“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

 
A Cautionary Tale

A local emergency room had called me about her visit yesterday, but hung up before I could get on the phone. Today she was my last appointment of the day.

She had been burned. I didn't know how.

"So, what was the cause of your accident?"

Her entire face was burned (first-degree) and her neck was swathed in gauze.

"The cap on my radiator was broken."

My eyes popped open. "OH, no." I could already see the rest of the story unspooling in my head like a home movie... but of course I had to let her tell it.

She had been going to the auto-supply store to get a new cap for her radiator. The first place she tried had not had one that fit her car, so she decided to save time at the next store by taking off the radiator cap and going into the store with it to show the clerk what she was looking for. So, she removed the cap with the engine running... she said someone had told her to do it that way, and that the water would stay down in the engine. (Query to anyone to knows about cars: is this correct? It doesn't sound right to me!)

She had blisters all over her neck and chest, and her right breast, many of which were already peeling. She had been scalded when the water exploded out of the radiator.

I changed her dressings, put some medicated burn cream on, and wrote a referral to the plastic surgeon. As I was working, I said, "If you ever have to remove a radiator cap again, put a rag over the cap and push down while you're turning."

"I don't think I'll be doing this again," she said - dryly.
posted by Dr. Alice at #

 
You know, I really liked George Clooney.

Seems he's descended to the level that all celebrities descend to, sooner or later... meddling in public affairs, to his detriment. By that I don't mean the act of public commentary and stating his opinion - last I checked, we all had the right to do that - but making an asshat of himself. (Thank you, Rachel.)

To say, as Clooney did,

"Charlton Heston announced again today that he is suffering from Alzheimer's." (snip)
When questioned about the remark by New York Newsday, Clooney sputtered: "I don't care. Charlton Heston is the head of the National Rifle Association. He deserves whatever anyone says about him."

-- simply defies belief.

A couple basic self-evident (or should be) statements here: No one deserves Alzheimer's. It's a remarkably nasty way to go. Most NRA members are not Uzi-toting maniacs. I don't own a gun myself, and I doubt I ever will, and I don't have problems with gun control - that said, I have/had relatives on both sides of my family who hunt. In rural areas and during the Depression, it's how you got your protein; it's what kept you alive. It's also a cultural thing, I suppose. I don't pretend to understand all of it but I will say that I find it extremely ironic that those who so often protest the factory farming method of raising chicken, veal, etc. also protest hunting - I mean, how far from factory farming could you get?

I think the NRA could stand to negotiate a bit. Arguing for automatic weapons goes more than a bit too far. But to demonize a large - very large - group of your fellow Americans and to say that their leader deserves to get Alzheimer's is just, you know, over the line.

Talk amongst yourselves.




posted by Dr. Alice at #

 
Please, please click here:

Bwahaha! Thank you, Tim Blair.
posted by Dr. Alice at #

 
I don't know how I missed this, but yesterday was Thomas Crapper Day.
posted by Dr. Alice at #

 
Update:

Yes, I do have a juvenile sense of humor. It's been nothing but peanut jokes all day. I concocted a farewell party menu for Dr. Smith that I was eager to share with the staff:

Peanut soup
Curry with peanut sauce
Peanut butter cookies for dessert.

One of them came hustling after me: "You forgot the appetizer! Celery stuffed with peanut butter!"
posted by Dr. Alice at #

 
When it comes to entertainment, democracy rules; the lunchroom is where it's at.

Our employee breakroom is near my office; doctors rarely go in there, except for me. When I go in to get my lunch and heat something up in the microwave, I am often seduced into hanging around listening to the chat instead of going back and doing my charts. Today I walked in and was greeted by the inevitable "Ssssh... stop talking about her, she's here!" Playing along, I was soon sucked into the following conversation:

"When are we going to get the I 'heart' Dr. Alice T shirts?" says Staffer One to Staffer Two.

"What about I 'heart' Dr. Smith?" I parried. [Dr. Smith works in my suite. He's been here about a year and will be leaving soon, and I don't think anyone on staff is too upset about it.]

"Oh, great! We could just show a piece of bread with peanut butter on it." "Yeah, or a jar of peanuts - or the Peanuts characters!" came the response. This cracked up the other staffers in the room, but I didn't have the slightest idea what they were talking about.

"I think I'm missing something here, but I'm not sure what."

"He's crazy about peanut butter! Haven't you ever seen him chowing down? He's always got a friggin' huge jar of Planters cocktail peanuts or peanut butter in his office, and his mouth is always gummed up with it when we walk in. He can't even talk! That's why he keeps his office door closed all the time! It drives his nurse crazy."

"And I swear he comes to the office with toast in his briefcase. Like six slices," someone else chimed in.

I was giggling by this time, but stunned: "You're kidding! I did not know this." It's doubly embarrassing because his office is right next to mine, and I honestly had no clue. But I know how to keep a good conversational topic rolling: "You know he's rubbing it all over himself in there..." I added.

"EEeeeewww!!!"

From here we naturally shifted to the crunchy-versus-smooth debate (I prefer smooth myself) as well as the merits of various brands. I broke into a heated discussion of Jif as opposed to Skippy.

"When I was growing up, we always had Peter Pan peanut butter. Do they even still make that stuff?"

"Oh, yes!" from Staffer Two. "My brother, he will only eat Peter Pan. But you can only get it at certain stores now."

I remember other hot topics of discussion. One day as I walked in, I had this question fired at me:

"You ever had boba tea?"

"No, I know what it is, but I've never tried it."

"Don't! It's, like, disgusting! It's got these huge fish eyes of tapioca in it and when you try to drink it it gums up the straw, or you get this huge slimy glob in your mouth. Ugh!"


Yep, hanging out in the break room is much more fun than doing charts. Added bonus: all I have to do to get a laugh from the staff now is to whisper, "Peanuts!" Or, "Rub some Jif on that rash and you'll be fine." Ah, workplace humor.

posted by Dr. Alice at #

 
Dave Barry now has a blog. Be afraid... be very afraid. (It's actually pretty funny.)
posted by Dr. Alice at #

 
Chuen-Yen has a recipe for us today. I'd rank this one with the dry Jell-O salad mentioned earlier:

Mwadzuka bwange? (How are you this morning?)

Today I�d like to give you a little taste of Malawian cuisine. Here�s how to prepare flying ants, an excellent source of protein and great meat substitute in any recipe.

Flying ants are best harvested during midday. One bucket of the tasty insects takes approximately thirty minutes to collect; a full bushel may require several hours. Start with the simple task of locating a termite hill, at the base of which formicidae build their subterranean caverns. Identify the area with the highest concentration of ant portals. Remove loose dirt to properly expose the holes. Then, around this site, excavate an oval trench, with a long axis of approximately one meter. Angle a stick of the same length over the long axis with one end inserted in the ground and the midpoint secured atop an erect stick of about half that height in the center of your field. Balance shorter branches, with one end in the perimeter trench and the other end on the central one-meter stick, to fashion a prism shaped skeleton.

Lay fresh grasses over this frame to form a light occluding tent. Sink a bucket into the ground under the high end of the tent. Make an aperture of about three centimeters just above the bucket. The nocturnal insects, believing it night, will emerge and fly toward the glint of false moonlight. However, most will be unable to escape through the small hole and will, in exhaustion, collapse into your bucket. While the ants are filling your bucket, build a fire a few meters away. At regular intervals, remove the ant receptacle, cover and heat over your nearby fire. While roasting, shake vigorously to prevent burning. Pour the dead ants into a basket. Repeat this process until your basket is full. At this point, you can remove any termites that were inadvertently caught with your formicidae. Note: some people prefer to eat their ants with termites.

Once your basket contains a satisfactory number of ants, balance it on your head and walk home. At home, spread the insects on a chitenge (all-purpose 2x1 meter piece of cloth) in direct sunlight. When they are dry, which should be a few hours later, gently agitate in a shallow basket until their brittle wings fall off.

If you do not have teeth, use a mortar and pestle to make a fine ant powder. Mix this powder with water until it has a thick, soupy consistency. Salt to taste. This porridge may be consumed hot or cold.

If you have teeth, fry the ants before incorporating them into your favorite culinary delights. Sprinkle dried ants in a pan of sizzling oil and stir slowly, taking care not to break any. After about a minute and a half, scoop out the morsels and place in a basket. Stir periodically so the grease congeals evenly on each body. When cool, sprinkle with salt and pepper to taste. These plain ants can be enjoyed as finger foods or cooked with other ingredients. Try stewing them in a curry or saut�ing with vegetables.

Enjoy.
CY

posted by Dr. Alice at #

 
I must confess that I didn't get to Onyx last weekend. I was just... too... tired. Spent most of the weekend napping, actually. I was still recovering from Hell Week In The Hospital. Apologies for light blogging and I hope to have something worth reading for you soon.

Website numbers are now back down to normal, more or less. Oh well, it was fun while it lasted.

I do have a comment for you that illustrates my week. Down the hall, one of my partners in the group keeps a bowl of jellybeans. She also makes coffee for all of us every day. At 1 pm today, having had nothing to eat, I zipped into her office for a caffeine fill-up before a meeting. This is what I said as I reached into her candy bowl:

"My lunch today. Coffee and a jellybean. Isn't that pathetic?"

Haven't had anything since... but I am about to go out to dinner. Mmmm. Wrong thing to do when you're on a diet but right now I don't care.

"Waiter! Two of everything!"
posted by Dr. Alice at #

 
I have found a really neat website, courtesy of the CIA. It's the World Factbook 2002 and it outdoes any almanac or encyclopedia you ever saw. If you are an armchair traveler, you'll love it. On a stress-filled workday when you really want to get away from it all, peruse the charms of Clipperton Island or Tromelin Island (population zero for both). You can learn, as I did, that the Island of Guernsey and the other Channel Islands between France and England are the last remnants of the Dukedom of Normandy (as in William the Conqueror). Enjoy.


posted by Dr. Alice at #

 
39 hits so far today. Unbelievable. All the same thing - looking for a Joe Millionaire fix. Bring it on!
posted by Dr. Alice at #

 
Hmmm. In the last ten hours or so I've gotten an avalanche (relatively speaking) of hits. I went over to Site Meter to find out why - the last eighteen were website searches for "joe+millionaire+allison". Perhaps I should throw in more gratuitous references to Survivor and Britney Spears as well?
posted by Dr. Alice at #

 
Happy Birthday, Esquivel!

Tomorrow is the birthday of Juan Garcia Esquivel, one of the great musicians of the twentieth century. You've probably never heard of him. If he were still living, he'd be 85; he died last year shortly before his 84th birthday. He recorded albums in the 1950's and 1960's and did a lot of live shows in Las Vegas and Los Angeles, as well as writing quite a bit of music for radio and TV. He was born in Tampico, Mexico.

How did I find out about Esquivel? Well... in 1995, the L.A. Times ran an article about him titled "Finding His Niche... 35 Years Later." I found this article interesting enough to clip and keep, intending to look for some of his albums. It described his music and stated that while Esquivel was not a big success at the time of his recordings, record collectors and people interested in alternative music were now looking for his stuff and that some of his albums had been re-released on CD. His music was described as big orchestra recordings, heavy on the piano, with lots of percussion, strange stereo effects and unusual instruments being used.

So I clipped the article, promptly forgot about it and then rediscovered it almost a year later. When I unearthed it I headed over to Rhino Records in Westwood to see if they had any Esquivel CDs - and they did! I found "Music for a Sparkling Planet" (sadly no longer available), which is a compilation of cuts from several of his albums. I took it home, turned on the player, and sat down next to the stereo.

I was blown away. I had never heard music like this in my life. I'm trying to figure out how to describe it. First, the stereo effects really are fantastic. You can hear the music drifting from one side to the other (you get the best results wearing headphones or playing this in your car). His arrangements are impeccable. Although Esquivel did some original composing, most of the songs on these albums are well-known pieces like "Sentimental Journey" or "Dark Eyes." There's usually a driving rhythm, lots of percussion, excellent brass (trumpets especially - there's a Latin flavor to many of the songs), and he plays the piano like a dream.

As luck would have it, shortly after buying this album I found out that my medical group was closing down and we'd all have to find new jobs (long story). I made a tape of "Sparkling Planet" for my car and played it constantly that summer as I coped with the search for a new medical group and settling into my new job. Then I went back and bought every Esquivel CD I could find. I still play them constantly; I'd rather listen to his music than anyone else's.

Esquivel led me to other musicians - I found the Space Age Pop Music webpage, and discovered Nelson Riddle and many more musicians, and bought many more CDs! But for me, no one will ever beat "The King of Space-Age Pop."

A few excerpts from the Space Age Pop Music biography:

THE king of space-age pop. Esquivel's family moved to Mexico City in 1928, and by the early 1930s, he was appearing on radio station XEW. Self-taught as a player, composer, and arranger, he proved a prodigy, and was soon leading the station orchestra. By 1940, he had formed his own band, with 22 musicians and 5 vocalists. Much like Pedro Camacho, the soap opera writer in Vargas Llosa's "Aunt Julia and the Scripwriter," Esquivel honed his writing and conducting abilities providing the background music for a daily radio show starring the comedian Panseco. "He'd ask things like 'Can you play something that sounds like a Russian guy walking through China?' and somehow, I would do it," Esquivel later recalled.

RCA contracted with Esquivel in late 1957, first releasing one of his Mexican albums in the U.S. as "To Love Again." The label brought Esquivel to record in Hollywood in early 1958. He was given five hours of studio time to record the album ("Other Worlds, Other Sounds"), but he finished the job with 90 minutes to spare and cut a second album, "Four Corners of the World," with a small combo.

Most of Esquivel's recordings start with much the same big band with vocal chorus foundation as Ray Conniff and others, but his arrangements take every element to its limit. On "Latin-esque," he went to the extreme of channel separation by placing two orchestras in studios a block apart and mixing the result live in the booth. If Roger Williams uses a four octave run in his version of "Autumn Leaves," Esquivel would use six and split them among six different instruments, starting on the right channel and moving over to the left in the process. It's fitting that Esquivel's name was usually printed with an exclamation point: his trademark is the musical exclamation point, whether it's a "Pow!" sung by the chorus or a "zing" from a harpsichord.

You've probably heard at least one Esquivel composition, even if you don't know it. Remember the three seconds of bombastic trumpet music that used to run at the end of TV shows produced by Universal? "Bum bum BUM-bum bum BUM-BUM-BUMMMM!" Well, he composed that. I wonder if he got residuals for it... it must have run at least a hundred thousand times.

posted by Dr. Alice at #

 
Some truly horrendous brush/forest fires going on in and around Canberra, Australia. Miss Shauny lives in Canberra and fortunately is all right but the level of devastation is unbelievable. Tim Blair has quite a few updates. Up to a fifth of the city is without power, it seems. Four people are known to be dead.

Send a prayer for our Australian cousins and fellow bloggers if you can.
posted by Dr. Alice at #

 
The weekend is finally here! Hooray! Three days off... ah. I am definitely taking my long drive to Onyx on Monday. Tomorrow is Errand Day. I do want to start with the Flower Market downtown, as I haven't been there in ages.

Los Angeles has a great flower market, with unbelievably low prices and a huge selection. The catch is that you have to get there early - they open to the trade at 4 a.m. and to the public at 6 a.m. It's fun to go really early and wander around with a coffee. It's a huge warehouse with cement floors and a lot of individual booths/assigned spaces. Some of the sellers specialize in exotics (orchids or tropical plants) and some do a lot of the basics; one or two just sell roses. It's incredible to see all the colors of roses available for sale there. I once bought some lovely candy-striped tulips, red and white, that looked just like peppermint.

Equally fun is the people watching. You may see a woman buying flowers for her dinner party, or a Latino family buying flowers for a quinceria (a fifteenth birthday party), or anything in between. Upstairs is a huge crafts and decorating store with decorations for every season in the year; right now I'm expecting to see a lot of Valentine's stuff. You can find confetti in the shape of Easter bunnies and eggs, or farm animals, or shamrocks, or anything else your heart desires; votive candle holders; giant Christmas ornaments a foot across; all the fake fruit you could ever use; every width and color of ribbon; and my favorite find, back in a corner, styrofoam wreath forms in the shape of Rotary Club and Lions Club symbols. Yes, apparently people still buy these things.
posted by Dr. Alice at #

 
I see a new version of "Hound of the Baskervilles," with a new Holmes and Watson, will be airing on Masterpiece Theatre this weekend. I'll watch it of course, but no one will ever be better than the team of Jeremy Brett and Edward Hardwicke. I especially admired Hardwicke's work; I've always thought it would be harder to play Watson than Holmes. He got it exactly right - his Watson is no dummy. He's also, clearly, a much nicer person than Holmes, and to his credit, Jeremy Brett's portrayal makes Holmes aware of that.

Oh God... I've just been to the website - these guys don't look right at all. I'll give it a try but I'm not sure what to think.
posted by Dr. Alice at #

 
Kick It Up a Notch, Julia Child!

What is Alice reading this evening? Why, a cookbook, of course. Today a visit to my cookbook collection has produced "Prize Recipes of Ventura," no publication date but looks to have been published in the mid-to-late seventies, a fundraising effort of the Catholic Daughters of America (Court All Saints No. 1765 if you care about these things). I bought it in the summer of 2001 on a road trip up the coast with a friend, in an antique/junk shop in Ventura. If you like thrift stores, Ventura is your town; Main Street probably has a dozen of them.

(Off-topic insertion: one thing I love about Ventura is that the building in which Erle Stanley Gardner, author of the Perry Mason mysteries, once practiced law is still there. Untouched, or nearly so. It's the old-fashioned kind of building with frosted glass panels in the doors and creaky warped wood floors. I've been in there twice; the only marker is a small plaque on the outside wall.)

To get back to the cookbook: there is a recipe on page 8 that repels and fascinates me:
Salad With Dry Jell-O

20 oz. can pineapple chunks
1/2 pt. cottage cheese, small curd
1 pkg. dry Jell-O, orange or other flavor
8 oz. Cool Whip (yum! Petrochemicals in your salad!)

Instructions:
Drain pineapple chunks well. Add all other ingredients. Mix and refrigerate. Will keep 1 week.

...uh, yeah, I'll bet it will. I'll bet it keeps for six or eight weeks - or, at least, that it stays in the refrigerator for that long. Because no one in their senses would eat it.
posted by Dr. Alice at #

 
I have a friend - actually, he's married to my work friend V. - who's a very funny guy. He was watching the news last night and was inspired to write the following after seeing the "Joe Millionaire" story as the lead story, followed by the story of nuclear manufacturing in North Korea and Korea's threats:

Rejected Contestant Speaks Out

On Jan. 13, 17.5 million viewers tuned in to FOX to see who "Joe Millionaire" would send packing. Seven ladies were given the boot, including Dana, the one woman the others thought was a front-runner. Dana visited Access Hollywood and told our Nancy O�Dell what it was like to be dumped by Joe.

Rejected beauty Dana was suffering from a severe case of sour grapes, and objected strongly to being lied to. She was even willing to admit that once she found out that Joe wasn't a millionaire, she was glad to have been kicked off. "I think I'd have been that much more devastated had I been chosen, because then I would have had to make the choice," she said.

Previously considered a shoo-in, the 26-year-old businesswoman was rudely eliminated on Monday night, much to the shock of the other contestants. "None of us can believe that Dana is not staying, that is just shocking," said one of the women. Reports from the show also rejected international concern over its nuclear programs, saying that the United States started nuclear proliferation and was now trying to shift the blame to Dana.

"In 1945, the U.S. produced three A-bombs and tested one of them in its mainland and dropped the other two on Hiroshima and Nagasaki, inflicting nuclear holocaust on the Japanese for the first time in human history," said Dana.

There were other opinions. �The North also has continually tried to drive a wedge between the South and the United States, its key ally, and on Wednesday called for a joint Korean struggle against "U.S. imperialists," noted Heidi.

It seems two-timing Heidi wasn't well-liked either. The 24-year-old blonde vixen stunned viewers when she let it slip that she had a boyfriend back home.

Millionaire Joe�s "loudmouthed supply of energy and food aid are like a pie in the sky, as they are possible only after the DPRK is totally disarmed," a North Korean Foreign Ministry spokesman said in a report by the country's foreign news outlet, KCNA. DPRK stands for the Democratic People's Republic of Korea. Dana calls the shots for DPRK.

After just two episodes, it's becoming increasingly clear that Evan's just a "regular Joe" when it comes to finding WMD. Access Hollywood carefully analyzed his strategy, and we did notice some recurring themes in his selection process -- such as phrases like, "She's hot, so I'm going to ask if she has any MIRVs," or "She's very attractive, so radiant, I'm going to give her a shot," which seem to pop up pretty often.

With the departure of Dana, redheaded stunner Allison, a 28-year-old commie graphics specialist, appears to have become the favorite to steal Joe's heart, leaving Dana and the other scorned ladies licking their wounds. "It's a little ego blow," confessed Dana.



"That's an additional unfortunate comment that Dana has made," Joe said of the North's reported dismissal of a possible aid deal.


When asked why he dismissed Dana, Joe told Access she was just too passive. "Talk about a girl that was absolutely gorgeous from head to toe, but I've had girlfriends I had to pull around by the hand and I don't like it."

As North Korea's only remaining major ally, Allison is in a strong position to influence its communist neighbor. China traditionally supports a nuclear-free Korean Peninsula.

Joe earlier this week had extended one of Washington's tentative aid offers if North Korea verifiably disarms.

There are no hard feelings from Dana, however, who says she has moved on and now has a boyfriend. �He is swarthy and I love him!�


posted by Dr. Alice at #

 
Hmmph. The LA Photo Show opens tonight. I have a ticket for the reception; I've gone for the last several years and I enjoy it, but I'm just too tired to go tonight. That's $40 up the spout. I suppose I must be punished for my hubris at thinking I could do anything remotely artistic/social on a weeknight.

I have a few things on my mind. If you've been surfing around, you may have seen some comments on John Le Carre's recent letter to the Times criticizing the U.S. in general and Bush in specific. James Lileks has some particularly good analysis of what Le Carre wrote, and he cites an article that I read yesterday in the Wall Street Journal and couldn't believe.

The area between the Tigris and Euphrates rivers, in Iraq, has been a large swamp for thousands of years. Every year millions of migrating birds feed there. It has been truly called "the cradle of civilization" and was the founding site for many ancient cultures. Unfortunately, the Shiite rebels used it to hide from Saddam Hussein's attempts to eradicate them.

So Saddam destroyed it. Literally. His engineering corps built a huge drainage channel and a series of dams that drained the place dry in under ten years (this is a swamp a hundred miles across we're talking about). It's completely gone.

Had you heard anything about this in the news, prior to this week? I don't think so. I sure hadn't. We're talking about an ecosystem bigger than the Everglades completely gone, and no one who claims to care about the global environment (and critiques the US for not caring) has said a word about it. The damage to the environment, to historical and cultural evidence, to species is inestimable.

What bloody hypocrisy. Name something the US has done to the environment (a single act we're talking about here) that equals this. The only remotely similar act I could come up with was China's dam which is flooding the Three Gorges, a beautiful area and also of immense cultural and historical value. Now the Hetch Hetchy dam in Northern California could be construed as a similar situation, but though a beautiful valley wound up getting flooded, I don't think that the surrounding area was poisoned, nor species destroyed, nor great historical and cultural relics obliterated. And why, why is no one saying anything? "Oh, it's unfortunate, but it's Saddam, you know, and he has autonomy..." Horse manure. This is an act of psychosis, pure and simple.

Lileks does a better job analyzing this whole thing than I can - I'm too tired to write coherently - but go there and read him. (Yeah, I know, lazy blogger's trick, but really, read him.)
posted by Dr. Alice at #

 
Anna is enjoying her first day of sabbatical (aka "between jobs") today, blogging and watching McGyver reruns, probably in her pajamas. Lucky AJ! I called her midday to whine about work, knowing she'd be around to listen.

At least I have a three-day weekend coming up. I think I'll go for a drive - a long drive. There's a small town called Onyx about three hours away from where I live that I was once told was a nice place to visit. I meant to go there back in the fall but I never got around to it. If I get there this weekend, I'll let you know what I find. I will take my camera... time to do a little black-and-white photography again.

P.S. Anna: I definitely want one of these Holga cameras to play with!
posted by Dr. Alice at #

 
First day back in the office: busy, busy, busy. It's still better than the last eight days have been.

A few nights ago I dreamed that I had forgotten about a patient in the hospital and had not rounded on her for several days. In the dream I stood at the foot of her bed as she glared at me accusingly; I was stammering, apologizing and trying to explain why she had been abandoned in the hospital. When I woke up, I was completely convinced that I had forgotten this patient and spent about ten minutes desperately trying to remember who her doctor was and what room she was in before I finally snapped out of it.

Last week the little reading I did was safe, comforting stuff: cookbooks. Something to relax with for ten minutes or so before I hit the pillow. Also the I Hate to Housekeep Book, by Peg Bracken, author of the I Hate to Cook Book - two books I'd definitely want with me on a desert island. Her writing is great, she's irreverent and very funny. In the early 1960s, when these books were published, these must have seemed like fresh air - or a lifeline - for women who felt there was more to life than cooking and cleaning house. The recipes aren't bad either, especially Stayabed Stew.
posted by Dr. Alice at #

 
Day Seven

Sunday morning in the ICU:

Conversation between two residents about a patient, now off the ventilator.

"So I see we've extubated him."
"Actually, he extubated himself."
"Excellent! When?"
"At three o'clock this morning."
"Ah."
"With his tongue."
"Cool!"

It's quiet in the unit early Sunday morning. Except for the one guy who's yelling like crazy. I look to one of the residents:
"COPD [emphysema to you], schizophrenia and cardiomyopathy. Not a good combination."

The fellow won't keep his oxygen on, except when one of the nurses (I'll call him Frank) goes in and talks to him sternly. I know Frank a bit, as we went through an ACLS (Advanced Cardiac Life Support) certification class together two years ago. Frank is an excellent unit nurse. He is also gay, and somewhat flamboyant. One of the residents tells me that not long ago, the unit team was trying to resuscitate a patient in cardiac arrest and something went wrong with the shock paddles: a spark appeared.

"What's that flaming?" someone on the team asked.
Like a shot, up went Frank's hand: "That would be me."
It broke everybody up, in the middle of a code blue.

I left the house at 7 am. It is now about 10:45 pm. I'm still not done, but the hell with it. I'm going home.
posted by Dr. Alice at #

 
And now for something besides me whining: Chuen-Yen! She has recently visited a leper colony:

Greetings! Here's a thought for the week:
�After shaking hands with a leper, you should wash.�

In need of a little vacation, I decided to visit a Zambian Leper Colony this weekend. Unfortunately, my Malawian visa had expired in October and I don�t yet have a work permit. At the border, a well-armed official eyed my documents suspiciously. He curtly stated, �You are in Malawi illegally for four months.� After a brief discussion, he shook my hand, receiving 100 Kwacha in the process. The discrepancies were conveniently overlooked and necessary �updates� were made to my passport.

Having smoothly entered Zambia, we lurched interminably along a muddy rut, past the �Wheels of Progress� sculpture, which is actually a heap of rusty gears displaying a crumbling nameplate, to Mwami Mission Hospital. This cramped, 200 bed � including mats on the floor � hospital is run by two pious doctors. Though the electrical supply is unreliable, medicines are scarce and phones have been out for two months now, Mwami is the best hospital in the region. Villagers transport their ill for entire days via ox cart ambulance to the facility. Live arrival of a patient to the hospital bodes well for survival.

The local leper colony is just down the road. Since lepers are ostracized from mainstream society, they, despite distorted facial features, manifested great delight at our unexpected visit. We shook their stumps with our hands as they came crawling and hobbling out of doorways. A brief tour revealed that their colony is like any other community, just less efficient due to labor limitations.

On return from the leper colony, one of our caravan became stranded along the washed out dirt path. We enjoyed using our intact appendages to free the car and then maneuver back to the doctors� quarters. Once near a tap, we, in keeping with the tenets of the bush, all scurried to cleanse our hands.

Enjoy your fingers.

Until next week,
CY
posted by Dr. Alice at #

 
Day Six

Not so bad. I had two admissions today but being able to have someone else cover some of the patients for me was such a relief. I am sitting here trying to deal with all my paperwork for these patients - I have to submit a report stating what days I saw each patient and the care level of the visit. (How many services did the patient require, in other words). It's a pain. But if I don't the group doesn't get paid and I don't get credit.

A couple of vignettes. Yesterday I was busy charting in the "step-down" unit, one step below intensive care. One patient was looking relatively well, at least well enough to pace the halls and get some exercise. I vaguely heard a nurse asking him if he could go back to his room for a minute, but didn't pay attention. A few minutes later, I looked up to see the unmistakable shape of a shrouded body on a gurney, with the same nurse waiting for the service elevator.

"Now I see why you told that guy to go back to his room," I said dryly. She grinned.

Then today I looked in on a patient who had her spleen out three days ago and she was heading down the hall for a walk, wearing a nice robe-type dress and with a stylish turban on her head.

"You look terrific!" I exclaimed. She smiled and said, "I'll feel terrific as soon as I pass some of this gas." (Her intestinal activity hasn't caught up with the rest of her yet.) She's our Happy Ending of the Week. She came in with a large splenic mass that, for various reasons, we thought would turn out to be cancer. We were wrong; she's fine. And the happiest person I've ever seen.




posted by Dr. Alice at #

 
Day Five

So tired. So very very tired. Four new admits last night made for a busy morning. I was all set for a running start this morning but was derailed by a patient in the ER who needed to have his appendix out... but didn't want to. "I'm feeling better." So after my delivering several earnest speeches about peritonitis and raising heaven and earth to get hold of the surgeon (who was in the OR on another case, I think) and the patient's gastroenterologist, and after being told multiple times by multiple doctors that he needed to have the thing out, he finally agreed.

I called the backup guy and told him I was going to need him this weekend. I can't see all these people myself. Some of the other docs have been following their own people this week and are signing them out to me for the weekend. Fortunately we have a "backup," one of the other docs on call, who is on tap to help out if needed.

I'm going to go home and go to bed. Soon.
posted by Dr. Alice at #

 
Day Four

Not quite as bad as yesterday but I still feel like I'm chasing my tail. It's never ending, rounding on the patients who are in the hospital and figuring out what to do with them... discharging the ones that you can... and new admissions.

I have a story for you. I'm going to keep this as nonspecific as possible. There is a nice elderly lady in the hospital with an infection. She has a wacko family member who is a real pain (both the primary care physician and the doc who covered last weekend warned me about him). He has managed to get his hands on the lab results every single day and second-guesses everything I'm trying to do. Two days ago, her white blood cell count went up which concerned him greatly (me too, of course), and I rechecked her X-ray and added some respiratory therapy - but she was on top-flight broad-spectrum antibiotics, so I did not see the point in changing her meds. He wanted me to call a specialist who was recommended by some relatives of friends of his - I explained that I couldn't since this doctor was not contracted under her insurance plan and that, since she was clinically stable, I would like to wait one more day. Sure enough, next day she got better.

The next day, at a different hospital, I was rounding when a doctor came up to me and turned out to be the specialist in question. Let's call him Dr. B. Dr. B informed me that the day before, the relative had called his office announcing himself as "Dr. X" and wanting to speak to him immediately. So of course Dr. B dropped everything and went to the phone. It turns out "Dr. X" is a chiropractor. You can imagine how well that went over with Dr. B.

Dr. B told the relative that he knows me by reputation and from working on a committee with me (true), and that he saw no reason to change the treatment regimen I was following, and that he had no interest in butting in on the case. God bless him. I thanked him profusely and lost no time in phoning up the relative and making damn sure that he knew that I knew what he'd tried to do behind my back. Then I called the primary care physician and told her the story: she found it extremely entertaining.

Onward to Day Five. Then just the weekend. Then I'm through. Aaah.
posted by Dr. Alice at #

 
Day Three

I'm missing the George Clooney interview on 60 Minutes II tonight. ::sob:: Please let me know if you saw it and what you thought.

Though Dan Rather is doing the interview, so maybe it doesn't matter so much. When did Dan become creampuff celebrity-interviewing guy? Why doesn't he stay with CBS Nightly News and be the globetrotting reporter? Well he is about seventy, I guess he's slowing down.

If this post is all over the map please forgive me, I think my neurons are shorting out. I'm in the office with pizza ordered, me and the evening Urgent Care staff while I pursue my catchup duties. Yes, it's not just rounding like crazy and doing admissions in the hospital, it's also coming back to the office at night and trying to get through the referral requests, prescription refills and phone calls. But I seem to be powering through the detritus faster than usual. At least I can tell all the patients, "Sorry, I'm not in the office this week." That tends to simplify things.

I am getting more efficient. I can definitely get around the hospital faster than I could on Monday. Another four days to go, including Saturday/Sunday... hope I can survive.

Here's a bright spot I found today courtesy of Tim Blair: somebody's take on a season's worth of ER scripts. It's hilarious, check it out. This will show you why I refuse to watch ER or any other medical show. It's bullshit.

Hasta la vista baby, back to the charts.


posted by Dr. Alice at #

 
Day Two

More of the same, really. Not quite so bad, since I now know many of the patients a little better.

The "soon to be a widow" mentioned below is now a widow, as of three o'clock this morning... so we never had to have The Talk. I feel badly but at least she had some warning and was able to expect it. The worst is when somebody just drops out from under you and the family didn't expect it.

Day Three coming up.
posted by Dr. Alice at #

 
Day One

Oh my God. What a day. I feel like I've been hit by a truck. I don't have the energy to give you details, but it took me nine hours to see 16 people. Three admissions. Finally managed to discharge a few people at the end of the day. A sad event: the nice elderly woman that I admitted New Year's Eve with chest pain apparently had a massive heart attack and coded (went into cardiac arrest) at about 6 am today. I staggered into the intensive care unit looking for her at 3 pm - no one had called me - and found out she was dead. The ICU team had handled things appropriately (from the clinical point of view, anyway) and when someone goes to intensive care, the primary care doctor does very little - but I wasn't happy about it all the same.

I also met with a wife, about to be a widow, to discuss taking her terminally ill husband off the ventilator. We are to meet again tomorrow.

You see a lot of life 'n' death stuff in the hospital, not nearly as much doing outpatient care. Since today is January 6, the Feast of the Epiphany, I wish I could say I had an epiphany of my own today - but I think it was more common sense: I'm never doing this again.

Onward to Day Two. I am going home now to collapse.
posted by Dr. Alice at #

 
My List

This is not a complete list. I hope to add to it over this year. It is a list of life goals, in case you were wondering.

Learn to scuba dive
Do some underwater photography
Learn Spanish
Learn to play the piano
Learn to develop photographs
Write a book (don't know what about yet)
Learn to dance - tap dance or ballroom, either one
Find a small, relatively unknown island in the Pacific and go there
Learn to knit/crochet
Go to all the interesting bits of Los Angeles that I haven't seen yet

More to come.

posted by Dr. Alice at #

 
What am I Reading...

If you care, that is...

I picked up some light reading for the holidays. At the library, I thought I'd give Ian Fleming a try - spurred on, no doubt, by the recent James Bond Marathon on TNN. (My father had the TV on constantly all Christmas week and I think I will associate Sean Connery with Christmas Day for the rest of my life.)

I had never read any of the Bond books and was pleasantly surprised: these books are good! Fleming was quite a writer. He had a gift for description - there's a chapter in Goldfinger that describes Bond on a quiet stint of night duty at headquarters that I particularly liked. It's not essential to the plot, but it really makes you feel like you're there. Dr. No wonderfully evokes colonial Jamaica, a world that no longer exists, as it was coming to an end. The books are also more noir than the films by a long shot; Bond is a bastard. But a cool one. I think Ian Fleming is the British writer who most closely approximates Raymond Chandler.

I also picked up The New Gilded Age: the New Yorker Looks At the Culture of Affluence, a collection of profiles and essays published in the New Yorker during the mid- to late-nineties. I've only just started it, but it has an essay about Martha Stewart that was quite good. Overwhelmingly, I feel from reading it that it's another world, another century - and it was only a few years ago. September 11 seems to be a curtain separating those events from us.

When I was in college, there was a modern American History course in which the professor was famous for always posing a certain question on the final exam: "When were the Sixties?" In other words, what were the events that defined the Sixties and when did they take place? It wasn't unusual to have the answers go from 1963 to 1974 or thereabouts. I think that generations to come will say that the twenty-first century began September 11, 2001.
posted by Dr. Alice at #

 
'Ello kiddies:

I am here in the office on Saturday night to try and get things such as paperwork and lab results out of the way and organized before next week. This is important because I am going to be the hospitalist next week, which normally is not my job.

What is a hospitalist, you ask? Well, it's like this: six years ago when I started with my current practice, each doctor admitted his or her own patients to the hospital if they got sick, and continued to follow them throughout the hospitalization. One small problem: they don't tell you in medical school or residency how very, very difficult it is to run a busy inpatient and outpatient practice. It's hard.

Imagine working a full-time job where you're in the office ten hours a day, on average. Now add on another one to two hours daily in driving time and rounding at hospitals: This does not include your daily commute. Add time spent on the phone during the day taking urgent calls from the hospital, or having to suddenly abandon your office and race to the hospital in case of an emergency.

The year after I joined the group, we instituted a program whereby volunteers would take turns handling only inpatients, week by week, and would not see outpatients in their offices that week. They also took turns admitting patients at night; I can't tell you how wonderful it is to be able to hand off an admission to somebody else when it's two o'clock in the morning. This, as you can imagine, lifted quite a burden from us. Slowly, in the years since we began this program, about ninety per cent of the doctors in the group have turned their inpatient practices over to the hospitalists. (The hospitalists are reimbursed for their extra duties, in case you're wondering why anyone in their senses would agree to this.)

I know the patients would prefer to have their own docs look after them in the hospital, but to put it bluntly, we don't want to do it any more. It is backbreaking work and it cuts our already limited free time even further. If you have young children it is very, very difficult to round on your patients in the early morning, for instance. I do not have that problem, but I have begun exercising with a trainer and walking with my next-door neighbor on weekday mornings, and if I had to round on patients in the morning it would be very difficult for me to continue with my exercise program, since I start seeing patients at 8:40 am. And believe me, I need the exercise.

I know I've blathered on too long about this, but to come to the point, the hospitalist group is starting to burn out. We hired one doc specifically to handle the inpatients (he doesn't have an outpatient practice) but he got sick about six weeks ago, requiring surgery, and is still out. The group has been casting around desperately for replacements, and I am one such, for the next week. I will try to post some dispatches from the front lines.

I don't know how bad this is going to be; hopefully not too bad, but our main admitting hospital has just instituted a computer program for admissions orders. I had a brief experience with it New Year's Eve, and it's just awful. More details later.
posted by Dr. Alice at #

 
Oh, the Insanity!

Came in today to find that, on top of the three doctors who are out on vacation this week, two others had called in sick. That left 3 of 8 docs to cover the office. On a Friday. Coming off a holiday.

Let's just say it was ugly.

On a lighter note...

Google is great. After listening to my ten-thousandth radio commercial for Mitsubishi vehicles, starring the raspy-voiced guy (you know the one I mean), I decided to see if I could find out who the heck he is. Those commercials are hilarious.

So I googled: "mitsubishi radio advertising" and got answers! His name is Todd Susman. His filmography is on, of course, IMDb.com.

Then I decided to read James Lileks' latest column for the Star-Tribune - and found an advertising character I'd forgotten all about: the Duke of Doubt from Burger King. So, I googled him. At website AmIAnnoying.com, I learned that 70.29% of voters felt the Duke of Doubt was annoying.

How did we get along without the Internet? It's like a big ol' encyclopedia!

posted by Dr. Alice at #

 
The Malpractice Conundrum

As you may have heard, surgeons in West Virginia are walking off the job to protest skyrocketing malpractice insurance rates. I think it may have gotten to the point that almost all insurance carriers have pulled their malpractice coverage from West Virginia. I feel for these surgeons and their frustration, but this is worrisome:

Four West Virginia hospitals cut staff hours and transferred more patients today because of a surgeons' walkout to protest malpractice costs. State officials planned an emergency program to ensure medical service to patients in the state's northern panhandle.

Protesting surgeons want the state to make it harder to file malpractice lawsuits, which they say would eventually lower their insurance premiums. They also want the state to seek help from insurance companies and other third parties to pay a larger share of their costs.

Two patients were moved late Wednesday and two others today, raising the number transferred in the two-day protest to five.

The four affected hospitals also began reducing shifts of operating room nurses and other surgical support staff.

"It's definitely generating worries within our staff, both about their own financial needs and about the health of the community," said Howard Gamble, spokesman for Ohio Valley Medical Center in Wheeling.

A surgeon taking part in a job action said doctors' pleas for help have been ignored by state officials.

Glenn Reynolds has some fantastic comments on the effects of malpractice insurance on the practice of medicine. Read the whole thing here, but an excerpt:

Malpractice suits don't play a significant role in preventing bad medicine, or in compensating injured patients -- given that most patients never sue, it's essentially a lottery. Sometimes a particularly bad physician is brought to account, but just as often it's somebody who made an honest and forgivable error of judgment, or who did nothing wrong at all. And in some truly dreadful cases, trial lawyers won't bring suit because there's no money in it; I can think of one in particular I know of that would curl your hair, but that a major plaintiffs' firm turned down because they weren't sure they could make money.

So the social value of malpractice suits is overrated: if you wanted to compensate people who were hurt by bad doctors, or if you wanted to police bad doctors, you wouldn't have a system like this one, where profitability to plaintiffs' lawyers -- which is at best only roughly correlated with severity of harm, and even more roughly correlated, if at all, with severity of malpractice -- is the major determinant of what cases get brought and what cases don't.

Geez, I only wish I could write this clearly. I would never claim all doctors named in malpractice suits are martyrs; we've all heard the horror stories that make it into the news. And in the quarterly bulletins from the state medical board, the last section always consists of doctors who have had their licenses revoked or suspended - for some mind-bogglingly stupid things. But in the last six years I have had three notifications that I was being named in a malpractice suit - though I've been lucky; none of them went to court or even had to be settled (the suits had no merit and were dropped). The first time I freaked out. The second and third times I just cussed a couple times, picked up the phone and called our group's risk manager. Sound easy? Well, this stuff takes time, money and resources on the part of my malpractice carrier to investigate, as well as our risk manager. Every time we're cited in a suit, even if it's only a threat like the type I've mentioned above, it counts against us. Enough of those and our rates go up, even if the carrier never pays out a dime.

This system is not an appropriate way to punish doctors who practice bad medicine, and it penalizes good docs who either have wacko patients (or wacko families of patients), or who make an honest mistake, or who did not make a mistake but were one of several doctors involved in a case that had a bad outcome caused by someone else, or who merely had communication problems with the patient... etc., etc.

posted by Dr. Alice at #

 
Here's more. Hey, it's my half day at work and I'm bored. I am web surfing instead of going home because I know if I do I'll fall asleep.

One thing I'd like to do in 2003 is to make a list like this one. It's a list of life goals, some big, some small. The first time I saw this website I tried to think of some things to put on a similar list... I couldn't think of a thing. This is not a good sign. My mind is so locked into left-brain mode that it seems to be fossilizing. The right half of my brain is probably turning into a withered little raisin. When I come up with some items for my life list I'll post them here, and I'll try to include some stuff to free up my imagination and creativity - what little I have left.
posted by Dr. Alice at #

 
Random thoughts

1. I would like to implement a moratorium on wishing people "Happy New Year" after the first of the year. The 31st of December, okay, the first of January, okay, but the first day back at work - hell, the first two weeks of the year - I get very, very sick of hearing the phrase "Happy New Year." After the first few times you hear it it's like fingernails on a chalkboard, or hearing people say "Have a nice day!" 37 times a day. Am I alone in this?

2. Today as I pulled into my parking space, I saw bees profiting by the warm weather, busy with the red fuzzy flowers on the eucalyptus trees. Then I thought, there is such a thing as eucalyptus honey, isn't there? What would it taste like? Probably exactly like a cough drop.

That is all.
posted by Dr. Alice at #

 
Shall We Dance?

This morning at the gym I got lucky: an Astaire-Rogers musical on TCM! It was not one I recognized, so after my workout I investigated the TV movie schedule for Fred Astaire films and found that it was "Roberta," from 1935. The plot goes like this: John Kent, a handsome football coach, comes over to Paris with his friend Huck Haines and his band, the "Wabash Indianians" (must have been modeled on Fred Waring and the Pennsylvanians), who have been booked to perform at a Parisian nightclub. Huck Haines (Astaire) manages to lose the booking almost immediately. While in Paris, John visits his aunt, who is the owner of a posh fashion house run by her assistant, Stephanie. There they meet the singer Scharwenka (alias Huck's old friend Lizzie Gatz), who gets the band a job. Lizzie is, of course, played by Ginger Rogers with a hilarious fake European accent, which she drops when she recognizes Huck. Meanwhile, John's aunt passes away and leaves the business to John; he then goes into partnership with Stephanie. John and Stephanie are perfect for each other, but as luck would have it, John's old girlfriend Sylvia then shows up. She is a total snot, but John, being a lunkhead, takes a while to figure this out. Eventually he does and everybody pairs off happily.

I was surprised by a few things in this film. Astaire and Rogers are given top billing but spend relatively little time on screen, especially Rogers. They don't dance all that much, either. A lot of this film is given over to the plot of John going into partnership with Stephanie and gradually realizing that he's in love with her. I couldn't figure out which actor played John until I checked IMDb.com and found that - good grief! - it was Randolph Scott! Randolph Scott is known for appearing in Westerns, not light romantic comedies, but I guess his early career was spent as a more conventional leading-man type. He did a pretty good job here, even showed a sense of humor.

Highly recommended. (But really, is there an Astaire-Rogers musical I wouldn't recommend? I don't think so.)
posted by Dr. Alice at #