The “Kobayashi Maru” is a training simulation from “Star Trek.”

Starfleet Academy cadets are tasked with the rescue of a spaceship named the Kobayashi Maru, that has been stranded in enemy territory.

The simulation, as it is designed, is un-winnable. 1/
Every possible attempt to rescue the vessel results in defeat, and the deaths of everyone on board.

The purpose of the Kobayashi Maru training exercise is to see how cadets act in the face of a no-win scenario.

The nature of their decisions when facing failure, and death. 2/
At its core, it is a test of character.

The purpose is not to “win,” but to act with grace and courage in the face of adversity.

To face the insurmountable and look it in the eye.

Today has been the Kobayashi Maru.

Yesterday was hope.

But today has been the Kobayashi Maru.
(To add some needed context, I’m on call this weekend. It’s been rough.

In the Star Trek world, cadet James T. Kirk was able to “win” the Kobayashi Maru exercise by essentially cheating.

In the real world, we can only cheat death so many times.)

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More from @TheRealDoctorT

21 Dec
Break-up lines by specialty:

ID: Sorry, our relationship is showing no growth to date.

Pulm: I feel like we need to breathe. We’re too restrictive.

Cards: This relationship is one giant stress test, and we’re failing it.

Endo: All we are is negative feedback loops. 1/
Peds: We don’t love each other anymore. BUT check out this awesome bandaid I’m gonna put on you, AND... you get a sticker!

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Ortho: ... bye, whatever.

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Neurosurgery: Wait, I’m supposed to say something? I don’t owe you anything! I AM THE RELATIONSHIP.

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17 Dec
Was paid a visit today, by a great horned owl.

It perches on a low-lying branch, and watches me with eyes so golden they seem like twin suns.

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Effortless. 1/
The gold of its eyes.

The yellow of his eyes.

I’m an intern, it’s the early 2000s, and I’m on a gastroenterology rotation.

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It’s a painful lesson I will learn again and again as the years pass.

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How sweet the mirage. 3/
Read 13 tweets
3 Dec
Every day I see the same cook in the hospital cafeteria.

I say hello, and ask him the same question.

“How’s it going?”

He always smiles and shrugs, “Eh, not bad for a Monday.”

Except he says “not bad for a Monday” every day of the week.

Finally I ask him about it. 1/
“Look doc, any day you gotta wake up early and go work, heck, that’s a Monday in my book.”

“So, a work week is five Mondays?”

“Yeah!” He laughs.

Another cook stands beside him. She shakes her head, “Don’t listen to him, doc.”

I offer her a grin, as she continues. 2/
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I nod, and smile. 3/
Read 11 tweets
24 Nov
(Shared with permission.)

As we finish up the visit, I wonder again.

What’s in the backpack?

The patient sits before me. A large man of few words, head shaved, muscles rippling, tattoos.

I finally ask.

“So... what’s in the backpack?”

He smiles, and reveals his secret. 1/
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It’s about... well, you decide.

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Unbidden, a song pops into my mind.

“It’s the time, of the season...”

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What does it have to do with anything? Nothing. But now it’s stuck in my head.

All us zombies. 3/
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13 Nov
There is something strangely hypnotic about the dialyzer, the way the blood pump keeps turning in its infinite loop.

Then again, when you’re tired enough, anything can seem mesmerizing.

It’s 2008, and I’m in the midst of my nephrology fellowship.

It’s been a long road. 1/
Being on call as a fellow usually means staying late, especially when the hospital is busy (i.e. always).

It’s a cold November night.

I’m sitting at a workstation desk in the inpatient dialysis unit, my gaze glued to the dialyzer across from me, zoning out.

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Her accent is soft, but still enough to be distinct.

It makes me think of places far away from here.

A warmer, more forgiving sun.

I smile, “Yeah, I’m awake.” 3/
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