Buy more, how you say, sheet!

I often am asked how much money I make in the US. I always say that that is a conversation I don't have as there is no point of reference for comparison. I generally ask something to the effect of "suppose you made 10x the amount you make now, what would you owe your patients?" (Many studies suggest that money has little effect on the quality of medicine one practices or desire to work harder, often quite the opposite.)

Suppose his BP was 180/110 and he had a headache.

So I often ask the above question only to get nervous silence in response. Typically, I gently prod, "Well, what do you think you would do as a physician if you made that much more?" A guy in the back said, "I would, how you say...buy more sheet!" The place dissolved into that laughter that comes only on a Friday afternoon after a long week.

As Eli would say, "You can fish or you can hunt." with lab.  But not both and you better be ready to know what to do with the fish.

A delightful student who is a nervous wreck thanks to us trolling through the lab.

Teaching the neurologic exam. The students learn it once then forget it as "only neurologists do this". Note the percussion hammer. This is the only one in the clinic and it is mine. I asked her to draw a clock and she couldn't as it wasn't digital!

Here is you heart, but your pain is near your clavicle

No evidence of heart pain, let alone MVP

We saw a student in the clinic who came in to get a sense of which echocardiogram (ECHO) to believe. He was very nervous and we as doctors had very effectively created it. The short of it is that he was having chest wall pain and saw a physician who unfortunately ordered an ECHO which showed very slight mitral valve prolapse. ALL the ECHOs here are read as that. As he is a med student he read up on it, became scared, and went home to Afghanistan, to Kabul, to be seen at an Indian clinic, had another ECHO which was negative, and now confused, scared and frustrated. As an aside this student knew three languages in three different alphabets. I said that I bet we could decide what was wrong without touching him and of course we did. However even after being extensively reassured he was unwilling to believe that the pain was not from his heart. It was a great illustrative case. Ultimately I asked him to think it over and call me with anymore questions or concerns

Yesterday I actually was able to find a bike rental shop. The owner showed up on Saturday morning the worse for wear, still smelling of alcohol and tobacco but was able to navigate the rental, adjusting my colleague Zhamila's bike, and fix a flat a kid. Zhamila grew up here so knew all the back ways to various sites; botanical gardens, exhibition center and a path that went along side a channeled stream.

Everybody loves to have their picture taken and they insist that I should as well. At least the lens didn't shatter.

The water from the mountains can move with so much volume and force that it will routinely take huge boulders with it, hence the channelling.

As an American expat I get a newsletter called Stepp'n Out from the Consulate and am on the email list for cultural events. Last night was the gala for the winners of the annual CIS accordion and bayan contest. Right, the accordion. Well it ain't Lawrence Welk we're talking about here.The banyan is a squeeze box with buttons rather than a keyboard. It was amazing. I like rock and roll, blue grass, jug bands, smooth jazz, and various groups. But I am starting to love the music here. I have been to seen numerous musical events and with the exception of that screwball marching band that was an exercise in self satire, they are excellent. Ever heard an accordion/banyan quartet? Me either. Amazing. And when it is mixed with a national wood instrument orchestra the sound is amazing. It was held at the Kazakhstan National Music Conservatory and with the exception of the final master couple who were truly masters, all the musicians were <30 y/o.

You know how really good instrumentalists can touch keys so efficiently that you barely see their fingers move as they play 128th notes? These banyan players were the same.