Feet First

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

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    Friday, April 29, 2005
    New Blog

    OK, this puppy is going on the sidebar right now. It's Waiter Rant. Absolutely hilarious. Anytime you click on a new blog and the first post that hits your eyes is something as funny as this, you know it's got to be good.

    Thursday, April 28, 2005
    "Grim Reaper Parties"

    Thanks to GruntDoc for this link to the latest social event: living will parties.

    Some Americans, prompted by their desire to avoid the problems that surrounded the Terri Schiavo case, are gathering at parties where they balance their chardonnay along with clipboards holding living will forms.

    "People are sitting around, munching on brie and talking about dying," says Dan Nicholas, an insurance salesman, while hosting a living wills party last week at his home in Santa Cruz, Calif.

    Whatever works. According to the article, the forms provided at these parties are often pretty generic and may not be all that helpful for detailed treatment planning. However, I like the idea of people getting to think about these issues in a non-threatening (social) environment where they're seeing their friends grappling with the same problems. We all have to figure this stuff out. These parties also give you a chance to swap stories and hear about other families' dilemmas and treatment decisions. So overall I'd say it's a great idea.

    I do wonder though if Mr. Nicholas, insurance salesman, took advantage of the party theme to hit the attendees up for extra life insurance coverage. Hee!

    Tuesday, April 26, 2005
    Mind Control

    Every doc has at least one patient who's a certifiable wacko. Not just somebody who rubs you the wrong way, not somebody who has their Own Ideas about what kind of treatment they need, I mean feet-off-the-surface-of-the-planet wacko.

    I saw mine today. She is definitely Doctor with a Cutlass material. I do feel sorry for her, but I have no idea why she keeps coming to see me, since she's rejected every conventional medical treatment I have to offer. Briefly, she was diagnosed with breast cancer some time ago, I think about two years. After considerable negotiation she underwent surgery and was told she needed adjuvant chemo and radiation because she was considered to be at high risk for recurrence. Instead, she has spent an unbelievable amount of time and money embracing every alternative treatment known to man, including a "cleansing diet" of raw organic fruit and vegetable juices that supposedly revs up the immune system to attack the tumor, coffee enemas (I wish I were kidding), and the latest treatment she sprang on me today. She has rejected follow-up mammograms because they involve radiation - obviously - and she is convinced that they will cause further tumor formation. Never mind that it took a mammogram to discover the thing in the first place, and the total lack of evidence that mammograms cause cancer.

    At least her treatment du jour lightened my spirits a bit - in fact, I found it hard to keep a straight face in the exam room. She had gone out and purchased some relaxation tapes which put the brain into an "alpha state," thereby raising (or was it lowering? I forget) cortisol levels, thereby making the body more able to fight off cancer. Now, I have no problem with meditation or relaxation tapes per se. There is evidence that daily meditation or relaxation techniques can help lower blood pressure, for instance. What nearly caused me to lose it in front of the patient was a sudden thought:

    What if these tapes are full of subliminal messages? What if she's being programmed to take over the world? I suddenly recalled the Charles Bronson movie Telefon in which previously brainwashed people picked up the phone, heard a coded message which "activated" them, and headed out to wreak havoc and then off themselves. Just picturing the guy pushing these tapes as a stealthy Donald Pleasence type recruiting a zombie army was enough to give me the giggles. It wouldn't be too difficult - patients who can be convinced to give themselves coffee enemas can be convinced to do damn near anything.

    How to Make Vacation Last Forever and a Day

    ...spend it cleaning out somebody's apartment. Preferably somebody that you don't know.

    OK, here we go. The storyline here actually begins back around New Year's, when for some reason I made three resolutions for myself:

    1. Visit Vegas this year. (See previous post.)
    2. Visit New York this year.
    3. Wear different earrings every day. (I buy them, I just don't wear them. I tend to stick to the same pair of studs on a daily basis.)

    Well, then skip forward to late January: I was at home one night when I got a call from V. on her cell phone driving home.

    "I need to talk."

    "OK, talk."

    She told me the story of a close family friend who had no local relatives (never married, no kids), who was in the hospital with a stroke. V. held her power of attorney (and had found this out just shortly before). Purpose of phone call: V. needed help - or, to be more precise, she foresaw the likelihood that she would need help. My response: "Well, I made this resolution this year that I would go to New York. Looks like this is it."

    The friend, Dottie, died about a month later. We decided to go to clean out her place the week after April 15 (tax day). So, we left the night of Friday, April 15 on the redeye flight and arrived early Saturday am. After a nightmarish trip on the subway - nightmarish because we were each lugging 40 lb. suitcases, and good luck getting those things through turnstiles - we arrived in Queens.

    This apartment building was the same one V. had grown up in, and in which her mother had lived until 2000. Let's just say this was not an easy trip for her. Add to this the fact that poor Dottie had clearly been a hoarder and compulsive shopper, and had given up on cleaning the apartment. Clothing was stacked everywhere - the closets were stuffed, clothing was hanging off every doorknob and molding in the apartment, and there was an ironing board in the dining room fringed with hangers loaded with clothing all the way around its perimeter. If it had been me alone, I would have taken one look, turned around and gotten back on the next plane to L.A. But such was not to be.

    "Pitch, Pitch, Pitch, That's All You Ever Do"

    We spent that first day frantically cleaning the kitchen and bathroom so that we could have a bit of room to maneuver without our feet sticking to the floor (so help me God, I am not exaggerating). I will spare you most of the details, but suffice to say that the glass facings of the kitchen cupboards were covered in a thick nicotine film - though Dottie had stopped smoking at least ten years prior to her death - and that V. found two dead mice in the kitchen. We also threw out untold numbers of cans of food with bulging tops that had corroded their bottoms and from which food had leaked. I recall V. waving a bottle of blackened bleu cheese dressing at me, which provoked an immediate gag reflex. I promoted myself to chief cook and bottle-washer so that V. had more time to go through the papers, photographs and personal memorabilia, of which there was no shortage: it was clear that this woman had never thrown anything away, and she had lived in the apartment for more than sixty years.

    On Tuesday, as we were leaving to finalize the arrangements at the restaurant where Dottie's memorial luncheon was to be held later in the week, I found V. wandering around the living room with a trashcan and a stressed look munbling, "Pitching, I'm pitching as I go." I immediately struck an attitude and whined, "Pitch, pitch, pitch, that's all you ever do." I got the laugh I was looking for (my other job for the week: court jester!) Speaking of pitching, rule number one of the week was established early on: never leave the apartment without a bag of trash in your hand. The apartment is a second-story walkup, so you can see why this was so important. It became difficult to approach the door without tripping on the one dozen or so plastic bags of garbage sitting next to it, so every now and then a garbage run or two was required to restore order.


    At the restaurant, there was a TV over the bar. We finished picking the lunch choices and suddenly noticed that there were bells ringing nonstop at the Vatican... white smoke... a new Pope! V. and I hung out for about half an hour, fending off offers of coffee from the owner, to see who the new Pope was. It was amazing to see the crush of people in the square. We drank a toast to Benedict XVI at lunch.

    Julius Caesar

    I was in charge of entertainment, and naturally left this important issue till the last minute before leaving. Fortuitously, I caught a review of Julius Caesar in the "Wall Street Journal" the week before we were to leave and bought tickets - not because of Denzel Washington, but because of his costar, Colm Feore. The review overall was not positive, but gave high marks to Feore, and that was all I needed to hear. (Fangirl that I am.) He was fabulous, and V. and I both thought the play as a whole was pretty good.

    Well, now I'm back and overwhelmed with work, so shall sign off for now. Overall it was a good trip - V. and I both came back with resolutions to clean our homes and throw stuff away!

    Oh, and the earring thing - I'm doing pretty well with that resolution, too. Wow, resolutions I've actually kept... what a concept.

    Friday, April 15, 2005
    Hello, Gentle Readers

    I've been meaning to post. Really I have. But Things kept getting in the way. Things like meetings, and patient-packed days that produced fatigue like unto brain death, and my performance review. Yes, doctors do get performance reviews. No, they aren't going to fire me. (Dr. Alice does not play well with others. She needs to work on her communications skills.)

    Last weekend I took a whirlwind trip to Vegas and had a total blast. I met up with a friend from college that I hadn't seen for years. It was cool and breezy (it actually rained Friday night!) The funniest part of the trip was the leaflet in the hotel room apologizing for the Vegas moth infestation - the extra rain this year produced a bumper crop of moths which were somehow getting into the hotels and annoying people. The second-funniest thing about the trip was the realization that the hotel was infested with "Parrot Heads." As I checked in I saw a homemade sign behind the bell desk:


    Say what? was my reaction, but I was too tired to ask. As I rode up in the elevator, three people wearing aloha shirts, draped in Mardi Gras beads, and carrying Corona beers got on with me. I made eye contact with the most cheerful looking of the trio and asked, "What's a Parrot Head?" Gleefully, he waved an ID badge at me which was emblazoned with a picture of a grinning man on a beach with a guitar slung over his back and the name "Jimmy Buffett." Aha! Let me say that nothing adds to the Vegas experience like having a bunch of fun-loving drunken guys in grass skirts and parrot hats wandering around your hotel.

    That Saturday night we took a helicopter flight around Las Vegas. The skyline was spectacular, and as we passed the Luxor, with its pyramid shape and laser beam, I noticed what looked like glittering confetti in the beam... oh my God, those are moths! Yep, hundreds of moths drawn to the Luxor like, um, moths to a flame. Well, if they're frying in the laser beam at least they're not infesting the hotels.

    Tonight V. and I are en route to New York for a week. A relative of hers died and she has to clean out the apartment; I said I'd help. (She believed it!) In all seriousness, I'm going to help her get things organized and start dropping things off at thrift shops, etc. We do plan to do some sightseeing and theater as well. If I can make it to an Internet cafe, I'll post; if not, you will hear from me upon our return. Hasta la vista, baby!

    Tuesday, April 05, 2005

    Glenn Reynolds posts observations on women, and cellphones, on campus. About the health risks: no one knows for sure, but V. recently recounted to me (V., are you there? Pipe up here.) a conversation with a neurologist we both know. V. saw this neurologist talking on the phone using an ear plug.

    V. - "What do you think about the studies on cell phones and brain tumors? Does that concern you?"

    Neurologist - "Oh yeah." (Or words to that effect.)

    Me, I almost never use the things because I hate them, but if I used cell phones regularly I'd get an earplug for sure.

    And on a totally different subject, please join me in congratulating the King of Australian Home Cooks on a blessed event! This thrills me no end.