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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    Tuesday, January 31, 2006
    One Out of Ten Doctors Recommends It

    Got the following email from V. and had to pass it along.

    Subject: Ask your doctor or pharmacist...............

    Do you have feelings of inadequacy? Do you suffer from shyness? Do you sometimes wish you were more assertive? If you answered yes to any of these questions, ask your doctor or pharmacist about Tequila(TM).

    Tequila(TM) is the safe, natural way to feel better and more confident about yourself and your actions. Tequila(TM) can help ease you out of your shyness and let you tell the world that you're ready and willing to do just about anything. You will notice the benefits of Tequila(TM) almost immediately, and with a regimen of regular doses you can overcome any obstacles that prevent you from living the life you want to live. Shyness and awkwardness will be a thing of the past, and you will discover many talents you never knew you had. Stop hiding and start living, with Tequila(TM).

    Tequila(TM) may not be right for everyone. Women who are pregnant or nursing should not use Tequila(TM). However, women who wouldn't mind nursing or becoming pregnant are encouraged to try it. Side effects may include dizziness, nausea, vomiting, incarceration, erotic lustfulness, loss of motor control, loss of clothing, loss of money, loss of virginity, delusions of grandeur, table dancing, headache, dehydration, dry mouth, and a desire to sing Karaoke and play all-night rounds of Strip Poker, Truth Or Dare, and Naked Twister.

    Sunday, January 29, 2006
    Oscar Chase

    The nominations are coming out this week. In stark contrast to last year, I have actually seen some of the films that are likely to be nominated.

    Brokeback Mountain. Entertainment Weekly called this "Edith Wharton with Stetsons," and by God, they got it right. This story of a doomed love slowly but surely draws the audience in and strikes a nice balance between romance and accurately depicting how the relationship between these two men destroys their lives and the lives of their wives/(female) lovers. It's just absolutely outstanding. Ang Lee does a wonderful job of directing, and the scenery is amazing. The attention to detail is remarkable, too; I kept thinking, "Oooh, look at the cars! Look at the hairstyles! Is she doing the laundry on a washboard?"

    Good Night, and Good Luck. George Clooney did a really, really good job. The power of metaphor drives this film, re-enacting the paranoia of the Communist hunt that poisoned US society in the 1950's. Apparently he filmed this picture on a budget of $8 million using his buddies and the CBS studio in Los Angeles. GN&GL is an object lesson in how to make a movie on a small budget - it uses only one set, more or less, and a small cast. I must confess that I have a thing for men in white dress shirts with their sleeves rolled up; when I saw this film I thought I'd died and gone to Fetish Heaven. On the other hand the good and bad guys are, like the movie, depicted in black and white. I was reminded of the 2004 Rathergate showdown: That, too, pitted the little guys against the big establishment (oh, exquisite irony! CBS had become the big establishment). That story would make a riveting film... but George Clooney will never make it.

    Partner? I Don't Even Know 'Er!

    Odd incident in the office this week, which I recounted to two friends during an evening at the movies. They were vastly amused:

    I saw a patient of mine a few days ago who had recently had back surgery. While in the hospital she was followed by the hospitalist group we're contracted with. (Yes, I do some hospitalist work, but the managed care plan for seniors has a separate hospitalist contract. Long story; don't ask.)

    "So," my patient said, partway through this visit, "the hospital people said this doctor was your partner."

    "Well, sort of," I qualified. "She isn't a member of our group, but she is one of the hospitalists who see patients for us."

    "No, they said she was your partner. In the vernacular sense."

    I stared blankly, then I got it. "Oh, no. I don't think I've even met her." The patient shrugged, and we both laughed; there must have been some lapse of communication there, but I'm not sure what.

    By coincidence, the movie my friends and I had just seen as I recounted this story over dinner was this one. (I highly recommend it, by the way. Go see it if you haven't.)

    Make Your Own Bollywood Movie

    We now return to our usual inconsequential blather...

    I call this "Tryouts for Cats."

    (Via Tim Blair)

    UPDATE: I'm supposed to be catching up on my charts, but this is way more fun:

    "Call Night from Hell"

    Tuesday, January 24, 2006
    Whoa, Dude

    You've heard of In-N-Out Burgers' double-doubles or triple-triples perhaps? Well, feast your eyes on this 100x100. (from L.A. Foodblogging)

    Quick, Watson, the Lipitor!!

    Sunday, January 22, 2006
    This Says It All (via Diversion Surplus)

    Friday, January 20, 2006
    Death Watch

    Dr. Oscar London is right when he says "It's the young deaths that kill you." It's hard to lose somebody with good protoplasm who "should" be able to triumph over their disease, or at least could have several years ahead of them (with luck and good treatment). Nothing is more frightening or makes doctors feel more impotent than watching patients like that fail treatment. Right now V. and I are standing on the sidelines watching someone die.

    She is younger than either of us. She was diagnosed with cancer six weeks ago. She is in Intensive Care, on a ventilator, in multi-organ-system failure - actually, it's mainly her liver that is failing; it's riddled with tumor. She has breast cancer. She's under forty years old. We are trying chemo, treating her bleeding diathesis with fresh frozen plasma, doing all the things we can to keep her going. If she were ten years older, she'd already be dead, but no one's body can take this kind of punishment for long. Over the holidays I was covering V.'s practice, so it fell to me to tell this poor woman that her CT scan showed tumor in her liver (her initial complaint was persistent abdominal pain). She had only just gotten the results of the breast biopsy the week before. Now two weeks later she's in the ICU.

    Lately I've been thinking a lot of a case I saw as a new intern. My first rotation was in the ICU. One day a woman in her early forties came into the emergency room. She was in good health, had had the flu for several days, and came in because of shortness of breath. When I first saw her, she was able to talk and tell us about her illness; she was on a ventilator within the hour; one week later she was dead. It was pneumonia, followed by sepsis and organ failure. The culture results - I still remember this - showed uncomplicated strep. pneumonia as the causative agent. It wasn't drug resistant, it was even sensitive to penicillin, for God's sake! Why couldn't we save her?

    We're used to taking action, to implementing plans that work. When cases like this come along they remind me that I don't have the power I like to think I have. I can't fix people. I hate being reminded that diseases are smarter than I am. I hate feeling useless.

    I hate watching people die.

    Thursday, January 19, 2006
    Site of the Day

    Grocerylists.org - post after post of discarded grocery lists. Why? I don't know, but I think it's pretty neat. It feeds into that universal fascination of seeing what other people are doing with their lives... or is that just me?

    Wednesday, January 18, 2006
    To the Guillotine With Her!

    It's the Marie Antoinette action figure... with ejector head!

    I then got carried away and found this. Ew.

    Email Aliases

    We continue to be besieged with spam at work, although fewer now that we have a new Windows program which is more accurate at sorting the email sheep from the goats, as it were. I have come to admire the writers' ingenuity at coming up with names which slip past the program, and so has V., who emailed me the following:

    I got a junk email from Supple P. Apotheosized. I never open them. But anyone who sounds like it could have been a role played by Groucho Marx is highly tempting.


    Tuesday, January 17, 2006

    So, 24. I had never seen the show till this weekend, though it's up to the fifth season. I know the premise - anti-terrorist guy has a really bad day - but it took Dave Barry's demented recaps of last season to convince me to try it. Fox TV aired two 2-hour episodes for opening weekend, which takes us up to 11 a.m. That means that four hours into his day, Jack Bauer has had his cover as Harmless Oil-Rig Guy blown, has been framed for the assassination of the former president, has kidnapped his girlfriend's sullen 15-year-old son to keep the kid from going to the cops, sneaked into the murder site wearing a disguise consisting of sunglasses and a stolen ID even though the building is crawling with FBI agents, and thwarted a hostage crisis at Ontario Airport. (My reaction: what, Burbank wasn't good enough?) Oh, and managed to bond with the kid.

    Midway through the first episode, I realized what this show really is: Hollywood has dusted off the adventure serial format and updated it. That's all this is. Most of the viewing public is too young to have experienced cliffhanger-type shows... unless you remember Batman, a parody of same, which I insist doesn't count. That's why this show is such a success. Throw in a healthy slug of paranoia, computer screenshots, cell phones that can do damn near anything, blood and gunshots and you're all set. If only they'd named Keifer Sutherland's character Jack Armstrong instead of Jack Bauer, it would have been perfect. Once you realize this, it's fun to hear Jack Bauer say code phrases like, "I am in a FLANK TWO position!" and watch it go right over the terrorists' heads, when even I could figure out that he might as well be holding up a cue card that says, "DON'T LISTEN TO ME THIS GUY IS HOLDING A GUN TO MY HEAD."

    So next week, return with me to those thrilling days of yesteryear... or possibly in the not too distant future, it's kind of hard to tell... and give 24 a try. Cheer Jack on, hiss the villains and try to figure out what the heck is in those mysterious canisters the bad guys were unpacking at the end of Episode 4.

    "Rodents of Unusual Size? I Don't Think They Exist."

    ... oh yes they do, and I can prove it.

    My family and I went to Mexico after New Year's; the high point was seeing lots of capybaras running around the hotel grounds. My sister's kids dubbed them "rat-rabbits" and they do look like a combination of the two. These things were semi-tame and perfectly happy to eat bread, crackers or anything else thrown to them.

    More later, as I am still up to my eyeballs. I did watch "24" for the first time this weekend and absolutely loved it, so will probably spend time ranting about that.