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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, October 31, 2002
    R.I.P. Peggy Moran

    Don't know who Peggy Moran was? Well, neither did I:

    CAMARILLO (AP) 10.31.02, 8:15a - - Peggy Moran, who made more than 30 horror and Western films in the 1930s and 1940s and was once dubbed one of Hollywood's top "shrieking violets," has died. She was 84.

    Among Moran's handful of horror movies were "The Mummy's Hand," "Horror Island" and "Ninotchka," starring Greta Garbo.

    While under a six-month contract to Warner Bros. and three years with Universal, Moran made dozens of "B" films that were made every two or three weeks.

    The thing I like most about this obituary is that it lists "Ninotchka" as a horror movie! Which it is not (it's a comedy), unless you find Greta Garbo scary.

    When you live in Southern California, you see these stories a lot. Somehow it underscores how much a part of daily life here the film industry is; an old-time "working class" B-movie actor who never became well known and may not have made a film in decades will still merit a respectful mention at his or her passing. I like that this community respects the profession and cares about the people in it enough to do this, no matter what their ranking. And, of course, I like the sense of history that goes along with it. The old "contract system," which obligated actors to sign with a single studio and to commit to a certain number of films over the life of the contract, no longer exists in Hollywood. Imagine cranking out a film every two to three weeks for five years straight.

    Check out this clock, it's great. (Via Instapundit.)

    Wednesday, October 30, 2002
    I Think They Should Ask San Francisco

    The town of Biggs, California, which has no dairy industry whatsoever, is considering changing its name to Got Milk? at the invitation of the California Milk Processors Board. This organization is trying to find a town willing to make this change to mark the tenth anniversary of their advertising campaign, which of course features that phrase. The town wouldn't get any monetary benefit from doing so:

    "First and foremost the benefit would be in the publicity and notoriety in changing the name to Got Milk? We are not cutting a check," [the Board's executive director] Manning said, although he added that the milk processing board would be open to helping Biggs establish a "Got Milk?" Museum or to do something for the town's children.

    The mayor of Biggs, Sharleta Callaway, must have been short on sleep the day she decided to take the Dairy Board up on their offer, or hung over, or something. Then again, she may want to emulate the town of Truth or Consequences, New Mexico, formerly known as Hot Springs, NM, which changed its name to match that of the old quiz show.

    Tuesday, October 29, 2002
    Some Good News

    Disaster averted, if only temporarily:

    Los Angeles County Supervisors have decided to delay a vote on closing two more medical centers, although the health care system remains in grave fiscal shape. KFWB's Steve Kindred reports there are signs of hope for the ailing health system and other solutions to the crisis may emerge in the three weeks before the next vote. A property tax hike goes before voters on Nov. 5, and federal involvement or a special legislative session dealing specifically with the issue are still a possibility.
    The board has already shut down nine of the county's 18 health clinics to trim the budget. The budget deficit is due largely to a phase-out of federal funding. Officials had planned to vote Tuesday on closing Harbor-UCLA and Olive View-UCLA, the largest trauma center in the San Fernando Valley. However, there was mounting political pressure to hold off on further cuts.

    Lawmakers say they are holding out hope for the passage of Measure B on the Nov. 5 ballot. Board Chairman Zev Yaroslavsky believes voters will approve the measure, which would increase property taxes by $168 million to provide funds for trauma care. Also, the president's envoy on health care will have visited Harbor-UCLA on a fact-finding mission by the time the board takes up the issue again on Nov. 19.

    Well, we'll see. If Olive View and UCLA-Harbor are shut down, we'll be in deep trouble - and that means anybody who's in a automobile accident, who gets shot or knifed, who falls off the roof while doing home repairs, or who has any other sort of bad luck. Other information relating to the proposed health care system cuts is here in the L.A. Times (use password and keyword "laexaminer" if you can't access it) and an article explaining the problems the trauma system, in particular, faces is here. It's amazing to me that there has been relatively little attention paid to this issue, but if B does not pass it will probably get a lot more - after the county winds up in crisis. Cross your fingers.

    My friend Anna has a blog which is her journal about preparing for the Vancouver marathon next year. If you go here you will see my pledge (she is raising money for charities) - which is $2 per pound that I lose between now and the race. This should provide me with a little impetus to get back on the health wagon. The more public I go with this, the more I am committed to it.

    Monday, October 28, 2002
    NaNoWriMo, Here I Go

    November is National Novel Writing Month. Really. The NaNoWriMo.org website runs an annual novel-writing competition encouraging people to produce a novel in one month. The rules are that you have from midnight on November 1st to midnight November 30 to write a 50,000 word novel. You are not judged on quality, just quantity. The idea is that the pressure of a deadline will loosen people up enough to just sit down and write and not worry about whether their output is any good or not; if you like what you've done you can always go back and polish it up later.

    I registered today. I am sure I have 50,000 crappy words in me somewhere... I have no idea what I'm going to write about yet, but I figure it doesn't hurt to try. I will keep you updated.

    ADDENDUM: As I was on the phone with a patient last night, I was absentmindedly doing the math and figured I would have to write an average of 167 words per day to finish by month's end. No problem, I thought, I can do that. As I was driving home later, I realized I had skipped a decimal place and that I'll need 1670 words per day to complete 50,000 words in a month. I almost lost control of the car ("NO WAY!!") I'll give it a try anyway.

    Sunday, October 27, 2002
    Stamp Act

    A few months back, around the time that the cost of a first-class postage stamp went up to 37 cents, I was cleaning out my desk drawers and found a collection of old, unused stamps now well out of date. Being in an organized mood that day, I made a list and took it down to the post office so that I could buy enough supplementary postage to actually USE these stamps. After doing a little research I realized that some of these stamps had been hanging around well past their sell-by date. To wit:

    1. One G stamp, dating back to 1995 (!) and worth 32 cents. (For those of you not familiar with US postage, the Postal Service inaugurated a series of stamps with letters instead of monetary value which were used when postal rates were changed. In this way, the stamps could be designed and printed early in the process, often before the Post Office knew what the new rate was going to be.)

    This site has some interesting info about the lettered stamps, including their dates of issue. After dithering around for awhile, the postal service finally decided to match the picture on the stamp to the letter - in other words, the E stamp showed Earth, the F stamp a Flower, the G stamp Old Glory and so on. Unfortunately they stopped this system after the H stamp. Too bad we'll never get to see a Yak or a Zebra on our stamps.

    2. Some leftover Chinese New Year stamps from the Year of the Rabbit (1999), bought by me because I was born in that year (1963, if you must know). These were worth 33 cents. I love the Asian zodiac system, possibly because the Rabbit is described as being "the luckiest of all 12 signs."

    Apparently many countries got into the idea of issuing Chinese New Year stamps; here is a page of the many Year of the Rabbit stamps that were issued. Some of them are really beautiful. I love the different graphic design approaches.

    3. A 32-cent stamp from the "Celebrate the Century" series - the Monopoly stamp from the 1930's stamp series. This stamp series was a great idea. To celebrate the end of the century, the Postal Service asked people to vote on the standout people/achievements/books/movies/ideas/etc. of each decade. The 1930's stamps included Superman, the Golden Gate bridge, the WPA, Snow White and many more. These stamps came out in, I think, 1998 and were promptly rendered useless by a rate increase at the beginning of 1999 (that would be the H stamp). Way to go, guys!

    I got a lovely glow thinking of all the money I was saving by using up my old stamps. I had quite a few left over, so this exercise turned out to be worth while financially, not to mention the esoteric stamp knowledge I've picked up by surfing around the Web to research these things. The moral is, go through your desk drawers early and often... you never know what you will find or where it will lead you. (Nowhere much, in this case, but at least it gave me something to post about.)

    Oh, hallelujah. The Angels just won the World Series. Or to put it another way: we beat the Giants. Ha!!

    Thursday, October 24, 2002
    Constant Reader

    This week I found an article in the Tech section of the Wall Street Journal that I just had to share. Titled �Constant Reader,� it profiles a woman named Rebecca Johnson who has become one of the best-known book critics for Amazon.com. She reads, it appears, a dozen books a week, has written more than 1200 reviews for Amazon all told, and is the third most highly rated reviewer by Amazon users. She is not paid for doing this.

    I quote:

    The 35-year-old, who writes and reads from her home near Issaquah, Wash., doesn�t have a full-time paying job but occasionally makes some money doing Web research. Ms. Johnson estimates she spends three for four hours a day writing reviews. She�s been known to take a break from reviewing for a couple of weeks, but Ms. Johnson says she finds it hard to stop reading.

    Damn. Does this woman have an independent income? How the hell does she manage to exist doing nothing but read all day? And, most important, why can�t I have this job?

    Alas, there is a dark side to Amazon heaven. As per the Journal:

    Being a successful Amazon reviewer brings a kind of fame of its own � and the problems that come with such recognition. Ms. Johnson says reviewers will occasionally go on negative vote campaigns against their rivals to try and knock them down in the popularity rankings (she recalls one instance when her reviews received 10 negative votes in a single day). An Amazon spokesman says the company has systems for identifying customer �abuse of reviews.�

    I guess we all have our crosses to bear. Who knew that reviewing for Amazon could be such a rat race? Not to mention the fact that, if these Amazon flunkies feel impelled to go out and malign their fellow reviewers in order to move up on the ratings totem pole and validate their existences, in a job they're not getting paid for and that no one asked them to do, they�ve really got problems.

    To prove that this is a blog, I will link to Ms. Johnson's reviewer's page on Amazon here. Enjoy.

    ADDENDUM: Ms. Johnson's reviewer page at Amazon states that she is married and that she has a lot of time to read "because my husband plays golf a lot." Well, I suppose this IS a healthier outlet than getting it on with the pool guy...
    ...still, the pool guy might be more fun.

    Monday, October 21, 2002
    More from Malawi

    *Whew* Thank goodness. Something on-topic I can pinch from someone else (Thanks Chuen-Yen!)

    If you think AIDS is a problem here, you're right. But it seems it's even more of a problem where my friend Chuen-Yen is. I had no idea that the disease was still being denied so powerfully by the culture there, and even by the local hospitals, who ought to know better:

    Mwadzuka Bwange. (Good Afternoon)

    Thanks for the messages. Hope you will visit.

    It has been another amusing week of adjustment to Malawian perspectives.

    One of the most sensitive, as well as common, issues is the taboo topic of HIV. At least 15% of the Malawi is infected, people are constantly bombarded with awareness programs, and everyone pleads ignorance when the topic arises. So, when I proposed doing an anonymous survey about HIV testing, the native general practioners told me that I was delusional if I thought I would get answers. The basic message was that people don't want to hear about HIV and will circumvent the topic if it arises. The project would undoubtedly cost our hospital coveted business.

    Within a day of this meeting, my clinic was flooded with HIV patients referred by physicians who had deemed me so insensitive to the very issue. I even had patients referred because their anonymous (that's the euphemism docs use when they don't tell the patient the test is being run) HIV tests came back positive. Though clearly out of touch, I am now the chosen one for management of this delicate topic.

    As THE HIV DOCTOR, I took the liberty of writing "HIV" as the diagnosis on a chart after extensive discussion with an agreeable patient. Subsequently, the business manager of our capitalist mission hospital curtly informed me that I was not to use the terms "HIV" or "AIDS" on any documentation; patients were upset.

    A few days after I had upset other physicians with my proposed project, then become the person to talk with about HIV, then offended patients with my handling of the "immune problem" topic, I found myself on the phone with Television Malawi. The station had sent a letter to our hospital requesting an interview with a medical professional. Certainly, I, the new American Internist, would provide good publicity for the hospital. In discussing the interview logistics with Television Malawi's "Your Health" program coordinator, I revealed my background and that I would be in Malawi for a year. The coordinator ascertained that I could be available one afternoon every week, lamented that the previous "Your Health" host had recently left the country, then genlty eased me into the position of the new "Your Health" host. Starting sometime in November, I will have a weekly half-hour show on TV Malawi. Perhaps you can get it on satellite if it really happens.

    Who knows how the HIV epidemic will play out in Malawi? But, an anonymous survey on the topic will be handed out to all the Blantyre Adventist Hospital patients for now. And, Malawi and its neighbors may get to deny hearing anything about HIV on "Your Health."

    Good-bye for now,

    Uhhh. So tired. I had a busy weekend (well at least Sunday was busy), so will recap.

    Got up, did AIDS Walk. This is my third year doing the walk and I do enjoy it, but I've been a little lazy with collecting pledges. Fortunately I still have a few weeks to collect my checks and send them in so I can get that T shirt that I covet. It's not about helping society, people, it's about the prizes.

    Get home, shower, change, go to nursing home to see my new 96 year old guy that I picked up when I was on unassigned call recently (unassigned call is like Russian Roulette but less fun). He's not eating, so I had the "shall we give him a feeding tube?" talk with the guy's son. They're both really nice, and I enjoy taking care of this patient - he is a very cute little old guy with beautiful manners. Nevertheless it's never fun giving relatives this sort of news, and I'm not crazy about sticking a tube in his nose anyway because it automatically means he'll have to have his hands tied down. (Stick a tube in a confused person's nose and what's the first thing they'll do? Pull it out.)

    Then... off to Encino, where my friend Jim was giving an organ recital - he did a great job - then dinner at Jim's. He has just acquired a pair of Jack Russell terriers, which are very sweet, and a good time was had by all playing with the dogs. Lots of church and musician gossip ensued, as three of the five dinner attendees are church musicians. The best kinds of gossip, in my opinion, are church gossip and hospital gossip, especially church gossip where you get to dissect bad sermons!

    So that was my Sunday. Sorry for the brief shallow post, will try to do better next time. I do have lots to tell you, just haven't had time to post.

    Friday, October 18, 2002
    Forgive my whining. I just got off the phone with Airhead Patient. I had called to tell her that her lipid levels had increased significantly from the previous year and to review her diet.

    Me: "You need to watch your diet and cut back on your fat."
    Her: "Like what?"
    Me: "Like red meat, dairy..."
    Her: "Oh. Well, but I don't eat red meat and I don't drink milk."
    Me: (becoming exasperated) "OK. You need to cut back on olive oil. Mayonnaise. Cheese. Ice cream..."
    Her: "Oh, I have been eating a lot more ice cream. But it was all-natural ice cream."


    Me: "It doesn't matter. Fat is fat, it doesn't matter how organic it is."

    This is what I deal with every day, people.

    Quote of the Day:

    "Serial killers get sick, too."

    James Alan Fox, a professor at Northeastern University's College of Criminal Justice, said the one prediction that can be made about this killer is that he's unpredictable.

    That quote I highlighted sounds like something the HMO rep would tell me if the DC sniper showed up in my office and I tried to kick him out.

    Wednesday, October 16, 2002
    They'd Better Do Something Quick

    KFWB.com reports that Governor Davis is calling a special session of the California legislature in January 2003 to try to solve the health care crisis that the state is facing. Once federal waivers expire in 2005, the county health care system will be facing a $700 million budget shortfall. Potentially, the county's trauma system could have to shut down entirely.

    I'd like to suggest that you consider voting for Proposition B in November. Yes, it will raise taxes and I'm not thrilled about that. But as I posted here, I'm terrified of what might happen if the county health care system runs out of money. The strain on the emergency rooms of hospitals that continue operating will be overwhelming.

    I think the new doc in our office is going to fit in just fine. Yesterday I saw her walking down the hall with a little plastic canister of something that looked like aquarium gravel and turned out to be "Sweet Pebble Chocolate" that she got in Koreatown. Candy that looks like little stones. She beamed, held out the container and said, "My patient just passed these. And they're really tasty!"

    We also spent some time discussing the cuteness of the two orthopedic docs in our group and why orthopods in general tend to be so buff. Like I said, she'll fit right in. :)

    Great quote of the day, from Rebecca:

    "By definition, a wildlife biologist is somewhat of a freak. An introvert. A poor person, rarely employed. Willing to make woodchuck stew. And eat it."

    Dammit. Still can't get the email to work but I'll keep trying.

    Tuesday, October 15, 2002
    Heartbreaking stories coming out of the bombing in Bali. Like this one. Four bridesmaids dead. For more information, go to Instapundit or Tim Blair - especially Tim Blair. He'll link you to dozens of other sources.

    This summer while traveling in Turkey, I decided to visit Gallipoli. It was rather a spur of the moment decision and I didn't know all that much about its history, other than what I read in my guidebook. Most tourists who visit the battlefields spend the night in Canakkale prior to the tour, as I did. Relatively few Americans visit; most of the people in my group were from New Zealand or Australia. The hostels all show the film Gallipoli nightly; mine also showed an Australian television documentary about the war. As we sat watching the documentary, I suddenly realized that a middle-aged woman, sitting one or two rows ahead of me, either an Australian or a New Zealander, was weeping.

    Oh, my God, I thought. What have I gotten myself into?

    Next day came the tour. It was incredibly comprehensive and covered all the major battlefields. More than the details of the fighting, though, was the understanding I got that day of how important this battle was to the Australians and New Zealanders who fought there. (Also to the Turks, of course, I'm not trying to leave them out, but this post is really about Australia today. I'll talk more about Turkey some other time.) One older woman in my group, an Australian, was looking for her uncle who was buried there... we found him at the Lone Pine Memorial. I thought the people in my group were terrific - I had really never met many Australians or New Zealanders before. These people are fun, gregarious, they love to travel and they love to have a good time.

    Having fun is not a crime, dammit. That's why these people died. They were dancing, drinking, and their hair wasn't covered up and that made them criminals in the eyes of the radicals who killed them.

    I get the impression that Bali is sort of to Australia as Hawaii is to the mainland US in terms of its importance as a vacation and honeymoon destination. Imagine if someone had pulled this in Honolulu.

    Anyway. My thoughts and prayers are with the Australians today, and I hope yours are too.

    Monday, October 14, 2002
    How to Be Very, Very Popular

    Get put in charge of the monthly call schedule for your call group, like I just did. For extra credit, make sure this happens just before the holidays. That's the situation right now. I've never gotten so many faxes and e-mails in my life. Between this and the radioactive pineapple (see post below), the whole idea of holidays needs to be re-thought.

    I didn't volunteer for this, I was drafted.

    Sunday, October 13, 2002
    It Can't Possibly be That Time of Year Already!

    Yesterday, trying to get my shopping done for the week, I was wandering through the produce section in the grocery store. Toward the back I came across a bin full of plastic containers of preserved cherries, pineapple, orange peel and citron. The pineapple was a lurid red and green, as were the cherries. Bags of Brazil nuts and hazelnuts were stacked up next to this scary-looking display. Oh, no! I thought. Holiday baking?? Now? Already? Who in Southern California bakes with this stuff, who even eats this stuff? It's much too heavy for this climate. Not to mention the fact that when we can expect temperatures ranging into the 80's from now until Christmas, the whole idea of "aging" fruitcake becomes more of a penicillin farming project. I've never been fond of fruitcake, even the "good" ones without the astronomical levels of food coloring in the fruit. My grandmother made a white fruitcake that was universally supposed to be one of the better ones people had eaten, with white rum and white raisins; my aunt loved it. I couldn't stand it.

    What is citron, anyway? was my next thought on this subject. I've always really disliked citron. It doesn't seem to have any identity to it or any taste. It's like a jujube without the flavoring. Is it some sort of processed lemon peel? It merited investigation, so I did some research... thank goodness for Google.
    Here is the definition, off the Food Network website:

    Definition: [SIHT-ron] 1. This semitropical citrus fruit looks like a huge (6 to 9 inches long), yellow-green, lumpy lemon. Citron pulp is very sour and not suitable for eating raw. This fruit is grown instead for its extremely thick peel, which is candied and used in baking. Before candying, the peel is processed in brine and pressed to extract citron oil, used to flavor liqueurs and to scent cosmetics. Candied citron can be purchased fresh in specialty markets, or with preservatives (necessary for the expected long shelf life) in supermarkets. Either should be stored in the freezer for maximum freshness. Candied citron halves are sometimes available, but it will more likely be found chopped or in strips. 2. Citron (pronounced see-TRAWN) is also the French word for "lemon"; citron vert (VEHR) is "lime."

    Ever since reading this, I have carried in my mind the image of some deprived nineteenth-century ten-year-old kid gnawing on fruitcake. Hershey bars are as yet unknown. To this poor sod, candied citron is as good as it gets. ("Please, sir, may I have some more?") But this entry explained why citron has no flavor... it's all been sucked out with the citron oil. So when you next see those tasteless, transparent chunks in your fruitcake, should you be rash enough to eat any, you will understand that the function of citron is to say, "Yes, this is fruitcake. Here is your federally mandated candied something-or-other."

    Saturday, October 12, 2002
    Anybody who's the slightest bit interested in science should be checking out this blog. It's written by an Australian who seems to know his scientific onions, as it were. He is a former member of an environmentalist group, and broke with the Greens in disgust when he realized they weren't going to let mere science get in the way of their political agenda. The particular post I've referenced deals with the risks of everyday exposure to radiation as opposed to possible nuclear risks (specifically nuclear power).

    I am the radiologic supervisor for my office. I have a license to prove it. One earns this privilege - if privilege it is - by taking a state test, which I did about four years ago; I still remember the experience. The test was given in Norwalk or Carson - one of those nondescript towns in southern Los Angeles County, but the site was picked because that's where the county government seat is. I had to study for it; I was given a thick stack of information about radiation, X-rays, OSHA precautions, etc. The surprising thing I found in the course of preparing for the test was that living creatures are a lot more resistant to radiation than you might think, probably because we are all exposed to quite a bit of background radiation every day of our lives. It's just part of existing in the universe. In other words, all life had to evolve DNA that is resistant to radiation damage. Obviously if someone is exposed to a massive amount of radiation, or to amounts that are appreciably higher than normal over long periods of time, the body's defense mechanisms will not work. But the average amount of medically related radiation, or nuclear-power-plant radiation, or radiation in spent uranium fuel is much, much smaller than you would think.

    I just wish people would do the math and look at the science, instead of under- or overestimating the damage we (the U.S.) do to the environment. And the last I checked, third world countries are contributing a lot more to pollution than industrially advanced countries. We're not the ones burning down entire forests and using coal to heat cities.

    Just a thought.

    Thursday, October 10, 2002
    The Inscrutable Cable Mystery
    This morning at the gym I was flipping channels as I was doing my aerobic workout. I go to the sort of chichi place that has TV screens for people to watch as they're doing their thing, but that isn't the point of this post. I lit on a channel which turned out to be TCM (Turner Classic Movies), in the middle of a black-and-white murder mystery which looked to be from the 1930's. It seemed fairly run-of-the-mill, but I always enjoy looking at the cars, the furnishings and the clothes the actors wear in these things.

    So we're going along, and a suspect gets murdered, and suddenly one of the characters addresses a dapper-looking guy with a carnation in his buttonhole as "Mr. Wong." Mr. Wong had looked Caucasian to me up until that point, but I suddenly realized that this movie was a subspecialty of the 1930's mystery programmer: the Oriental detective! (The word "Asian" was unknown in those days, so forgive me. I'm not trying to be offensive, just accurate.)

    Now there were three main movie series which starred Oriental detectives which were produced during the 1930's and 1940's. All three had Caucasian stars playing the main characters. The first and best-known was the Charlie Chan series, from the books by Earl Derr Biggers. The next best-known was the Mr. Moto series, which was also drawn from a series of books written by John P. Marquand. (I've read some of the Mr. Moto books; they're not half bad.) Third came the Mr. Wong series. I don't believe Mr. Wong was a literary character at all - he was entirely derivative.

    Charlie Chan was played at various times by two actors named Sydney Toler and Warner Oland. Warner Oland cut his teeth playing Fu Manchu, so you can see that he was tailor-made (by 1930's standards) for the role. The Charlie Chan movies are quite fun, for the most part, and often involve "cutting-edge" crime solving technology - I remember seeing one which involved transferring a photographic image long distance by means of something that looked like a hand-cranked predecessor of the fax machine. They also starred Keye Luke as Number One Son. (Years ago I was watching an episode of Remington Steele with my family; when the guest star list flashed across the screen, I startled everyone by shouting, beside myself with excitement, "Keye Luke is in this!" Somebody asked, "Who's he?" "He was Number One Son in all those old Charlie Chan movies!" I replied. Sadly, no one else was moved by this information.)

    Mr. Moto, a globetrotting Japanese detective/spy, was played by Peter Lorre. Yes, that Peter Lorre. Mr. Moto was portrayed as a sympathetic character, probably unique for a Japanese character during the 1930's and 1940's. Interestingly enough, Mr. Moto spent at least part of his time helping the Allied cause. (What would the Emperor have said?) One of the Mr. Moto films started out as a Charlie Chan vehicle, but when the star (whoever it was at that point) dropped dead halfway through filming, rather than scrap the effort, they grabbed Peter Lorre, slapped some makeup on him, and popped him into it.

    So, who was Mr. Wong? At first I couldn't remember. After studying the film carefully and ransacking my memory (fortunately or unfortunately, I have a bottomless capacity for this sort of trivia), I was pretty sure I knew which actor had played the role. When I got home I looked the Mr. Wong films up in my movie guide and found I was right.

    Mr. Wong was played by Boris Karloff.

    Stop laughing. Karloff did a pretty fair job in the part and he had an absolutely fabulous, actorly, British voice, sort of like Alec Guinness. It's too bad he was stuck in all those nonspeaking horror roles. As I was listening to him speak I could hear faint echoes of "How the Grinch Stole Christmas." Would Karloff have thought that 65 years later, he'd be relegated to the early movie slot on some cable channel? Would he have cared?

    I suppose the hallmark of being a professional is that you do the best job that you can. In spite of the faint air of absurdity that hung over the whole production, despite the fact that "Mr. Wong" was about as Asian as Tim Allen, Boris Karloff did his job. He was great fun to watch, grounded the movie and held it together. I'm actually sorry that I missed the denoument of the mystery (although I'm pretty sure I know who did it). In fact, I'm going to go hunt up some more Karloff movies this weekend just for the pleasure of hearing Mr. Wong speak those polished phrases and watching him carefully hook his cane over his arm.

    If you're a fan of the Sopranos, or even if you don't watch the show, you might want to go here. This is a blog as written by Tony Soprano. I don't know who's doing this, but they seem to have the lingo down pat. I found it very entertaining.

    Wednesday, October 09, 2002
    Why Is the Verb "Nuke" Acceptable When Applied to Popcorn But Not When Applied to Apple Juice?

    From the Wall Street Journal:

    The FDA will allow U.S. food companies to petition it to avoid using the word "irradiation" on their labels. If approved, they could use language such as "cold pasteurization."

    Other options:
    "Deep Atomic Level Cleaning"
    "Sizzled for Your Protection"
    "Ain't No E. Coli in Here!"

    Contribute your own. Talk amongst yourselves...

    Grand Rounds

    For those of you who do not know, medicine has an academic side. All teaching hospitals, and some non-teaching hospitals, will have Grand Rounds in their specialties once a week or so. This ritual is suspended during the summer, but we are now well back into the academic year again. I get a weekly email about the grand rounds offerings coming up, most of which do not relate to my specialty, which is internal medicine. Let's have a look at what's offered this week:

    A Novel Way to Catch Up on Your Sleep
    Department of Medicine
    Division of Rheumatology
    Rheumatology Grand Rounds
    "A Novel Holistic Explanation for the Fibromyalgia Enigma: Dysautonomia"

    The Total Downer Lecture

    Guest Speaker

    Xxx Xxxxx, MD
    Director, Center for Biomedical Ethics

    Oooh, Trendy. But Relevant
    Department of Psychiatry
    "Post-Traumatic Stress Disorder: Post 9-11 Update and Review of Current Research and Treatment"

    Nothing Wrong with This Except That I've Heard It a Thousand Times
    Department of Medicine
    Division of Nephrology
    Combined Renal/Endocrinology
    Grand Rounds
    "Diabetes and Hypertension"

    Guaranteed to Cause Controversy!

    "Childbirth And Incontinence - Is the Cesarean Section Rate Too Low?"

    (In case you're wondering, the answer is probably yes. My father, who delivered a few babies in his time, has been heard to voice the opinion that all women should have C-sections. But he never says this in public. He knows he'd be pilloried.)

    I Have No Idea What This Has To Do With Anything
    Department of Pediatrics
    Pediatric Grand Rounds


    This Must Be One of Those Federally Mandated Topics

    "Physician Order Entry Systems
    in the
    Patient Safety Environment"

    And there you have it.

    What the Hell?

    Can anybody tell me why UK police should be wasting their time on this?

    LONDON (Reuters) - A Welsh police team dubbed "the Frying Squad" has been formed to sniff out motorists who fuel their cars with cooking oil from fish and chip shops in a bid to avoid paying high government fuel taxes.

    "I have halved my motoring costs since I started running my Subaru on cooking oil," the paper quoted one of those stopped as saying.

    "The car runs just as well and even smells a lot better than diesel."

    The drivers were fined 500 pounds ($780) and warned that persistent offenders may face up to seven years in jail.

    The government should be giving these guys medals, not fining them. They're probably producing fewer pollutants and they're certainly reducing Britain's dependence on foreign oil. Shouldn't the British government be taking this as a warning that people are sick of paying the sky-high taxes over there? But no... "They're tax evaders! Punish them!!" Idiots.

    Tuesday, October 08, 2002
    There must be a lot of Baptists in Tehran.

    Way Cool Diagnosis of the Week

    I'm chatting with my suitemate and she says, "You know that patient I had you look at with me last week?"

    "Yes." (She had a swelling on her neck that didn't look like a lymph node or a cyst and we couldn't figure out what it was.)

    "Well, it's scrofula." (That's a localized soft-tissue infection caused by tuberculosis.)

    "NO WAY! Samuel Johnson had that!" I was really quite thrilled to hear this.

    "Samuel Johnson? Was he a president?"

    "Uh, no. He was a writer, an eighteenth-century writer."

    "Oh. Well, I sent her to the ear-nose-and-throat guy, who gave her antibiotics and she still didn't get better, then she finally said, 'Oh, my mother had tuberculosis in her neck once.' So I gave her the skin test and it was really strongly positive. But her chest X-ray was completely clear!"

    "Yep, sometimes you see that." The patient in question is from India. One thing about LA, you never know when you might see some sort of unusual tropical disease since we've got so many people from so many places. It's one of the things I love about being here.

    "Well, Infectious Disease wants a biopsy so we're going to do that this week."

    "Let me know the results when you get them back."

    I'm glad she let me know about this patient - I've never seen a case of scrofula in my life. But I can't believe she didn't know who Samuel Johnson was.

    You could test this theory at any nursing home in town. (Sorry, I know that's in bad taste.)

    From wsj.com: (no link, you have to pay up for details)

    'SpongeBob' Attracts Gay Fans

    SpongeBob SquarePants is the biggest childrens' phenomenon to capture the imagination of gay men since the purple Teletubby named Tinky Winky started carrying a purse.

    Well, I know my dad likes it... say, wait a minute...

    Monday, October 07, 2002
    The Coders

    My medical group is quite large and is spread amongst several offices, including an administrative office over on Wilshire Boulevard which handles lots of the tedious billing and paperwork generated by my efforts, among others. My office is on Olympic - it's the original office dating back to the first years of the group before we started expanding. On one side of the hall is a series of four suites where the doctors work and patient care is handled; the other side is administrative and hasn't been really used for a coherent purpose since the original administration moved to a different building near Cedars. As a result there has been a positive circus of people moving in and out of that space. If memory serves, we have played host at various times to Member Services (handling phone calls from patients trying to register with the group or who were having various problems), then Central Scheduling (an abortive experiment designed to make things easier for the front desk/receptionist area), who were then evicted and the space given to the coders.

    The Coders. Sounds like a WWII back-room operation, doesn't it? Unfortunately it's not nearly that exciting. The coders have been rotated to Olympic in batches from the Wilshire office. Their job is to translate the doctors' information on the fee tickets into codes which will be accepted by the insurance plans for reimbursement. The full name of the coding system is the ICD-9 coding system, or International Classification of Diseases, 9th revision. It's universally accepted by insurance plans, disability payors, insurance companies, etc. etc. ICD-9 merits its own post, which will be coming soon, I assure you. But for the moment, let us stick with the coders.

    Why are they being rotated here from their Wilshire homeland? Nobody seems to know. Why not just move one batch of people in here and leave them, so that they could get used to the place? Again, no answer. Our current batch of coders is a grim, monastic bunch. They don't seem to want to talk to anyone here, unlike their immediate predecessors, who were quite friendly and cheerful and seemed to like being at Olympic. They were always up for a chat if I wandered through en route to the Olympic manager's office. This group doesn't want us tromping through and disturbing them - they want us to go further up the hall and double back so we won't distract them from their exacting (HA!) work. As you can imagine, I have made it my business to wander through at every opportunity after hearing that.

    This afternoon, having a chat with the office manager, I nodded toward the coders' domain and asked, "Who are those guys?"

    She shrugged. "I dunno."

    I then told her about an article I'd read in the New Yorker about a year ago, about somebody who'd wandered into a dot-com company and stuck around for two weeks, showing up every day and hanging out in a cubicle, just to see if he could get away with it. He did; no one questioned his presence.

    "For all we know, that could be happening here," I pointed out. She cracked up.

    Our coders continue to sit across the hall, dug in like ticks. I hope we get a more cheerful group soon. We could use some party animals around here.

    Sunday, October 06, 2002
    Alllrighty Then!

    The Angels beat the crap out of the Yankees! Go, Angels, Go!

    The Department of Health Services' recommendation to close 11 health centers in L.A. County was approved by the L.A. County Board of Supervisors on August 20. Apparently all 11 health centers were in need of critical maintenance and repairs estimated at $20 million, and 10 of the 11 were recommended for replacement or major remodel, estimated at $27.5 million. This move cuts almost $57 million from the budget of the DHS. This link will take you to the LA Public Health website, should you wish more information.

    This week I saw a patient I hadn't seen in more than four years. She had lost her insurance and was being seen at a clinic, which was one of those closed by the DHS at just the time she finally qualified for health insurance through a new job. She felt like she'd escaped by the skin of her teeth, and I agree. This move may save money in the short run, but the overload of deathly ill people to the County emergency rooms will happen soon enough. I hope we don't wind up with increasing cases of TB or other preventable diseases because of this decision... tetanus, anyone? I predict the rates of cervical cancer will be going up within two years.

    My friend Chuen-Yen finished her residency in June. She worked with me twice a week seeing patients as part of her training in outpatient medicine. Being a lover of travel and adventure (she went trekking in Nepal twice in the two years I worked with her), she volunteered to go to Malawi for a year to do volunteer medicine at a Seventh-Day Adventist missionary hospital. She has been sending us weekly e-mails which are simply amazing... such as this one...

    It has been an eventful week in Malawi. Although I treated several cases of Malaria, Schistosomiasis, Typhoid and assorted varieties of meningitis, the highlight was a weekend trip to Mulange.

    Mulange is a town (between village and city in size, prosperity and importance) 1.5 hours East of Blantyre by car and 4 hours East of Blantyre by bus. We were lucky enough to have a sub-compact car for 6 large, sweaty people, all our luggage and food for the weekend. Seatbelts are not an issue here. They don't really exist and overcrowding of vehicles is the norm. When we arrived in Mulange on Friday night, we had a quick (service in 1 hour) dinner at The Currypot, which serves only 3 different Malawan dishes, none of which has curry as an ingredient. Then we walked to a volunteer's house in the nearby village. The first stretch was along a dark highway, complete with speeding head-lightless cars and drunkards, while the last km took us on down a unlit dirt "road" with many treacherous rocks and ruts. Dust storms ensured that everything was red, including us by the time we reached the house.

    Because we had planned to hike, a torrential drought-terminating storm began with our arrival. 4 of us still opted to hike to Chambe plateau, which took 3 hours and 2500 meters of altitude gain. We had a porter / guide, selected from a mob of men screaming "pick me, pick me," to carry our pack. The
    pack contained 12 liters of water, 6 butter-cheese sandwiches, 2 jam sandwiches, chips and a loaf of bread. The gorgeous trail through dense vegetation and cloud forests culminated in a smouldering, black field of young pine trees (charcoal field). Apparently, charcoal is a major crop in Mulange. We had our sandwiches in the charcoal field. Back in the village, I slept under a mosquito net where I sustained 14 mosquito bites on my fingers b/c they were at the net's edge.

    We did many things that you should supposedly avoid in Africa. We drank the tap and river water when our filter failed. We also savored raw vegetables, including lettuce. We even had to hitch-hike back to a main highway when the evening motola (large flatbed truck on which you can ride for a small fee) failed to show. This is normal for the Mulange volunteers, who also do not take malaria prophylaxis b/c "It's easier to just take the medication when you get sick." Also, according to them, "the water in Blantyre is very safe."

    Blantyre is really luxurious. We have warm (not hot) and cold water. The water is reliable, i.e it doesn't stop running for a few weeks every so often. We have pavement. We have stores in buildings, as opposed to wooden stands where people ply their home-grown vegetables and carvings. Most homes have electricity. Some people have their own cars. People are overweight and wear shoes.

    I am now back to my on-call everyday schedule.
    Hope all is well over there.


    Saturday, October 05, 2002
    This is ridiculous. As far as I know, no attempt was made to rob the guy. This wasn't your typical mugging; it seems clear to me that it was a hate crime. I bet there will be some big changes in the WeHo Sheriff's dept. come the next election.

    As for me, I have done a whole lotta' nothing today. I made it through yesterday at work in one piece and that was enough for me. I'm just catching up on my rest and thinking about all the things I could do, but have no intention of doing.

    Here is some really interesting info on the Maryland shootings. Sounds like there may be an ID on the killer. I hope they get this guy soon.

    Thanks to Instapundit for this (excerpted) post from Lynn Sislo:

    >>I don't think I've actually shifted to the Right. It's just that since September 11 the Right has done a much better job of shutting up their lunatic fringe, while the common sense Left has gone into hiding and let their lunatics take over. So the Left is worried about the Right dominating the blogosphere...

    I come across lefty blogs all the time. I've even linked a few of them. The "problem" is not that the blogosphere is dominated by the "Right", it's that the blogosphere is dominated by common sense. Let a blogger from the far right start preaching their own brand of lunacy - (Sept. 11 happened because God is angry...Creationism is just as valid as evolution etc.) - and that person is just as likely to get a severe fisking as any of the loonies on the far left.<<

    I love blogs. I tend to agree with what she says. I have seen a few blogs dedicated to taking down some of the better known sites (warbloggerwatch.com, instapunditwatch.com) and find them to be poorly written and even more poorly reasoned. Not to mention that they're full of plain old spite - it seems to be the main power that's actuating them. Check out my links to the left if you don't know about these weblogs already - they're excellent.

    Thursday, October 03, 2002
    So I have this tape that I've made for my car. It's not an ordinary tape. This is my Space Age Music tape extraordinaire. I've got the theme from "The Man From U.N.C.L.E.," two versions of "Caravan," two versions of "The Quiet Village" (which is my favorite song EVER), Nelson Riddle's "Route 66," "The Tiki Room Song," three Esquivel tunes, and a lot of other stuff. I love my tape, it makes me happy when I drive. No one else has heard it but me because I have this secret fear that they might think I've gone around the bend. I know I'm not the only one that loves this music, but it seems to be one of the loves that dare not speak its name. If you're interested, you might try going here for a brief rundown on Space Age (or lounge, or easy listening) music. The Space Age pop site is a wonderful reference source.

    Today I'm home sick with a stomach bug. Not much happening except that I have found ample evidence for my theory that daytime TV is awful. I found myself watching an art class on KOCE (Orange County's PBS station) just for something to do. I have been hitting Instapundit and KFWB.com for news updates on Hurricane Lili (or cut-rate Hurricane Lili, as I suppose it is by now) and those weird shootings in Maryland. Terrorism or not? You make the call! But if it were terrorism - at least if it were organized by a group - surely someone would have taken the credit by now.

    Thank God for Coca-Cola. Its reputation as a stomach settler is well-deserved. I think it's time to try some rice now.

    Wednesday, October 02, 2002
    Welcome to my blog! Big, first, initial post here. News of the day: from the Wall Street Journal, "Test to Detect Ovarian Cancer Is On the Way." Looks like a new test is in the works which should be much more reliable than the CA-125 test. This is MAJOR good news. I am so sick of patients coming in begging for that test because they got some random spam on the Internet telling them to ask for CA-125 no matter what! Guess what, people: it doesn't work. If you doubt me, go to truthorfiction.com and look it up for yourselves. This new test should be available in eighteen months or so and apparently "uses powerful mathematical algorithms to zero in on protein patterns that indicate ovarian cancer."

    Case of the Day: a new patient came in to see me last week complaining of pain in his left upper abdomen. I examined him and found a large spleen, but no enlarged lymph nodes. Blood tests come back: elevated white blood cells, 91% lymphocytes, 9% neutrophils. Holy guacamole, this guy has chronic lymphocytic leukemia! And, to boot, sickle cell trait (not that that matters to the leukemia, but it may make all you hematologists out there salivate.) You don't get a case like that walking in the door every day. Warms this internist's heart. It should be very treatable, once we get his CT scan done and finish the immunologic typing.