwise, what's the point? Really?

I know I will end up using this blog to bitch about the bar, I just realized that. Sorry in advance :).

Also, I am pathetic. I signed up for ABC Familiy.com so I can finish watching the episode of Greek that I missed on Monday. Even I am disgusted.

Well, I'm signing off for today.

In Treatment Update

I am not asleep at 1:30AM b/c I am watching In Treatment - mind you it's on DEMAND...w/ever

Anyway, this episode started with a Jewish boy who is a law student and he can't get it up! ANd I jsut thought it was hysterical when he said "She is sitting there naked with law reviews behind her back" :). Oh law school!

Ok I am turning off the tv.

hahahaha

http://www.thebigmoney.com/articles/judgments/2009/05/17/big-max

half asleep

my leg is really not into this changing weather :(

so my Norway boy won!



he is an amazing singer! and this is him singing one of my favorite songs




in non-Alexander Rybak related news - and you know I hardly ever have a crush on a singer, but I guess sometimes! Also, what bothered me most about this whole Eurovision business is the way they praised the bitchy girl who represented Russia. They kept saying how she is awesome and wonderful and kept incenuating that the only reason she didn't win was because it doesn't ever happen that the same country wins twice in a row. Yeah, except she got 11th place...and this is after Russia made finals automatically. This is the same girl who thinks Nazis were right, who is openly racist and anti-semetic. And she didn't even qualify properly she was pushed into representin' by the TV channel. Yuck. So I am glad the boy from my hometown won! :)

This girl Yohanna got 2nd place, and except for the clumpy eyelashes she is gorgeous and an amazing singer




I also love this duet - they came in third!



So moving on...but not too far. It's Real Housewives of NJ time! Apparently some of the hubbies have criminal records! and not moving too far away from NY, here is the story about Kelly
http://www.nypost.com/seven/05162009/gossip/pagesix/ruined_kelly_rues_wives_169481.htm

Ok, now I am sleepy so nap time, maybe more blog time later.

What's the #?

4? 15? 

http://blogs.smh.com.au/lifestyle/asksam/archives/2009/05/15_lovers_one_too_many.html

On hygiene etc

Since I've started taking the subway again, I realized what I haven't been missing for 2 1/2 months of driving, I thought I've seen it all, but NYC subway never fails to amaze me. I actually sat next to  a woman with a toddler in her stroller doing her nails on the subway. Now, we are talking making fancy designs with red and sparkly grey/black nailpolish over her painted toes and fingernails. Like stripes and dots and whatever else. She apparently left her WetOne with nail polish on the floor under the seat because there was a woman sitting across from us who bent down and picked up the dirty WetOne before exiting the subway. I would never ever ever pick up someone elese's garbage off the subway floor. Please,  I don't even want to touch the railing going up and down the stairs. Why would someone do it? 

In other news, The Fashion Show is on Bravo, and if you know me you know I love everything Bravo. Isaac Mizrahi is awesomely funny, in a gay wicked way.  What Ilike is that everyone is critiqued on the show in front of everyone else, that's awesome! What I don't get is the whole "sell it oon Bravo TV.com" concept, but hey, who am I t know these things. On yesterday's show they had Tisdale or whatever her las name and one team really really blew it with their ooogly clothes. "I'm not a seamstress" and he keeps digging himself deeper into the hole with that "This is not America's best Seamstress" lol. 

It was also the end of Real Housewives of New York City and there was so much reunion drama that they had to do two episodes of it! I love it love it love it! I know I am easy to please. 

And I am saving the best for last. Yesterday, a drunk guy at Katwalk kept taking his pants off and showing pple his butt, w/girls taking photos of it. When I walked back inside that was literally the first thing I saw - some guy's naked butt. Fun times... 

Hmmm

Ok so now I have time to post and catch up....

I went to see Irena's Vow this Saturday, and it was AMAZING! WOW! I absolutely loved the play. I am usually not a fan bcause I get bored about half way through, but this one was very very good. It was sad but also really really funny at times and so uplifting at the end! I would highly recommend it to anyone and everyone :).

Some memorable quotes from Saturday

"You, you what's your face" - Faina to me at the GAP

"The only thing that's keeping me from punching you in the face is that this one is doing even worse than I am" - blind item

"I like you better when you can't speak" - another blind item

The other weekend I got the most random text from a number I didn't recognize> Someone txted and said "Who are you you txted me and i didn't recognize your number" I checked and nothing. So I txted back and said "sorry, don't know maybe wires crossed." Person txts me back "wait your number does look familiar." And I think maybe there was something wrong with his phone but every message was x2/3. I txt back say "Sorry, don't know you pls stop txting." Person txts back "You don't scare me you big fat scary person." and "c'mon ha ha ha" and something else. I ignore it. Next day "Wat up." Well, wat up is that now you can call verizon and they can block the number from ever txting or calling you ever again. Which is awesome b/c I remember before you could only put a stop on all txts, not selcetive txts... but why me? hwo do these idiots find me of all pple?

I was watching Eurovision with my mom yesterday. It was mother's day and when else do you get to see so much pop gone wrong? although Abba and Celine Dion both won it at some point. It's going on in Moscow now. I am from Belarus and apparently we are representin' this year. The guy from Belarus is very good and another guy is from Norway but he was born in Belarus and he is good too!

So this is the Belarussian guy from Belarus - if I cut my hair I'd sorta look like him, no? :)

and this is the Norway guy - and he is very very talented - writes his own music and plays the violin and he is so cute :) in that "cute" way! I wish I could vote in Eurovision! I'd vote twice - once for the boy #1 and the next for boy #2 :)

and this is just funny

in other news i am done with my orthopedist! yep. exactly 3mo after surgery i no longer need to make appointments to see him. i just need to take it easy and increase my walking as time goes on. i am excited!

RIP

It makes me very sad to say that one of my favorite college professors, Professor Lev Loseff, passed away. He was the department chair, an incredible professor, and a very kind and intelligent person. I also didn't know that he was such a prominent figure in Russian literature.

Free Physical Therapy

When I got out of the subway today, there was a man preaching Jesus Christ the Savior will come and save all of us. As I passed him by with my cane, out of the blue he said "Free physical therapy!" So I guess in NYC, you can still get religion with a side of free physcial therapy, all before 9:30 in the morning. 

That being said, I just fail to see the logic in the flyer give-awayer (?)  I have a bag in one hand, a cane in the other hand, why are you shoving the flyer into my face? Why? 

So my new obsession is In Treatment. I was sitting flipping the channels & trying not to fall asleep with my icepack yesterday and stumbled upon the "making of in treatment" so today in the morning as I was getting dressed I turned it on. ME LIKE IT! And definitely beats watching the Real Housewives of NYC. I highly recommend! I mean it's no secret that I used to go for therapy weekly so to me this is very interesting. And it helps that the episodes are short. I guess I'll catch up on them when finals are over. 

I just watched our Governor & guy in charge of the health department in NYS give a conference about swine flu. Some reproter asked "What's the big deal considering how many pple die from regular flu. Beyond the novelty, what should we be worried about? How is this flu different if symptoms seem the same?." I think it was very amusing that governor Patterson answered the question and started with "That's an excellent question. What I find interesting about this flu is that it (now I am not quoting) is different in US than in Mexico. In Mexico there is pollution blah blah blah." I think the man was asking something totes different & perhaps the MD in charge of health should've answered? My mom heard on the, where else, Russian radio, that if someone sneezes in the subway car you should leave the subway car b/c one sneeze can infect everyone. Well, yeah, you try doing that in rush hour. 

In the future I'm hoping to put here sites to the things I  read on line. However, it's finals time so not going to happen for a while. But

Now courtesy of Deborah "Joke of the day: "The economy is bad. It’s so bad, third graders in China are being forced to take second jobs."

Also in class today my prof gave us the "policy" question that we'll have to answer on the final. He specifically said it's a 30 min question that we can prepare at home and just copy on the final.  He said it's a fun question that we should just think about given today's economy. A girl raised her hand and asked "Professor, what's the word limit?" Ummm, dude, this is NOT a competition in who can type the mostest words in 30 minutes. I loved his reaction - sad/bemused look with a "you can answer this in 1 page or 4 paragraphs and it should only take you about 15 min to retype." 

Ok I am saving this for last b/c i just need to get it out of my system, but it's mean so yeah. Anyway, a girl I know got herself a Hebrew name - Nissan. All I could think about immediately was "Why not BMW?" and then i couldn't help but think of others - it's like things that sound dirty but are not! 

1.  "Nissan - only 199 a month for well qualified buyers" 

2.  "Nissan -cash back due at lease signing and low APR!" 

3. Nissan - shift_the way you move! http://www.nissanusa.com/?dcp=ppn.16575170.&dcc=0.95072658

4. How much is Nissan paying her?

5. I looked up the meaning of the name - ummm, it's a BOY's name

6. Toyota - a smart way to keep moving forward.... 

k it's out of my system. But really, how do you purposefuly choose a stupid name like that? I mean parents get Coca Cola to pay them to name their child Coca Cola & you, as a girl, pick a boy's name that happens to be a car to be your name for free? NFG... 

August in April

It's that excitig time of the year - SHORT SKIRTS time :). Even though this year I can't partake in the full short skirt/ballet flats or platforms thing, I am still excited. Yes, perhaps the chunky Pumas aren't the perfect accessory to a short skirt, but hey that never stopped me before. Ok, maybe it did but I guess I am just so excited to wear "matching shoes" as one of my profs has been saying every day for the past month or so, that I don't even care if my look is circa 1998-99.
So it's all been about rehab and finals - not exactly exciting stuff blogs are made of. The most exciting thing that's happened to me was the discovery of the massage chair at the rehab place. Now, at first I assumed that they were just chairs for people with certain medical conditions - like you have to have back problems to get into one, but no, it's for everyone! So yesterday, I sat in one for about 10 minutes. It's AWEsome. Meaning, it starts out great, slightly weird, but great, but somehow, you end up w/a feeling that someone just pounded you on the back, and not in a good way. Maybe I should've used the gentle cycle. Maybe next time.
Speaking of next time. My rehab place has a lot of older russian men and women. Some of them really need to be there, others are just bored sitting at home so they get Medicare to pay for them to attend. Now, all these elderly bicker non stop! They will comment maliciously on everything. EX#1: Woman #1 has shoulder problems. She is wearing low heels & she is old and not russian. She gets on the special bed for Tracy, the teeny tiny 25yo rehab therapist to do her shoulder stretches (whatever that may be). Woman #2 is this nasty nasty older lady is sitting on the weightlifting machine across from her and says nastily, in Russian "Woman, take off your shoes, what are you crazy?" No response. Woman again "Someone, tell this one to take off her heels. What are we derevenskie (from the village) here?" Now that's the most insulting thing you could've told someone way back when in Russia when everyone strived to move from the country to the village, it's like saying "coutnry bumpkin." And this was repeated another few times. My other ave is when they all fight over the pseudo elliptical machine (it's more like a bike) and the stationary bike. It's a classic study in passive agressive behavior. Also, it's amazing how fast most of them can move in their quest to be the first ones on the machine! It's the adrenaline!

Well I am going to go now b/c as much as I want to write more, I gotta go do Business Reorganizations.... ugh.

And I am back

Well, Why am I back - and precariously just a week before my 3 finals? (Besides the fact that I am insane)? Bc I just read someone's blog, and I realized how boring it was and thought - man, I was sooooooooooooo much better than that! So yep. that's it.

Early Morning TV

I turned off my TV yesterday after watching half of the Daily Show and falling asleep. When I woke up today it was set to Comedy Central - paid programming. Usually the infomercials in the morning tend to run the gamut from health/gym to cleaning to makeup/acne. Today was the exception - the infomercial was for LuvRub, the lube for "Him or Her and of course they can be used together." What kept me watching for 3 minutes (yes, I timed it) was the fact that the infomercial featured three couples: 1 jewish couple, 1 latin couple and 1 white, old, WASP couple. They all sat around the coffee table littered w/bottles of lube and talked about their sex lives. Even in infomercial all the stereotypes were right there, played up to no end! The blonde jewish girl was all over her bf as they both gushed about the wonderful sensations and longer/stronger erections while ahving sex. The latin couple - the guy was a joker, the girl was a slut and although they wer supposed to be a couple, she definitely saat at the far end of the couch and mentioned how she is always looking for something new to do in bd and likes to keep a tube by her bedside for her...err..partner. The old couple...yeah...the guy said how he didn't want to go to the MD and get a prescription b/c that would entail him telling the MD all th partiuclars of his sex life and he didn't want to share those. Well, buddy, you are right, why keep it in the privacy of the doctor's office when you can just go on national TV and let us all kno just how wonderfulyour sex life has become.
Then I switched to MSNBC Squak Box, nothing like waking up with a little sex news and market nes in the morning! I caught the interview with a hedge fund guy who is against the bail out. He was sharing the screen with another man who I assume is pro-bailout. I loove how diferent they were! The hedge fund guy never twitched, looked hot and calm. the other guy was gesticlating so wildly that half the time his arms didn't fit on the screen. His voice would raise and fall and it was jsut hillarious ot watch the scrawny "boy man" battle the man. My favorite was when the boy/man made a point about something and ht eman dodged it by saying "Thank you for bringing up that point, I as going to tak about it later, however, let me now talk about my third point which I believe is even more important." That's his answer to a particular question! I love it! What a great strategy! And mind you, never twitched a muscle!!!
OK I am going back to sleep now.

gross

ok if you choose to eat an apple during class at least choose to use a napkin and please don't keep putting it on the dirty desk. it's gross, you pick up germs, and i don't want to later put my stuff where your saliva has been. yuck. it's called NAPKIN.

It has arrived...

I turned on my cell phone this morning only to receive a video message from one of my former coworkers. Ladies and gentlmen, the new generation of text chain letters has officially arrived. I can't believe that that's what it has come to. It's cute...sorta. It's pretty much a little video a la anime. The message: "Give this heart to evryone you care about including me if you care. Try to collect 5, it's not easy. I may not be the most important person in your life but at least you can smile when you hear my name and say that's my friend because i am your friend and i love you." Sweet, sure! However, think of all the junk mail you get, now, let's say your plan charges you for video messages, you think you'll have many friends left after their bills skyrocket? Also, collect five of what? So if I only got 1 of these, I don' t have friends? But if I get 50 cents worth, then I have friends? Great! And really, aren't we a little too old for these? I am always amazed when my cousin, who is an amazing doctor and runs a private children's ER clinic forwards me the most ridiculous chain letters. I can't understand how someone so clever can actually believe the latest "fwd this to 10 friends if you want to have good luck or else!"

In other news, as you know I have been following the Alitalia saga, for purely personal trip related reasons. Apparently, they are holding a public "for sale" campaign. So, if you happen to have unused liquid assets lying around, and you can guarantee "medium term" continuity of service, then here is all the info you need to know:

"Such expressions of interest shall have to be received at the offices of the
Extraordinary Administrator, at Via Marchetti 111, 00148, Roma, within 30 September 2008, 12.00 a.m., together with all the documents necessary to evaluate such expressions of interest in view of starting potential negotiations."

Yep. I hear it's a bargain!

I am not huge on the Onion, but this one's good

Obama Promises To Stop America's Shitty Jobs From Going Overseas

I"m Back!

Hmm, I actually typed up an entire post, and then something happened and it didn't save :(. That's not cool at all!
I am not going to retype everything but suffice to say I am going to try to keep this thing from now on. We'll see how that goes!

Just a thought

Yes, the blog is officially BACK IN BUSINESS! :)
So, i'll start with this question: In today's world of dating, what are the benchmarks by which you can judge where you stand with the guy when you first start dating?
I used to believe that certain things objectively meant that, even if he is not exclusive with you, he is leaning toward it. I always thought, for example, that when you meet each other's friends - no let me re-phrase it - when you meet the guy's friends, it's a sign that at least they like you enough to do the the "show'n'tel'n'judge" w/the boys. Now I am not so sure. Calling? What if that's just the guy's way of doing things? It's almost as if some of these things aren't happening then you are definitely NOT going anywhere. So, all I have left for "markers" is, really, either "the talk" or meeting the parents. What else is honestly left?
Thoughts?
GO BARACK!!!!!!!!

Goodbye My Ipod

Dear Ipod,
You've been with me for, a month shy of, three years. I still remember getting you in February, 2oo5. You arrived so perfect in that cute box and, unlike the IPods of today, you even had a real "in the wall" charger!!! I remember staying up nites to upload music and I've amassed over 2999 songs! I have so many memories associated with you! You were there for me! You've outlasted two of my boyfriends, countless sleepless nites, long train commutes and being dropped over and over again. In return, you got to go to Washington DC, Boston, Albany (ha!), upstate NY, NJ, San Francisco, Chile, cruise, London, and on countless trips to Long Island. You held music and for me and my eclectic (weird?) taste in music you held memories, of better and worse days.... I only wish I were not so stupid as to keep putting off and putting off backing you up on my laptop. After that big fiasco with the crushing of the laptop I lost all my backed up music :(. I also wish I remembered to transfer the list of songs out. Some of the songs I painstakingly looked for everywhere, others came from my wonderful friends, not so wonderful ex boyfriends and even less remarkable random dates. Ipod, I'll miss you.

Cashmere Mafia

I saw the first episode of the Cashmere Mafia series yesterday. I couldn't resist. I was watching Desperate Housewives and smart people at ABC knew to follow it up with this new, and highly anticipated, show. Let me first say that I am a huge Sex and the City fan. I've seen every episode numerous times and watch it all the time on HBO on Demand. I don't love each and every episode and some I don't particularly care for, but overall, it's truly one of my most favorite shows of all times and I can't wait for the movie to come out in May. I keep hoping for a new Sex and the City that would be, if not bigger and better, but at least on par or not too far below. Did I find the replacement in Cashmere Mafia? Sadly, no.

I think, to me, what made Sex and the City special was the message I always got out of it - if you have your best girlfriends, determination, hope and drive you can do it. You can have it "all" and the "all" is not a cookie cutter concept. Every one's "all" is different and that's what makes our lives interesting. Each character brought something unique to the show and, at least for me, I could see a part of me in every one of them: Carry, Miranda, Samantha and Charlotte. I guess, to me, yes it sounds silly, the show was always so positive, there was always that aura of optimism and a sense that yes, things will be great in the end. As I said, that's just me. I always got a warm fuzzy feeling inside from it. Go on, mock me, I don't care :).
With Cashmere Mafia, I don't know. Those rose glasses come off immediately. I think if the show seeks to empower women, it fails miserably. Essentially, I got two messages from the first episode. Well two and a half. The first was positive and reminiscent of Sex and the City - with your girlfriends by your side, anything is less miserable and life goes on no matter what else is crumbling around you. All you need are your trusted friends to sit you down and hand you a glass of wine. That part I liked. The other message(s) were less touching. There is no humility. The messages are (at least right now): the woman must ultimately pick between family/husband and great career. Message #2 was that men are dogs who cheat on their wives/can't put up with their girlfriends' success and ultimately just want to get laid and have their egos inflated Sure, I am not naive, I know it must be extremely difficult for powerful women to balance careers and having a family. I also have experienced first hand what it's like to have your boyfriend be jealous of your accomplishment, regardless of how silly that jealousy seems. I also understand that the premise of the show is to show it "like it is." One of the characters, after revealing to her friends after one of the friends saw her husband making out with their mortal enemy that she and the hubby have an arrangement that he gets to cheat on her, that "what can we expect from these men who earn less than we do, are not as powerful as we are ...blah blah." I understand all that with my mind, yet, at the same time, do I want this onerous message reinforced to me every Wednesday night at 10PM? I think not. I think I'm better off holding on to my Sex and the City ideal that for a modern woman in NYC, given time, it is possible to have "it all," whatever that "all" may be. In this world of positive thinking, I think we can all use a little more of that, no? Here is to hoping that NBC's Lipstick Jungle will be better!

I think it's appropriate to follow up with this article from the NYT

Fashion & Style
The Falling-Down Professions
By ALEX WILLIAMS
Published: January 6, 2008
For lawyers and doctors, gold-embossed diplomas are no longer so golden.

http://www.nytimes.com/2008/01/06/fashion/06professions.html?ex=1357275600&en=e6188de13887a970&ei=5124&partner=permalink&exprod=permalink

YELLOW BELT!!!!

I did it! I am officially no longer a lowly white belt! I am a bona fide YELLOW belt!!!! I ddi write my "big" essay - no bluebook citations required tahnkyouverymuch! :). My topic of choice was "why would I recommend martial arts to someone." So I wrote that it's "a workout and therapy all in one." I just praised them A LOT. I love that place and, honestly, I sometimes feel I get 10x more out of the 45 minutes spent there than I do out of the 45minutes spent at the therapist's office. I did do Karate in HS before, but that Dojo was horrible and I would leave feeling like I had a scarlet L for "Loser" stamped permanently on my forehead. So yep, I am going to start training for my black belt - no laughing! I didn't go for a month and boy oh boy what a difference one month could make when you are not in great shape to begin with. Talk about embarassing. But, I did learn two new, amazing, self defense moves, so if anyone needs to be defended, you know where to find me!
http://www.dunnsdojo.com/index.html
And as much as I love karate, I must admit that watchign the Ju Jitsu class this morning was something else. All those men grappling each other. I don't know, stirred something in me. There were two women in the whole class. I don't know I guess it's more of a "manly" sport.
This is what I wish I could do
http://youtube.com/watch?v=Z-v7zNkclME
This is what I actually do - to better music :)
http://youtube.com/watch?v=TjiYauCN0Wg

Medical Errors et al

From the NYT
January 1, 2008
Cases
Explain a Medical Error? Sure. Apologize Too?
By SANDEEP JAUHAR, M.D.
Correction Appended
One morning not long ago, I got a call from the emergency room at my hospital. A young man — an intern, in fact, who had been on rounds that morning — had been admitted with chest pains. Could I come to evaluate him?
He was 30, a Pakistani man with a long face and a disconnected look, which I attributed to anxiety. I asked him about the pain. It had started after dinner the night before, lasting about 10 minutes. He had slept comfortably, but the pain recurred while he was walking to the bus stop that morning, persisting almost an hour. It was a dense pressure in the center of his chest. To be on the safe side, he had decided to leave rounds and come to the E.R.
His blood tests were normal, as was his first electrocardiogram. He had none of the traditional risk factors for heart disease. I suspected he was suffering from acute pericarditis, a usually benign inflammation of the membrane around the heart often treated with over-the-counter anti-inflammatory drugs. Characteristic of pericarditis, the pain worsened when he took a deep breath. I told him that if blood tests in six hours were normal, we would send him home. I joked that there were easier ways to get out of internship duty.
Later that morning, I got a call from an E.R. physician informing me that my patient’s pain had resolved completely after he took ibuprofen, further confirming the diagnosis of pericarditis. For a moment I considered sending him home right then, but I decided to wait until the next set of blood tests was complete.
Just before leaving the hospital that evening, I ran into a physicians’ assistant. He told me that my patient’s subsequent blood tests showed evidence of minor cardiac muscle damage. Though surprised, I quickly explained that the problem was probably myopericarditis, where inflammation of the surrounding membrane can partially involve the heart muscle.
He asked me whether the young doctor should have an angiogram to rule out artery blockages. It was late; I told him that any work-up could wait until morning. I assured him that a 30-year-old with no risk factors did not have coronary artery disease. I told him to draw more enzymes and to order a cardiac ultrasound for the morning, and to call me at home if there were problems.
My patient had chest pains through the night. Doctors who were called to see him attributed them to myopericarditis, the diagnosis written in the chart. Further blood tests showed evidence of continuing heart muscle injury. An EKG the following morning showed nonspecific signs consistent with a heart attack. Though I still doubted that he had coronary disease, I reluctantly sent him to the cardiac catheterization lab for an angiogram.
I received a call about an hour later asking me to come over to the lab. When I arrived, the angiogram was playing on a computer screen. It showed a complete blockage of the left anterior descending artery, the so-called widow-maker lesion. The artery looked like a lobster tail, unnaturally terminating after several centimeters. Within minutes, the blockage was opened with a balloon and a stent.
Afterward, in the control room, heat rose to my face as colleagues wandered in to inquire about what was going on. “How could we have missed this?” I asked aloud. I was well aware of the disturbing prevalence of heart disease in South Asians, whose risk is up to four times that of other ethnic groups. I knew that heart attacks in this population often occurred in men under 40, who often do not exhibit classic coronary risk factors. I knew all this, but somehow my mind had suffered a block.
“Don’t beat yourself up,” a colleague said sympathetically. “Every doctor I know would have done the same thing.” Another told me that it was his policy to “cath” almost anyone who came to the E.R. complaining of chest pains. In his opinion, the risks posed by routine angiograms were much less than that of a missed heart attack.
What now? I knew I had to explain myself, but how much should I say? Like all doctors, I had made errors before, but never one this big — and in my own specialty, too. Should I just tell my patient the facts? Should I apologize?
Most doctors are afraid to take responsibility for medical errors. We are acutely aware of the potential hazards — legal and professional — of taking ownership of a mistake. But studies have shown that physicians’ apologies do not necessarily increase malpractice lawsuits. In fact, they may protect against litigation. Twenty-nine states have enacted legislation encouraging such apologies, some even making physicians’ expressions of remorse inadmissible in court.
It was not always this way. Hospital legal departments routinely used to advise doctors never to admit responsibility for an error.
During my internship orientation nearly a decade ago, a lawyer for the hospital said that at some point in our careers every one of us would likely be sued. The lawyer offered some advice: document your decision-making; document when a patient refuses treatment; never admit wrongdoing; never talk to an opposing attorney; and, finally, be nice to your patients. Doctors who were nice to their patients were rarely sued, even in cases of egregious malpractice.
I couldn’t bring myself to talk to my patient in the cath lab, while everyone was watching, so I decided to wait until he got to the recovery room, where it was more private.
I found him there lying on a stretcher. The pain in his chest was gone, he happily informed me. However, the groin, where the catheter had been inserted, now hurt. “They substituted one pain for another,” he said, laughing.
I grasped the rails of the gurney. “I thought you had pericarditis,” I said carefully. “I was obviously wrong. I’m sorry.”
He seemed embarrassed. “No, no, please, the past is finished,” he replied. “I am more interested in the future.”
He asked about his prognosis. I told him that I thought it was good, though he would have to be on medications for the rest of his life. He nodded, looking disappointed.
A few days later, just before he was to be discharged, I stopped by his room. I asked him with whom he was going to follow up. He told me that he had been given the name of another cardiologist but that he had decided to go with me. “You have been terrific,” he said. “Thank you.”
I nodded silently, feeling empty. “You are much too generous,” I said.
Sandeep Jauhar is the author of a memoir, “Intern: A Doctor’s Initiation,” being published this month by Farrar, Straus & Giroux.
Correction: January 4, 2008
The Cases column in Science Times on Tuesday, about a doctor’s decision to apologize to a patient for a medical error, misstated the number of states that have enacted legislation encouraging such apologies. It is 29, not 17.