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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    Sunday, June 28, 2009
    Overdue Update

    I've been feeling bad for a while now that I have not posted more on this blog. But pretty much all I have to talk about is work, and I don't want to be posting about other people's (which is to say patients') travails. It's bad form to reveal someone else's personal tragedies. Listing is one thing, details another.

    Though I haven't written about it, much has been happening here in Feet First Land and not all of it good. Back at the start of the year I went on a lovely trip which I still intend to post about more someday... but I returned to several other changes: my two former office partners have left -- one moved to NYC, one moved just down the hall -- and I now have two new partners. I will refer to one of these two new partners as The Thorn In My Side, or TTIMS, because that's what he is. TTIMS is, at a rough guess, 35 years older than I am. He's a nice enough fellow but he seems to have graduated from a residency program circa 1912. Lest you think I am exaggerating, I will tell you that he calls all female MD's he works with "honey" and "babe" and squeezes their arms -- not meaning to be creepy but affectionate. I can deal with that (just), but there's more. He also micromanages (in the sense of holding a magnifying glass over his secretary) his office, but apparently to little effect: He sees about half the number of patients that I do. The biggest problem is that he perpetually complains but refuses to change anything about his office arrangements. My motto has always been "Don't complain unless you're willing to take action," but this is exactly what he won't do.

    In addition, and more saddening, is the almost endless parade of bad news among my patients. A new patient with mental status changes turned out to have a glioblastoma (brain tumor) and died within a month. I've had several new diagnoses of lung cancer, brain cancer, myeloma and a probable amyotrophic lateral sclerosis. And a beloved relative has been diagnosed with a serious illness, is now undergoing chemo and will need further aggressive treatment later this summer (I have been signed up as caregiver when relative begins this treatment). In short it's been a difficult six months.

    The good news: I think I have finally found the impetus to begin the novel about primary care medicine that I've always wanted to write. Who knows if anything will come of it.


    Thursday, June 25, 2009
    Man In the Mirror

    I'm always going to wonder what Michael Jackson was thinking about when he sang these words:

    I'm looking at the man in the mirror
    I'm asking him to change his ways...
    And no message could've been any clearer
    If you wanna make the world a better place
    Take a look at yourself and make that change

    I had a chat with one of our pediatricians this afternoon after the news broke. We agreed that children everywhere could probably sleep better now. Sadly, the man had talent to burn and he was one of the world's great dancers; he was also completely screwed up.

    He also left us a legacy of whacked-out wedding videos... we will be watching wedding parties reenact "Thriller" for a long time.

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    Sunday, June 21, 2009
    Pixar Aims High, Doesn't Miss

    I saw Up this weekend, which means I've already seen two more films this summer than I saw last year. Here's your real short film review: it's excellent. Go see it.

    Long version: last week after seeing Star Trek my friends and I went to dinner, during which I whined: "What is it about screenwriting today? Why doesn't anybody realize it's about the characters, and the dialogue, and the plot? I mean, look at those trailers we watched!" (G.I. Joe and Transformers II, in case I have to remind you).

    One of my friends who has a fair amount of screenwriting experience responded with reasonable answers (the amount of money invested in films today, the value of toy rights, video game rights, etc.) I know he's right, but in all but the most exceptional case you wind up with crappy, unwatchable films with the sound of things blowin' up for two hours. Oh, and perhaps the hero and heroine getting it on for a couple minutes, just for a change.

    Pixar has miraculously managed to avoid this pitfall. They consistently come up with brilliant, imaginative, watchable films featuring characters that the audience identifies with. Up is no exception; in fact I would say that Pixar has outdone themselves with this film. From reading reviews on IMDb I got the impression that the people who had issues with Up thought it was either a) too sad or b) had too much comic relief. Me, I thought they hit just the right balance.

    Let me be honest and say that you probably don't want to take a little kid to this film. It deals with the Big Scary Stuff like aging, death and having your parent desert you. But Up touches lightly on these heavy themes and gives us a healthy dose of imagination and adventure to sweeten the bitter undertone, and sends you out of the theater feeling uplifted. So to speak.

    I will just give you a few of the highlights that struck me. The montage at the beginning of the film, which tells the audience about Carl (the protagonist's) life, is brilliant and will in fact move you to tears. What really hit me was a split second shot during the wedding scene. The camera viewpoint moves from the bride's family, madly applauding and happy, to the groom's family - tightly smiling and tepid. That's all we need to know about why child Carl is so monosyllabic and why he is the way he is as a senior citizen. Brilliant.

    The dogs: some of the commenters in IMDb felt they were crappy comic relief. I couldn't disagree more. They don't literally "talk," but wear translator collars which turn their thoughts into English. This was another incredibly imaginative idea, as it allows for lots of humor when the collars malfunction (Alpha Dog's collar keeps doing this) and gives the dogs an interesting cadence in their speech. It's slightly stilted and the syntax is a bit off - in short, they don't sound like people, they sound like dogs. Also, I give the film major points for avoiding butt-sniffing jokes, "dogs marking their territory" jokes and so forth. They don't have to go there: they're Pixar.

    Ed Asner does great voice work as Carl Fredricksen, and it's a delight to hear Christopher Plummer as bad guy Charles Muntz (his character resembles Errol Flynn crossed with Charles Lindbergh). His character's name is a bit of an inside joke, as Walt Disney's original backer was named Charles Mintz. He later co-opted the rights to Disney's first hit character, Oswald the Rabbit. Disney responded, of course, by coming up with Mickey Mouse.

    Long story short, this is probably the best movie of the summer. It'll make you laugh, it'll make you cry, it'll make you think (but not too hard). It has travel, adventure, life, death and talking dogs. Go see it.


    Sunday, June 14, 2009
    Get Your Trek On

    Star Trek premiered on first-run TV when I was just a tad, and though I have a few memories of the show in its original run I never really watched it until I went to college. My freshman dorm had a lounge with a television -- what, have your own television in your room? That's crazy talk! -- and the local TV station showed reruns of Star Trek every night at 10:30 pm. (In those days it wasn't referred to as TOS, since there were no other shows from which to distinguish it.) I forget now what drew me down there in the first place, since I never had really watched the show, but I know what kept me coming back: the sense of community. The audience was mostly guys who had watched the show so many times that they could tell you from the opening shot of the Enterprise circling a planet which show it was. In fact, they would compete to see who could shout out the name of the episode first.

    I still have happy memories of those evenings in the lounge. For one thing, even though the gender makeup of the audience was about 80 male/ 20 female, there was no misogyny, no sense of anyone hitting on anyone. People were there to share their love for the show, and that was it. All attendees were welcome. For another, the fans' affection for ST was not blind hero worship but rather ironic. I was introduced to all the tropes of the show early on (i.e., Captain Kirk sleeps with alien girl and converts her to the cause of the Federation). My favorite moment may have been the bit when the crew was hiking up a mountain and somebody yelled "Dammit Jim, I'm a doctor, not an escalator!" After an evening of panicked studying, it was a refreshing break.

    Years later when I was in medical school along came Star Trek: The Next Generation. You may not remember how eagerly this show was awaited at the time: Trust me, I sat in a lecture hall with Trekkies every freakin' day and I can tell you it was a hot topic. It was pretty good, actually, though the earnest PC premise of the show wore thin after a while. My real issue with it was the persistent theme that everything, everything, would be solved in the future. I'll give you an example. In one episode Captain Picard is complaining of a headache, and what's her name the Betazoid empath replies earnestly, "Something must be wrong. No one in the twenty-fourth century has headaches any more." I'll tell you what my response to that was: BULLSHIT.

    Fast forward to residency. Deep Space Nine premieres. I'll tell you, as far as I am concerned this was the best Trek show ever. It had character development, conflict, drama, and the show wasn't afraid to develop plot arcs that took more than one season to resolve. This is almost unheard of in television even today; fifteen years ago it was an absolutely revolutionary idea. It also had Garak, the tailor/spy/refugee from Cardassia, and the most morally ambiguous character since Captain Renault in Casablanca. Oh, and did I mention the brilliant writing? Okay then.

    I am finally getting to my point, which would be the recent Star Trek movie. I had not intended to see it, assuming it would be terrible, till I read a couple of glowing reviews online. Last night a couple of friends (who had already seen it once) invited me along, swearing I would love it.

    They were right. It really is that good. It's true to the spirit of the show and the writers get the essence of the characters, but it doesn't take itself so seriously that it adheres fiercely to every bit of the backstory. And there's a good reason for this which is worked into the plot very nicely. The words "alternate reality" may make you cringe, but in this case they shouldn't - it works. What I really liked, in fact, is that "alternate reality" is usually just a toy for the writer to play with, but in this case you see the implications (very serious implications: the loss of a parent) play out. These implications are a bonding point for Kirk and Spock, who can't stand each other to start with.

    All the characters get their moment in the sun. McCoy is a hoot, Scotty is a joy, Uhura is hot and smart. She and Spock appear to be getting along quite well by the end of the film, and I can't wait to see what happens with them next. If you're looking for small nods to the audience, the film has them: Kirk's commanding officer is Christopher Pike, and at the end of the movie he shows up in a wheelchair - you have to have seen a particular episode of TOS to get this. When we first see Scotty he's got a pet Tribble in a cage. And so forth.

    Suffice to say my expectations were low, mainly because I have a deep distrust of movies that rely on special effects rather than character development (we had to sit through trailers for G.I. Joe and Transformers II, which are exactly the sort of dreck I am talking about). Star Trek does not make that mistake. You don't have to be a raging, con-attending Trekkie to enjoy this movie; despite my comments above, I don't fall into that demographic. Go and enjoy.