It’s 5 a.m. and I’m actually at work, where I am allowed to sleep. Unfortunately, I’m all keyed-up and can’t seem to sit still. Hurry up and wait, indeed.

I got to thinking about how my life has been organized in four year blocks, running on an academic schedule from (roughly) July-June. Technically, the academic year has one more week left in it (at least where I’m at) and then I’m off to the final year of my residency.

Holy mother of God.

I remember starting this particular journey in this particular hospital, doing night-float, which essentially means the guy who puts out fires. Not literally (usually) But you’re the go -to guy when something untoward and unexpected happens to a patient that you pretty much really don’t know, except for the one paragraph blurb that your fellow intern wrote for you before he/she went home.

I described it—and would still describe it—as incredible amounts of boredom interspersed with moments of panicked terror.

Called it ennui. Called it being jaded. The pathologies I’m up against haven’t at all changed, and my armamentarium of solutions is not really all that much more impressive. To quote the Fat Man yet again, the optimum delivery of medical care is to do as much nothing as possible, which is really just an obtuse but funny way of putting Hippocrates’ injunction to do no harm.

And yet the terror is replaced a lot of times by annoyance. Impatience. (Mostly with the emergency department and the nurses, respectively. Uneasy allies even in the best of times.)

I used to sweat bullets when someone started to literally die, even when it was expected. I suppose now, I can see impending death from a mile away. I can find it just by looking at the emergency room board and the one liner next to the patient’s name.

You see enough of anything, maybe it’s just human nature to get used to it.

Sad and disturbing, perhaps.

But if I could choose which way I would die, or if I could choose which organ system would fail first, I certainly wouldn’t choose the liver. End-stage liver disease is perhaps one of the most excruciating, long, and dragged out way to go. (Metastatic cancer, particularly of the gastrointestinal tract, is perhaps a close second.) While heart failure or respiratory failure, or—God help you—brain failure (read, massive incapacitating stroke) is no walk in the park, either, these things tend to make you dead in seconds. There’s no long and drawn out suffering and agony. There’s no ambivalence as to whether or not they should keep trying to perform heroic measures. One moment you’re alive, the next moment you’re dead, end-of-story, and everyone leaves at least with some sort of definitive closure. Oh sure, you can leave anyone on a ventilator for a long period of time, but the soul is gone, man. Evacuated. An empty shell that only has primitive reflexes and can’t feel a damned thing. Eventually, even it, too, falls apart, no matter what you do. But you’re de facto if perhaps not de jure dead. Call it quits, man. Pull the plug.

The sad, sad, very sad thing about end-stage liver disease is much of it is preventable. If you outlawed alcohol the way we outlawed heroin and crack, I guarantee that the incidence of end-stage liver disease would drop. I mean, you’ve really got to drink to kill your liver. The liver is one tough mother, man. It’s the proletariat of the human body, doing all the dirty jobs that no one else wants to do. You can even hack half of it off and it’ll grow back, I shit you not. So when you kill it, you’ve really killed it. It takes effort to destroy your liver. You’ve got to actively pursue it. You’ve got to dedicate time to it.

So, yeah, I’m sure there would be lots of hard-core alcoholics who would find some way to get their fix even if alcohol were outlawed, but still.

My particular solution would be to outlaw alcohol and legalize marijuana. Oh, sure, you can still die of lung cancer or emphysema, and while they can be slow, drawn out ways to die, too, it’s still not as horribly awful as the experience of the liver bomb. Yes, I would rather have lung cancer than cirrhosis. Simple as that.

The other thing is, when’s the last you heard of a pothead getting involved in a high-speed crash and obliterating an entire family of four? (And don’t tell me it’s because marijuana is not as common as alcohol. That may be so, but it sure is pretty damn common.) Most potheads I’ve met would (1) not be able to find their keys (2) not be able to find their car (3) be too lazy to make the effort to find them anyway and (4) even if somehow they made their way behind the wheel of their car, chances are they would either fall asleep before even turning on the ignition, or they would creep home at 5 mph in neutral, wondering why they’re stepping on the accelerator all the way to the floor, and not going any faster.

The lesser of two evils, I say.

I’m convinced that the beer companies have conspired to keep marijuana illegal, because they know that people would easily switch to a less toxic drug.

On a related note, I think we should endeavor to make heroin much cheaper than methamphetamines. As anyone who’s in the know knows, methamphetamines are classically the drug of choice of poor white trash. If there were ever a drug that could be considered less classy than crack, this would be it.

I’ve seen people do horrible things to themselves and to other people while hopped up on crystal meth—blowing an aneurysm, having a heart attack, having a massive stroke, or going aggro and shooting up a neighborhood, or hacking up their girlfriend into tiny pieces with a chainsaw. Heroin users are way more mellow people. About the worst thing that can happen is that they stop breathing, which, while bad, is theoretically reversible. (Of all the drugs of abuse, the one we can reverse quickly and life-savingly is in fact heroin.) If heroin were dirt cheap (and not that black-tar shit, seriously—I’ve actually seen quite a few people get botulism from that crap) I bet you that people would gravitate to it in a heartbeat.

And we would get to practice a lot more intubations.

But I digress.

Somehow I always wander far afield from the topic at hand. Suffice it to say, I’m tired, but I can’t go to sleep, and I can almost guarantee that as soon as I go to sleep, my pager will go off.

Damn it.