“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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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

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Kona the Wonder Dog


OK, just to cheer you up from the previous post here are some pics of the recent snowfall in Colorado, courtesy of my sister. Included are pictures of their lab puppy Kona - I met him over Christmas and he is adorable.









Brrr! I'll stick to Los Angeles, thank you.

Labels: Doggies, Snow, Travel

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Recognize this?

Australia, ladies and gentlemen.

The Great Barrier Reef, taken from a helicopter (apologies for the poor image).

More pics forthcoming. I wish to thank Tim Blair and his lovely partner Nadia for their generosity and hospitality while I was in Sydney (including letting me ransack their library) and for introducing me to Turkey Flats rosé. If you ever come across this wine, get some. It is great.

Labels: Travel

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Catchup Time

(I apologize for brevity here, but I am on the clock at an Internet cafe.)

I only just realized it's been six months since I posted. Unbelievable. I promise more posts will be forthcoming, but not right away. Currently I am in Australia on vacation - a place I have always wanted to go - and am in Melbourne riding trams and drinking coffee. I will post a few pictures as well upon my return.

Yesterday was Australia Day, a sort of combination of the US holidays Memorial Day and Columbus Day. We the newswatching and -reading populace were treated to any amount of guilt from the "indigenous people" of Australia. They actually went after the Prime Minister, who was at a ceremony in Canberra giving awards to emergency relief personnel, and security had to be called to escort her from the mob (who were beating on the glass walls of the restaurant and trying to attack her).

After seeing that spectacle on the news I make no bones about suggesting that the British who "stole" Australia from its indigenous people have accomplished a lot more in 200+ years than the indigenous types who lived here for thousands of years prior to that. And I don't care who hears me say it.

Labels: Random Thoughts, Travel

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Dots on a Map

Lately I seem to spend a lot of my online time on Mapquest. I look up the small towns where my parents grew up, revisit the parts of Philadelphia I remember from college and medical school. I spend a lot of time virtually wandering California's Central Valley, heading north on Route 99 and zooming in on the small farm towns that dot the valley floor. Some of these towns are only a few blocks long. I eyeball the bar scale at the bottom of the map, trying to estimate their dimensions: are they half a mile wide? Less?

Then I wonder what it would be like to live there. Hellish, no doubt: if these towns were thriving they would be bigger, plus the farm economy isn't doing well these days. Not to mention that the Central Valley is hot as hell in the summer. Nevertheless I can't keep myself from daydreaming about retiring there. On the map every one of these tiny little towns is an idyll. Everyone knows one another, it's peaceful there, there's a little high school with a scrappy football team that the whole town supports. Folks sit on porches and drink iced tea.

In real life, the denizens of these towns are probably either dead-eyed clerks at the local convenience store/gas station or toothless geezers who cook up meth in their spare time. I don't want to chance my fantasies being shattered, or ending up like Janet Leigh in the Bates Motel, so for the foreseeable future I'll confine my travels to Mapquest. And when I drive through California it will probably continue to be on boring Interstate 5.

Labels: Random Thoughts, Travel

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Home Again, Home Again...


jiggety jig...

I was home for all of 60 hours and then packed up for the annual ACP meeting in San Diego. I am now home from that and am happy to report that it was a great meeting. Basically, you sit in lecture halls all day and listen to talks on various aspects of medicine. These talks begin at 7 am and go till about 5 pm, every day, for three days.

It is less exciting than it sounds. But you learn a lot.

In an effort to save money on the trip I shared a hotel room with three of my fellow partners from The Firm. (I'm getting quite used to this whole roommate thing by now.) I am sure I bored the hell out of them by mentioning Guatemala's lack of showers, hot water and working toilets every time someone complained about sharing the bathroom.

Do I have anything else to say about Guatemala? Well. The clean air regulations we have here, they don't have there, and it shows. The air quality is terrible whether you're in or out of the city.

Guatemala has great buses. In Antigua we went to the crafts market and while wandering around found ourselves in the bus depot. Their buses are all deactivated school buses from the States, shipped down to Central America and treated to bright, eyecatching paint and chrome jobs. Mostly they run shuttles between Guatemala City and Antigua but they run to other towns as well. "I love these buses!" cried one of my fellow internists (who had a lot of experience in third world countries). "Nepal, Guatemala, Peru - it's all the same bus!"

We went to Antigua for the last two days of the trip, which is traditional for the group. It's always wonderful to get there after a hard week's work but it was doubly so this year, partly because of our no-water ordeal and partly because we got accomodations at the best hotel in the city. It's called Hotel Casa Santo Domingo and, if you ever get to Antigua, I highly recommend it. Breakfast was included and was outstanding: The best breakfast buffet I have ever been to. They had custom made omelets, fantastic homemade tortillas and pupusas, delicious fruit and great beans and rice. I am all about the beans and rice.

So now I'm home and making lentil soup. I posted about lentil soup previously, but I'm going to do it again because I have found a better recipe, courtesy of Nigel Slater. To make it, first, you need better lentils than the standard brown grocery store lentils (although they will do in a pinch). I highly recommend ethnic markets for cheap, good quality, fine green lentils. If you're in Los Angeles, Pico Boulevard has a stretch heavily populated with Israeli markets which are a great source for lentils, barley and dried beans. So you've got the lentils. Chop and saute some onion, celery and mushrooms and throw in a chopped garlic clove. Sort, wash and add the lentils once the vegetables are soft. Cover with chicken broth and bring to a boil. Add a splash of Worcestershire. Once the soup is on its way, wash, chop and add some baby broccoli and let cook until done - I usually give it 45 minutes to an hour. It is SO GOOD and is even better the next day. This recipe is cheap, delicious and good for you and makes a lot. It lasts me a week for work lunches.

Labels: Ingestion, Medicine, Travel

posted by Dr. Alice at #

 
Life In Guatemala


I walked in the back door of my house at 1:30 this morning, having left ten days previously. The Friday night of week before last I caught a shuttle to LAX, destination Guatemala City. I last went on this sort of trip four years previously and it had taken a little time for me to nerve myself to do it again.

Our destination was a town in Guatemala called San Cristobal. I don't know exactly where it is, as I never saw a map. All I can tell you is that it is not the Mixco suburb of Guatemala City; it is about four and a half hours away from the airport by bus. San Cristobal is home to an actual hospital, built in a fit of generosity by the United States government in 1962 back when they were making the world safe for democracy. Sadly, most of it has stood empty as the local government has neither the money nor locally educated providers to staff it.

I loved the building as soon as we walked in; I am old enough to remember the classic 1950's sort of hospital with green walls, linoleum floors and tile, and engraved plastic placards mounted over the door to tell you where you were. (e.g., "Emergencias.") This building was exactly like that. Hello, Dr. Ben Casey!

The organization I worked with, HELPS International, emphasizes surgery on these trips. The surgeons (Plastics, ENT, OB/GYN, General) do much more good than we primary care MD's or GP's can do. If you are looking for a cause to support, I can highly recommend them. Despite the relative luxury of having an actual hospital to operate in, this was our toughest year yet - as I was told by several old hands who have been on many more trips than I have. Allow me to demonstrate.

• A serious water shortage to the point that we were not allowed to flush the toilets or bathe. We were driven to use the bottled water (intended for drinking) to sterilize instruments in the autoclave before the water truck finally showed up.


• Random power outages.


• The hospital was host to a local Peds ward and emergency clinic. This meant that we were regularly woken by crying babies in the middle of the night. Let me tell you, those babies can raise the dead at that hour.


• Our first night there we had a sobering experience: a hospital employee dropped dead of cardiac arrest. The locals threw him into an ambulance and rushed the poor guy into the ward in a wheelchair... I caught a glimpse as he was rushed past and instantly thought that he looked dead. The surgeons did CPR on him and got a pulse back, but he coded again in the ambulance and was DOA at the local "real" hospital. It turned out that he had a history of diabetes and had had a pacemaker placed three months before. In addition, he had been hospitalized the previous week for pulmonary edema.


• A thyroidectomy patient who couldn't be extubated and needed MedEvac to Guatemala City.


• This is a minor point, but our chef's skills were off. We were treated to undercooked bean soup, "vegetable lasagna" (veg cooked in tomato sauce without noodles. It would have been fine if they had explained that before we sat down to eat) and cold canned pea salad with mayo, cheese and chopped onion. I will pass over this chapter of the trip without comment.

All that said, the camaraderie among the staff was outstanding; this is why people return year after year. I shared a dorm with five other women, mostly internists and one pediatrician. We chatted every night about spouses, medicine, the day's patients and everything else you could imagine. We got laughs out of the smallest of things. For instance, in most parts of Guatemala you can't drop used toilet paper into the toilet - the plumbing can't take it. You have to throw it into the trashcan. A couple days into our stay, one of my roommates glanced at the overflowing toilet bin and commented acidly, "I see maid service didn't come today." It sounds like a small thing, but we laughed like maniacs. We slept on cots I firmly believe were designed for Satan's Army - even our inflatable air mattresses didn't really help. After a full day of work they were comfortable to start with, but by the end of the night we were tossing and turning with every muscle in our torsos protesting.

After the first rush of presurgical clearances was finished we clinicians were subject to, as one of my roommates termed it, "the bullshit parade." Duele todos in corpo soon became the last phrase any of us wanted to hear. Not to mention dolor in cabeza or back or foot pain. Our pediatrician announced one day at lunch, "I saw this lovely baby today, she was really kind of fat. Her mother told me she wasn't eating and hadn't eaten for a month. I'm looking at this Buddha baby and just said to the mother, "I don't believe you." (Not eating is apparently a favorite complaint among Guatemalan mothers.)

I came up with a haiku one day, in a haze of clinic induced fatigue: Feet hurt all the time/Headache, neck ache and back ache/Gastritis, she says

Next installment later... I have to get some sleep.

Labels: Medicine, The Doctor's Life, Travel

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What Dr. Alice Did On Her Summer Vacation, and Vacations Past


Yep, I'm back from my trip. I went to Brighton to visit my good friend Jess (hi, Jess!) and returned sooner than planned due to a few reasons. I got bronchitis; Jess got sick, too; I decided I did not want to go on to Paris as I had originally planned. I switched flights and came scooting back to Southern California like nobody's business.

So the rest of my vacation will be spent here, and I am fine with that. My first homecoming challenge came via email from my sister; my oldest niece has gone to sleepaway summer camp for the first time. I was invited to send a letter and perhaps a care package to said niece. Back in the last millennium when I went to camp, care packages were not common things; we got letters and the occasional newspaper clipping/comic strip and that was the end of it. But now, care packages are apparently so common that they are sold online - that is just WRONG! What's the point of a care package that has not been lovingly put together by hand (she ranted pointlessly)?

Food is verboten in camp care packages, that is the other thing. I can understand this as otherwise kids might be living on chocolate, popcorn and potato chips for a week. Can't have that. When I went to summer camp, I will never forget two standout food-associated moments. The first was the morning we had corn fritters and maple syrup for breakfast (still one of the highlights of my life). The second was the night we had "Swiss steak" for dinner, smothered in tomato sauce. I found it rather dry and crumbly but forged on. Suddenly my dining companions began to gag and scream, "This is LIVER! I can't eat it!" (Since my mother cannot stand/will not eat liver, I had never had it.) I ate it, but I still can't say whether or not I like liver since all I could taste was the tomato sauce.

But back to the care package. I went to my trusty local supermarket with a big toy/personal care section and hunted around. I found hand sanitizer in a "crisp apple" scent, hair elastics and glittery bobby pins, waterproof sunblock and a note pad and pens. All of this I have packaged up and sent off. I feel so... parental.

With the package I sent my niece a letter with my recollections of summer camp from 35 years ago. Some things have dated. For instance, back then we drank water right out of a mountain stream without treating it (this was in a remote part of the Rocky Mountains). Thanks to the ubiquitous Giardia, such a thing is no longer possible unless you want to have a nasty case of diarrhea. But I have to say it was the most delicious water I have ever tasted.

We also camped out next to the stream one night, and it was the coldest night of my life. But it was worth it... the stars were beautiful. I stared overhead at a fuzzy part of the sky and finally realized I was looking at the Milky Way. Part of a galaxy. As a suburban kid I was stunned. Sadly, light pollution is so common that I have only seen the Milky Way three times in my life (the third time was last year). But that was the first time, and it really blew my mind. Early the next morning I opened my eyes to see a pair of deer in the meadow perhaps fifty yards away. Again, for me this was an amazing sight.

Camp activities included archery and riflery. Yes. I, a twelve-year-old, shot bows and arrows and a .22-caliber rifle. And I had a lot of fun, and there were kids younger than me shooting rifles too. Safety regulations were strictly followed and nobody got hurt. Sadly, I think any camp allowing riflery now would be viewed as a Waco cult waiting to happen. We were also allowed to dig around in a 60 to 70 year old trash dump and found neat rusted junk and china fragments dating from the early 1900's (or so we hoped).

We also had crafts which mostly involved sprinkling enamel powder on copper pieces and baking them in a kiln, or building rockets from Estes kits and setting them off. Or of course the inevitable leather embossing. There was an AM radio in the background playing a loop of Top 40 hits. I think the "Theme from S.W.A.T." has been burned into my memory as well as "The Night Chicago Died." (I realize I am completely dating myself by mentioning these songs.) But iPods, CD players or even Walkmans were completely unheard of. And there was no television available, let alone DVD or VHS players.

Camp memories... on the one hand I thought posting this would be indulgent rambling. On the other hand writing this made me realize how much things have changed since I was a kid. Reader, any thoughts/memories you would like to contribute?

Labels: Ingestion, Los Angeles, Pop Culture, Travel

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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.

Labels: The Doctor's Life, Travel

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The Noble Art of Medicine

...and here we are at the ACP meeting. V. and I are roommates this time around and are sharing my computer (she brought hers but can't seem to get the wireless access to work). Philadelphia is beautiful at this time of year, though the budding trees are giving her allergies.

The national meeting of any medical specialty is always fun, giving MD's a chance to catch up with old friends from residency and/or medical school and two or three days of luxurious learning without having to worry about patients and phone calls. So far today I have attended lectures on insomnia, dementia, neurologic examinations and pain management. Tomorrow will include wound care and renal disease. This may sound dreary, but it's not; the speakers here are the best in their fields. You don't get an invitation to speak at a national meeting unless you're really good.

I haven't been to the sponsors' hall yet (drug companies, medical data management companies, locum tenens companies and so forth) but V. has. She came back with all sorts of goodies: a T shirt, travel coffee mugs, pencils, a flashlight and hand disinfectant. I plan to go there tomorrow and see what I can get.

I ran into one of my old cardiology professors from med school. He remembered me, and I was greatly flattered. Also, I took V. for a cheesesteak today and we toured the Reading Terminal Market, which she greatly enjoyed. We're both beat due to jet lag but it's going to be another early day tomorrow - lectures start at 7 am.

Labels: Medicine, The Doctor's Life, Travel

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I'm Home


Q: How do you know when you're back in L.A.?

A: You wake to the drone of a helicopter hovering in your neighborhood.

Finally, I'm back. This is the longest vacation I've taken in quite some time (I got back to the US yesterday and don't go back to work till Friday). The 10 freeway is down due to fatal accident - apparently some dude driving the wrong way. It happened in my neck of the woods, so I assume traffic on city streets is going to be really bad; have not left the house yet to test this theory.


It was one of those "herd 'em on the bus and go out to see the sights" kind of vacations, but considering we were in the Middle East this was by far the best option to choose. Specifically, my parents, my aunt and I toured Egypt and Jordan. I'm really glad we went and I would recommend both of these countries as destinations, should you be wondering whether to go. We saw Roman ruins, monasteries, mosques, Biblical sites and (of course) the Pyramids. Flat Stanley played a large part in our tour as well and I'm glad he did, as it forced me to do some actual research and learn something about the area we were touring. We will hear from Flat Stanley in a later post.

Our Egyptian tour guide was a sharp, amusing and tall fellow by the name of Achmed, very fluent in English. He gave us tons of information about Egyptian society, politics and history. His catchphrase was "Everything started in Egypt," and by the time he got through with us this didn't seem like much of an exaggeration. He's a self-described agnostic and was quite insistent that we not cover our heads at any of the mosques we toured - this stance actually got us evicted from one site. No one was wearing low-cut shirts or anything the least bit provocative, but the moment we entered the Al Azhar Mosque in Cairo we were surrounded by a group of locals (no imams or anyone with authority, just kibitzers) and after five minutes of heated argument from Achmed, we left. Interestingly, when we toured a mosque in Jordan - supposedly a more developed/Westernized country - all the women in our party had to put on hooded robes that covered everything, including our heads. We did as we were told but were not particularly happy about it.

Achmed also had some interesting analysis for us about how Egypt views the US, particularly its presidents. They loved JFK (predictably), but interestingly Nixon is respected there as well. This is partly because of his progressive stance on foreign policy and partly because, in the Middle East, Watergate is viewed pretty much as business as usual (Achmed quote: "What's the big deal?"). Per Achmed, the Egyptians really liked Clinton and hated GWB. When asked to comment further, he explained: "Bush should never have used the word 'crusade' after 9/11. The Crusades are a very bad memory in this part of the world. Then, when he said 'You are either with us or against us', this sounds like bin Laden. The people here, they don't like bin Laden either, but a bin Laden in a cave is no problem. He can't hurt anybody. A bin Laden in the White House, this is a big problem."

Achmed also had some cogent comments the day of Obama's inauguration. "Nothing's going to change," he said, shaking his head. "Everybody here is so happy because they think Obama is going to change everything. But that is not the way your government is set up. It's not like here, where the head of state can do anything he wants. Nothing is going to change." Give that man a cigar, I thought. He's got American politics figured out better than most Americans.

We did all watch the inauguration at our hotel in Luxor (it was 7 pm local time). The hotel had set up chairs for us in the lounge area. I hadn't felt strongly one way or the other about watching, but decided to join the group. It isn't partisan, but I just don't have much attention span for this sort of thing. Perhaps it's a character flaw, but Big Moments generally leave me uninterested, particularly if they involve speeches. I did feel sorry for the Obama kids, though, having to sit out of doors in the freezing cold. Their noses were clearly running.

A side comment re: the inauguration. I spent a lot of time catching up on blogs today, and if I see one more comment along the lines of "I was so happy I've been in tears all day" I'm going to hurl. Seriously, people, get a life. My thoughts were more along the lines of Went well, nice speech, let's get on with it.

And now I've got to get on with it and go run some errands. More later.

Labels: Travel

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Off Track

I'm going to be off the map for a bit; back at end of January. I'm traveling with my parents. Will let you know about it upon my return.

Labels: Travel

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Paris in the Rain

This is the second of my two days in Paris: I got in late Wednesday night and will be leaving for home tomorrow. Right now I'm sitting in an Internet cafe watching the rain pour down outside, trying to decide whether to continue with my plans to tour around or just go back to my hotel and sack out. The sack-out option is looking pretty good (it's a very comfortable room), but I think I'll soldier on for a little longer before going back.

I've been to Paris before so I don't feel the need to run to the Louvre or Notre-Dame; I've really just been wandering around the city, doing some shopping and so forth. I've found the city quite pleasant and have scraped together the remnants of my high-school French, though I occasionally find myself substituting Spanish by mistake (it's embarrassing to be saying "gracias" instead of "merci"). I also had a delicious choucroute garni for lunch yesterday, which is sauerkraut cooked with ham, sausage and various other meats; reason enough to come to Paris if you like sauerkraut.

My Internet time is about to run out so I'll sign off here. Next week it'll be back to the patients and paperwork, but I will be armed with a slightly better attitude thanks to the break. And Labor Day is coming up, so I still have a three-day weekend to look forward to.

Labels: Travel

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Now This is a Reality Show!

In a sense my vacation has been misspent. I have watched more television in the past week than I have in the past several months. But, I tell myself, I am gaining a valuable insight into the British psyche by doing so. I have learned the following:

• British soaps are telecast in the evening, not early afternoon. The storylines are real-life and revolve around the working classes; not a scrap of glamour is to be seen.
• Britcoms continue to be the best by far.
• Britons love their reality shows, oh yes they do. Both "Big Brother" and "X Factor" (the inspiration for "American Idol") are on right now and garnering big ratings.

Last week here saw the premiere of a new reality show called "Maestro," in which nine celebrities learn to conduct an orchestra. Each week they are assigned a piece of music and take turns conducting the BBC Orchestra, with one or two competitors getting knocked out each week. The winner gets the chance to conduct a real performance of the orchestra. As far as I'm concerned this is a brilliant idea: who hasn't conducted along with the radio and fantasized about directing an orchestra? I've been gripped by the show, enjoying the music and watching the efforts of the competitors to learn an entire piece within a week. Most pleasant of all, they aren't jostling for money or fame. They're doing it for love of music.

I hope this show is successful. It would be nice to see more reality shows with a higher tone about something besides scrabbling for cash.

Labels: Pop Culture, Travel

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Checking In

Vacation has been great fun, considering I was stupid enough to check my work email a few days ago only to be greeted by the news that one of my partners is quitting. Which means the fall will be a slow ongoing disaster. Never mind.

Brighton, where I am staying, is a beach town and very fun: Lots of pubs, lots of shops, the Prince Regent's summer palace to tour and so forth. The palace was built in the late eighteenth century, is known as the Pavilion and is right in the middle of town. It's a pile of Indian-styled domes and peaks and looks as if an architect had designed it while under the influence of a dysenteric fever dream. Today I walked down to the beach with Jess and watched the waves crashing - the surf is very high for August, so she tells me - and we wound up having a full English breakfast for lunch. So I guess it was brunch.

The classic full English breakfast is a cardiologist's nightmare: bacon, sausage, toast, two fried eggs, baked beans and a grilled tomato (to balance all the meat). But it's very delicious. I requested my eggs scrambled but apparently this is unheard of: they arrived sunny side up with scary quivery yolks. Solved that dilemma by just eating the crispy whites.

I'm off to Paris in a day or so and hope to post more then.

Labels: Ingestion, Travel

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