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

Email Dr. Alice

    follow me on Twitter
    This page is powered by Blogger. Isn't yours?
    Wednesday, July 30, 2003
    I Wonder If George Clooney Has This Problem

    Sadly, I found this article all too believable:

    A report claims television hospital dramas have led to a trend in viewers who think they can treat medical emergencies.

    A growing number of people who watch the shows believe they have learned enough to deal with emergencies or even carry out surgery.

    I guess this means you don't have to be a brain surgeon to, er... be a brain surgeon.

    One ambulanceman told the Broadcasting Standards Commission study how a member of the public gave him advice on how to perform a tracheotomy, explaining he'd seen it done on "Casualty."

    Forgive me, but I find that hilarious. Don't worry about the vocal cords, who needs 'em?

    Others reported patients demanding that the ambulance's blue lights be switched on for the journey to hospital because they had seen the same happen on TV.

    And the siren! I want the siren too, and I want you to floor it through the red lights... Good grief. When did a trip in an ambulance become an E-ticket ride?

    Gotta Post This

    One of my responsibilities here at The Firm is to manage the after-hours clinic we run (staffed by residents and fellows). It's open weekday evenings and Saturdays. Part of the job involves reviewing the progress notes written by the MD's.

    I give you the following: (identifying details omitted)

    Chief Complaint: lost condom

    Patient was having sexual intercourse in shower and condom either fell into drain or is still inside.

    I can't help wondering why someone would pick such an awkward position, especially if they had enough forethought to use a condom. Anyway, suffice to say the missing prophylactic was found on examination.

    Most of the notes I have to review are not nearly that interesting.

    Monday, July 28, 2003
    Dr. Ack-Ack

    More adventures of the medical transcriptionist. Believe me, I am taking notes on what not to do when I dictate.

    Malawi Memorandum

    Here is Chuen-Yen's weekly email. Sadly, there will not be many more as you see below; I will soon be thrown back on my own resources. In the meantime, however, I am pleased to present the following:

    Greetings! Here's this week's memoir. There will be only two more after this since I'm leaving Malawi in August.


    Acquiring Malawian souvenirs prior to departure is a good idea. But sending Gift to purchase �the three most beautiful hippos in town� was a clear lapse in judgment.

    For Gift, who can obtain curios at the �Black People price,� my fancy presented an entrepreneurial opportunity. In support of industriousness, I acquiesced to let him do my shopping and keep the Black-White cost differential. As an aesthetic precaution, we considered several prototypes. Gift meticulously examined the specimens I purchased a few weeks ago. Then we visited Blantyre�s vendors to evaluate available candidates.

    I subsequently provided the funds and asked Gift to bring the carvings within a week. This time period seemed adequate for peddlers to forget our association. However, Gift immediately changed his clothing, went to curio row and returned with three deformed hippopotami.

    Gift�s hippos do share a gestalt with mine. They are nearly the same size, of similar proportions and composed of wood. But the resemblance ends there. His are vicious, bedraggled swamp monsters now relegated to storage. Mine are jovial, handsome creatures that frolic blithely atop my dresser.

    I should have known anyone who thinks all Black people are the same; that changing one�s clothes immediately transforms one�s identity; and that enviable individuals run high risk of being cannibalized, would be imprudent in choosing hippos. Contrary to popular belief, African villagers are not all big game experts.

    We should all learn to do our own hunting.

    Take care.


    Goodbye, Bob Hope:

    "I bumped into Gerald Ford the other day. I said, `Pardon me.' He said, `I don't do that anymore.'"

    A funny, generous man. I remember the years when he hosted the Oscars, every year like clockwork. I don't think he will be forgotten for his work with the armed forces, either.

    Friday, July 25, 2003
    Friday Blog Menu

    I have been checking out this site for a couple of weeks and can't stop reading it: Walker New York Eats. This woman loves to cook, loves to write about it, and it's good reading. The recipes are not complicated, either. Thanks to Ernie at LittleYellowDifferent for this recommendation.

    In the previous post I mentioned I mentioned Ilyka Damen, who is a dictation transcriptionist (and so much more!) I'd recommend her entire site.

    Any present or previous Dr. Who fans might be interested to hear that Richard E. Grant, late of an ill-conceived adaptation of The Hound of the Baskervilles, is slated to be the next Doctor. Yes, the BBC is apparently reviving the show - though it sounds like it's going to be animated instead of live-action. Me, I always liked Peter Davison the best...

    Wanna see a purple polar bear? Here's your chance.

    I will probably be in the office again this weekend to study for the Boards, so you can probably expect some more posting. But if you have better things to do, and I'm sure you do, it can wait till Monday.

    Happy weekend. Now I'm off to the ER to admit a demented diabetic whose sugar is out of control. Poor sod. (I just reread this and realized that perhaps I should clarify that I meant the patient, not me.)

    My Dictation Style Is Completely Different

    If you want to read a 'rillee' funny blog entry about another side of health care - namely, the experience of the dictation transcriber - check out Ilyka's post here. Definitely worth reading. And, just for the record, I am not perky when I dictate. I think I sound more like Mickey Mouse in a bad mood. With control issues.

    (via Tim Blair)

    Thursday, July 24, 2003
    I'm Shocked, Shocked

    As you may have heard on the news today, the latest press release from the Center for Science in the Public Interest states that ice cream contains a lot of fat and is really bad for you.

    My favorite response to this was one local newscaster who rolled his eyes and said, "This really doesn't surprise me."

    Details follow:

    "The staggering calorie and saturated fat content of most of the treats served up at chains like Baskin-Robbins, Ben and Jerry's, Cold Stone Creamery, Friendly's, Haagen-Dazs and TCBY is bound to surprise most consumers."

    The CSPI said an empty Ben & Jerry's chocolate-dipped waffle cone, designed to hold at least two scoops of ice cream, itself packs 320 calories and 10 grams or half a day's worth of saturated fat.

    "If you put a regular scoop of Chunky Monkey ice cream in that cone, it is going to be worse for you than (a) one-pound rack of baby back ribs, with 820 calories and 30 grams of saturated fat," CSPI nutritionist Jayne Hurley told a news conference to publicize the study.

    "This is something eaten by people strolling around a mall," she added. "They have no idea they have just eaten 820 calories and one and a half days worth of saturated fat."

    Well then, they must be really stupid. We've known for years that super-premium ice creams like Ben & Jerry's taste so good because they're made with - surprise - extra butterfat. And did they really think the add-ons like Oreos, fudge sauce, etc. were calorie-free? Give me a break.

    Wednesday, July 23, 2003
    Personal Post

    Today is my parents' wedding anniversary. They've been married forty-three years.

    I just wanted to post that.


    If you're a voracious reader, may I recommend Blog of a Bookslut? I've been checking it out for about a week and I quite like it. Lots of links to interesting interviews and articles about what's going on in the literary world, and recommendations for interesting-sounding books. Sigh. I used to love to read. Still do, but I don't have the time anymore. Now I read myself to sleep at night with soothing pap like mail-order catalogs and cookbooks.

    Hmm... perhaps I should start reviewing the catalogs. It'd be good for a laugh, anyway.

    Humbling Moment

    Yesterday I saw a woman who's been my patient for five years. She had several health issues, which we addressed - then at the end of the visit she told me that she's been laid off and will be losing her insurance at the end of the month. Her husband has no health insurance, and also isn't employed.

    Then she gave me a present and thanked me for being her doctor.

    I was undone. She's being laid off, she's the one with no insurance, and she brought me a gift?! I didn't know what to say, except to thank her profusely. I also resolved not to complain about my schedule, even to myself. (Who knows how long I'll keep that resolution, but I'm going to try.)

    Tuesday, July 22, 2003
    Math in Malawi

    I have been asked by a new reader who Chuen-Yen is. She's a friend of mine who recently graduated from our medical center's residency training program, and worked with me as a resident seeing outpatients. This year she is doing a year of volunteer work as a staff physician in a Seventh-Day Adventist missionary hospital in Malawi, Africa. Her weekly emails are a delight.

    In this week's email, Chuen-Yen describes a typical day of elementary school in Malawi. It's dramatically different from the educational system here, as you will see:

    Moni -- Here's this week's memoir:

    Each day the Mpange Pre-School students place their tuition fees in a pile. The fagot is lit to warm the outdoor classroom and heat the group�s porridge allocation. As the morning chill dissipates, children enjoy their nourishment. Then learning activities commence.

    First pupils sing about bountiful harvests, ancestors or family ties. Some run tantivy about grass mats, which represent schoolhouse boundaries, enacting the verses. The village storyteller usually adds a brief anecdote. Everyone enjoys these word-of-mouth lessons.

    Students subsequently proceed to counting. There are no pens, paper or chalkboards. Rather, discarded bottle caps are tallied. Caps are also strung together in rounded bamboo shavings to form musical instruments. Math thus becomes quite melodious.

    After arithmetic, students either play with urban offal or imitate adult activities in the �pretend area.� The pretend area has one clay pot. So, the children relish pretending that they have real toys.

    Class is dismissed after pretend time. Older siblings, many of whom head families orphaned by AIDS, walk the preschoolers back home. En route, they have fun cutting down the next day�s fees.

    Given the inadequacy of this simple learning experience, several NGO�s are diligently training African teachers to emulate their Western counterparts. Instead of singing about heritage, students will read history books. Mathematics will be done with pencil and paper rather than bottle caps. And the pretend area will be refashioned with contemporary paraphernalia. It is hoped that the next generation will thus realize the importance of leaving their villages to pursue success.

    Monday, July 21, 2003
    DASH diet - It Works!

    I saw a patient today who I diagnosed with high blood pressure a few months ago. She was reluctant to take medication (they all are), so we discussed options and I gave her information about the DASH diet and its role in controlling hypertension. I didn't have high hopes, not because I don't believe the diet can work but because very few people can actually stick to it. After all, we're talking about nine servings of fruit and vegetables a day when most people barely get down two.

    Her blood pressure in April was 154/92. Today, it was 138/80 (I took both measurements myself). She had lost a little weight but only about three pounds, so I don't think that was a contributing factor. I congratulated her and told her to keep up the good work!

    This is a rare case of patients actually following advice - I realize that may sound snotty, but believe me, it's rare that people do cut down on their food intake and increase their exercise. I find that patients are looking for "natural" ways to treat their problems, which is fine; but what they don't realize is that this usually entails a major revamp of their lifestyles and habits. That's a difficult thing to accomplish and many people cannot or will not do it. It's easier to give the pills, yes, but at least we know they will work reliably.

    I do still try to get people to eat right and lose weight if they're taking meds. When the patient asks if they'll ever be able to get off the medication, I counter, "If you lose twenty-five pounds I'll be happy to take you off the medication for a while and see how you do." Sadly, it's rare that the person loses the weight.

    Friday, July 18, 2003
    Coral Calcium - The Expose

    Just found a great new website, Quackwatch. Included there among other useful links is this article on coral calcium, which has been wildly popular as a dietary supplement here in Los Angeles for months. I never knew exactly what it was, but now I do: it's limestone. Which is to say, calcium carbonate. Which is to say, Tums at fifty times the price. Unbelievable.

    I'm adding this link to my website for future reference; I have the feeling I'm going to be visiting it a lot. Lots of useful stuff here.

    Friday Stuff

    I have a little surfing itinerary for you. You can enjoy it anytime this weekend.

    First, surf over to Dave Barry's weblog to read his evil plan to vandalize - actually, to improve - the website poetry.com. Then, go to poetry.com and view the submissions (you can search for "Freemont" either as a first name or a last name; some entries used it as a last name). All poems must contain the phrase "the dog ate mother's toes." If you are so inclined, you can contribute one yourself.

    Now, for part two, check out the advice column at Achewood. Frankly, I don't understand Achewood myself, but quite a few people seem to like it; even I, however, love Ray's advice column. It's hilarious. In a pathetic attempt to tie this post to a medical theme, I direct you to the letter third down in the most recent column. It's about the Atkins diet and contains the best definition of gout I have ever seen: The gout is a disease that pirates got from not eating "carbs." Oh, and he says the Atkins diet is a bad idea. Thank you, Ray!

    Enjoy your weekend. That is all.

    Malawi Menu

    Almost forgot. Here's a tasty post from Chuen-Yen for this week:

    Travelers customarily explore local mores. Thus I�ve tasted potatoes from Ntcheu, Chambo from Mangochi and watermelons from Balaka. I�ve bought pottery in Dedza. I�ve chatted with robbery victims in Lilongwe. I�ve viewed the prostitutes of Lunzu. And I�ve sipped tea in Thyolo. But, despite several journeys to Salima, I have yet to savor that region�s most popular delicacy.

    During a recent visit, I took a closer look at the infamous shish kabobs marketed alongside Salima�s smoldering fields. The skewered viands had distinctly rigid silhouettes. Each morsel had a tail, a pointy nose and four little legs. Upon further examination, singed black fur was evident. I gawked in disgust as several vendors aggressively solicited five Kwachas per rat or forty Kwachas for a stick of nine.

    After opting not to purchase any toasted vermin, I learned why rat salesmen raze sparse local shrubbery. The conflagrations are intended to chase small animals out of their habitat. Eager hunters wait on the perimeter to capture fleeing rodents. Once caught, they are boiled, arranged in tantalizing postures until rigor mortis sets in, skewered and then broiled.

    Properly prepared rats are crunchy, taste like chicken and can be stored in a cool, dry place for up to one month. Connoisseurs recommend consuming them in savory little bites. However, some uncouth individuals devour them whole. Tempting as it sounds, I bypassed this experience. Like sushi and pate, singed rats are an acquired taste.

    If you visit, I�ll take you out for rats on a stick.


    Nursing Homes In Trouble

    I spend a lot of time at nursing homes rounding on patients. My group has contracted with a company which has several skilled nursing care facilities. None of these places are Disneyland, but they keep the patients clean and safe and are able to give IV medications and other therapies as ordered. They pass their inspections.

    The reason I bring this up is this article which I saw today:

    Substandard care remains rampant at nursing homes throughout the country, according to the General Accounting Office, an investigative arm of Congress. Twenty percent of homes evaluated during an 18-month study ending January 2002, had "serious deficiencies that caused residents actual harm or placed them in immediate jeopardy," the report states.

    Investigators criticized state-run systems designed to police nursing homes, saying that they suffer from a lack of consistent standards that cause them to routinely understate the danger that inadequate care poses to elderly nursing home residents.

    Sad but true. As I said, my group takes care that the homes where we place patients are safe, and we've dropped contracts for subadequate care. We have to keep checking because these places are running on a tight budget, and here's one reason:

    Many lawmakers remain concerned that nursing homes are poorly paid by the Medicaid health system for low-income persons, forcing facilities to make up shortfalls by charging Medicare, the program that finances care for the elderly.

    Most custodial, or long-term, patients switch to Medicaid (here it's known as Medi-Cal) to pay their costs. These plans never paid very much to begin with, and chances are good that reimbursements are going to be slashed. Whether these places are going to stay in business I don't know - we'll have to see. Probably they will have to raise their rates significantly for the patients who don't qualify for Medicaid and are paying cash. I also worry that standards of care may slip further and we will be faced with yet more dangerous situations for the elderly in nursing homes.

    Thursday, July 17, 2003
    How Romantic

    Here is this year's winning sentence from the annual Bulwer-Lytton Fiction Contest:

    They had but one last remaining night together, so they embraced each other as tightly as that two-flavor entwined string cheese that is orange and yellowish-white, the orange probably being a bland Cheddar and the white ... Mozzarella, although it could possibly be Provolone or just plain American, as it really doesn't taste distinctly dissimilar from the orange, yet they would have you believe it does by coloring it differently.

    This contest is unique: the idea is to submit a single sentence - the worst opening sentence of a novel ever written. It's named after Edward George Bulwer-Lytton, a successful but singularly ungifted writer who began his 1830 novel Paul Clifford with the phrase, "It was a dark and stormy night." (He's buried in Westminster Abbey, believe it or not.)

    In the "Dark and Stormy Night" category, the following submission won:

    It was almost a dark and stormy night � not dark or stormy enough to be called that but just the kind of sweaty night that makes your shirt stick to your back and make you wish you were still at home with the air conditioning and eating pig skins and watching the Martha Stewart trial on TV.

    I like it.

    Friday, July 11, 2003
    Are You Now, or Have You Ever Been, a Quack?

    Specialists in the field of Internal Medicine (internists) need to be recertified every ten years. This is my tenth year and my first experience with recertification. The Board examination for first-time qualifiers is a two-day test; I have heard that when recertifying it's only one day (I hope that's true). I thought that recertification, while rather annoying, would be a simple matter of showing up and taking the test: I was an optimist. It turns out there's a lot more to it than that, and some of the recertification requirements are downright degrading.

    I first realized things were not going to be all that simple when my information package from the Board last year contained order forms for "Self-Evaluation Modules" (a.k.a. home study courses) which recertification candidates were required to complete prior to qualifying - at great personal expense, I might add. I have been struggling with my self-evaluation modules for a year, and no, they're not done yet. I thought that would be the worst of it but this week I received a form I couldn't believe: the Form Attesting Current Appointment. In the upper right-hand corner of the form, boxed much like the warning on a cigarette package, is the following advisory:

    This form is not to be completed by the candidate.

    You mean I can't give myself a glowing reference? Well, dang!

    My medical director has to certify that I am employed and reliable, fill out the form, and send it in. I got a tiny bit of revenge out of this nonsense by attaching a Post-It to the form before putting it on her desk: it read:

    Whatever you do, don't tell them about my assault conviction, drug use, credit card scams, arson history or the fact that I like to torture animals.

    Friday Chuckle

    This is the funniest thing I've seen all week. Enjoy.

    (via WhackingDay)

    Wednesday, July 09, 2003
    League of Extraordinary Dollar Bills?

    Sean Connery looks mighty good on Iranian money, and the beard suits him. Check it out. Even funnier, the next post has G.W. Bush photoshopped onto the same currency.

    (via Instapundit)

    Tuesday, July 08, 2003
    Toujours Malawi

    I almost forgot. Here's Chuen-Yen's post for this week:

    Happy Fourth of July. Here's this week's memoir:

    Gift has taken to swatting imaginary insects in my presence. This practice commenced shortly after I confronted him about pilfering a handful of anti-malarials.

    Having observed my recent recovery and discovered a new mefloquine supply, Gift decided to treat himself. Thus Gift, who regularly riffles through my belongings and pockets food, household necessities and writing implements, filched several Larium tablets. Though I overlook the frequent disappearance small items, his nicking of my prophylaxis after last week�s malaria episode was exceptionally disconcerting.

    So I resolved to dismiss Gift. To facilitate the transition, I forgave his many debts and told him to keep the iron he had �borrowed.� Gift cried. He apologized. He begged forgiveness. He promised to compensate me. (I have no idea how.) He vowed to reform. And I caved in to this pathetic bunkum.

    To repent for his transgression, Gift is demonstrably protecting me from malaria. He assails invisible mosquitoes when I am nearby. He spews Doom, the odiferous �kill on contact� bug spray, about the house. And he has hermetically sealed my bedroom windows. Unfortunately, the purloining continues.

    Gift, for whom honesty seems a luxury cast to the wayside by desperation, is actually quite astute. From me he garnered some information about malaria treatment. From government role models, he learned to steal, ignore genuine problems and conspicuously tackle non-issues.

    Hope you�re staying clear of those pesky mosquitoes.


    Sum- Sum- Summertime

    Summer has hit. The weather is good, and patients are no-showing in droves. I am bored out of my skull. I should be making the few phone calls I have still to make, or dictating a letter for a patient about her ganglion cyst, but I am inflicting my angst and boredom on you instead. I could be studying for the Internal Medicine Boards, which I have to retake in November, but I would rather stick needles in my eyes. Doing something constructive?? How dare you suggest such a thing!

    I guess I'm just really hard to please. When it's busy, I whine about that, and when it's slow, I whine about that. I could be researching some relevant and timely medical topic to share with you, like my compatriots MedPundit and DB. But I'm not. Feh.

    I'll come back when I'm in a better mood. Adios.

    "Ask your doctor whether prescription cash is right for you!"

    Scrappleface is right: "Studies show that cash becomes an increasingly effective analgesic as the dosage is increased."

    Monday, July 07, 2003
    Muggles Rejoice

    Just found out that Michael Gambon, who I think is a fantastic actor, is going to replace Richard Harris as Dumbledore in the next Harry Potter film. In addition, Gary Oldman is going to play Sirius Black. What a cast this is going to be: If nothing else, the Harry Potter films are a feast for those of us who love British character actors.

    Sunday, July 06, 2003
    I'm Not Demented, I'm a Surrealist

    This morning I did my usual weekend nursing home rounds. "Skilled" patients have to be seen once a week, "custodial" patients once a month. (The qualifiers do not refer to the patients' talents, but to the level of nursing help they require.) Currently, I have more skilled patients than usual and therefore am having to round more frequently than is my wont.

    I was sitting at the nursing station reviewing my patient's blood sugar levels when I became aware of a little old man in a wheelchair nearby. Actually, it would have been difficult not to be aware of this fellow since he was yelling at the top of his lungs. This isn't exactly an unusual situation in nursing homes, but this particular scenario was priceless. Picture the following:

    Yelling old guy in Wheelchair Number One. Perpendicular to him, and slumped over, grumpy guy in Wheelchair Number Two. Guy Number Two clearly cannot stand Guy Number One.

    Guy Number One: Telefono!
    #2: (slurred speech) Shurrup.
    #1: Telefono!
    #2: Shurrup.

    (Repeat about half a dozen times, then a pause, then the telephone rings, setting Guy #1 off again):

    #1: Telefono! Hello!
    #2: Shurrup!

    I start to mimic Guy # 1, though more quietly: "Telefono!" The nurses are cracking up. Things start to calm down a bit and I finish my charting, but then the first guy decides to start yelling something else:

    #1: Help!
    #2: No!

    #1: Heeelp!
    #2: NO!

    -- etc. (He didn't appear to be in any sort of distress, if you were wondering.) The head nurse is rolling her eyes; apparently this has been going on for awhile. I wish her a good day as I hand her the orders for review.

    "Yours will probably be better," she replies dryly. As I head out the door, I can still hear "Help!" faintly in the distance.

    Saturday, July 05, 2003

    1. Happy July 4th. Hope you all enjoyed it. I had a great time, even though I'm on call, because I have had relatively few phone calls. It's hot here, finally, after an overcast June and the city has emptied out. (Rumor has it everyone has gone to Santa Barbara.) I've been able to enjoy the lazy feeling of summer for the first time this year. I went to a friend's house for dinner and we shot off fireworks in the street.

    2. Tuesday, my jury duty day, was actually my tenth anniversary of working as a practicing physician; July 1, 1993 was my first day out of residency. I can't believe that ten years have gone by so fast. If this sounds like I'm talking about a wedding anniversary, that's what it feels like; I think I'm one of those people who is truly wedded to their job, for better or worse - and there has been a fair amount of worse - but I can't see myself doing, or wanting to do, anything else for a living.

    3. Fellow blogger Jack has a great post about Harry Potter and the Order of the Phoenix. I haven't bought the book yet because I know if I buy it, I'll read it, and I'm saving it to savor later in the summer. I didn't think there were any major spoilers in the post, but if you don't want to know anything that happens in the book, don't read it. Since he's on Blogger and the links don't work, you may need to scroll down a tad.

    Wednesday, July 02, 2003
    Jury Duty II

    I decided to split this post.

    So, anyway, we're finally in the courtroom. The judge is female and seems really nice. She's given to making jokes and seems anxious to make sure that we are at ease and that we understand everything. She starts from scratch with the now-standard speech about the importance of jury duty: "Thomas Jefferson said..."

    Oh, no! Not again! I think. Thankfully, this part is brief; we are introduced to the attorneys, support staff and the plaintiffs and then we get down to business. Eighteen names are called and one of them is mine. We file into the jury box and sit. The judge proceeds to ask each of us a series of questions:

    - where we live
    - our marital status, and if we have kids
    - what we do for a living, and what our spouses/kids do for a living
    - whether we have "yes" answers to any of the questions on a handout she's given us
    - whether we've been on a jury before

    "And what do you do for fun?" is her last question. After explaining that I'm a physician and the details of my job, my answer is a dry one: "Sleep, Your Honor." That gets a laugh from my fellow jurors.

    "Not in my courtroom!" she replies with mock indignation.

    The questionnaire is a long one, and covers all sorts of possible juror conflicts. The case in question is a motor vehicle accident where the plaintiffs are suing for damages, including injuries. As soon as I hear this, I realize that I will almost certainly get kicked off the jury. I take care to emphasize my familiarity with physical therapy, and elucidate the number of patients I have in rehab facilities who are getting therapy. The judge asks me if I see patients who have been in motor vehicle accidents; I say yes, quite frequently.

    The process takes all day. We got into the courtroom at about ten-fifteen, broke for lunch from 12 to 1:30. I took advantage of this by walking uphill to the new downtown cathedral, which was dedicated late last year. Our Lady of the Angels is stunning. I'm not one for modern church architecture, but I like what I see. As I walk around the perimeter peering into the individual chapels, I see a mimeographed flyer pointing to one chapel: "For the Victims of Sexual Abuse." Cardinal Mahoney's token gesture. I peek inside and see picture after picture of children -- Oh God, I can't take this -- and keep walking fast.

    There is a noon Mass going on, on a Tuesday. There are about fifty people in attendance. I am impressed by this. But I keep going, have to get lunch and get back to the courtroom.

    To bring this to a close, after the judge finishes up the initial round of questioning each of the attorneys take turns asking questions. I am asked several, as I mentioned above. She and the two attorneys confer in chambers. When they come out, seven people are called and told that they are not needed and to return to the call room downstairs. I am one of them!

    By the time we check in downstairs, it's almost four. Within ten minutes, we are dismissed for the day. I'm free! My day is over and I haven't been picked. Hallelujah!

    Jury Duty

    It's finally over. What a crazy three weeks this has been. It ended with my first full-fledged experience of jury duty under the new L.A. jury system.

    A few years ago, California went with the "on-call" system for jury duty that a lot of other areas of the country seem to be using: you phone in every night during your week to find out if you have to show up or not. The good news is that you go in for one day, and if you don't get picked for a jury that day, you're done. The bad news is that there is no way to get out of it any more; the only other time I've been called for jury duty was in 1995, and I showed up and explained that I was an MD and my patients would suffer if I wasn't there, and was dismissed. Not any more! No excuses are accepted, it seems.

    Monday I got lucky and didn't have to go in at all. Cockily, I phoned in Monday evening for Tuesday convinced that I was golden, only to find that I was not so lucky. I was assigned to the downtown court on Hill Street and had to report at 7:30 am. So, off I went. I had heard that the downtown traffic sucks early in the morning, so left early. I found the assigned parking lot without any trouble, made it through the weapons check at the building entrance, and arrived in the jury call room on the second floor.

    What is jury duty like? It's a lot like waiting at the airport, only you never go anywhere.

    First we had to hand in our paperwork and listen to a series of instructions from the woman who was in charge, then we had to watch a video narrated by one of the judges about why jury duty is important and how it's SO GREAT that we showed up to perform our CIVIC DUTY, etc. etc. The judge quotes Thomas Jefferson on the subject of trial by jury: that the right to trial by jury is more important than the right to vote. I query this, but decide that after decades of summary trials under British rule I might have felt the same way.

    "We know that you didn't volunteer for this," says the judge on the video, drawing a bitter laugh from his captive audience.

    Then we sit. And sit. I have brought reading material, but find myself dozing off. I trade comments with the guy sitting next to me. I am pleasantly surprised to find that a) I'm not surrounded by weirdos, and b) on jury duty we're all equal and everyone is called. I see all ages from Generation X'ers to people in their seventies; I see black, white, Hispanic and Asian. Every once in awhile the Mistress of Ceremonies calls off a list of names; people come forward and are sent up to one courtroom or another.

    Finally it's my turn. We go up to Courtroom 73, and after a brief delay because one of our jurors speaks no English (he's Armenian and his nephew came to translate for him), we are escorted into the courtroom.