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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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    Tuesday, April 27, 2010
    The Aesthetics Fairy

    Los Angeles has a problem called "teardown chic." Basically it involves the destruction of perfectly nice homes which were probably built 50 to 70 years ago, measuring under two thousand square feet on relatively small lots. People buy these homes, tear them down and build huge, garish two- or three-story replacements that cover the entire lot like frosting spread to the edge of a cake. These structures are usually some sort of indeterminate pastel color and have overwrought iron fencing with gilt details. They are hideous.

    Yesterday as V. and I went on our 1.2 mile fitness march around the neighborhood after work we saw several of these ghastly structures. I began to fantasize about a being called the Aesthetics Fairy, who would punish homeowners guilty of erecting these crimes against good taste. Might he or she look like... Simon Cowell?

    Right, that's it. You have been voted out of this neighborhood.

    Or perhaps Nurse Ratched? (A terrifying thought.)

    There are rules here, Mr. Homeowner. If the rules are not obeyed you will be punished.

    And of course there's the obvious, Jorgen von Strangle.

    Dis hideous structure must go! Hasta la vista, baby!

    Were it up to me, I'd sentence them to two weeks in a mud hut with no indoor plumbing followed by six months in a condo with noisy neighbors overhead. It's nice to fantasize about, anyway.

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    Saturday, April 24, 2010
    ANZAC Day

    In 2002 I took a six-week break from work and spent some time traveling through Turkey and Bulgaria. I had planned to visit Troy and on a whim I decided to go to Gallipoli as well, thinking it would be historically interesting; the battlefields there are very well preserved and the entire area of Gallipoli is a national park. I shortly found myself in a hostel in the town of Canakkale, which is near the battlefield.

    I had no idea that I was in for one of the more memorable experiences of my life (I should confess here that my history knowledge is not the greatest and I really had no idea what to expect). My first hint that this was not going to be your average museum-type tour came when I arrived at the hostel; nearly everyone there was either Australian or a New Zealander. I wasn't the only American there, but it was close. I know you're probably thinking "Duh," but again, I was incredibly naive and had never heard of ANZAC Day or the facts behind Gallipoli. I learned from my fellow tourists that it is like Pearl Harbor, only more important, as Gallipoli had a great deal to do with Australia and New Zealand forming their national identities apart from the British Empire.

    The evening before the tour the hostel showed an Australian-made documentary about Gallipoli, a recap of the history behind the battle (believe it or not, I had no idea that Winston Churchill had masterminded this colossal disaster) intercut with scenes from the film Gallipoli. As we watched I suddenly realized that a woman behind me was weeping. My God, I thought. What have I let myself in for?

    Two buses packed full of people left the hostel the following morning. Our tour guide was a charming Turkish man whose grandfather fought and was killed at Gallipoli. He told us that his knowledge of the battlefield came from his father, who had not yet been born when his father was killed, and who had made trip after trip to the battlefields trying to find where his father had been buried (he never did; it was an unmarked grave). There was a lovely elderly lady on my bus who was there to look for her uncle's grave. As young men, her father and his brother had both fought at Gallipoli. Her father survived the battle, his brother did not. She had promised her father before he died that she would some day visit her uncle's grave, as he had never had the chance to do. She had been told that he was buried at the Lone Pine cemetery.

    The tour of Gallipoli takes the entire day; the site is huge. We visited every cemetery, stood in the trenches and saw the dugouts, which are still there (although we were warned not to go in, due to the danger of collapse). The entire site is incredibly well preserved. The trenches of the opposing sides are literally feet apart at some points. Today Gallipoli is beautiful and peaceful. I stood in what had been "no man's land" and tried to imagine what it would be like in the middle of a muddy battlefield with constant gunfire, barbed wire and mortar shells raining everywhere.

    As I wandered around the Lone Pine cemetery later that day I saw from a distance the elderly lady from the bus kneeling beside a grave. Our guide stood by her, his hand on her shoulder.

    She had found her uncle.

    In 1934 Kemal Atatürk, leader of Turkey, said these words to the Australians and New Zealanders visiting the battlefields:

    Those heroes that shed their blood And lost their lives. You are now lying in the soil of a friendly country. Therefore rest in peace. There is no difference between the Johnnies And the Mehmets to us where they lie side by side Here in this country of ours. You, the mothers, Who sent their sons from far away countries Wipe away your tears, Your sons are now lying in our bosom And are in peace After having lost their lives on this land they have Become our sons as well.
    I do not think that there is anything else to be said.

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    Thursday, April 22, 2010
    To Boldly Go Where California Has Gone Before

    Okay. This picture

    And this site made my day. William Shatner as Governor General of Canada? You know you want it. If he ran Canada in full-on Denny Crane mode, think of the fun that would ensue.

    That is all.

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    Losing Our Religion?

    When I read this post on Twitter it made me start thinking: When people say they don't trust "organized religion" but do respect spirituality, what exactly does that mean? Do they know what they mean? And how is organized religion controlling? Is it because it confronts people with difficult ideas like self control and self-sacrifice, challenges them to move beyond their boundaries?

    Certainly religion can be used as a controlling force, particularly when mixed with politics. For two examples I direct you to the present-day Middle East and the struggle in Tudor England between Protestant and Catholic factions. It can also be a stabilizing force. I think controlling and stabilizing are opposite ends of the same spectrum. Anything can be good or bad depending on how you use it.

    To me, saying you believe in spirituality but don't trust religion is like saying you breathe air but don't believe in oxygen. Doesn't make a lot of sense. Without a framework to build on, too often spirituality leads absolutely nowhere. I was impressed by the section in "Eat, Pray, Love" in which Elizabeth Gilbert spent time at an ashram in India, culminating in a significant spiritual experience in which she felt at one with God. But she did not have that experience until she had spent months praying, meditating, following a strict schedule set by her spiritual mentor, and performing tasks including scrubbing the temple floor. If that's not organized, I'd like to know what is.

    I believe there are people who can manage an impressive dimension of spirituality in their lives without going to regular worship services or following the tenets of a specific religion. I loved this post from Head Nurse in which she addresses exactly that. But I think they are few and far between, because spirituality - real spirituality - takes work and practice. Religion is a framework, providing the opportunity to practice, providing reminders to keep your mind on the higher things. You can view it as a cage or as a support; it's really up to you.


    Tuesday, April 13, 2010
    Inventing Dinner.

    Lately I've been playing the "what can I make for dinner tonight without going to the store" game. Some nights you lose... such as when I have oatmeal or cold cereal for dinner. Some nights you win. Tonight I won, thanks to a weekend shopping trip in which I took advantage of the coupons my local store had mailed me. I made a batch of Spaghetti Sauce from the cookbook Frozen Assets and bought some (cheap) shredded mozzarella and parmesan thanks to the coupons.

    With the sauce in mind I found a half box of mostaccioli in the pantry and threw together the following. Cook the pasta and drain. Mix with a cup or so of mozzarella, a drained can of sliced mushrooms and as much spaghetti sauce as you need. Top with parmesan and bake at 375º until done. Excellent.

    Here is the recipe for the spaghetti sauce - I made a half batch and there's plenty in the freezer now.

    Two lb Italian sausage or ground meat (beef, chicken, turkey)
    2 C. chopped onions
    1/2 C. chopped bell pepper (red or green)
    1/2 C. chopped celery
    2 tsp minced garlic
    4 large cans tomato sauce - these would be about 28 oz each
    4 16 oz cans Italian style diced tomatoes (undrained)
    1 large can sliced black olives (I omitted this and used some chopped mushrooms instead)

    Brown the meat and the next four ingredients. Add the sauce and tomatoes. Simmer for an hour or so, then add olives (if using). If adding mushrooms, brown with the other vegetables.


    Friday, April 09, 2010
    A Fearless Friday Recipe

    Home Ec 101 has a great feature known as Fearless Friday. The idea is that you are supposed to stretch your boundaries by trying something different - no matter how big or small the recipe. On Easter Sunday I tried a recipe for a beef roast that sounded rather odd, but I had come across an eye of round roast on sale and was trying to figure out what to do with it. Roasting beef always makes me nervous, probably because I can't stop thinking about the cost of the meat I'm shoving into the oven. It's like throwing ten-dollar bills in there. But I found this suggestion on the internet and several posters swore it worked, so I tried it.

    Take a three-lb (approximate is fine) eye of round roast. Let it come to room temp, or at least let it sit out for 45 minutes or so. Rub with your seasonings of choice - I used Lawry's Lemon Pepper which worked great. While you are doing this, preheat the oven to 500º F. Then put the roast in a baking dish, put it in the oven and turn down immediately to 475º. Roast for seven minutes per pound. Then turn off the oven and leave the roast in for 2 1/2 hours without opening the oven. I mean not even for a second or so. Don't cover it with foil or a lid, don't put any liquid in the pan.

    It works. The meat will be done but rare. If you want it a little more done you can either leave the oven on for another seven minutes or you can turn it back to 350º after the 2 1/2 hours are up and leave it in for another 30 minutes. Bring the meat out, slice it thinly (thinly is important!) and seve with the rest of dinner.

    This recipe is a piece of cake and it forces you to plan ahead, which is a good thing if you are serving a group of people. And if you are roasting three pounds of meat, you probably are; or else you are me and this will feed you all week for lunch (a good thing, you have great lunches to look forward to all week!) The other good news is you can't overcook it, i.e., ruin it. If you like it more well done, that is easy to remedy - see above. Should you come across an eye of round roast on sale, I heartily recommend this recipe.


    The Rev. Barbie

    Apparently Barbie has now become an Episcopal priest. She's prettier than the Presiding Bishop Katherine Schori, and a better theologian to boot!

    (via Christopher Johnson)

    UPDATE. There is an excellent Sunday column addressing the state of the American Episcopal church, and what the existence of Rev. Barbie symbolizes to same, here. Hat tip to Instapundit.

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    Wednesday, April 07, 2010
    Can't Win for Losing

    For the past few months The Firm has been preparing us to switch to a new EMR system. This thing is complex and all of us are dreading it. The Big Switchover is scheduled to happen this weekend, and our current system will be offline as of Friday as we prepare to upload to the new system.

    Did I mention I was scheduled to be on call this weekend?

    So I was delighted when I got an email from one of my partners asking to switch call weekends with me, as he wanted to go out of town to a conference the following weekend. I did warn him in my answering email ("Caveat Emptor!" I replied), but he accepted anyway.

    So you can imagine my reaction to the following voicemail I received last evening:

    "Hello everyone. After a lot of thought we've decided to put off our switchover for one week. We will be taking the system offline on April 16th, not the 9th..."


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    Friday, April 02, 2010
    This Urologist Has, Um, Cojones

    A urologist in Orlando, Florida has made no bones about telling his patients what he thinks about Obama's healthcare plan:

    A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."

    This is legal, as far as I can tell. The doctor in question has made it very clear that anyone who wants to see him won't be turned away. The sign he posted says:

    "If you voted for Obama… seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."

    He's right. My patients are all complaining about their drug copays being jacked up, increased fees to be seen by a doc, and so forth. I explain to them that the insurance companies raised their rates proactively, expecting the healthcare legislation to pass, and that the result will be higher fees for everyone. C'est la vie.

    (via JammieWearingFool)

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