The British Museum

(7-2-06)

Today I caught the shuttle to London with the hopes of getting a chance to watch part of the Wimbledon. I arrived at Victoria station only to discover that there were no matches today. Instead, went up to Hyde park to have lunch. I have to say that despite all the hype, I was a bit disappointed. It was not even comparable to Central Park or even the Boston Common. Nevertheless, it was interesting to note that Henry VIII used to hunt deer there, and like everything in Europe the history attached to the place is clearly the main appeal. After that, I hopped on the tube to check out the Brittish Museum. After viewing the artificacts from Egypt, Greece, Rome, and the rest of Western Europe, I couldn't help wondering how long America's prominence as the epicenter of civilization would last. Lately there seems to be a lot of discussion about our economic prominence being overtaken by Asia, and from what I hear "The World is Flat" is a must read. After spending a few hours reflecting on the entirety of the history of human civilization, I was struck by how small my role would appear to be in this grand design. It was an excellent lesson in the ability of time to wear away any contribution we may make to the world during our lifetime. As a case in point, probably the one human being that gets the most attention in the British Museum is Alexander the Great. As far as I can tell, if you ask most people today what they know about him, they'll tell you that he was gay and played by Collin Ferrel. I'd hate to think what Alexander would have done to Oliver Stone if he was alive today.

Homeward Bound

(6-30-06)
The last day of our trip was almost entirely consumed by traveling. Our train was 2.5 hours late getting from Ljubljana to Budapest, so by the time we arrived I barely had time to grab a quick bite to eat and catch a taxi to the airport. As I near completion of my first tour backpacking through the continent, I feel much more acclimated from when I first arrived. After finding my way around cities with currency that is less than 1/200th of a dollar, where English isn't universally spoken, and where I'm not always sure where I'll lay my head at the end of the day, returning to the comforts of Oxford should be a cinch. In the meantime, I'm already looking forward to my next opportunity to venture out past the English channel again.

Slovenia

(6-28-06)
When we got to Ljubljana around 11:00 yesterday morning, for the first time since arriving in Europe I reached a point where I had no list of things to do, no agenda, and really no plan other than to pick up Jackie in Klagenfurt and find our way back to Lake Bled. Since neither Sam or I had any clue how to navigate around the country, we made obtaining currency and a map our first priority. This turned out to be relatively straightforward--even though I was nearly as far from home as I had ever been in my life, just about everyone spoke English. This was very helpful since we had nothing but a street address from which to locate our car rental. When we finally located the rental car company, we were told that our economy sized vehicle was not available, but for no extra charge we would be given a brand new Euro-station wagon. Perfect for transporting 3 people and all of our luggage. As we made our way north into Austria, we were surrounded by the beauty of the Julian Alps. Even though I spent some of the most formative years of my life living in some of the most beautiful mountains on the planet, I was still amazed by the breath-taking distinctiveness of southern Austria. The occasional church steeples poking out over the landscape were a constant reminder of the history that surrounded us. As we returned to Slovenia after picking up Jackie, I became acutely aware of my good fortune in having 2 travel partners with so much experience. As I handed our passports over to the border patrol, I realized that the two of them had stamps from countries that I had never even heard of. After driving for about an hour through terrain that could have been used for the set of a Peter Jackson movie, we finally arrived in Lake Bled. The first glimpse of the lake with its castle overlooking from a cliff and historic churches on its banks and island were enough to convince me that this was truly one of the most unique and beautiful locations I had ever been to. I am still scratching my head as to why anyone would waste a trip to Europe visiting the Tower of London, the Vatican, or the Eiffel tower and miss out on seeing this unvelieveable sight. Lake Bled is literally one of the world's best kept secrets. Being here gives me a feeling that I have only had a couple of times in my life during trips to the crater in Tanzania or diving in the underground Sinoras in Cancun where you realize that you are taking part in something very special that most people will go through life and never see. Our bed and breakfast overlooked the lake, and after checking in we immediately set out to explore the city. Many gigabytes of memory were wiped out in the space of the first hour taking pictures. We eventually found our way into town, where we stopped for a pizza while watching the France/Spain game. Jackie had a vested interest in the outcome, having just scored tickets to watch the winner take on Brazil back in Germany. On our way back to the Bed and Breakfast, we witnessed a spectacular lightning storm just behind the Bled Castle up on the cliff across the lake. Sam and I slept in a little the next morning, and then the three of us went down to a cafe for breakfast and a cappuccino. We then piled in the car and headed for Bohem. We took a gondola there to the top of one of the ski resorts, where we spent the morning hiking, having lunch at the top of one of the peaks. We then drove back to Bled, where we drove up to the Bled castle overlooking the lake. The views from the top were nothing short of spectacular. After that we hiked along a gorge to a waterfall nearby, which was remniscent of something from Lord of the Rings. We made it back just in time to catch the sun setting over the lake. We enjoyed dinner at a very nice restaurant that was right on the waterfront before turning in for the night. Although we had all fallen in love with Bled to the point that we never wanted to leave, the next morning we decided that with the rest of Slovenia unexplored and another day on our rental car, we really owed it to ourselves to venture out to the south. Before departing, we visited a beautiful church that was perched overlooking the water. The inside walls were covered with a beautiful series of paintings that depicted various elements of the Lord's Prayer. It was pretty money--reminded me a little of the Naval Academy chapel where the stain glass windows all have a maritime theme. We then hopped in the car and set our course for the Predjama castle. This castle was originally built in the 12th century and was constructed directly on top of an elaborate cave system. The building literally merges with the face of a cliff which contains the numerous hidden passages. I don't know if Tolkein ever visited Predjama, but it is inconceivable to me that its legend didn't in some way shape his creation of Helm's Deep. Historically, the castle's most famous inhabitant was Erasmus the loyal follower of Hungarian king Matthias Corviscus, who rebelled against the Austrian Emperor Frederick III. Erasmus withstood a year and a day of attacks against the castele walls before being betrayed by one of his servants, who tipped off the imperial troops by shining a light on the target for the catapults--the room where Erasmus was taking a squat. We returned to Ljubljana after finishing our tour of the castle, only to find that our reservations in the hostel (famous as the sight of a former prison where each room is a cell previously inhabited by an inmate) had been screwed up by the tourism office. Fortunately, there was a 3 bed private room available in a hostel down the street, so we dropped off our things there before setting out to explore the city. We were not disappointed. We climbed to the top of a hill that overlooks the city and wandered around the castle that was built there. After taking some pictures of the sun setting behind the mountains that surrounded the city lights, we climbed back down to the village below, where we had dinner at a Greek restaurant. The city was booming with acivity, with street performers and outdoor seating from the many restaurants that were packed full. It was impossible to confuse this Eastern European flavor with any city I had ever visited before. Eventually, we returned to the hostel to catch a few hours sleep before catching an early morning train back to Budapest.

Venice

(6-27-06)

We arrived in Venice and spent the better part of an hour flailing around with a new currency, a new language, and a new city that mapquest has yet to discover. We eventually found the campground where we dropped off our packs, refilled our water bottles, and embarked on our tour of Venice. We rode the water shuttle along the grand canal before getting off at the Basillica of San Marco. After viewing the beautiful interior (also famous as the number 1 tourist trap in Italy) we got back on the water taxi and had dinner near the beaches of Lido, one of the adjacent islands. Our waiter seemed very distracted throughout the meal, as did the entire restaurant staff. Eventually Italy scored a goal on Australia, everyone breathed a sigh of relief, and we got to eat our dinner amidst the symphony of car horns, fireworks, and screaming Itallians. We returned to the square of St. Marcos, where we took the elevator to the top of the tower just in time to catch the sunset. From the top of the tower we could hear 4 seperate orchestras warming up around the square, so we went back down and grabbed a table next to the one playing Con te partiro. After putting down a couple of espressos, we returned to the campground where we found college students from all over the world participating in one huge drunken orgie. We decided to forgo this opportunity to live like a European, and although I'm sure Rick Steves would have been disappointed, the images from studying Sodom and Gomorrah in BSF this past year were a little difficult to erase.

Midnight Train

(6-26-06)

We arrived at the station just in time to board the train leaving for Venice. We were initially assigned to a couchette with 2 other travelers. The first was an American named William. William was from California, but had spent the last year in Alaska after graduating from Harvard (class of '05). He was on his way to meet up with some friends in Rome before heading back to the US, where he was planning a move to DC. Prior to returning, however, he had plans to visit Pamplona for the running of the bulls. Our other bunk-mate was a little Itallian guy named Charles who had been vacationing in Budapest and was on his way back to Milan. As you might expect, it wasn't long before the four of us (at least three of whom had seen "The Sting") decided that it wouldn't be a night train ride if we didn't break out a deck of cards. Charles only understood about 5 words of English, so it took several hands before we were successful in explaining to him that the Queen of spades (or peakes if you will) was worth 13 points. Several hands after that we were successful in communicating to him that points are bad in Hearts. Our game was briefly interrupted by the wind blowing away our discard pile, but Charles was kind enough to donate his 3 gram miniature stick of Old Spice deoderant (fresh from being applied all over his body) to the job, serving as a paper weight.

Before long, everyone was getting pretty sleepy, so Sam and I said arrivederce and snuck into an empty couchette, where we pulled the bunks down and watched the sun set over Hungary's hills and lakes with the wind blowing in our faces. I fell asleep relatively quickly, only to be waken up every couple of hours as we crossed the borders of Croatia and Slovenia on our way to Italy.

Budapest

(6-27-06)


We checked out from the hostel early, grabbed a quick breakfast, and hopped on a bus for St. Stephen's Cathedral (Szent Istvan). This was the largest basillica in Hungary, named for the first Hungarian king to be baptized. He subsequently converted the rest of the country to Christianity "by hook or by crook" before his death. Legend has it that his hand is still preserved in the cathedral in a hyperbaric chamber similar to the one worn by David Decovney in the movie "Zoolander." Unfortunately, public viewing of the hand didn't open until 1330, so we had to forgo witnessing this miracle of taxidermy in order to move on with our tour of the city. We climbed to the top of the Basillica's tower, where we were able to see an excellent view of the entire city. From the tower it was easy to appreciate how the Cathedral had been built in the city's highest point, constructed after a flood wiped out the rest of the city in the mid 1800s, prompting its residents to pray for God to spare them and promising to erect the cathedral if their prayers were answered. We then visited the "liberation" monument, climbing to the top of a hill where the citadel was located across the Danube. The citadel was built in 1849 by the Austrians after defeating the Hungarian rebellion. The freedom statue was built after the communist takeover in the 20th century, during which time the Russian artillery shelled the city for several days from the citadel.

Having the opportunity to visit these sites with Sam (who had previously lived in Budapest for 6 months) was a tremendous enrichment to my experience, even if he did disagree with my claim that the word "Budapest" actually stems from the German word for "a whale's vagina." We had a quick lunch and then visited the Szecseny Furdo Turkish bath house, which was notable for a huge collection of pools which ranged in temperature from Big Trout Lake in April to McDonald's coffee. There were also a number of saunas and steam rooms, and on a cultural note, PDA seems to have been perfected in Hungary (if it wasn't invented here). We ate dinner on Andressi St. where I inhaled a bowl of Hungarian goulash before racing to the train station to catch the evening train to Venice.

The Hostel

(6-24-06)


I arrived late in Budapest and didn't make it over to the hostel until nearly 1 am. My worries about missing the curfew were quickly relieved when I walked in the door and realized that the party was just getting started at Hostel Marco Polo. There were dozens of sketchy looking travelers like myself from all over the world hanging out in the street outside. I checked in and headed up the elevator to the fourth floor where Sam was already unpacking in our room. The accommodations were actually quite good, apart from the fact that there was no air conditioning and it was as hot as an oven. Nevertheless, I can't imagine paying a Forent more to stay in any hotel in the city, since this one was equipped with a private bathroom! Despite the traveling and late arrival, I found that I was so amped to be on the continent that there was no way I was going to be able to sleep. Therefore, Sam and I set out for the city, where a nearby Pagan Summer Solstice festival was attracting a crowd of young people to the Magyar Nemzeti art museum. Out in the courtyard of the museum, people were gathered around watching some performers juggle fire. I looked at Sam and said, "I can't believe we're in Europe watching some dudes throwing around fire at a pagan festival." It was unbelievable. After getting our fill of the gymnastics and fire-eating performers, we grabbed some ice cream at the local coffee shop and headed back to the hostel.

The Terminal

(6-24-06)

I'm just killing some time in Heathrow waiting for my fligt to leave for Budapest, so I thought I'd take a minute to update my traVel log. Every adventure has to have a few unexpected twists in order to be interesting, and in my case this came in the form of both my laptop and my compass watch losing battery power before I left the airport in Minneapolis. As a result, the next several days became quite a challenge without internet access or navigational capabilities, not to mention having to figure out what time of day it was with my jet-lagged body only confusing the issue. Fortunately, the department of surgery had done an outstanding job making preparations for my arrival. After reassuring the customs agent that I was cool to enter the country for six months and occasionally cut open human beings in England, I met up with Steven (my driver) and headed for Oxford. I was delighted to see signs for "Slough" as we made our way toward M40, but was told that I was going to have to make it a seperate trip if I was going to meet up with David Brent and Gareth Keenan. I was surprised upon arriving at the flat at how small a 2 bedroom apartment can be.

At first finding my way around the city was quite a challenge. It took me 5 attempts at entering my car from the left side before I remembered that the steering wheel was on the opposite side. Although they have been few in number, my experiences with the roundabouts have involved 1 or 2 "look kids, Big Ben, Parliment" episodes.

I spent most of Thursday traveling to London in order to process my medical license at the GMC. After verifying that all of my paperwork was in order, I breathed a huge sigh of relief knowing that I could now spend the next week relaxing before starting work on July 3. Yesterday morning I made a visit to the JR to meet up with my teammates on the UGI service. Seems like a great group of people, and I look forward to getting started.

The Lake Home

Today is the day. In about 4 hours I will be getting on an airplane and leaving the country, not to return for over 6 months. In order to say goodbye to the USA and kick off my journey, I decided to spend the weekend in the place my mother once described as her favorite destination of everywhere she had traveled in the entire world: Crosslake, MN.

The weekend started out like a typical Griswold family vacation, with flights getting delayed due to bad weather and bags getting lost. We were finally able to sort through all the travel mishaps, however, and by 2 am I was pulling in to the cabin with my brother-in-law, Dave, and my friend, Coach. After getting a few hours sleep, I wandered up to the kitchen where the activity was already starting. Much to my surprise, I quickly learned that my sister, Laura, had somehow managed to ditch out on her family responsibilities and jury duties in Oakland to join us for the weekend! For someone who is not easily taken by surprise, it was a truly joyful moment. There are not very many opportunities when the entire Joyce clan gets the whole crew together, and although there was still a major void with the absence of Chubbs (my other brother-in-law), having Laura there was analogous to Clemens being back with the 'stros.

We spent most of Saturday morning putting in the dock, which went pretty quickly with all the help. In addition to my family and Coach, we also got to spend the weekend with Nick and his sister, Sara, as well as Anna (Daniel's friend). By the time evening rolled around, the weather had cleared up and the water was absolutely perfect for waterskiing. After taking a few runs, we secured on the barefoot boom and took turns working off the short rope. By the time we finished, it had been pitch dark outside for at least an hour. The next morning we went to Drive-in church, where amazingly they were having the yearly tradition of "bless the animals" day. After securing Stan's salvation, we went home and played some hoops, hit the mini-golf course (an annual Joyce tradition in which the loser is required to purchase a douche), and went back to the lake house for a steak dinner. Monday provided another evening of picture-perfect conditions on the lake. Unfortunately it was a day of failures as well: the Joyce kids were unsuccessful in getting up behind the boat (all 5 at once) after yours truly suffered a debilitating Charlie Horse (KNIGHTS OF COLUMBUS THAT HURTS!!!). I also missed after 3 attempts at doing a deep water barefoot start. Rubbing salt in my wounds, Daniel nailed his on the first try.

By Tuesday morning, we were back in the Twin Cities and I was making preparations to leave the country. Stay tuned for the journey abroad...

The Match

Ladies and gentlemen, can I please have your attention. I've just been handed an urgent and horrifying news story. I need all of you, to stop what you're doing and listen. Tomorrow at 12:00 p.m., fourth year surgical residents all across the world will be opening an envelope that contains inside the location of where they will be spending the next 2-3 years of their lives. That’s right, it’s Match Day 2006 for Thoracic Surgeons!!! So it breaks down like this: 35 states. 88 programs. 150+ fellowship positions. 42 applicants. 27 of them speak English. You do the math. In the words of my Division Chief: “It’s a buyer’s market!”

So that leaves me with 365 days and counting to narrow this list down to 1 program and make a decision about where I will take my stand during the crucible of fellowship training. Fortunately, most of the programs can be quickly eliminated based on geography and lack of volume. After making some quick modifications to my excel-based decision calculator, we are left with the following options:

1. Los Angeles. UCLA Medical Center
2. Palo Alto. Stanford University
3. Denver. University of Colorado
4. Atlanta. Emory University
5. Ann Arbor. University of Michigan
6. Minneapolis. University of Minnesota
7. Rochester. The Mayo Clinic
8. St. Louis. Washington University
9. Durham. Duke University
10. New York. Columbia University
11. Cleveland. The Cleveland Clinic
12. Nashville. Vanderbilt University
13. Houston. The Texas Heart Institute
14. Houston. Baylor College of Medicine
15. Salt Lake City. University of Utah
16. Charlottesville. University of Virginia
17. Seattle. University of Washington

It may seem like this should be an easy thing to figure out, but let me tell you something: it’s not. The American Board of Thoracic Surgery doesn’t give you the opportunity to ease into getting to know these programs by asking a series of random questions, followed by a list of “must haves” and “must not haves” the way eHarmony does (I mean, that’s what people have told me). You have to just show up at the interview and figure out if you’re ready to commit to them or not.

The clock is ticking…

The Little Differences

This summer I will participate in a tradition of Hopkins surgeons that dates all the way back to William Halsted by traveling to Europe for completion of a portion of my training. Starting on July 1, I will spend six months operating at the John Radcliffe Hospital in Oxford, England. I plan to spend the first three months working on the Upper Gastrointestinal (UGI) service with Professor Jonathan L. Meakins, Chairman of the Nuffield Department of Surgery, followed by three months of vascular surgery. From the stories told by many of my predecessors, life in the UK is radically different from what I’ve grown accustomed to over the past 3 years of general surgery training:

• OUT: struggling to defy the federally mandated 80-hour workweek without compromising your program’s accreditation. IN: complaining about how much harder it is working almost 40 hours/week compared to the French system.
• OUT: spending every third night draining pus from nearly every conceivable anatomic location. IN: operating independently during once-a-week call without having to carry a trauma pager.
• OUT: Unlimited laboratory and radiologic resources for the efficient diagnosis of routine pathology regardless of cost. IN: England’s National Health System.
• OUT: Friday night outdoor movies in Little Italy. IN: Spending the weekend in Venice, Italy.
• OUT: ABC’s. IN: BBC.

I guess I’d be a liar if I said I weren’t a little nervous about the changes that lie ahead. It will be a lot to adjust to, and in a way I can kind of understand why some residents elect to stay home. But all it takes is one whiff of the characteristic stench of the Johns Hopkins Department of Emergency Medicine, and I am quickly reminded of the immortal words of Samuel L. Jackson (minus the expletives): “I’m goin’, that’s all there is to it. I’m ….. goin’.”