Last night I learned about a drug called Disulfiram. I won't go into the technical details about how it works, but what's important is that it causes individuals who take it to feel almost immediately nauseous when drinking alcohol. The most common use is to help alcoholics attain and maintain abstinence.

This method of treating addiction is called aversion therapy and the more literary of you will recognize the similarities to the "treatment" given the protagonist of Burgess' A Clockwork Orange. For those of you who haven't read the novel, the character in question is psychopath who spends much of the first portion of the novel beating, robbing and raping indiscriminately. Captured and imprisoned, he is treated with The Ludovico Technique. After this treatment he is set free only to discover that any violence makes him violently ill. It's important to not that he still wants to commit violence but that he is prevented biologically. Unable to commit suicide (He can't abide any violence, even to himself), abused by his previous victims and unable to defend himself, his life becomes a tortured prison.

After the protagonist receives the treatment, a priest criticizes it. He claims that people must be allowed to choose whether to commit good or evil.

Disulfiram treatment worries me. It can only be given with the patient's consent and I can't imagine prescribing it to anyone whose health wasn't seriously threatened by alcohol abuse, but I'm still disturbed by it. My anecdotal experience leads me to believe recovering alcoholics tend to shift their dependence onto cigarettes, and overeating. Though less concrete you could argue that many shift their addiction to religion or therapy as well which, though less harmful physically, may still spring from the same root cause.

This drug addresses the symptoms and not the cause of the addictive behavior. If I have a patient with a failing liver, am I really making him healthier by giving him an opportunity for that liver to heal in exchange for damaging his lungs with cigarettes and diabetes due to secondary obesity?

As doctors we're asked to look at problems and offer solutions, but this is the first treatment I have read about that has really made me ethically queasy.

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Starting this block, we've been having more clinical experiences. Most of these have been fantastic. You get to meet doctors in their workplaces, interview live patients, see their treatment first-hand. Yesterday, though, I had a session at a hospice center which was probably the worst experience I had since starting med school.

Just to be clear the entire experience wasn't bad. We had the opportunity to tour the facility, meet with the chief doctor on their staff and even interview a patient receiving palliative care. I quite enjoyed these aspects.

The part I did not like was the first activity. Our preceptor took the twelve of us into a room and, in turn, had us speak about an experience we had with death or loss. People told some very emotional, personal stories. Obviously each of us is going to confront pain in our lives and I don't feel like all doctors should be unfeeling robots, but the vibe of this activity seemed really wrong to me.

To start the preceptor had an odd way of encouraging people to take their stories further so that, in a weird way, everyone was trying to outdo the last one. You almost felt that, if you didn't tell a gut wrenching tear-jerker, you weren't participating in the activity. Additionally, if you weren't emotional during your telling there was a not-so-subtle implication that you wouldn't be an empathetic or caring doctor.

It was an extremely surreal and unpleasant encounter for me. In fact, I found myself getting really angry. I felt as if I was being violated; like I was the victim of some emotional vampire. Still, when it came time for me to speak I didn't revolt, I just gave a perfunctory story.

I felt that, while I knew some of the people in the room, none were my close friends or confidants. Trust takes a long time to build up between people and stories of loss and pain, for me at least, are private matters to be held close. For me, sharing a story of that depth is a symbol of great intimacy. It seemed to tarnish the stories to have them clinically examined for the sake of an educational activity.

Thinking on it later, I realized some of the irony of this situation. As a doctor, I'm going to ask perfect strangers to reveal very private aspects of their lifestyle and anatomy with me. I know that will be very uncomfortable for some. Still, as a doctor I would like to believe I would a) Always value my relationship with the patient as confidential and professional. Additionally, I hope to respect my patient enough to explain *why* I need to invade their privacy and to act on behalf of their health.

Still the whole event felt really wrong. Maybe it's just me.

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Last week, we worked on a case concerning Down Syndrome. If you don't know, Down syndrome occurs when a child is born with three copies of their twenty-first chromosome (instead of the normal two). It happens in about one out of every one thousand live births. It's associated with a number of developmental symptoms including mental retardation and physical growth impairment. It's certainly not something you would wish on anyone. Even Mr. Deity thinks it's awful.

By the end of last week, I had pretty much settled on my opinion. Basically that the human body had evolved a pretty solid quality assurance system, and that most fetuses with chromosomal abnormalities are aborted spontaneously (i.e. naturally). The evolved QA system isn't perfect though and some chromosomal aberrations evade termination and result in a live infant with a severe disability.

With maternal blood testing, placental sampling, and amniocentesis, an expectant mother can detect chromosomal abnormalities relatively early in the pregnancy and can willfully abort the fetus. Seemed pretty straightforward until yesterday morning. That was when I had the chance to meet with a few mothers who had children with Down Syndrome.

The first mother had three children, the oldest with down syndrome. She had not had an amniocentesis done (this is a prenatal procedure that can diagnose birth defects in the early stages of pregnancy). While she was pro-choice she said she was very happy that she hadn't had the amniocentesis because she probably would have aborted the fetus.

The second mother had five children. Her youngest had down syndrome. She also had not had an amniocentesis. She did have an early blood test that gave cause for concern but she was determined to have the baby no matter what the amnio test would have told her so, in her words "what would be the point?"

Hearing the rest of her story, though, the point seemed very clear in that neither she nor her family were prepared for the news that their new member was disabled. To be clear, I found both mothers impressive. I was truly astounded by the strength of each but especially in the second one. Most of us don't have real opportunity to test the lengths of our love. I mean, who would choose such a hard life? This would also didn't have a choice, but she certainly didn't flinch when her feet were put to the fire and I have a huge amount of respect for that.

One thing the second mother said was that nothing made her more angry than people treating her daughter differently, as if she were less than a full person. This is where I am going to break from the politically correct herd. I see their point.

Most people who get the benefit of government services, police, fire, garbage etc. do so with the understanding that the society as a whole is going to reap a reward for providing those services. That the individual will work and pay taxes and improve society. Down syndrome children not only need many more resources but their life expectancy and diminished productivity (due to mental retardation and a high risk of early-onset Alzheimer's disease). Economically speaking, a citizen with Down syndrome isn't as valuable as a citizen without it.

Not just that, but those afflicted with Down syndrome cost the government. Our first speaker told us that all the medical expenses for her DS child were paid for by the county. She also told us ways they would be able to manipulate the system so that he would be covered by medicaid until he was 21 years old. In other words, this couple chose not to have a screening test that would give them an option to abort an affected fetus.

It's true that there are ethical consequences to both sides of that decision, but choosing not to abort affects not only their family, but everyone who pays taxes. I'm not claiming that anyone would deliberately have a baby with DS to gouge their government, but the government does subsidize families that choose not to have an abortion. Despite this, the state gets no influence over the decision. It just struck me that both mothers felt they were owed this money, that the government was obligated to take responsibility for an unfortunate, but preventable, situation.

I sound like such a republican.

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I know haven't written much but things have been somewhat ugly in my progress. Well, that's not quite true. I did do a lot, but I've had some setbacks as well. The first of which is poker. From May 6th to May 10th I lost 80% of the profit I had earned since I started this goal back in March. That's a tough week.

tilt is an amazingly tough nut to crack. It's really hard to know when you are just getting unlucky and when you are playing bad. I still don't know for sure but I have noticed that when I lose a lot of money there are some patterns.

1) I tend to try different games, for example if I branch into turbo tournaments or Step tournaments (these are tournaments that don't award cash prizes, but entries into higher buy-in tournaments).

2) I tend to play a lot more than my usual volume.

My regular pattern is to play one "set" of four tournaments simultaneously. This usually takes a little longer than an hour. Ideally I would like to increase this. I would like to be able to play poker, profitably, for several hours a day, but every time I try, my advantage seems to fly out the window. It's possible that this is just variance and I really am just getting unlucky and my seemingly poor performance is simply anecdotal superstition. I might try combating this with a strategy. Tomorrow I think I will try to play three sets during the day with a one hour break in between. Hopefully that will be enough "cool-down" time to let me still play my A-game.

The other unfortunate event is that I hurt my left calf. Not really sure what happened but I started limping. Resting didn't seem to help in fact, it was usually after a rest that it would be at its worst (such as when I woke up in the morning), but if I was walking around for a few minutes i would hardly feel anything. I took last week and this week off from running and it has been better but it's still not 100%. I'll start running again next week, less ambitiously, and we'll see how it goes.

I have been working on a website redesign. Still tweaking the look and feel but I think it'll be a nice change. It's very clean and easily readable.

I have only been to one live baseball game so far. April 28 (lost to florida 4-7)

I *did* got to the Baseball hall of fame on May 2nd. I went with a buddy of mine and honestly, I have to say I had a lot more fun hanging out with him and playing some wiffle ball and HORSE with a basketball hoop we found at the hotel than I did at the museum. It's not that the museum was bad exactly, I'm not sure how I could have made a better one. It just felt a little fake to me. That the heart of baseball is found in a company league or a pickup game than in some corporate sponsored museum. It felt forced and not genuine.

After the hall of fame we went to a casino and I won $150 playing poker, which is nice because I'm broke.

on May 7th I did see a broadway show. I saw Waiting for Godot which was awesome. I'll probably make a separate post about it.

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Here's an interesting study in sample size.

Here is an image of my profit since I started my goal to make $1000 in online poker. As you can see the variance is striking. The end result is that I had a 13.5% ROI over the period and I am over 15% of the way towards my goal. Still, the graph *looks* ugly. Not only are the swings enormous, there doesn't seem to be any positive trend.

This is a chart of all my poker winnings since I started tracking. Much prettier, eh? This chart clearly does exhibit an upward trend, and the period charted by the first graph seems nothing more than an unpleasant break-even stretch. In actuality I have now made more money in poker than at any time since I started tracking. Interestingly enough, my ROI over this period is 12.3% which is less than the goal period charted above.

For those of you interested, I am calculating ROI by average profit/average buy-in (including rake). After I earn another hundred dollars I'll have enough of a roll to move up in buy-ins again. If I can maintain a decent ROI (I'm hoping for about 8%), this graph should have a very healthy spike in the near future.

My other goals are moving along nicely.

On Thursday I went to a passover Seder. Had a great time. Not counting it as a religious service because there wasn't a formal religious leader guiding it. I really do like passover Seders though. Probably the best religious meal I've had the chance to partake in.

On Friday I saw the neo-futurists again. I have to say I wasn't that impressed this time. We got there somewhat late and had to take seats in the back, so the intimacy was missing. Also, some of the players were clearly new to the troupe and we flubbing lines. I'll still see them next time but I'm hoping they get it together. The funniest performance was called "the grapes of wrath" and consisted of one of the players with a bunch of grapes just throwing them at the audience. Silly, but I enjoyed it. There was also a waiting for godot satire I found amusing.

Saturday I went to a dinner party that I made an ice-cream banana fudge pie for. I'm not sure if it counts as an original recipe since the crust and the ice cream were ready-made. If anyone actually reads this and wants the recipe I'll post it and include it in the goal list.

I went to an Easter mass on Sunday. A formal church service is a very surreal experience for me. On the one hand I'm a big fan of symbolism (Easter is especially loaded with pagan symbols of fertility) but the formalism irks me. It's like I'm a big fan of the themes they are trying to empart, but whoever wrote the script needs a good editor because it really doesn't come off right.

For example, I like the notion of greeting and expressing harmony with your neighbor. I'm all for forming genuine communal bonds but that part of the mass is just awkward for me. Relationships and community need to grow. Any attempt to just say "hey there brother!" and assume we're the best of chums makes me feel uncomfortable. I do try to put my best foot forward, but I never come away saying "Man, that guy I shook hands with was awesome. I wonder if he plays Madden?"

The sermon was vaguely interesting. The gist was that when mary came to Jesus' tomb and found it empty the angel that greeted her implored her to not hang around in the empty tomb but seek jesus who had risen. The priest said Easter isn't a time to sit back and say "man it's awesome being saved" but to seek out and challenge your religion. I liked that sentiment. Sort of a carpe diem of religious sentiment.

Last night I went to A Salt and Battery and had Fish and Chips. The food was pretty good, but overpriced. Probably the best part was talking about how they had fried mars bars and how unappetizing they seemed. A British guy who was there said that there was a translation error there and that a British mars bar was much closer to an American 3 musketeers bar. I exclaimed that this changed everything and he nodded sagely, but after he left I realized I like both candy bars about the same (i.e. not at all) and that a deep fried 3 musketeers sounded just as disgusting as the fried mars bar.

After that my companions and I jumped into a cab to make it to a movie theater to see Sugar (review to come). The cab driver was named Malik and was from Pakistan. Really a funny guy. At one point he asked me to navigate the cab and since I never drive I had no idea how to go. Eventually I said he should go down a street that was actually a one way in the other direction. When I gave up he laughed in a "haha now we know who the cab driver is!" sort of way.

Dan said it was an awesome Columbo interaction, which is true except that I admitted I had no idea where I was going to start with. It would be like a guy meeting up with Columbo and saying "Lieutenant, I killed the guy...arrest me" and Columbo responding ""Oh no no sir, I'm certain of your innocence. I was just wondering whether you could help me clear up one thing ..."

Still it was a fun cab ride. You gotta love new york. Tonight I'm seeing a live concert of Flight of the Conchords. reports to come!

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