You may be right, I may be crazy ...

... but it just may be a lunatic you're looking for.  - Billy Joel


Through college, grad school, med school, and residency I did well academically, but I struggled with the tests. Until my junior year of college, I had never taken a multiple choice exam. I know that sounds ludicrous to my American friends and readers, but it's true.

Growing up in Canada, the school system was very different from what I have encountered in the USA. There was no emphasis on standardized testing. We did have high-stakes exams in high-school, but they were nothing like what I have seen here. We had mid-terms and finals. Exam week was set up much like college exam week in the US. Exams for any given subject were given on a specific day and time. You would show up to the gym and there would be a dozen or more rows of desks. Rows were divided by subject with three or four subjects being tested at the same time. Like in college, you may have had to take more than one exam in a single day. I once took the wrong exam (French, I think) by sitting in the wrong row and didn't realize until the exam was over and I looked at my schedule. My next exam ... French (oops)!

Exams were multiple pages long, and they were all long answer, essay, diagrams, etc. No matching, no multiple choice. If I recall correctly, they were usually 2-3 hours duration.

When I moved to the US, I started out at a small college in Hawaii.

Most of the classes were smaller than my highschool classes ... 20 students in a class was pretty big, and I had a few classes with less than 10 students. Again, the depth and breadth of our knowledge was tested with explanations, answers, and essays. No multiple choice.

Imagine my shock and dismay when I walked into my first class (chemistry), held in a movie theatre, at Boston University my Junior year. There were 300+ students in that class. Exams were given in a booklet with answers bubbled in on the familiar Scantron sheet most Americans remember with much adoration. I actually had to read the instructions to figure out how to take the damned exam.

The next two years of classes were mostly like this. I did well, graduating with honors, but it was more of a struggle than I expected.

A consistent theme ever since has been that I know the material, can explain and summarize the concepts, and can usually even draw an accurate diagram, but I just can't pick the best right answer from the list of 4-5 similar sounding phrases on multiple-guess exams. This problem followed me through grad school, med school, and two residencies. I was never able to overcome it, despite my best efforts and the best efforts of my tutors and mentors.

After my Emergency Medicine residency, I moved to a high-volume, high-acuity practice. I thought that my practical, every day experience, coupled with what studying I could fit in would be enough to pass the Emergency Medicine Boards. Boy, was I wrong. I failed my first attempt by 2% ... probably 3-4 questions. My next couple of attempts had similar results.

I was working in a place that didn't require board certification and we were happy where we were, so I had decided not to continue further attempts. I was a good doctor, but not a good test-taker and I was ok with that. I knew it would limit our options a little, and my income would max out somewhere south of my potential, but again I was ok with that.

Then we decided to go work overseas. I was able to find some jobs without being board certified, but the locations and pay were terrible. No way we could afford to go with what I was being offered, so the pressure was on to once again attempt board certification.

I took yet another expensive, out of town, board prep course and I significantly reduced the amount I was working to focus on studying.

Working nights, I tend to be most awake and productive at night even on my days off, so most of my studying was done at night. Late at night, in my office, I started smelling cigarette smoke. Not every night, but most nights. I hadn't really noticed it much before and it was definitely cigarette smoke.

None of my neighbors smoke, but there are several houses with tweens and teens. I have a creek and woods behind my house and I assumed that someone was sneaking off into the woods at night to smoke. The problem was that the woods are easily 50+ feet from my house and it smelled like someone was smoking right outside my window. On more than one occasion, I walked out of my house, creeping along trying to catch Steve Miller* in the woods.

One night, the smoke smell was so strong I swore the smoker was next to me. And that's when I lost it. In the recesses of my primitive lizard brain I dredged up a memory of reading a news report describing someone with a similar experience. I can't remember if it was smoke, or noises, or what, but she had had multiple service people out to her house trying to find the source. Finally, one of the service people entered her crawlspace and discovered someone living there.

See this link: Stranger Living in Crawl Space

I was convinced that there was someone living in my crawlspace smoking cigarettes at night. I put coveralls on over my clothes, grabbed my MagLite and my Glock and headed outside.

I was going under the house and I was prepared to shoot if necessary. I briefly thought about calling my neighbor, a county police officer, but it was 3 am and I realized how crazy I might sound at that moment ... "Hey Joe. Do you mind coming over and backing me up while I crawl under my house to shoot the person under there smoking cigarettes at night?" The thing is, he probably would have said "I'll be right over."

So there I am, crawling around under my house, flashlight in one hand, semi-automatic pistol in the other. And I found nothing. NOTHING. The crawlspace was empty and there was no evidence anyone had ever been under there.

While I may be crazy, I do not lack insight. I realized that I was going nuts chasing after phantom cigarette smoke in the middle of the night. I engaged my scientific and medical brain and set about diagnosing myself. I discovered a condition called Phantosmia. In short, the cigarette smoke was an olfactory hallucination. Usually phantosmia can result from stress or nasal polyps/infections, but occasionally it can be caused by a brain tumor known as a neuroblastoma.

I saw an ENT who put a camera up my nose and took a look around, and then I had an MRI.

It's not a tooma'.

The smells went away shortly after having my MRI and I passed my boards about a month later.

I haven't smelled cigarette smoke late at night since.

Not for any related reason, of course, I added a padlock to the outside access panel for the crawlspace.

*He's a joker, a smoker, a midnight toker.

Breaking up is hard to do

Don't take your love away from me

Don't you leave my heart in misery

If you go, then I'll be blue

'Cause breaking up is hard to do

- Neil Sedaka & Howard Greenfield

It's amazing how much stuff we can accumulate. For years before I started med school, I was able to move everything I owned in the back of a pick-up in only one trip. I did acquire a few more things during my four years of med school, and we picked up a huge amount of stuff when Little Highstead was born. At least it seemed like a huge amount of stuff to me at the time.

When we moved to Washington DC for my surgery residency, we put everything in a Ryder truck and headed out on the highway. Our destination was a cardboard box, with a tarpaulin over it, in a ravine in Silver Spring, MD. Said "cardboard box" was about 950 sqft with a (poorly) finished basement. The house was small, but we weren't tripping over stuff and it was relatively easy to keep clean.

Two years later, we packed up to move to our Iowa Palace in Iowa City for three years of emergency medicine training. For this move, we hired 4 day laborers and loaded our stuff onto a tractor trailer. I think we took up about 25% of the total space. The Iowa Palace was about 1600 sqft with another (poorly) finished basement. The amount of space in this house felt enormous to us at the time. If we wanted to find someone, we used the intercom (it really did have an intercom system but in the 3 years we were there I could never figure out how to use it). One of the great features of this house was the garage. A place to keep our cars, and endless shelves on which to store "stuff". I had room for some of my tools and a workbench with enough space for small to medium sized projects.

(That white blanket in the picture was probably the main reason we moved to the beach.)

The next move was to Myrtle Beach, SC into a 3400 sqft "Executive style home" (whatever the hell that means). For that move, we hired a team to come in and pack for us. Everything was stuffed into a large moving van. I think they had to shove things in like salary men on the Tokyo subway just to close the doors.

We now live in a seriously big house. I know some of you live in a bigger house, but this place is ginormous for 3 people ... 3400 sqft, 5 bedrooms, 4.5 baths. I'm sure there are rooms I have never seen. Someone could live in one wing and I wouldn't have a clue. In fact, I think there might be someone doing exactly that (liquor disappears in this house much faster than I can account for).

Every single room in this house has so much stuff in it, I'm tripping over it. The master bedroom has a walk-in closet ...

The closet had those ubiquitous wire racks, and the racks on Kari's side kept crashing down. In the middle of the night *CRASH* ... clothes strewn all over the floor. I would frantically go digging through the pile looking for survivors. I "fixed" it by anchoring into the walls, and the anchors would pull out and the whole thing would crash down again. I finally built permanent shelves and built-in drawers, shoe racks, and boot racks (my side still isn't done ... more on that later).

In addition to the shelves, hanging racks, and built-ins, Kari also has a dresser. Despite this, every horizontal surface in our room, including the floor, has layers of clothes stacked on it. And this is true throughout the house. I used to joke that if we bought a table, or desk, it would be buried in a week. And then it happened ... we bought Little Highstead a writing desk on which to do her homework. If I remember correctly, it's made of wood, but I can't see it to confirm ... it looks like a beaver lodge floating in the middle of her room (I know there's a desk under there somewhere). We also bought her a travel chest for summer camp. She uses it for camp for 2 weeks every summer, otherwise it sits at the end of a bed in the spare bedroom and is used as a piling station for stuff.

We are methodically going through every room as we get ready to leave for New Zealand. We are purging things from drawers, shelves, closets in an attempt to make the place livable for the various guests staying in our house over the next year. Note to guests: be careful opening closets or you might get the Fred Flinstone bowling ball effect.

I also just spent 5 days ... five entire +8-hour days getting the garage cleaned out and straightened up. That mess is why my side of the closet has not been completed after two years ... I couldn't get to my tools.

I'm making space to get at least one car in the garage and to make it so guests can access beach accessories, bicycles, and tools as needed.

For comparison, I grew up in a 1600 sqft house (also with a poorly finished basement ... I'm starting to see a theme here). I have 3 brothers, so there were 6 of us in that house and I never saw any of them. I still can't remember exactly what they look like. There are pictures of us in that house, so we all had to be there at the same time at least once or twice.

There was plenty of room for all of us and all of our stuff. As far as I can recall, we weren't climbing over each other. There was a visible floor and never a mess. I'm sure my mother will back me up on that, right Mom?

As we purge our house of extraneous stuff, I don't find parting with it difficult at all. Kari has had a much more difficult time with it. I think that is the subject of her first post, so I will leave it for her to continue ...

Small Steps and Giant Leaps

"Funny how fallin' feels like flyin' for a little while ... "

- Stephen Bruton/Gary Nicholson

Like most of us, my life has been a series of small steps, one foot in front of the other, moving along a journey bounded by hopes and expectations. I have been fortunate, though, to have had many chances and opportunities to jump off the cliff and try to fly. There is no denying that has been a privilege of my upbringing and circumstances, particularly knowing that there was some semblance of a (threadbare) safety net to catch my fall. There have been times when it was scary nonetheless.

For the most part, I have landed on my feet, a little bumped and bruised for my efforts, but essentially intact. Occasionally, I have ended up much the same as Wile E. Coyote but without the ACME company and a bottomless line of credit to back me up.

It's been a little scarier since tying two more people to the same parachute, knowing that it might not open, but I have been lucky that at least one of them wants to jump with me. The other one (Little Highstead), doesn't have much choice! She goes kicking and screaming at first, then usually wants to go again.

And that brings us to this blog ... and the next leap.

A few years ago, most likely in jest, Kari said to me "Why don't we go work in New Zealand." This wasn't just out of the blue. We get phone calls and emails on a daily basis trying to entice us to go work in such exotic locations as Nebraska, or trying to get us back to the frozen hinterlands of Iowa. Every now and then, the solicitation (never with much detail) is for somewhere outside of the United States. For a while, there were frequent invitations for New Zealand.

I probably shocked her a little when I said "Let's go." Her reply was something along the lines of "What, seriously?" and so the seeds of a plan were born.

We took a vacation to New Zealand to check it out and on our return started working in earnest to get back there. As happens to the best laid plans, there were a few bumps and curves along the way, not the least of which was losing my work contract and having to start my own company to keep us going.

After a few attempts and false starts, we are finally taking the leap. We are hurriedly trying to get our Stateside lives in some kind of order, because in about one month's time, we will be leaving everything familiar behind to live and work for a year in New Zealand.

This blog is also a bit of a leap. I'm not much of a sharer, and certainly never considered myself much of a writer. I will lean on Kari to add a few posts, and if the Little Highstead has something to say, I will try to help her to do so.

Up, up, and away ...