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

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    Saturday, January 31, 2004
    Booty Food?

    Via Bookslut (hmm, seems appropriate) comes this mention of a cookbook called Booty Food. It was written by Jacqui Malouf, who has apparently hosted a cooking show called "Hot Off the Grill," and claims to offer recipes for food to take you through all stages of a burgeoning relationship, including the morning-after breakfast. Frankly, I don't think this is a cookbook I would ever use, and I say that based on a list of sample recipes. There is no way in hell I would ever cook a man something like "Lobster Eggs Benedict Poached in Champagne Butter," for instance - not even if he were Prince Charles.

    Why not, you ask? (I can hear you from here.) Well, I'll tell you: it isn't that I'm not willing to cook (I enjoy it), and I believe that feeding a man something he really likes to eat is one of the unsung pleasures of being female. It's that nurturing thing. But I think most men would really rather have scrambled eggs, toast, and coffee in the morning, and fifteen minutes alone with the sports page for dessert.

    Shall we put it to a vote? Who agrees and who disagrees?

    Friday, January 30, 2004
    Tenet's Infrastructure Dump

    Big story in Los Angeles today. Tenet Corp. is selling off nearly a third of its hospitals. I know a lot of these hospitals: I'm on staff at Midway and Brotman handles a lot of our open-heart surgeries. Queen of Angels, Daniel Freeman and Centinela all treat a lot of our patients (when you call 911, you get taken to the closest hospital in the area). Whittier Medical Center is less than a mile from my parents' house and has been part of the town for decades. Tenet's reason for doing this is that they can't afford the $1.6 billion earthquake retrofit mandated by the state.

    I have no idea what's going to happen next with this, but it'll sure be interesting to watch. I sincerely hope that most of these hospitals don't wind up closing or we'll be in big trouble.

    Wednesday, January 28, 2004
    Bulgaria Gripped by Potter Fever

    Apparently the producers of the Harry Potter film series have decided that they want to find a genuine Bulgarian to play the part of Viktor Krum in the fourth movie, Goblet of Fire. Ananova has the details:

    JK Rowling put Bulgaria at centre stage of the fourth book after being inspired by the country's fourth place in the 1994 World Cup. In Harry Potter and the Goblet of Fire, magicians from all over the world take part in the Quidditch World Cup, and Krum leads the Bulgarians.

    I applaud Rowling's decision: I spent a week in Bulgaria two years ago, and it's an amazing place. I remember seeing copies of Goblet of Fire translated into Bulgarian being offered for sale everywhere when I was there. Anyway, it looks like every teenager in the country is trying out for the part. Good luck to them.

    Tuesday, January 27, 2004
    People and Their Ears

    Saw a patient today who came in thinking that she had an ear infection. She'd initially thought it was earwax and tried the over-the-counter drops for this problem, with some success but continued discomfort. I looked in her ear and still saw plenty of soft wax. Treatment plan: irrigate her ear.

    It's not unusual for patients to present with symptoms that sound exactly like an ear infection, only to have it turn out to be wax, and that's what happened here. After a successful wax removal, her eyes popped wide with relief and she paid us the ultimate accolade:

    "I feel like I've lost weight!"


    Monday, January 26, 2004

    Come on, Bish. Where's your sense of fun?

    The Archbishop of Rio de Janeiro says samba dancers should be arrested if they go ahead with plans to re-enact the Kama Sutra during the 2004 carnival.

    I must say that a float like this would really liven up the Pasadena Rose Parade.

    How to Win the IKEA Online Adventure

    I'm on a roll today! Check out hints and tips to win the (totally nonexistent) IKEA roleplaying game here. Clearly written by an exasperated male who has been dragged through a furnishings store several dozen times too many (Good Lord, could my brother-in-law have written this thing?), it is hilarious. Samples:

    WORLD TWO: Showrooms

    You start this world armed only with a UNIVERSAL FURNITURE-ASSEMBLY ALLEN WRENCH. This is the weakest weapon in IKEA: You will have to hit a person 16 times with it to kill them. So your primary goal in this level is to find more lethal means of dispatching your enemies.

    As you enter the main area, you will see an EKHARD oiled solid-oak dining sideboard. Quickly kick it apart to acquire the TABLE LEG WITH NAIL.

    As you continue through the main SHOWROOM you will see groups blocking the walkways while chatting and others moving against traffic. These people should be killed immediately.

    ... and so on. I will have to remember some of these ideas for my next trip.

    (via Ernie)

    Dave Barry on Birthdays

    If you have small children, or know someone that does, you'll enjoy this column on children's birthday parties.

    Men's view of said parties versus women's:

    It would be different if dads planned birthday parties. First off, the party would be about a month after the child's actual birthday, which is when dad would remember it. Dad's party theme would be ''delivery pizza,'' which would also serve as the cake, the craft project and the party favor. The entertainment would be pulling dad's finger. The kids would have just as much fun.

    You know, he's right.

    No Win Scenario

    A very nice woman, who'd been my patient for several years, died two weeks ago. I feel frustrated about this particular case, so will give a few of the details to see if anybody has suggestions.

    Let's start by reviewing the statistics for stroke and atrial fibrillation. The stroke rate for patients with atrial fibrillation, who do not use anticoagulants, is six percent per year (so the statistics say).

    This patient of mine had had atrial fibrillation for several years, but was doing well on Coumadin - an anticoagulant - until she started passing massive amounts of blood in her urine and turned up in the emergency room. She was admitted, and workup showed a large tumor on her kidney. We had to stop her Coumadin due to the bleeding. She was discharged, I got her in to see the urologist who was willing to operate, and I was in the midst of making arrangements to have her evaluated by Cardiology when she had a stroke. It was a bad one. She never really woke up from it, and died a week later.

    This stroke happened within two weeks of her discontinuation of the blood thinner. This is the second such case I have seen; I had another patient who developed lower GI bleeding on Coumadin and who had a stroke within a week of discontinuing the drug. Now, for full disclosure, both these patients were over 80 years of age, so their stroke risk was much higher than the average risk I quoted. Still, what do you do when a patient develops life-threatening symptoms on Coumadin but you know their risk of stroke is astronomical?

    I still don't have an answer.

    Tuesday, January 20, 2004
    Late Breaking News

    I passed my Boards recertification!

    [Dean scream] YEEAAAGGGH!!!

    Oh, yes, and V. passed her Endocrine recert too. We're both very happy about it.

    Surfing Recommendations

    In no particular order:

    1. Spaulding Gray is still missing. I hope they find him soon; even a body would be better than not knowing at all.

    2. A listing of white trash recipes - the White Trash Farmer's Omelette is particularly gruesome.

    3. Tim Blair has a whole list of variations on Howard Dean's "concession speech" in his comments, and damn, they're funny.

    4. It's the State of the Union Drinking Game 2004! Get yourself a case or two of beer and play along!


    Yes, I have a blog; no, I haven't forgotten. I have things to say, but no time to say them at present. I'll do something later today while listening to the State of the Union speech.

    Tuesday, January 13, 2004
    I Adore Alan Shore

    So there's this TV show called The Practice, which I imagine some of you have seen - it's been around for years, though I have never been a fan. Apparently it's about a small, scrappy, dedicated firm of attorneys in Boston. They dedicate themselves to helping the downtrodden and take cases no one else will touch.

    Bored yet?

    Until a few weeks ago, I would rather have stuck needles in my eyes than watch anything fitting that description. I'm instantly turned off by any TV show about dedicated professionals - be they attorneys, doctors or teachers. They're guaranteed to be chock full of plots based on current events (slightly changed to prevent lawsuits from real people involved in said cases) and boring self-righteous speeches from the actors who are defending their clients/patients/students against... something.

    Really, what is it that the protagonists of these shows are fighting against? City Hall? Real life? "The Man"? Evil HMOs? Tobacco companies? Give me a frickin' break. First, scripts dealing with these issues magically turn into a bundle of stale cliches - every scriptwriter in television has been there and done that. Second, there's almost always some sort of wrapped-up ending, which rarely happens in real life. Third, these "antagonists" AREN'T. In real life we deal with big corporations every day of our lives; we have to work with others like ourselves, who are overworked and overwhelmed - not evil; and we have to pace ourselves. If I practiced medicine the way the characters on these shows do, I'd burn out in six months. There's no point in treating everybody who doesn't do what I want like The Enemy. You've got to go along to get along, though that may not make for good drama.

    Meanwhile, back on "The Practice": enter Alan Shore, played by James Spader. He's an attorney of slippery ethics who won't stop at much to win his cases. Granted, the writers push this a little far; in the first episode this season Shore admits to his future partners that he embezzled from his previous firm and that's why he was fired. In real life this guy would have been disbarred. Be that as it may, it's clear that he's an asset to the firm. My take on it is that he's the only attorney there who can find his ass with both hands. He isn't troubled by the Big Issues like civil rights violations or racism; he just wants to get his client off and get paid. Huzzah, finally a character I can relate to.

    Someday I'd like to draft a script for a TV series about a medical group myself. It wouldn't involve evil HMOs. It would be more about the doctors and office staff, and they'd be real characters that you could relate to. Their sex lives would be offscreen, and none of the docs would have affairs that you'd know about. Plot lines would involve real-life petty issues, like patients with runny noses who insist on antibiotics and docs letting off steam about patients who annoy them. It might not be a success, but it'd be true to life, and I think it could be more interesting than the current high-minded drivel I see every week. I'd give my characters flaws. Example: me, complaining about patients changing their prescriptions because of the ongoing grocery strike. I've been inundated with phone calls for new prescriptions, and I'm sick of it. Why should my staff and I have to waste time with this do-over work because some self-righteous aging lefty doesn't want to cross a picket line?

    Now. Is that a plot line, or what? You could spend an entire episode on it!

    Thursday, January 08, 2004
    Signs of the Apocalypse

    Lord of the Rings Barbie and Ken. (Do they come with a Middle Earth Malibu condo?)

    Think I'm kidding? Click on the link.

    (via Instapundit)

    Reading Recommendation

    A while back, Glenn Reynolds recommended the Lord Darcy mystery series, written by Randall Garrett. He made them sound quite interesting, so I gave them a try.

    I hereby give them a 9/10. The premise of the series is that it takes place in an alternate universe where Richard the Lion-Hearted never died, the Plantagenets still rule, and the Normandy Invasion resulted in the Anglo-French Empire. The stories are set in a twentieth century that sounds a lot like the nineteenth century crossed with the Middle Ages. They have gaslight and wrist watches, but no internal combustion engines (steam locomotives but no cars).

    Oh, and magic is a science. Every crime investigator works with a forensic sorcerer. Give them a try, they're quite good.

    Wednesday, January 07, 2004
    L.A. Restaurant History

    Today's L. A. Times has an interesting article about the history of theme restaurants in Los Angeles. They first became popular in the 1920's.


    L.A.'s oldest theme restaurant is the still-vigorous Tam O'Shanter in Atwater Village. It has a Disney-esque, artfully ramshackle roof that looked hundreds of years old even when the place was built in 1922. (It's probably no accident that Walt Disney was a regular customer for years.)

    If the link requires registration, use "laexaminer" for ID and password.

    (via L.A. Observed)

    Ilyka, You Shouldn't Have

    Ilyka links to this incredibly funny story, which involves using potatoes in a way you've probably never thought of...

    Tuesday, January 06, 2004
    Golden Oldie

    My last patient of the day yesterday was an add-on belonging to some other doctor in the group. I heard him singing at the top of his lungs in the exam room next door; the patient I was seeing at the time looked at me and rolled her eyes. "I think we've got an Alzheimer's patient in here," I said dryly.

    The note on his chart read "hand laceration." I stepped into the room to be greeted by the unmistakable aroma of Unwashed Elderly Male.

    "Hi, sweetheart!" my patient greeted me. He was a cheerful looking old guy, with what was indeed a nasty-looking laceration across the heel of his hand. At least the margins were clean and it was relatively superficial.

    "How'd you do this?" I asked.

    "Well, honey, I had a tooth pulled yesterday and at 2:30 in the morning I went to the bathroom to rinse my mouth out. Whadda ya know, I forgot to put the lid back on the mouthwash and dropped the whole goddamn bottle on the floor. Next thing you know, I was on the floor." He turned the story into an epic. "I knew it was bad but I didn't want to go to the emergency room, so I just put some tape on it."

    I looked closely at the wound and decided it was something I could suture. I don't do more than three suturing jobs a year (internists almost never use their hands), but I enjoy doing it when I can.

    "Is it gonna hurt?"

    "I'll be honest with you, the first part will hurt. I have to put some numbing medicine in there so I can sew it up and take my time."

    "You do whatever you want, sweetheart. What do I call you?"

    "Just call me Alice." I was starting to like this guy: 86 years old and as sharp as a tack.

    "You don't mind if I sing, do you, Alice? It takes my mind off my troubles."

    "Go ahead." He howled a bit as I injected the lidocaine, and broke into "Shanghai Lil" and then "Shuffle off to Buffalo" as I proceeded around the wound margins. As I broke out the suture material, we started to chat.

    "So you're retired. What did you do for a living?"

    "I ran a newsstand on Wilshire for 42 years," he said proudly.

    "See any movie stars?" I asked, curious to see what kind of local history he could give me.

    "Hah! Did I see movie stars! I saw Jeannette MacDonald! I saw Charlie Chaplin, Paulette Goddard..." The guy was a walking time capsule! He might be a tad eccentric, but there was nothing wrong with his memory. "I worked near the Four Star Theater. They had Lost Horizon playing there for a long time."

    "Ah, yes," I said, stretching my memory. "Ronald Colman."

    "And Margo, Edward Everett Horton..." he proceeded to give me the entire cast list. I was impressed.

    As I finished up, Newsstand Guy began to be concerned about what he'd be able to do with his right hand for the next few days.

    "Keep it dry," I advised him. "Do you have anybody around who can help you?"

    "No. I never married. My sister and I were close, but she's been dead for twenty years." His cheerful demeanor slipped for a moment.

    "Well, look, if you have any trouble this week, you can call Dr. X [his primary care doc]. Or call me."

    "Okay, Alice! Thanks a lot, sweetheart!"

    "You're welcome!" And for once, I meant it.

    Scott Adams is Channeling Me

    I have a new favorite Dilbert quote, culled from a calendar I got for Christmas. After a typically humiliating interaction with a client, Dilbert says: "Lately, the only thing keeping me from being a serial killer is my distaste for manual labor."

    Dogbert's reply: "You're preaching to the choir."

    Monday, January 05, 2004
    Starbucks, Ten Past Seven

    I left for work earlier than usual this morning, shivering: it was cold and overcast as I left the house and the sun was just cracking the horizon. The radio weather forecast is for dry weather, but cold and windy for the next several days: that means static electricity and chapped hands to look forward to. I couldn't wait for office coffee, and decided to hit the Starbucks en route so I could warm up a bit.

    Just after I placed my order, a crowd of people walked in. I was surprised, as usually the morning rush doesn't start till a bit later. I noted the full parking lot as I left, and suddenly realized: everyone is heading back to work and trying to get there early. The holidays are over, and Winter (two months' worth) is ahead of us. You'd think I would have figured that out by now, but seeing the marked-down holiday tchotchkes, the Eggnog Latte off the drinks menu, the crowd of preoccupied workers somehow made it more real - almost official.

    Friday, January 02, 2004
    Happy New Year

    Hope all is well with you. I spent Friday fielding calls from agitated patients (as the office was not open). The good news is, it was telephone call only and I didn't have to go in to the hospital. Saturday night, also, I spent on call - and battling another respiratory infection - but fortunately had no admissions.

    I have spent some time thinking over some New Year's resolutions. I never have been one for making resolutions but this year, it seemed to me that if I did not I would not get anything fun done. So, here are my resolutions (frivolous though they may seem):

    1. Wear a different pair of earrings daily. (I have them, I just don't wear them - I am capable of wearing the same pair of studs for months on end.)
    2. Go to Las Vegas this year.
    3. Go to New York City this year.
    4. Lose weight.
    5. Corollary to #4: Once a month, allow myself to eat out at a restaurant listed in Counter Intelligence. (I have followed this man's columns for years: he is a food writing genius.)
    6. Go to the beach at least once this year. (I have lived in L.A. for ten years and have never once gone to the beach.)
    7. Get kissed. On the lips. By a guy. Not related to me. (Yes, I know it's pathetic. Bugger off.)
    8. Go to the movies once a month. (I rarely go to the movies.)
    9. Go on a vacation outside the U.S. Reading Shauny's posts this year inspired me. I would dearly love to take a rafting trip - perhaps in Siberia (Not as crazy as it sounds) - but we shall see.

    If You're Considering Lasik Surgery

    You might want to read this article from Quackwatch first. Essentially, it states that there is evidence that the Lasik Vision Institute (LVI), which operates in several states in the US, may be practicing bait-and-switch pricing techniques.

    "We Could Survive Here for Weeks!"

    Well, it's the day after New Year's and it's raining. Those of us who had to show up for work did so, sullenly. I have considered issuing an executive order sending everyone home, but I am booked for the day, at least on paper. Some of my patients - the considerate ones - have shown up for their appointments, but quite a few have not. Phone calls: done. Let's blog.

    Doctors' offices, during the holidays, are no healthier than any other workplace. Grateful patients - or those who are trying to kill us by inducing cholesterol poisoning - have been dropping presents off; so have the drug reps. Many of these presents are edible. (I'm working on a handful of pistachios as I write this.) The sport of choice for the last two weeks has been to wander up and down the hall, hunting and gathering like a latter-day Cro-Magnon tribe member. A box of chocolate covered pretzels vanished within a day; one of those tubs with three flavors of popcorn doesn't last long here either. (Except for the caramel-covered popcorn, which none of us really likes.) Let's not think about cholesterol levels just yet.

    Southern California has pulled off its annual New Year's Day miracle again; the massive rainstorm that was supposed to hit us on December 30 veered off to the south, and the storm following it didn't move in till early this morning. Result: no rain on the Rose Parade, again. For those of you who have never seen the parade in person, it's worth it. Everyone should go at least once, just to see the incredible detail on the floats; seeing it on TV just isn't the same. My family never went to the parade when I was growing up, but for the last several years I have been one of a group of people that makes the annual trek to Pasadena. A kind friend who lives within walking distance of Colorado Boulevard hosts us, provides chairs, and hires students to hold them overnight. (It's traditional for parade watchers to camp out overnight for the best seats.) After the parade, we all march back, eat a huge buffet lunch, and fall asleep watching the football games. It's great.

    Hope you had a good New Year's.

    "Firing Metaphysical Blanks"

    This site awards the "Puffies" to some of the worst book blurbs of 2003. I found it riveting! Gripping! I couldn't put it down!

    ... uh, well, it's amusing. Give it a look.

    (via Bookslut)