“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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Thoughts On Social Media

 

In the wake of the Night of the Long Knives on Twitter (if you weren't aware, Elon Musk deleted several journalists from the website), I have been wondering whether building a presence on social media really has the value it has been credited with for the past several years. Last night's episode, if nothing else, highlights how transient social media presence is. Leaving politics aside, I can think of two major issues that complicate "building a brand" (a term I hate). This doesn't apply to casual fun users, but to those who have made it a significant part of their careers.

First is financial. There are rumors that Twitter is currently in financial trouble, and this isn't the first time that has been the case. If a pundit or celebrity goes to a lot of effort to build a presence on a selected website, and then said website goes bankrupt and disappears, all that work is wasted.  A big part of the reason social media became so popular is that it's simple, cheap and fast to register. The problem is that those factors influence the audience of the site. "Fickle" would be a good word to use here - a reader that may like you today may block you tomorrow, or simply get bored and leave. Plus, a following does not translate to money. For example, Alexandria Ocasio-Cortez has a huge following on social media yet her recent book did poorly. It appears that few of her followers were willing to buy it.

Second is the proliferation of social media websites. One way for a pundit to hedge their bets is to register on multiple sites, but how well does that really work? The more sites there are, the fewer members each one is likely to have. Is it worth it to spend time on multiple sites rather than investing that time in writing, researching or creating product? Plus those sites are not guaranteed to function well. From what I have read of Mastodon, it is more like a series of fiefdoms than an open site such as Twitter. Each node on Mastodon is run by separate individuals or groups, each of which can block anyone they want. Quite a few recent users have found this out to their dissatisfaction. 

I don't have any answers here, but I do think the issues I have mentioned play a large part in keeping analog or "old school" public presence alive. It will be interesting to see what happens in social media over the next few years. 

Labels: Random Thoughts, Twenty-First Century Crap

posted by Dr. Alice at #

 

 Giving Thanks

Nearly a year ago, I began a personal journal. At that time my father had passed away, my mother was still alive and I was not sure where I was going or what I was doing. I left full-time practice in January of 2020 and knew I did not want to go back.

At first I made entries every day, but at this point I haven't made any for several months. Nevertheless it served its purpose. I made the decision to keep working part time; I sold my house and moved into my parents' home; I weathered the loss of my mother; I committed to moving out of state. So for now, I have a new normal. The only thing I really haven't accomplished is to start writing on a regular basis, but I no longer have any excuses. My big test is over and done with (I passed the Boards recertification, hooray!)

I am grateful for where I am and what I'm doing. Grateful for my good relationship with my siblings and their families. Glad that I've made the effort to see my friends more often and that I have the time to help them when they need it.

I'm even grateful for that cat. Gazebo still won't come near me but seems to be slightly more at ease with my presence, and I feel good that I've been able to make his/her/its life easier. And I want to end this post with my holiday advice to you all: Sharpen your knives. 

No, really. The kitchen knives here were the dullest things you've ever tried to work with. Finally I found a sharpener, got them taken care of, and now kitchen prep work is so much easier! It's made a huge difference and I am more inclined to cook now that I don't have to wrestle with trying to chop vegetables. This will, as they say, change your life. 

Happy Thanksgiving and Advent.

Labels: Changes, Holidays, Random Thoughts

posted by Dr. Alice at #

 

 Picking Up the Pieces

"Well, somebody's got to rebuild Rio!"

I doubt more than a handful of people will recognize that quote, let alone find it amusing, but it perfectly expresses how I feel. My final challenge for the year has been met. I took my Boards test three days ago, and now... what? 

2022 has been nothing but a series of hurdles, with just enough space between them to catch my breath.  It began with my mother's decline and death, quickly followed by my decision to sell my house and move out of Los Angeles. Then came arranging her memorial service while juggling the move, followed by a midsummer trip to Europe (I had booked this two years earlier and could not cancel it), and then studying for this test. All year I've been saying to myself: You just have to get through the next thing. And: Just wait till that test is over with and I can start unpacking! 

Strangely, I now find myself with no desire to unpack. Or to do much of anything, really, except make lists. Big, ambitious lists. I have made a couple of large decisions without too much trouble... I am not going back to work full time but will continue with my part time schedule. I have made a down payment on a condominium in Florida, though the project has not yet broken ground - it looks as though I will be moving in two or three years. But it is the day-to-day decisions that are the difficult ones. Namely, where to start cleaning and organizing? In the kitchen? Master bedroom? My bedroom? Should I be working toward a garage sale, or try to donate everything, or look into selling on eBay? I don't really want to think about any of it. 

Perhaps scheduling my days would help. So many hours per day cleaning and organizing, so many hours per day working on paperwork. None of it sounds like much fun. I did start cleaning out my mother's desk today and made a dentist's appointment, so that is something accomplished at any rate. And I am trying to spend more time with my friends. I am coming to realize, though, that I have been too busy to come to terms with the losses of my parents and aunt; it's catching up with me now, as I am constantly finding little things that belonged to them which keep bringing me to tears.

Exercise helps. And I think I need to go back to church, as I have not been regularly in years. Perhaps plan another trip for next year? Something that is a challenge. I will keep cleaning, contemplating my options, and working on rebuilding Rio.  

Note: Drive-In is a fun, silly comedy from 1976 set in a small Texas town, at (yes) the local drive-in movie theater. I do recommend it if you can find it. [Update: Hey, it's available on YouTube! Maybe I'll watch it tonight!] The parody disaster movie playing at the drive-in is a lot of fun, if you remember the disaster movies that were all the rage during the 70's. 

Labels: Changes, Loss, Memories, Random Thoughts

posted by Dr. Alice at #

 

 The Pool

I have been back at my parents' home for two and a half months now, and for whatever reason despite the summer heat have not used the pool once during that time. I think the last time anyone swam was the weekend of my mother's memorial service. My brother continues to pay for the upkeep of the pool and has been encouraging me to use it; today I finally did. 

The old pool house, which my father built to contain the pump and heater, is falling apart. The doors are too warped to close and I made a mental note to get that fixed as I poked around looking for the pool skimmer, which I was unable to find. I think our pool cleaner must be bringing his own. I had a sudden memory of one weekend morning years ago when my father, in his usual weekend mode of beat-up hooded sweatshirt and work pants torn at the knee, was working on the pump. It was a beautiful sunny morning and he looked happy. On an impulse I quickly ran upstairs to my room, fetched my camera and made him sit for his picture on the low wall outside the poolhouse. 

"Why?" he asked, clearly finding the whole thing amusing.

"I just want to," I answered. 

The picture came out really well; in fact I framed it and gave it to him for Christmas. It graced the mantel at his memorial service. It's so uniquely him and I'm so glad I took that picture. 

Finally, I gave up on the pool skimmer and stepped cautiously into the water, not wanting to slip on the steps. As I did so I had a sudden memory of my mother getting into the pool in exactly the same way, carefully, hoping the water wasn't going to be too cold. She was younger than I am now, I thought. 

The pool was as warm as a tub. I started swimming slow laps, pausing to pick leaves out of the pool and remembering how our dachshund Otto would run around the pool barking at us (he hated the water), clearly wondering what we were doing in there. On very hot days we would carefully lift him into the pool, no lower than the first step, to try and cool him off. He didn't appreciate the gesture. 

The pool is surrounded by postholes in the concrete, put there to hold a safety net to keep the grandchildren out of the pool when they were little. I suddenly remembered my sister holding her baby daughter in her swim diaper, letting her paddle in the water... my niece turned 24 this week. 

I had not expected to be overwhelmed by so many memories; as I swam my tears landed in chlorinated water. But the pool was soothing and was just what I needed on this hot day after studying for several hours (I have a recertification test coming up in two months).

Finally I got out, ready to come back to the silent house and get ready for tomorrow. At the top of my mental to-do list: pool skimmer. And my bathing suit is rinsed out and ready for my next swim. 

Labels: Family, Random Thoughts

posted by Dr. Alice at #

 

 

Journal Post #1

I’m going to try something different here, cross posting pieces from my journal on this blog. At least doing this will ensure that I will be producing more posts to entertain any wandering reader who happens by. Briefly, several months ago I decided to start keeping a personal journal to document my decisions for the coming year. I had retired, or semi-retired, in January of 2020 to take care of my ill aunt and parents. As it turned out this was just in time for Covid to come along. My aunt passed away one year ago, followed by my father six weeks later, followed by my mother three months ago. Now I am in the process of selling my home and moving back to my parents’ to try and get the house on the market. Come along with me, won’t you? It’ll be fun. Hopefully at least engaging, in the way of a train wreck.

Yesterday I was able to get the mirror on my car fixed, and I feel much safer driving now. Did some more packing and moving. My mother’s celebration of life service is in three days, and the other fam members will arrive in two days. So I’m just trying to get the place pulled together, bedrooms ready, food in the fridge. I do wish they could stay longer, but everyone has to get back to school/jobs.

Last night, to distract myself, I wound up looking at housing prices and other facts about Provo, Utah as part of my research for my long-term plan to move out of California (why Provo? Only because I’m thinking of attending a conference there next year). But Utah, like California and much of the western US, is suffering from drought. This has reinforced my vague plan to move to the East Coast. I don’t like floods or hurricanes either, but it would be nice not to have to worry about water.

I also spent some time with my tenant, reading lines with her. She is an actress and currently is auditioning for a Netflix show called “Obliterated.” As far as I can tell it’s about a bunch of Navy SEALS who spend their time cursing, having sex and taking drugs when they aren’t saving the world. Good Lord, I’m glad I’m not an actor; I cannot fathom having to take roles like that.

More later.

Labels: Los Angeles, Random Thoughts, The Doctor's Life

posted by Dr. Alice at #

 
It's Time, It's Time, It's Time

Labels: Family, Random Thoughts

posted by Dr. Alice at #

 

 The Dying Patient

They don't tell you what it's like to be with someone who's dying. As in, being there all the time, day in and day out. Sometimes I wonder if even the hospice doctors and staff know. It isn't that they are not kind. But the nurse, who currently is coming twice per week, checks vitals and asks about bowel movements - "Do you have any questions?" and then she is out the door within 15 minutes. I do not say this to criticize, as I have done my share of such visits. But after a while it is hard to know what to do or say, how to pass the time when not focused on such minutia. 

My aunt is suffering. Not to say that she is in pain, but she is a very social person and has always been someone who likes to stay active and do things. At holiday dinners, rather than sitting around with a cup of coffee she was always the one cleaning the kitchen or getting the meat off the turkey carcass. Now she is too weak to walk and too confused to focus. She cannot get much enjoyment from reading; cannot remember which of her friends has called her from hour to hour. Her sole consolation is conversation and I am not the best source of that. I have tried to think of entertaining topics but have long since run dry. My father is too demented to talk to her and my mother is too hard of hearing; plus my aunt has suffered vocal cord paralysis due to the tumor and can barely make herself heard.

Two days ago she told me she wanted to pursue assisted suicide (I think the preferred term is "assisted euthanasia" these days). Her first discussion with the hospice doctor is scheduled for tomorrow. I don't see how she could not qualify, I just don't know whether she will be able to last the next two-plus weeks until all the criteria are met. We should perhaps have discussed this sooner, and I feel badly about that now. I told her that once again she was a groundbreaker, as she has been so often in her life. 

She was raised in a small Southern town and went on to teach as a career - not much else was open to women in those days. Her first marriage, the product of elopement, failed shortly after she moved to Alaska (her husband was transferred there). She went on to marry again, and eventually left her second husband for a female partner. That relationship lasted 25 years. She successfully fought cancer once and then developed lung cancer more than ten years later. She has traveled, volunteered, has made many friends and excelled at entertaining them. 

Religion is not a consolation for her, she puts her trust in friends and enjoying life. She has outlived her prognosis by nearly three weeks, but I don't know how much longer this is going to go on. All I can do is to be here, and it is humbling. 

Labels: Family, Medicine, Random Thoughts

posted by Dr. Alice at #

 

Therapy Session

Back I am at the blog, in search of counseling. Did I mention that this blog serves as my makeshift therapist? I visualize it as female, of no particular appearance, leaning forward, professionally caring but geared to forcing the truth out of me. 

Then we sit and look at whatever this truth is. 

Well, (I brace myself,) the past month has been a little tough. It's indisputable that my father's dementia is getting worse. His sister called last week to speak with him and then asked to talk to me; she wanted to know how he's doing. He can't really carry on a conversation any more, though he is always glad to hear from her. I think he had another stroke about a month ago; he has to be coaxed to eat, and often falls asleep during breakfast or dinner. He can't tell us when he has to go to the bathroom any more and is often incontinent without being aware of it. In addition to that my aunt, the one with metastatic lung cancer - remember? She's on hospice now - is becoming weaker and weaker. She is eating less and her weight loss is accelerating. A few weeks ago I made the decision to move in with them, and I've been staying there more or less full time. 

This means I won't be seeing patients for now. Not that I was seeing many, just one four hour shift per week, but it was something. It made me feel like a doctor again and not just an overloaded daughter, gave me a chance to dust off my skills rather than letting them atrophy. Even virtual visits are not an option, as it has become impossible to spend four uninterrupted hours online due to the needs of my parents and aunt.

My aunt is my main responsibility right now. She is becoming increasingly confused as well as having major memory loss (probably due to the chemo and radiation). She isn't able to keep herself occupied with much - she does read but I don't know how much of the book she retains day to day. In an effort to give her variety, I tried to show her how to use my Kindle but she simply could not fathom it, even after I set up a book for her with a large font. She could not remember how to tap it to turn the pages. Physically, she is wheelchair bound and requires oxygen at all times. Even taking her to the bathroom has become a significant journey.

Her friends have been very supportive and have made the drive from the Palm Springs area many times in the past two months to visit. Two came yesterday and two more are coming today; yesterday, two men (partners) and today two women (also partners). The women have a lovely long-haired dachshund that loves my aunt, and my aunt loves her right back. I will miss seeing her today as I had to go into town for an orthodontist's appointment (my treatments are over and I am graduating to a retainer, hooray!)

My aunt has outlived her prognosis, I think due to force of will alone. Major props to her for this. Taking care of her has taught me a lot, as I have never seen major illness from the family point of view before - only as a physician. Eventually I will go back to work part time, and I hope I will take what I have learned with me.  

I don't know whether all of this commentary adds up to anything or not. At least it is a relief to put it down.

Labels: Family, Random Thoughts, The Doctor's Life

posted by Dr. Alice at #

 

Update

Not much new to report here. I have signed up to work in the clinic on Saturdays in March (after talking about it for more than a decade, The Firm has finally opened on Saturdays - another instance of the pandemic changing work patterns). My aunt clinically is about the same, but I don't know how long that is going to last - so I did not want to commit to more than one day per week.

It's been stressful having her here, even though I know it's the right thing for her (and she knows it too). I know she feels isolated and depressed, though at least she is not in a nursing home but with her family. It is just too difficult to talk to my parents for any length of time, given my father's dementia and my mother's severe hearing loss. My aunt and my parents spend their days at opposite ends of the house. I have not been able to come up with a solution, as my parents claim a large part of my time and to be quite frank about it I do need some time to myself if I am not to implode. She has had many visitors, cards and letters and I think that is helpful but it doesn't make up for the fact that she is facing the end of her life. My aunt has asked for a television to be installed in the living room, where she sits; so we are going to be doing that next week. She loves to watch the news, so maybe this will make her feel better. 

My study review materials for the Medical Boards have arrived, so that is something else I need to start working on. I have to recertify every ten years to keep my Internal Medicine certification. It's a couple of years early, but I would like to get it over with and this seems as good a time as any. Formerly the test was given twice a year, but (again due to the pandemic) it has been cut back to once. This will be the last time I have to take the test - but then again I promised myself eight years ago that I would not be doing this again, so there you are. 

I had my colonoscopy done, but unfortunately I have to do it again! I followed instructions exactly but apparently the prep was not sufficient. That mixture you have to drink is the absolute worst. The archaic term for it was "saline laxative" and it works by pulling additional fluid into the intestine. This rinses everything out, so to speak. It contains magnesium, potassium, citrate and other lovely things. You also have to drink a lot of water with it so as not to induce dehydration. 

Lately I have been pondering what to do when I am free to travel again. I would love to go back to Australia, to see the Netherlands and Scotland; but first of all I think I would like to travel Route 66. I'd bring along my camera and seek out some of the old buildings and locations to photograph. The route was decommissioned in 1985, with the completion of the Interstate Highway System, but has refused to die. It has a stature in American lore that I don't think will ever be replaced, partly due to the song, of course, but it is even mentioned in works like "Fear and Loathing in Las Vegas" and, of course, "The Grapes of Wrath."  A sadder bit of travel history associated with it: "The Green Book," a travel manual specifically for Black motorists, listing places that were safe - and unsafe - for them to stay. There were plenty of  "sundown towns" along the route where African Americans were not allowed after dark.

And now I have to figure out my schedule for the week. More later. 

Labels: Medicine, Random Thoughts, Travel

posted by Dr. Alice at #

 

 Recent Developments 

I'm trying to blog more. Partly because of the new crackdowns and censorship on social media platforms (namely, F and T), and partly because so much has been happening here, most of it not good. 

I left full-time work a year ago and have not regretted it one bit, though I have been continuing to see patients part time. One main reason I left was my parents' and aunt's ill health. My mother in particular has been in a slow decline for months. Just before Christmas, their caregivers were diagnosed with COVID and my parents tested positive the day after Christmas; I tested positive one week later. Fortunately none of us had to be hospitalized. My father had basically no symptoms, I had the equivalent of a bad cold; my mother had a heavy cough and bronchitis but no fever. All the caregivers were out sick and it was a very rough two weeks, but things are much better now. 

Unfortunately my aunt has metastatic cancer and without giving details, she is not doing well. I will be staying with her to provide support as she tries to make a decision about stopping treatment. Ironically, my COVID infection could not have been better timed; I'm bulletproof now, at least for the next few months, and am no longer infectious. I tested positive 17 days ago.

The inauguration is tomorrow, I have no plans to watch. I am honestly disappointed with the results of the election. I don't see things going well, what with immigrants on the march from Central America and the president-elect's plan to shut down the Keystone XL pipeline (what the hell is that about?) - and the New Management hasn't even been sworn in yet.

As for the immigration issue, I have one word: COVID. Uncontrolled immigration into Southern California and other areas of the Southwest US, already a hotbed for COVID infection: what could possibly go wrong? Or to put it another way, how is our already overloaded health system supposed to cope with this? No one has thought to ask that question so far. 

I'm going to sign off for now and try to find something else to think about.

Labels: Medicine, Politics, Random Thoughts

posted by Dr. Alice at #

 
I sit here waiting for my first patient of the day, desk fan set up, coffee ingested. The iPad is set up for video visits and charging cords snake over the desk. A freshly charged phone is at hand for the inevitable telephone visits for our older patients and the telephone number for the translator service is within reach. All set to go.

Labels: Random Thoughts, The Doctor's Life

posted by Dr. Alice at #

 
Feral Cat Land

Labels: Los Angeles, Random Thoughts, The Doctor's Life

posted by Dr. Alice at #

 
The comedian Eddie Izzard has a wonderful routine called "Cake or Death." It's sort of a meditation on religious and geopolitical history and you can see it here (language warning). Basically, he's saying that if the Church of England tried to mimic the Spanish Inquisition everybody would  wind up getting cake. Why would you choose death if you were offered cake?

Labels: Random Thoughts

posted by Dr. Alice at #

 
Thoughts on Fan Fiction

Fan fiction, for those who don't know, is a term for writings or artwork based on a preexisting work, written by fans of said work. The work in question could be a film, a television show, literature, radio program, comic strip or even other works such as video games.  Fanfic has been around for decades and first really made it into the public eye with Star Trek, I believe. Fans of the show wrote stories about the characters which were collected, mimeographed and stapled into fanzines and then mailed to subscribers. Nowadays fan fiction is published on websites (the two best known are Archive of Our Own and FanFiction).

Traditionally fanfic has not been highly regarded; if you say the phrase "fan fiction" most people will either be unaware of what you are talking about or will cringe in revulsion. There are reasons for its poor reputation. Unfortunately, although some fan fiction is well written the genre as a whole has a reputation for bad writing. Consider the term "Mary Sue." The original Mary Sue was the main character of a Star Trek fic, a Starfleet cadet who wound up on the Enterprise somehow. She was depicted as impossibly gifted and accomplished, although the story contained no scenes showing her doing anything which would justify this portrayal. Readers expecting Kirk and Spock got Mary Sue, plus main characters basically drooling over her and how amazing she was. The author of the story was named Mary Sue Something-or-Other, and the story was immediately recognized as nothing more than wish fulfillment. It was reviled by other fans and "Mary Sue" is now used as shorthand for this type of character. But there are other reasons for the critical view of fan fiction: often it is simply viewed as derivative and lacking in imagination since it is based on other works. "Create your own characters!" critics will cry. "Do your own thing!"

Everything above pretty much describes what my opinion of fan fiction used to be... until I started writing it. I blame Season 5 of 24 for starting me on this hobby. Every season of 24 had loads and loads of characters and enough subplots for three other shows. Some of the subplots were more compelling than others. I got drawn into the Season 5 saga of the First Lady and her stalwart bodyguard Aaron Pierce, who were investigating the web of intrigue surrounding the President... as well as developing a relationship of their own. It may sound cliched but in the hands of two gifted actors, Jean Smart and Glenn Morshower, it worked incredibly well. Some of the online 24 commenters were also fans of these characters. We formed a discussion group and several members began contributing stories about them. I was coaxed into writing an initial story and then found that I could not stop. It was just too much fun, as well as being good writing practice. The next thing I knew I was embarked on an epic story that took me two years to write and ran to over 100,000 words.

What's good about writing fan fiction? If you want to write, it's a good place to start because it allows you to concentrate on plot, dialogue and settings. The beginning writer does not have to focus on creating characters because readers familiar with the source work know who the characters are; that work has been done for you. Original characters can be created one at a time and allowed to interact with established characters. You can also get critiques and suggestions from other writers (this is called "beta" (noun or verb). If you want your story to be beta'd before you publish it you can request input on it. Most critiques I have seen are supportive. With this kind of practice writers can become successful: "Fifty Shades of Grey" started as fan fiction of the "Twilight" series; the author changed the controlling vampire character to a controlling billionaire character. I won't claim it's great art, but the author sold tons of books and got a movie deal, so there you go.

What isn't so good about fanfic... for me this divides into two categories: stylistic errors and terrible plot ideas. The style stuff is usually pretty basic: misspellings and grammar mistakes such as changing tense from paragraph to paragraph, or even sentence to sentence. Using quotation marks erratically, a more common mistake than you'd think, drives me nuts. Sentence fragments may or may not be a problem, especially if these occur in dialogue; they can add realism and an informal tone, if that's what you are aiming for.

Terrible plot ideas: Oh, God, don't get me started.

• "What if [Character X] had a long lost sister/brother?" [Mary Sue ahoy!]
• "What if [Character X] was gender flipped?" [It's pointless! Work on your plot.]
• "What if Show X and Show Y characters met and started working together?" [A.K.A. the crossover - most of these are awful.]
• "What if [Characters X and Y, who clearly are not in love with each other in the original work] fell in love?" Especially if X and Y are the same gender... "Hey, let's make them gay, even though they weren't in the original story!" There are TONS of these stories in fanfic land. And they're total crap.
• "Take That" fics, written by someone who really hated what happened in the story or how one or more of the characters were portrayed. Often related to politics or gender issues. I call this the "Why Was Aslan So Mean to Susan" category, after the denouement of the Chronicles of Narnia series.

Let me turn the subject to my bias in favor of plot. Many of the works I read rely on romantic scenarios between characters and have little or no plot, another reason I will give a thumbs down judgement on a piece (mental judgement only; I don't post negative reviews). I love lots of plot, and subplots make me really happy.  I am heavily biased in favor of Gen (for general) fics for this reason. Usually Gen fics contain little or no romance, or at least the romance is not the focus of the piece. My 24 fic did have romance between the main characters, but this was well-established in the show and I spent a lot more time on my plot, which involved the unwinding of a major political conspiracy.

Going back to the ever popular idea of slash fiction (gay romance between characters): The authors do have a point. It's true that there are not a lot of LGBTQ heroes in pop culture, even today. My response to that is to write some original new ones. It makes a lot more sense to me to create original characters to fill a need rather than to radically change a well-established character.

Another motive for writing, if I am honest, is positive feedback. A complementary review on something I have written is an ego boost like no other. As I tend to write about works that are not so well-known, I don't get that many of these but I certainly enjoy them when I do.

Reading fanfic is like panning for gold, basically. The good stuff requires a search but it's there. If you have a favorite book, TV show or film it's worth doing a website search (see the sources above); you may be pleasantly surprised at what you find.

Labels: Pop Culture, Random Thoughts

posted by Dr. Alice at #

 
Insomnia

"I'm having trouble sleeping" is one of the most common complaints I hear from patients. This is understandable, as up to 25% percent of the American population reports occasionally not getting enough sleep (though it seems like more to me). However the percentage suffering from the true definition of insomnia is smaller, about 6 percent. Per the DSM-5 definition, insomnia patients feel impaired from lack of sleep during the daytime; symptoms last at least a month; and are not associated with other medical conditions, substance use or other sleep disorders (restless legs syndrome would be a good example of this).

Certainly sleep issues are seen most often in the elderly but insomnia can hit at any age. Recently while sorting through a bunch of stored papers I found a literary quarterly published by my university which I had saved for some reason. The theme was "All Night Long" and at least two of the pieces dealt with insomnia... it could have been more, possibly three or four. (These were written by people in their late teens and early twenties, mind you, and they were complaining of insomnia!) There are plenty of factors other than age, however. Sleep problems are often connected to lack of physical activity, especially these days when so many people work sedentary jobs. Daytime naps are also not a good idea as they relieve physical fatigue just enough to make it difficult to fall asleep. And irregular sleep patterns, such as working nights or sleeping late, can also ruin a good night's sleep.

I empathize with patients as a fellow sufferer. I have had insomnia most of my life, to the point that if I sleep through the night I almost feel cheated. My nighttime awakenings are my "me time," when I ponder my work schedule, to-do lists and various deep thoughts. Certainly I need sufficient sleep to function, at least six hours. Back when I was a medical resident I realized that I was usually very depressed the day after being on call. It took a surprisingly long time for me to figure out the connection between my mood and lack of sleep.

The basic recommendations:

• Regulating your sleep pattern is a big one. Yes, you have to become one of those boring people who goes to sleep at the same time every night. 
• Don't go to bed too early. If you go to bed at eight-thirty, you won't sleep through the night unless you have to get up at four-thirty every morning - or even earlier than that. 
• Limit alcohol and caffeine. Alcohol can really screw with your sleep. No caffeine after noon. 
• Don't go to bed until you are ready to go to sleep. I once had a friend, a fellow MD, who stated that if he had his way every bedroom in the US would be deprived of its television. Likewise, no reading or crossword puzzles in bed. You should do these fully dressed and in a separate room until you are ready to go to bed. 
• Keep the bedroom cool, dark and quiet. 
• And now that we have computers and smartphones, the same applies. Don't grab for your phone if you awaken in the middle of the night. You don't want to be looking at a glowing screen. 
• Do try to get some physical activity in, it will tire your body and you will sleep better. 
• Don't use sleep medications if you can possibly avoid it. 

Labels: Medicine, Random Thoughts

posted by Dr. Alice at #

 
In Mourning

This past week I lost a friend, the husband of my good friend V. Shortly before Christmas he became very ill and after several weeks in intensive care he passed away. He would have turned 62 today.

R was an unassuming, yet fun and interesting, man. His interests included astronomy, woodworking, music (especially novelty music - his Christmas CDs have to be heard to be believed) and dogs. He dabbled in brewing his own beer. He was a wonderful father and was always to be seen at his children's soccer and softball games, acting as team photographer. He was proud of his Irish heritage and every St. Patrick's day he and V threw a huge neighborhood party.

A hospitable couple, they made me welcome on summer weekends - I would drop by, bringing wine and appetizers, and R would fire up the barbecue after we swam in the pool.

I will miss him very much; he will be missed by many. The funeral is in a week and I am sure the church will be full.

Labels: Family, Random Thoughts

posted by Dr. Alice at #

 
I don't know if you've ever had this experience.

You go to a funeral. You yourself didn't know the deceased very well, maybe not at all, but you go for one reason or another; maybe your partner was connected in some way with the person who died. Maybe the deceased was the spouse of someone you worked with, or someone your parents knew. At any rate, there you are.

You find yourself looking around, feeling mildly concerned but detached (you don't have an emotional investment in this event). The service begins. Everyone who speaks has one or more personal anecdotes about how good/gifted/caring this person was. Eventually, you yourself start to weep because of the grief of others and because you realize the world has lost a good and caring person that it could not afford to spare.

This happened to me today. The wife of one of my co-workers, who had struggled with a long and difficult illness, passed away a few days ago. From everything I heard today, she had a gift for connecting with people (a gift I myself do not have) and cared immensely about her family.

As I sat there, I speculated for awhile about who would attend my funeral, and then I thought this. If I could accomplish as much as this woman accomplished, and bring a near-stranger to tears at my funeral because of a sense of loss, I would have lived a good life.

I don't know whether that will ever happen, but I need to try.

Labels: Random Thoughts

posted by Dr. Alice at #

 
There Was No Gilligan, But There Was a Mysterious Dude.

I was converted to the concept of the e-reader (eBook, whatever) by my roommate on my Guatemala trip several years ago. Another busy physician, her specialty was family practice and we bonded over finally having the time to read without guilt, since there was nothing else to do in the evenings after the clinic closed for the day. She was glued to her Kindle every night. I was jealous that she never seemed to run out of reading material, whereas I zipped through my book and two magazines in nothing flat.

So when I got home I knuckled under and bought one. At first I wondered if I would ever download enough to justify the purchase, but that really has not been a problem. Have I bought more books? Yes, I have. But did you know that there are a lot of free books available for the Kindle? Yes, free. FREE. If you subscribe to Amazon Prime it gives you access to the Amazon Library system; there are a ton of books that you can obtain on loan. The limit is one per month, but if you are an avid mystery reader it's great to have access to all the paperback cozies you want without having to spend $7.95 on a book you'll never read again.

(Incidentally, what is it with mysteries these days? When did cozies start to incorporate recipes, scrapbooking, witchcraft, knitting and God knows what? I still read them, all right, but I'm starting to hate myself. The heroine/detective usually spends more time enthusing over her cats or her latest yarn purchase than she does solving the crime. I mean, Philip Marlowe would NEVER.)

But back to Free. I had heard that there was a big self-publishing market on Kindle, but I didn't realize how big until I started reading a prepper/homesteading blog in which the author used to publish a daily list of free books available on Kindle. I'd link to it, but the author then made the list available by subscription only. The books focus on topics of interest to preppers and homesteaders, such as homeschooling, working from home, religion, food storage, agriculture, etc. I have downloaded some of them, all of which were self-published, and the quality varies widely. Some are better than others.

But then I thought: What if I just type in 'free' on my Kindle? I tried it, and realized that on any given day there are thousands of free books available. Many of them are classics which some deserving soul has laboriously transcribed into a Kindle compatible format. Jane Eyre, Pride and Prejudice, Tom Sawyer - I felt as though someone had set me loose in a candy store and told me to grab everything I wanted.

And that is how I came to be reading Jules Verne's The Mysterious Island.

I love Jules Verne. Around the World in Eighty Days is still one of my favorite books, and one of my daydreams is to someday take three months off to go around the world. I also loved Captain Nemo, the self-exiled main character of 20,000 Leagues Under the Sea. Mysterious Island (published 1874) is commonly called the sequel to 20,000 Leagues, but that's not all it is by a long shot. I would rather call it a stand-alone novel which incorporates a character from his previous novel. Verne started with this premise: if a group of people are marooned on an island with nothing but fortitude, knowledge and the clothes on their backs, can they survive?

 The book is set in 1865 and focuses on a group of Americans, prisoners of war in Richmond, Virginia (they are Yankees). They escape from Richmond via a hot-air balloon which I guess someone carelessly left sitting around, are caught up in a storm over the open ocean and are forced to throw everything they own out of the balloon to reduce its weight before eventually crashing on an island. Captain Cyrus, the leader of the group, is an engineer; the other characters include his servant, a free black named Neb; Pencroft (a sailor); Herbert (the teenage ward of Pencroft whose hobby is natural history); and a journalist named Gideon.

It's interesting to read the book from a twenty-first century perspective. Our heroes have no qualms about exploiting every resource they can lay their hands on. They even wind up dynamiting part of the island to form an indoor shelter (it's a large undersea cavern, and the explosion allows them to drain part of the water out). The island just happens to contain clay, iron ore, nitrites, etc. etc. and the engineer figures out how to smelt the ore, build a kiln to make pottery and so forth. One running joke is that Pencroft is constantly hungry. Every time they find a new species, his question is: "Can you eat it?" Environmentalists everywhere would scream reading this book.

When the group initially lands on the island, of course, they have absolutely nothing. One of their group gets into trouble and then is mysteriously rescued; then they discover a chest of clothing and supplies sitting on the beach. Pretty soon they figure out that they aren't alone on the island...

The Mysterious Island is a good read, though somewhat stiff by today's standards. The adventure parts are interspersed with pages of straight-up chemistry whereby the engineer explains how the group is going to make gunpowder, why he knows the island contains iron ore and so on, which absolutely kills the suspense. But you can skim these parts. It's kind of like reading Tom Clancy where you blip over the parts describing tanks and aircraft in loving detail.

To get back to my initial point, I've been completely converted to the concept of e-readers. I continue to buy and read print books, and I don't think print will ever go away - nor should it. But the equipment is inexpensive and lasts a long time. I've had my Kindle for four years and it's still going strong. It's an older model to be sure, but I have not felt the need to purchase a new one. If you have been considering the purchase, or have bought one but aren't sure what to do with it, the free options alone are worth it in my opinion. Give it a shot.

Labels: Books, Random Thoughts, Science

posted by Dr. Alice at #

 
To all who are reading this now, or in the future. The annual Christmas miracle kicked in about 24 hours ago. Traffic has slowed down, nay, has all but disappeared. Peace reigns over Los Angeles (more or less). Merry Christmas to you and yours. Be well and avoid the flu.

Labels: Random Thoughts

posted by Dr. Alice at #

 
A Really Good Headline

As a good Stepford staff member of Tertiary Care Center, TCC's intranet web page doubles as my home page. Every morning when I fire up the box I am greeted by perky articles about the Star Safety Team Member of the Week, the latest blood drive/fundraiser/politically correct spokesperson for Disease X, or warnings about parking restrictions due to construction. There is nothing intrinsically wrong with this. It's just part of working for a big corporation (which, let's face it, I do).

My complaint here is that whoever writes the headlines for Tertiary Care Center's intranet web page needs some remedial education. This morning the top caption reads:

A Benign Brain Tumor, a Malignant Tumor, a Love Story and a Doctor's Reassuring Presence

I haven't read the story, but I'm sure it is heartwarming. No doubt. Unfortunately when I read this, my twisted brain immediately produced the following:

...and a Partridge in a Pear Tree
...and Two Hard Boiled Eggs. Make That Three Hard Boiled Eggs
...and Six Weeks To Live

Rewrite, people! Rewrite!

Labels: Critiques, Random Thoughts

posted by Dr. Alice at #