“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

 
So Tired

I've taken on extra shifts in the evening urgent care clinic and for night call to try to get this home renovation thingy paid for. I'm working Thursday, Friday and Saturday shifts this week; wasn't scheduled to work tonight, but the doc who was called in sick and I took his shift. This means I've been seeing patients for, oh, eleven hours or so. It feels like I'm back in the ER.

I'm not afraid of work. I used to have a part-time job in the Northridge Hospital ER back when I was working in the Valley (more about that tomorrow) and the weekend shifts there were twelve hours - that's standard in most ERs. One Memorial Day weekend I set myself a goal: to see one hundred patients in three days (Saturday, Sunday and Monday). I almost made it: we saw 97. They closed down the Fast Track early Monday evening because people stopped coming in and sent us home to save money. I was pissed, not grateful: I wanted those last three patients.

The indoctrination starts early in medical training. Don't complain, suck it up, the more you can do the better you are. I'm not writing this to grouse, I'm grateful to have the work and the extra money, but sometimes I sit back and wonder about the insanity of a professional mindset that encourages us to push everything else (families, our health, hobbies) to the wall and put our patients first.

The system as it exists now is coming to an end, not imminently, but within the next ten to twenty years. The docs coming out of residency now are shooting for specialties that allow them to spend more time with their families, like Derm: no one wants to do primary care anymore, or if they do, they want nine-to-five hours and no night call. Specialties like hospitalist care and emergency medicine are becoming more popular because they have set hours. With dropping reimbursements, there simply is no financial incentive any more to take on the backbreaking work of primary care. My prediction: in 25 years most people will be getting their primary care from nurse practitioners or physicians' assistants. I don't think that's intrinsically wrong, but it won't be the same level of care. I know a lot of very competent NP's and PA's, but to claim their training is comparable to an internist's four years of medical school and three years of residency is simply not so.

Sometimes I think that when I retire, I'll be put in a glass case with a plaque that says:

LAST INTERNIST ON THE NORTH AMERICAN CONTINENT
EXTINCT

posted by Dr. Alice at #

 
It's Frighteningly Real

Okay, this is funny. At least once or twice.

(via Dave)

posted by Dr. Alice at #

 
Where's the Neck Clamp?

When I saw this picture, all I could think of was Gene Wilder in Young Frankenstein.

"You mother-loving bastard!"

posted by Dr. Alice at #

 
Burning Question

For lunch today, I split a "Quattro Staggioni" pizza with a friend. The name means "four seasons" and refers to the pizza topping. The pizza is divided into quarters and each quarter has a different topping: Kalamata olive, mushroom, Canadian bacon, and artichoke. It's a very good pizza, but the question that is driving me crazy is this:

Which topping symbolizes which season?

Let the speculation begin!

posted by Dr. Alice at #

 
Through L.A. With Mouse Ears

Two weeks ago I spent Sunday afternoon touring downtown Los Angeles on a bus. This wasn't your ordinary tour riding around looking at Hollywood Boulevard; it was led by a man named Charles Phoenix, who loves L.A., mid-century culture and architecture, and general oddities. He's become well-known locally for his slide shows of mid-twentieth-century life in Southern California. Yes, slide shows. Charles Phoenix has a hobby collecting slides from thrift stores and estate sales; he found enough to put together shows illustrating the city and its denizens' lives as they were forty, fifty or sixty years ago. I've been to several of his shows and they're great. He researches the people in the slides and can usually give some information about who they were and what they did for a living. (Example: older lady in a suit and gloves at Disneyland: "This is Gladys, she lives in Burbank and runs a beauty parlor.") Anyway, he's branched out and started running tours of the city, which he calls "The Disneyland Tour of Downtown Los Angeles." Phoenix leads the tours, and he does in fact wear a Mickey Mouse cap with ears.

We toured:

* Union Station (Main Street U.S.A. and the Disneyland Railroad)
* Olvera Street and Chinatown (Adventureland)
* Carroll Avenue's Victorian homes in Angelino Heights (the Haunted Mansion)
* Bob Baker's Marionette Theatre and Toyland (Fantasyland)

and much, much more. I loved the detail he was able to provide: did you know that there are cigar cutters installed on the walls of Union Station, for instance? They looked like brass decorative dinguses, but no. They're cigar cutters and they work. We were able to go into the station's original restaurant and bar (which are now closed to the public) just to look around - it's an Art Deco treasure. Toyland isn't as much fun as it sounds - a couple of streets in industrial downtown where all the toy manufacturers and importers are. It also happens to be part of Skid Row. But some of the buildings are quite beautiful, and Phoenix enthusiastically pointed them out.

Highly recommended, if you're in Los Angeles. Click here for information on the tour. Currently the tours are basically sold out, but he will be adding more tour dates. It's $65 per person and worth it - the most entertaining six hours I've ever spent.

The L.A. Weekly has written an article about Phoenix's tour: click the link and scroll down to the fourth article, "Mr. Phoenix's Wild Ride." They liked it too.

posted by Dr. Alice at #

 
Link Time

Ernie has been on a roll lately. First, check out this post about computer games encoded in 1980's vinyl computer records. Really. It's a very interesting article, not least because it highlights by example how remarkably primitive computers were twenty years ago and how far we have come. The process for playing said games was quite cumbersome. First, you had to tape the encoded information off the record and then insert the tape into a home computer - the Sinclair Spectrum system, which used the TV screen as a monitor. Most of these games were the old-fashioned text adventure type of game. You know, where you had to keep a map on graph paper to keep track of where you were going and if you didn't get the verbs right the program would merely say, "I don't understand that command." Instead of "go" or "walk," it might be "march" or "saunter" or "crawl"... whatever the cackling little geek writing the game could come up with. Sadistic bastards.

Next, a neat little website about bento lunches with mouthwatering pictures. Sushi isn't my thing, but the food is arranged so beautifully... and these are school lunches, packed by a mom!

Lastly, the world's silliest NASA promotional tie-in: "One small step for man, one giant leap for Giant Shrimp."

That is all. Carry on as you were.

posted by Dr. Alice at #

 
Why I Like Orthopedists

At least this orthopedist...

[excerpt from consult note]

[Patient] injured her left knee in yoga class. The class is in a chiropractor's office, and as soon as she injured her knee doing some type of a twisting maneuver, the chiropractor applied a 40 dollar knee wrap.

This is the first consult note I've read in a while that made me laugh.

posted by Dr. Alice at #

 
What Doctors Talk About in Staff Meetings

During our monthly office meeting on Friday, we met with a spokesperson for a company which provides home nebulizers and meds to patients with breathing problems. He was particularly proud of a new, miniature, portable nebulizer which he demonstrated for our use, and which consisted of a small inhaler attached to an on-off button which looked rather like a computer mouse. Among its other virtues: it's completely silent. When the demonstrator pressed the button a stream of what looked like fog came out of the mouthpiece, with absolutely no noise. Wonderful little toy, expensive as hell, I'm sure.

I stage-whispered: "It's a bong."

Our medical director: "I hope you never run for public office, Alice, because I'll have to come forward and tell everyone about this. You seem awfully familiar with drug paraphenalia." (Yes, she was kidding.)

Me: "I, uh, read about them somewhere."

General laughter, including from the rep, who fortunately had a sense of humor.

posted by Dr. Alice at #

 
As I Was Saying...

My "pause" turned into a hiatus, it seems. I just haven't had the time or energy to post for awhile, but I'm back. I may need to do more blogging on weekends, since that's the only time I have to think or write right now.

From Allen: "How's the remodeling coming?" Glad you asked. It's coming along fine, except for the two days without hot water I had to deal with last week. My brand-new water heater malfunctioned, and my contractor spent an entire day trying to fix it himself before giving up and phoning the manufacturer, who sent somebody out who was able to figure out what the problem was. I also had to renegotiate my home equity loan, which has taken up a chunk of the last two weeks as well. This project is expensive, but it'll be worth it when it's done; the new furnace and fan are in, and on hot days I can now turn on the fan which sucks all the hot air down into the space under the house and pulls cooler air in through the windows. The first time I tried this the temperature in the house dropped ten degrees within twenty minutes. This should make summer nights much more bearable (I don't have air conditioning).

In recreational news: I have finally seen the first two installments of the Lord of the Rings trilogy, thanks to an "intervention" from friends of mine who said that I absolutely had to see it. (Thanks, Scott and Mary!) Yes, I know, I'm two or three years behind the times. My reaction: wow. I've never read the trilogy and couldn't get through "The Hobbit," so I wasn't sure whether I would enjoy it or not - but I did. The scenery is stunning! Elijah Wood as Frodo is wonderful, as are all the actors, but I liked the hobbits best. Now I have to see the final installment, hopefully next weekend. Peter Jackson deserved every Oscar he won.

More soon.

posted by Dr. Alice at #

 
Greetings, Gentle Readers

Sorry - it's been the week from hell. Will post more this weekend, I promise.

posted by Dr. Alice at #

 
Unexpected Vision

Tonight on my way home I was startled to see a car draw up alongside me with a beautiful Afghan hound leaning out the back window. (With his ears flopped back behind him, I thought for a moment I was looking at Jar Jar Binks. I blame this on my hallucinatory post-call state.) He looked to be having a wonderful time. I tried to keep up with his driver, but unfortunately lost him.

This dog had a sense of dignity. Unlike many dogs in cars, he wasn't hurling himself hysterically around the back seat; he simply wanted to see what was going on. He was eyeing the traffic with almost scientific interest.

I want a dog. Damn, do I want a dog.

posted by Dr. Alice at #

 
Cute Easter Idea

Oooo! Mozzarella cheese bunnies! I wonder if they make Peeps out of Mozzarella too...

posted by Dr. Alice at #

 
I Got Yer Productivity Enhancer Right Here

Feel like playing some 80's video arcade games? Pac-Man, Frogger, Donkey Kong, Space Invaders - they're all here. You can even play Pong.

posted by Dr. Alice at #

 
Most Guilt Inducing 404 Page Ever

Click here.

posted by Dr. Alice at #

 
Suessentennial

Today is the one hundredth birthday of Theodore Suess Geisel, better known as Dr. Suess. To celebrate, go read On Beyond Zebra or one of his other books. I've always been partial to And to Think That I Saw It on Mulberry Street, myself.

posted by Dr. Alice at #

 
No Weddings, Two Funerals

Apologies for the lack of posts. This has been a difficult week. On Tuesday I went to church for a school board meeting and ran into a friend who told me that a mutual friend of ours (I'll call her Jennifer) had died that day. She had metastatic colon cancer which was diagnosed about eighteen months ago; unfortunately, it had already spread to her liver at the time they found the tumor.

Jennifer was the parish administrator for many years, and did a fantastic job. She also sang in the choir, and her memorial service was attended by current and former choir members who sang with her. The music was outstanding, and the eulogy was given by the choir director.

Jennifer's illness kept her away from church for over a year before she died. I sent her a card or two, and sent some food for her family after her initial diagnosis, but I could have done more. I always intended to call or send her a letter to update her on what was going on at church, but I didn't - I always got sidetracked. It hurts to think of that now, but I have promised myself that I will not let that happen again.

Michael's funeral was Saturday, and Jennifer's was yesterday. I was acolyte at both services. I'm glad I did it but I'm still wiped out. Please excuse the lousy writing today, but I wanted to let you know what was going on and I know I'm not going to have time to edit this.

posted by Dr. Alice at #