Feet First

“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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    Friday, February 28, 2003

    Apparently, a 16-year-old Irish girl is a candidate for the world's first face transplant. No joke. I hope it works... I'm sure she's had a very difficult life. She sustained massive facial burns in a motor vehicle accident as a baby.

    Thursday, February 27, 2003
    The World's Fattest Cat...

    ...lives in Russia, weighs fifty pounds, and apparently can eat 1.3 frankfurters per minute. If they have an SPCA in Russia, somebody call them!

    Suddenly I had an idea for a new gourmet treat after reading this article - pate de foie gras du chat.

    Thanks to Roger Bournival for this one.

    This morning it's raining again. Of course, the commute to work took longer than usual. As I sat in traffic at a stop light, I glanced to my left to see how my fellow drivers were handling the boring wait: the driver next to me was busily making notes on a paper pad propped against the steering wheel. Then the light changed and we took off again.

    A few blocks later, I glance again. This time there's a woman next to me, and she has a Day-Timer in which she's making notes! Am I lazy, I wonder, or disorganized? I'm not taking advantage of my commute time to accomplish anything; I'm just drinking a latte and listening to lounge music. Suddenly I feel luxurious and sinful, like the grasshopper in Aesop's fable who sat around and fiddled while the ants worked. I turn up the music and press the accelerator as sensually as I can, now in a really good mood.

    Wednesday, February 26, 2003
    Endocrinologists Live for Moments Like This

    My friend V. called this evening from her office down the hall:

    "I have something you ought to know."


    "Well, I was going through my Textbook of Endocrinology and Metabolism when I found a chapter on micropenis, hypospadias [malformed urethra] and cryptorchidism [shrunken testicles] in infancy. The author is a Doctor Wellington Hung."


    "You made that up."

    "No! I swear!"

    There's a guy named Rob Brezny who writes a weekly astrology column that I get emailed to me. I first found him in the (now-defunct) New Times, a free alternative newspaper. He tends to aim more for life advice than for the "you will travel over water and meet a handsome stranger" type of prediction, which is why I read him. He tends to hit the nail on the head in a very spooky way, as my latest prediction will show (granted, it has more impact if you actually know me):

    You're progressing nicely in your efforts to master life's most complicated skills. For instance, you're making better and better mistakes all the time. You're getting pretty good at being three places at once, too; and with every passing month you know more about using your fears to motivate you so they won't paralyze you. What you'd benefit from most right now, though, is a refresher course in the simplest fundamentals. For starters, you still have a lot to learn about how to sleep and eat. And it's not too far-fetched to say that you could use some breathing lessons. For that matter, Sagittarius, you're not exactly a PhD in the art of happiness. I suggest you sniff around to see if there are any crafty elders offering workshops on how to regard everything that comes your way as a blessing.

    He's not telling me anything I didn't already know, but still... I tend to come away from his columns feeling like a strong-minded, good friend has smacked me upside the head in an effort to knock some sense into me. Some of his stuff is too oddball for my taste, but not the astrological predictions.

    Tuesday, February 25, 2003
    Apparently President Bush has declined Saddam Hussein's challenge to a debate, but instead suggested the ultimate challenge: a chili cookoff.


    This morning at the gym I really lucked out with the TV. I found Speed, from 1994 (yes, I admit it, I never saw it). As I watched it (I had tuned in in the middle, after Keanu Reeves gets on the bus), I felt my central nervous system divide into two parts. My left brain half was saying, This is horse manure. But my right brain half was saying, Dude! This is excellent!

    Keanu Reeves did a pretty good job here, as did Sandra Bullock. His job: Look buff and tough. Deliver lines in an authoritative yet reassuring way. Dennis Hopper is good as the maniacal bad guy handling things by remote control, delighted to be watching the crisis on half a dozen TV's. Now admit it, most villains would not have thought far enough ahead to tote all those TV screens in there. Lastly, as a bonus, I noted that one of the bus passengers is that sad-looking, long-faced guy who was in Ferris Bueller's Day Off and Twister. You know, Cameron. I have no idea what his name is...

    Hold on...

    He's Alan Ruck. Thank you, IMDb.

    And I found my motto for the week: "There's a fifty-foot gap in the freeway!... Floor it!!!"

    Monday, February 24, 2003
    Three Patients

    I have a few clinical vignettes for you about some of my patients.

    The first one is a patient who I've been seeing for several years. She's Orthodox but very modern in her way, outgoing, loves her kids (she has six and would love to have a seventh, believe it or not). Once, I offered one of her children a sticker; the only ones I had were bright orange and labeled Allergic To: (they usually go on the front of the chart), but the child was charmed with the bright color and gladly took the sticker. "We don't let them watch TV," said my patient. "At the pediatrician's they don't know who all those cartoon characters are, so they usually ask for flower or dog stickers." My response: "Good for you." And I think it's great, as long as she can keep them entertained sans TV without their driving her nuts.

    Anyway. I saw her last week and I made some remark during the exam about buying duct tape (that seems to be an obsession of mine lately). Then we started talking about smallpox vaccination.

    "I'd take it, for sure," said my patient. I thought for a moment and said, "I would, too. It hasn't been offered to us yet, but if it is I will definitely take it." She nodded approvingly. A few minutes later she told me that she'd been trying to talk her husband into moving back to Israel: "I feel so much safer there."


    "Every Israeli is issued a gas mask and told how to use them," she explained. "Every house has a sealed room. People are just so much better prepared there."

    I haven't been able to get that conversation out of my head.

    Patient Two I saw a few days later. She came in for a routine physical and casually mentioned that she'd recently been vaccinated for smallpox. She works in a biologic laboratory - and they're manufacturing smallpox vaccine.

    I had never seen a smallpox vaccination site before and, after asking her permission, eagerly took off the Band-Aids covering the vaccination site. It was eight days old, and was a round white raised spot, slightly larger than a dime, surrounded by a mildly reddened area of skin. I went and got one of my colleagues, who was eager to take a look as well. After admiring it, I re-covered the site with Band-Aids and then asked (slightly nervously) if any precautions should be taken.

    "Well, you should wash your hands," she advised. I did. Thoroughly.

    Patient Three, you'll be relieved to hear, has nothing to do with bioterrorism. I hadn't seen her for over a year; when she came in I saw she'd gained a lot of weight (nearly fifty pounds) and that her blood pressure was way up. She'd been in better condition the last time I saw her and had been able to discontinue her BP meds.

    She explained that the stresses of her job had a lot to do with the state of her health: She works in the child abduction department for the county of Los Angeles. She is the only provider for the entire county.

    "What do you think of the Amber Alert system?" I asked her. (California recently started statewide alerts for missing children, named after one child named Amber who was kidnapped and murdered several years ago.)

    "Usually the lawyers won't let us use it," she replied.

    "The lawyers?" I queried. "Why not?"

    "Practically all our abduction cases are parental. Either the parent takes the kid or a friend or relative of the parent takes the kid and then turns them over to the parent. That recent case you may have heard about, where the mother took the kid?" [I nodded, though I couldn't remember which one it was.] "Well, the only reason that one got broadcast is because the cops got the info out before the mother's attorney turned up and tried to stop it."

    Unbelievable. But at least it's good to know that there aren't as many maniacs out there abducting kids as I had thought. She then went on to tell me about a recent tangled case she'd had to deal with on Valentine's Day - apparently I'm not the only one with weird associations with Valentine's Day and work. Briefly, the case involved a family of gypsies; the mother had had the child taken from her at the age of one by the father. Father wound up in jail and the child had been passed from relative to relative within the tribe. Mother finally got the kid back - after five years - on Valentine's Day. The kicker: she wasn't even sure who the father was. The child was kidnapped by a "father" who may not even have been a relation.

    Do you wonder that her blood pressure's up?

    Sunday, February 23, 2003
    Here's a mighty scary story for those of you who live in Los Angeles. Hint: It involves anthrax. Thanks to Rabbit for this one.

    And in other news, Chuen-Yen tells us what it's like to drive a car in Africa:


    Driving on the wrong side of the road isn�t so difficult. It�s just tough to be a good driver, especially when navigating strange locales. At least inadvertent detours can lead to interesting places.

    My life as a wheeled Malawi expat began when our visiting ENT surgeon insisted I baby-sit his car. Initially, I was hesitant even to relocate it in our parking area. But, after much cajoling, I agreed to use the vehicle this weekend. In preparation, Jen, my old college buddy, and I went for a spin in Blantyre.

    Adjusting to the left hand pattern was perilous. I was inclined to face head on traffic. Attempts to signal resulted in changes of windshield wiper speed. I had a tendency to weave. Like most motorists, I nearly ran over several pedestrians. Amazingly, I really had only one near accident.

    After a few minutes of practice, the honking of annoyed tailgaters directed me to a picturesque Jacaranda lined road. The well-maintained path, devoid of other automobiles, was an excellent place to hone driving skills. We cruised past magnificent greenery, while fiddling with various controls, until we came upon an ostentatious gate flanked by two guarded kiosks. A watchman approached to assess our intentions and informed us that the route was reserved for those conducting official business with the president. He confirmed that we had discovered the illustrious Sanjika Road, gateway to President Muluzi�s Blantyre estate. Then he escorted us off the grounds.

    Two days later, on the return from Kuchawe, I nearly drove into the president�s Zomba estate. Apparently all of his holdings have the same grandiose entry.


    Thursday, February 20, 2003
    Damn, I Wish I'd Found This For Valentine's Day

    The other day I read a book review of something I might actually want to read (a rare event) titled Things My Girlfriend and I Have Argued About. Today I had a bit of time on my hands and decided to surf over to Amazon and check out the info available on this book (see link above). One of the things that I found out is that the guy who wrote it has a website titled, wait for it, Things My Girlfriend and I Have Argued About.com.

    It is frightening. It is hilarious. Check it out. Women, would you live with this man, who chronicles every last irritating habit you may possibly have? (To be fair, he lists his irritating habits as well.) Here is a sample from the website:

    Margret thinks I'm vain because... I use a mirror when I shave. During this argument in the bathroom - our fourth most popular location for arguments, it will delight and charm you to learn - Margret proved that shaving with a mirror could only be seen as outrageous narcissism by saying, 'None of the other men I've been with,' (my, but it's all I can do to stop myself hugging her when she begins sentences like that) 'None of the other men I've been with used a mirror to shave.'

    'Ha! Difficult to check up on that, isn't it? As all the other men you've been with can now only communicate by blinking their eyes!' I said. Much later. When Margret had left the house.

    Amazingly, they're still together and have two children.

    Hmmm. Must.... write.... blog. Must think of something to say.

    I wish I could contribute something to our ongoing conversation here, but I'm having a hard time at the moment. Not for any particular reason. I could tell you every detail of what I did this morning, or this week, for that matter - but I don't think people read blogs for mind-numbing monotony. We've all got enough of that in our own lives. If you're Lileks, you can write about daily life and make it fascinating - but I'm not Lileks.

    Work is fine, thank you. It's busy, but not busy enough to drive me crazy.

    Preliminary work on the house (aka digging out the basement) is proceeding.

    I'm trying to figure out when I can take some time off work and what to do with it when I do.

    The staff is still coming up with peanut jokes.

    So. How about that new Dragnet? Ah, a topic! Let me proselytize here for a minute - if you haven't seen this show, give it a try. It's on ABC on Sundays at 10 pm. Ed O'Neill plays Joe Friday, and he is good. Really good. He's not doing a Jack Webb imitation by any means. A lot of critics have said it's "just another cop show" and similar to Law and Order, which may well be true. But since I don't watch a lot of TV and haven't really seen Law and Order, I'm enjoying this one. I'm mainly watching it for Ed O'Neill. Enjoy.

    Wednesday, February 19, 2003
    Another Update

    I know you weren't exactly holding your breath to hear this, but the Little Outhouse on the Prairie finally has a home. I can get into my garage, the guys working on my house can pee, and everybody's happy.

    And it's not in the front yard. I don't have to worry about privy tipping.

    Not much else to say, really - except that Lileks has a wonderful phrase today: "We're the axis of Elvis."

    Tuesday, February 18, 2003
    Sanitation Update

    When I got home last night, that freaking Porta Potty was sitting in the driveway right in front of the garage door. I guess the delivery guy couldn't get it up the stairs. I'm going to have to call my contractor and get him to move the blasted thing. It may wind up right in my front yard but at least I'll have access to the garage.

    Monday, February 17, 2003
    Here We Go

    I was hindered in my dash from the house to work this morning by a nice man trying to deliver a Porta-Potty. I did not recall ordering one; apparently, my contractor did. I've never had one of these before, even when I was going through the Great Kitchen Renovation of 1999. Oh God, I thought, what have I gotten myself into?

    My driveway is very narrow and the steps into the backyard are gated - with a rather narrow gate. My delivery guy initially left the Porta-Potty right in front of the garage, ensuring that I couldn't get the car out. After I implored him to try again he gave it the old college try, but had trouble getting it up the stairs. After fifteen minutes or so he kindly moved it out of the way so that I could leave - then he resumed his attempts to wrestle with the thing. I feel sorry for whoever has to move it after it's been in use for a month or so!

    Saturday, February 15, 2003
    In Malawi, even an innocent garden show may mask sociopolitical issues... as Chuen-Yen's most recent email demonstrates.


    My last memoir evoked a plethora of safety concerns. So, this week I will share with you something very tame � Blantyre�s Annual Flower Show.

    The flower show is actually a general garden and craft exhibition organized by expatriates who are enamored of their own handiwork. While these proud expats relish flaunting backyard crops, they rarely do their own cultivation. Most have a well-trained Malawian gardenboy, who, like all natives, knows basic agriculture by necessity.

    The Garden Society holds its magnanimous event in the Blantyre Sports Club Tae Bo room. Everyone, including children, is encouraged to participate. However, a small entry fee effectively eliminates local competition.

    I attended the show this afternoon. Dozens of wilting entries, all with attached award certificates, were displayed on card tables. Categories included traditional floral designs, cut specimens, crafts, and every fruit, vegetable and herb imaginable, as well as a few unimaginable ones. The surfeit of produce divisions � sweet corn, white corn, yellow corn, tomatoes, rhubarb, all types of lettuces, mangoes, papayas, squashes, potatoes, etc. � ensured that a maximum of two submissions, often from the same contestant, was submitted to each. With first, second and third place prizes, entrants were guaranteed multiple victories.

    Afterward, I asked one young lady, whose winning arrangement included perfect blooms, along with a teapot and Barbie doll, how to nurture such fabulous flora. She innocently clarified, �I don�t know. My mom gets it from a shop.� Then, just outside the venue, I procured salad ingredients far superior to the flower show entries from a barefoot peddler whose backyard harvest is for sustenance, not presentation.

    See you soon.

    Friday, February 14, 2003
    The Internet may soon be getting a patron saint. I just thought you'd like to know. (Thanks to Laura Antoniou.)

    Going back to my drug rep post of last week, here is a good link to another physician's blog - this post is about drug companies marketing to the public. DB Medical Rants is a good blog and I recommend it. It has a lot more academic authenticity than mine. :) I'm more eclectic.

    Leech Update

    If you want the rest of the leech article I posted below, you can find it here. You will be asked for User ID and password. Use ID "dralice" and password "leech." The article is fifth down from the top: "Leech Treatment Eases Pain from Osteoarthritis."

    Valentine's Day

    You knew this was coming.

    Most blogs I have seen with this topic are either gooey-happy or bitter: I'm in the bitter camp. And then there's the occasional philosophical post about dating. Here's a very good one (via Instapundit).

    I'm going to give you my most vivid Valentine's memory from a few years ago. It's medical, not romantic. Disclaimer: I'm not posting this because it's funny - it's not - but because it was one of those ironies that just hits you sometimes.

    My first patient of the day. A woman whom I'd seen several times. Scarcely had I gotten inside the room when she burst into tears and told me her story: her husband had been caught on Sunset Boulevard with a prostitute. She wanted to be checked for "everything."

    I counseled her as best I could, examined her and told her everything looked fine, and ran the tests. (Happy ending: everything was negative.) It was only as I was completing my progress note that I realized what day it was: February fourteenth. The moment I realized this, I got the sensation of icewater down my back.

    That's it, really.

    But just to let you know that I'm not completely twisted, I did bring valentines for the staff today.

    Quote of the Day today goes to a co-worker, who wishes to remain anonymous, about another co-worker: "Some days I just wish I could sabotage her birth control."

    Thursday, February 13, 2003
    Drivel and Trivia Edition

    Yesterday in my fortune cookie:


    Will do. Heh heh. (What do you mean, "what plans"?)

    Next, I wish to congratulate a young friend of mine, Becky, who started school last week. (It's preschool; she's three.) She had a lovely time and was led all around by big brother David (age 5) who showed her the "bestest" playground equipment to play on. She was tremendously excited and has been eager to go back. So far she only goes two days a week.

    I wish work was more like that: naps, monkey bars and graham crackers.

    Last, we are breaking ground on the home renovation today. What was once a dirty unfinished dirt-floored crawl space will someday be a lovely multimedia room/storage/office space. I will keep you updated.

    Wednesday, February 12, 2003
    Ahhh, rain. It's about time; we haven't had any here since the week before Christmas. I am praying for a light day at the office today, as is often the case on a rainy day; people just don't keep their appointments, especially those who get here on the bus. It may seem funny to those in parts of the country contending with heavy snow and below-freezing temperatures, but here a heavy winter rainstorm is a big deal. It really snarls traffic, and it's not unusual for roads to flood out - especially in the San Fernando Valley.

    One of our medical assistants just arrived, over an hour late; she commutes here from the Lancaster/Palmdale area, more than sixty miles away. She staggered in looking strung out and told us that her commute this morning took over three hours. In the high desert at this time of year the roads are a mess. The only real way in or out of Lancaster is Highway 14 and when it rains here, it's often snowing there.

    Read Lileks today. His topic is exactly what I spent all day yesterday thinking about - getting our emergency supplies together in the event of an attack. Unbelievable. Were people advised to do this during the Cold War? I mean, officially, by the government? I'm not sure. I made a mental list as I coped with my evening commute: Must get sheet plastic and duct tape this weekend at Home Depot. The last time I had anything to do with those items was twenty years ago, in winter, as a college student in a drafty Philadelphia rowhouse. We had to cover all the windows or freeze our butts off.

    I made plans earlier this week for a vacation in Mexico later this year. I wonder if I'm being insanely optimistic, will the world still be in one piece? and then I think the hell with it, there's no reason not to plan for vacation.

    Have a good, safe day.

    Tuesday, February 11, 2003
    Oh, Wow

    I don't have a current link for you, but I just read an article in Internal Medicine News:

    Leech Treatment Eases Pain From Osteoarthritis

    accompanied by a disgusting close-up of a leech doing its job. To continue:

    Exeter, England -- The therapeutic leechmania that swept Europe during the mid-19th century is staging a 21st century comeback for osteoarthritis.

    German researchers have found that treatment with the medicinal leech Hirudo medicinalis can provide rapid and extended relief of osteoarthritis pain.

    The patients treated weren't using any of the usual oral meds like anti-inflammatories (think Motrin) or Tylenol. The leeches were tested against diclofenac gel (which is an anti-inflammatory medication) applied to the skin.

    Leech treatment involved application of four to six leeches [to various sites around the joint]. The leeches were allowed to feed to satiation, which generally required 40-90 minutes. Following feeding, the leeches spontaneously fall off and are not reused.

    There was an "overwhelming and rapid pain reduction" with leech therapy beginning within 24 hours and reaching statistical significance by 3 days after the treatment.

    The therapeutic effects of treatment with H. medicinalis derive from the presence of numerous active compounds in leech saliva...

    If I get an active link to the rest of the article later I'll let you know. I'll spare you the rest of it for now. Seriously, if this treatment can minimize the use of drugs like aspirin and ibuprofen (which can have side effects like ulcers and elevated blood pressure) for arthritis, I'm all for it. But I don't know how eager my patients would be to try leeches... and somehow I don't see managed care being willing to pay for them. Unless they have generic leeches. Heh.

    Rabbit gets the quote of the day today:

    Making major decisions using your imagination, or using your complicated, circular thoughts, is pretty much a waste of time across the board. I think the best way to make good decisions is to decide you're good at making decisions. Then, when a decision needs to be made, you just pull the damn trigger. I do this extremely well when I've had a big cup of coffee.

    Sunday, February 09, 2003
    More Grand Rounds Fun

    Let me present some more actual titles of grand rounds or other presentations recently given at my hospital. Comments appended. Let the fun begin:

    1. The Center for Health Care Ethics

    A Bioethics Noon Lecture
    �Medical Futility: Where Do We Stand?�

    ... Foursquare behind it!

    2. "Irritable Bowel Syndrome: The Role of Bacterial Overgrowth"

    Breakfast provided by � [X] Pharmaceuticals

    Ah, a drug breakfast. Which will, no doubt, prevent that nasty bacterial overgrowth.

    3. The total grossout lecture...

    Medicine Grand Rounds

    Livers, Autopsies, and
    Professionalism in 2003

    Five Case Histories

    The five case histories were listed at the bottom of this announcement; let's just say that none of them had a happy ending.

    4. Pituitary Support Group

    �Take a moment for you��

    For all those heartsick pituitaries out there roaming around without a central nervous system to call home.

    5. * SOCIOLOGY 1, INTRODUCTION TO SOCIOLOGY: This course is an overview of what we know (and don't know) about human behavior.

    Well, that covers the waterfront, all right.

    6. It's All About Information

    Career & Education Expo 2003
    "Hot Careers in Healthcare"

    Find out about career growth and educational opportunities at [Hospital X]

    Visit with representatives of local colleges & universities; learn about the educational programs that help you train for Hot Careers in Healthcare

    Snacks, Raffle prizes, Souvenirs and Inspiration Brought to You By

    Organization Development Services &
    The Institute for Professional Nursing Development

    ::sob:: Can't I find out about a hot new career, or get some snacks? And God knows I could use the inspiration...

    7. Department of Pediatrics
    Pediatric Grand Rounds


    Good grief. This makes pediatricians sound like androids. ("What is this 'caring' that you speak of? I do not have an emotion chip.")

    Thanks to Dave Barry for this article. His response: "How, exactly, is this different from opera?"

    The first notes in the longest and slowest piece of music in history, designed to go on for 639 years, are being played on a German church organ on Wednesday.

    The three notes, which will last for a year-and-a-half, are just the start of the piece, called As Slow As Possible.

    The article goes on to say that the piece was composed by John Cage, the man who brought us 4'33" - a piece which consists of 4 minutes and 33 seconds of silence, with a pianist sitting at the keyboard doing nothing. As Mr. Barry would no doubt say, I am not making this up.

    I obviously picked the wrong profession. If Mr. Cage could become famous and respected doing stuff like this, what's stopping me? I'm going to record myself banging frantically on a xylophone for seven minutes and twelve seconds and call it Bad Vibes. How soon do the Carnegie Hall bookings start pouring in?

    Friday, February 07, 2003

    First Haloscan goes down, now it's Sitemeter. How am I supposed to get through the day without minute-to-minute updates?

    ADDENDUM: Oh, and Blogger is sending me weird error messages too. Damn.

    Thursday, February 06, 2003
    Thanks to Ken Layne for his post, "Bitter Little City of Hate," regarding a recent editorial in the SF Examiner about the local response to the Columbia disaster. From the Examiner:

    Several readers have called or written to complain about the selection of letters we have printed about the space shuttle Columbia tragedy.

    Where, they asked, was the universal outpouring of grief for the seven brave astronauts and their families? Why were so many of the letters tinged with gratuitous bitterness toward President Bush or otherwise infused with cynicism or conspiracy theories?

    Frankly, my colleagues and I were asking the same questions Saturday as we sorted through the several dozen e-mails and faxes that came in after the disastrous breakup of the shuttle on its final descent home.


    Even more startling was the cynical, even hateful, tone of many of the letters. The outtakes were considerably harsher and more jaded than the selection we printed.

    One letter writer flat-out accused the government of a secret plot to "sabotage the mission to direct future finances away from NASA to further the military industrial complex." A recurring theme was resentment that Bush would somehow exploit the tragedy for political gain.

    Perhaps it is idealistic to assume that a tragedy would prompt us to draw on our common humanity, rather than to trigger unprovoked animus based on racial, national or political differences. And these were not anonymous tirades. The above e-mails were sent for publication, with names, addresses and phone numbers.

    For all the readers who asked, we do want to print more letters that pay "tribute to the memory" of the Columbia crew, as we have today. But we can only choose from among the letters we receive.

    I lived in San Francisco for 4 1/2 years during and after my medical residency before I moved back down to Los Angeles. I made many friends there, and have many good memories of my stay.

    But this editorial tells you why I left. I just got sick of the Attitude I confronted on a daily basis. The post above expresses it in a nutshell.

    Another post from my friend Chuen-Yen, a sobering one about rampant crime in Malawi, where your shoes can be literally stolen off your feet and machetes are the local substitute for baseball bats and Saturday-night specials:

    Happy February!

    Despite the serenity of Malawi�s natural beauty, outdoor activities can be quite stressful. Earlier this week, a lady was assaulted by a group of thugs while on her morning stroll. They pinned her down, seized her walking shoes and left her barefoot on the street. Another person was robbed of groceries en route to his car. Such incidents are becoming alarmingly common, especially off the main roads. In order to avoid mortal injury, it�s best to acquiesce when threatened.

    I was informed about the recent footwear incident when, wearing �made in China� Adidas, I visited a friend who lives a block from my home. In light of her area�s unsavoriness, she thought my well-worn sneakers too fine for walking outside alone. Consequently, she and one of her watchmen escorted me during my jaunt back to the hospital.

    Kenlow, the barefoot guard, was clearly hesitant to leave his station in the encroaching dusk. However, he could not object to madam�s wishes. Before unlocking the gates, he sharpened a one-meter machete and tucked it inside his patchwork jacket. The weapon was brandished only once during our tense five-minute journey, when a beggar approached. No violence transpired.

    After this foray, I was glad to be back in the safe part of town, where all frippery can be worn outside at any time and shotgun wielding sentinels escort me only after dark. Of course, crime is still common, but it�s usually an inside job.

    Hope you�re staying out of danger.

    Wednesday, February 05, 2003

    Just went back to ScrappleFace and found a sharply funny post from a few days ago regarding the ongoing doctors' slowdown/walkout in New Jersey (protesting malpractice rates there, too):

    Patients Fail to Notice Physician 'Slowdown' Protest

    (2003-02-03) -- Although more than 1,300 New Jersey physicians staged a work slowdown Monday to protest the high cost of malpractice insurance, patients reported no difference in service.

    "Sure, I sat there naked under that flimsy gown for several hours, but what's new?" said Alan K. Seltzer of Paramus, NJ. "I thought protestors did unusual things to get your attention. This was the same old same old."

    A spokesman for New Jersey physicians said next week's protest will include ice-cold stethoscopes, withholding eye-contact and illegible prescriptions.

    No comment! No comment!

    Made For Each Other

    Dave, I completely agree with you.

    Sigh. It's a busy week. I was tired and frustrated when I left yesterday - still so much undone after 11 hours in the office. Better today though - I blew off a meeting so that I could get some of my paperwork done. (The fact that I am blogging and websurfing as well is beside the point.) You will be getting kind of a ramble here today, deal with it.

    Unfortunately, I didn't get to hear Powell's speech to the UN; I would have liked to, but I have consoled myself with reading the response to it on various websites. Go here to read the Scrappleface pre-speech commentary; this guy is hilarious. And if you missed the speech too, you can find a transcript of it here.

    Anna continues to enjoy restful and productive time off. Anna, come over and clean my closets when you're through with yours!

    And the peanut jokes are still going strong. All we have to do now is to catch each other's eyes walking down the hall and we crack up. One staffer's favorite trick is to stand outside Dr. Smith's office and start sniffing the air: "I smell vapors!" And as I hit the vending machine for lunch today (bad Alice!), somebody eyed me and asked: "Are you getting peanuts?"

    More later as always... now back to the charts. More coffee! I need caffeine!

    Monday, February 03, 2003
    One thing about being a doctor is that you are almost guaranteed to have pharmaceutical representatives, aka "drug reps," dropping in on you. A few places, like Kaiser, have an ironclad rule against visits by drug reps - but my group has no such policy and, as a consequence, we get lots of drop-in visitors. They come bearing drug samples, ballpoint pens, the occasional bribe (small pack of M&M's - so hard to turn down at three in the afternoon when you've got that sinking feeling!) and much, much more. I routinely threaten one drug rep with the possibility that after I retire, I will pay my expenses by throwing garage sales and selling all the junk I collect from these people.

    Here for your entertainment is a list of what is currently in my office/on my desk courtesy of drug reps, with descriptions of the medications advertised:

    1. Highlighters - set of three in different colors in a purple plastic holder. Drug: Nexium (a proton pump inhibitor. It treats ulcers)

    2. Small plastic chair, suitable for use as a bathtub toy. Drug: Wellbutrin (an antidepressant)

    3. Stress ball/hacky sack. Drug: Axert (a triptan, antimigraine drug)

    4. Tape dispenser. Drug: Protonix (another proton pump inhibitor)

    5. Small collapsible plastic telescope, Allegra (antihistamine for allergies)

    6. Hole punch, Nexium again (it is purple, as are all Nexium associated products)

    7. Set of two rechargeable penlights, Allegra

    8. Gel eye mask that can be heated or cooled, Axert (finally, an object that relates to the condition it's supposed to treat)

    9. Chapstick/lip emollient, Allegra

    10. Three pens that clip into holders suspended on cords so they can be slung around your neck. Drug: Altace (a medication for high blood pressure)

    11. Multiple ballpoint pens and Post-It notes - various

    12. Breath mints, sugar-free. Drug: Actos (an oral hypoglycemic - it treats diabetes. The mints are sugar free - get it??)

    13. A white lab coat emblazoned with "Avelox" over the pocket (a new antibiotic)

    14. My prize - a computer mouse labeled "Paxil CR" (an antidepressant). The end that fits under your palm is clear plastic and has two layers of fluid in it, along with a little person in a kayak that floats on the lower layer of fluid. I'm sure you've seen the sort of thing I'm talking about previously, as a paperweight or a travel souvenir. Well, here the point is that no matter which way you turn the mouse, the kayak will always remain upright and stabilized - just like Paxil keeps you stabilized! Or something.

    I showed #14 to one of our pharmacists recently to see what her reaction would be. First she laughed, and then she began to look disgusted:

    "Drug companies have money to spend on stuff like this, and meanwhile all our senior patients are scrambling to pay for their drugs?"

    "You're right," I said. "You're absolutely right."

    I had a busy weekend, and now it's Monday again. I hate feeling out of control, as though I have no influence on what my week is going to be like. I'm tired of going into a work week knowing that every second of it is already scheduled and accounted for. I'm tired of feeling guilty for sleeping instead of working. And I'm tired of having my house being messy because I don't have time to clean or pick up.

    Will post more later.