“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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Here's a couple of downer stories for ya:

Wall Street ends third straight year down. Yep, down. So much for my retirement fund:

Weighed down by terrorism, accounting scandals and fears of war, Wall Street ended its third straight losing year Tuesday � the longest such streak since Franklin D. Roosevelt was in the White House.

And the other:

2002 A Year of Anxiety for California

Some of the most chilling news in 2002 centered on a seemingly constant stream of stories of abducted, murdered children and of priests accused of molesting young parishioners.

Oh that'll put us all in the party mood, all right...
posted by Dr. Alice at #

 
This post tells you what doctors talk about after work. Beware.

Today was my first day back at work and it was a "total nightie" [nightmare], as my sister would say. I spent three hours on Sunday going through backed-up stuff and was constantly either on the phone or seeing patients today, but still I'm stuck with a backlog of lab results on people I have to call. In need of a break, I headed down the hall to see my good friend from work - let's call her V. V. is an endocrinologist but also does basic internal medicine, like me.

As I walked in, I saw V. on the computer playing with a Bob the Builder spelling program sent to her by her husband. The idea is, you get a picture and a three- or four-letter word, usually with one letter filled in to help you start. You click on a letter and move it to one of the open dashes. You get instant feed back from one of the cartoon characters via a word balloon ("Superb! Fantastic! Terrific!") Needless to say, this program is for beginning readers... but after watching this for about ten seconds, I said, "I need that. Something I know I can do that will stroke my ego."

"I'll email it to you," said V. After which I showed her my Christmas pictures of my niece and nephews. Then we got into a discussion of what a crappy week it was at work. The holidays are slower than usual, but we also have to cross-cover for each other. V. is following a patient in the hospital who belongs to one of our co-workers. He is hypernatremic (running a high sodium level) and is somewhat dehydrated, and not very responsive due to these problems.

"Let's fill him with fluids and watch his brain swell like a sponge," I suggested idly. [Note: not recommended]

"I'm doing it a little more gently than that," she responded mildly. After which we both went back to watching that hypnotic Bob the Builder spelling program. She was debating moving up to the six-letter word level when I left to go back to my charts.
posted by Dr. Alice at #

 
Federally Mandated End-of-Year Posts:

You have a choice. Dave Barry's recap of 2002 is always good for a giggle. Then there's Tim Blair's predictions for 2003... I find this hilarious. Enjoy.
posted by Dr. Alice at #

 
Here is a post of Chuen-Yen's Christmas experiences. I'd wager they were vastly different from most of ours:

Happy Holidays!

Home is where the heart is. Rather than spend the holiday in comfortable Blantyre, most workers will return to their villages. My houseboy Gift is no exception. He was so euphoric when I gave him ten days off that he rashly invited me to visit his family. He never fathomed that I would take him up on the offer.

During the expedition, I was subjected to the benefits of inequality, which Malawi�s masses whole-heartedly embrace. Each bus rushed us to the head of the cue. We were given the best seats. Items were snatched from Malawian customers and handed to us if I showed the slightest interest. Most disturbingly, Gift persisted in addressing me as �Master�.

The main stretch of our journey began aboard a dilapidated bus destined for Gift�s village of origin � Mikwasa. It did not budge from the congested dirt terminal until we had loaded far more than the posted maximum capacity of 48 seated and 52 standing. Weighed down by its excessive cargo, which included not only too many people, but also livestock, bundles of clothing and furniture, it crawled smoggily through the picturesque landscape of natives toiling on foreign owned plantations. The trip consumed 4 sweaty hours. Halfway through, I began to think my bladder might explode. When I finally did reach a �toilet,� an odiferous pit swarming with flies, I decided not to drink any more water until home.

At Mikwasa, Gift�s siblings navigated several kilometers of obscure dirt trails from the bus stop to their adobe house. While we picked mangoes, �The mother,� always referred to by that moniker, prepared small rations of greasy foods over a smoky fire in a dark, poorly ventilated room. Actually, the entire house was dark due to soot and lack of electricity. �The father,� blind from glaucoma, sat on a stump lamenting his plight.

Prior to dining, all hands were cleansed in a bowl of water fetched from a nearby stagnant pool. As one of those utensil-using foreigners, I was offered a serving spoon, which could never fit into my mouth. A tour of the barren farm ensued. Gift, ashamed of his village, repeatedly apologized because �White people cannot be in a place like this.�

For Christmas, I gave Gift a mosquito net and a few hundred Kwacha. His family received 5 kg of rice and 2 kg of dried beans. Everyone was delighted.

Having already appreciated the big bus, I squeezed most of my body into a minibus for the trip back to Blantyre. I, and fourteen other seatbelt-less passengers, clung to the upholstery as we tore down the treacherous one and a half lane road. Once home, I promptly enjoyed electricity, tap water and a flushing toilet.

Have a great Christmas.
CY
posted by Dr. Alice at #

 
Whew. I have been off work and a visitor to Kiddieland all this week. My sister was in town for the holidays with her husband and three kids - four, two and six months. As I have no children myself, this was quite an experience. I love the kids, and they're good as kids go, but the amount of attention they require is tremendous - especially as my parents' house cannot be described as "childproof" by any stretch of the imagination; to the contrary, I believe it would qualify as what is legally known as an "attractive nuisance." Then there is the inevitable infighting between the four- and two-year olds: They never want to share anything. I mean, anything. The six-month-old had a mild case of colic and still refuses to eat solid food. He won't touch cereal or veg. We got him to eat three spoons of pureed pear baby food the whole week, and that was a major triumph. He looks healthy though.

The baby had a major vomiting episode Christmas Eve - I was holding him at the time and let's just say I had to throw everything I was wearing in the washer.

But there were compensations of course, watching the kids open their presents Christmas Day, playing with the kids, taking my niece to the library (which she loved). My two-year-old nephew Mitchell is particularly cute - he's just started talking and listening to his speech is great fun. All winged insects are "flybees." He doesn't like them.

All my clothing had food or spit-up on it when I got back and is now in the washer. But I miss them already. Sigh.
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This Sunday afternoon has been a busy one, as they always are right before Christmas. After church this morning (fourth Sunday of Advent!), we spent an hour in the ice-cold sanctuary rehearsing the procession for the midnight Mass of Christmas Eve. If you're not Episcopalian, you may not realize the intricate etiquette of this process. All participation in church services requires training, especially a big feast like Christmas Eve; the only bigger one is Easter Sunday. My church is fairly high (a "high" church would be closer to the Catholic end of the specturm, a "low" church more Protestant), and we like observing the formalities. I was not raised in this tradition but it's congenial to me, and I enjoy being in the procession. I am to hold the banner, a heavy and awkward thing, and follow the priests, with half a dozen lay eucharistic ministers (aka "chalice bearers") behind me. The church is going to be packed.

I usually stay and help decorate the church for Christmas, but this year I had to leave early as I had to go to a nursing home, visit the office to get some work done (I am taking a week off) and then go home, pack, and drive to my folks'. So off I went to the nursing home, to visit a patient of mine who had a stroke after having surgery for colon cancer. The facility was brightly decorated, as it always is for Christmas - lots of tinsel garlands and plastic poinsettias. As I was sitting at the nurses' station writing my note, I suddenly realized that in the common room one of the aides was leading the patients in Christmas carols:

Oh come, let us adore him
Oh come, let us adore him
Oh come, let us adore him,
Christ the Lord.

I spent some time discussing my new orders on the patient with the nursing staff and then got up to leave. I walked to the entrance of the dayroom to observe the proceedings: one of the wheelchair-bound patients was wearing a Santa hat. The aide was still bravely leading them in carols:

Noel, Noel, Noel, Noel,
Born is the King of Israel.

I didn't find this sad or pathetic. As I looked at these people, I saw hope: no matter how old or sick we may get, we'll always be able to take pleasure in Christmas.

I hope your holiday season is a good one.
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I think this is really interesting. It's an article in the New York Times about a sonar-mapping project of the Hudson River that has uncovered every ship thought to have sunk there in the last 400 years. The scientists running the project also think they have found a series of walls, clearly of human construction, that date to 3000 years ago.

Check out the whole article, it's great reading. This is what the Internet is for, by golly.

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One of the doctors in my office emailed me today about a patient:

today, when asked what medications he's allergic to , said "all generic medications".....
"oh , I see" was my only reply......

My emailed response:

My favorite was the patient who said she was "allergic to cheap jewelry." I knew she meant a nickel allergy, but my response was "aren't we all?"
posted by Dr. Alice at #

 
Whew. It's been pretty busy - please excuse the anemic posting. I hope to have something good for you later this week. In the meantime, I can report that all my Christmas shopping is done (hallelujah) and nearly all my wrapping. I still haven't gotten lights on the tree though - it's sitting there naked.

The end-of-year surgical crush is upon us, so I am doing pre-operative physicals like crazy. Patients have met their deductibles and now want to get their surgeries done before the end of the year, when the clock resets and they have to pay all over again. Now that we have more managed care we don't see so much of that, but some patients' insurance plans still have deductibles, where you have to pay out a certain amount of money ($250 or $500) before the insurance coverage kicks in.

Managed care, meantime, is not without its issues; my elderly patients, many of them, have met their drug capitation for the year and are now subsisting either on samples, paying cash, or doing without their expensive but necessary meds until January. It never fails to amaze me how we manage to cobble together some sort of support for these people, at least most of them. Their generic drugs are covered, but brand-name drugs have a $2000 limit. (This is Secure Horizons we're talking about, the only senior plan we take.) Next year it will get worse. Pacificare (the parent company of Secure Horizons) thinks we're too expensive, due to the fact that our hospital contracts are with Cedars and Midway (a Tenet-owned hospital). They're right, we are too expensive. I will omit the long backstory and merely state that at Cedars, the cost for an outpatient surgery averages nearly twice the cost of an outpatient surgery anywhere else in town. So, to put the squeeze on the helpless elderly patients, they now will have to pay a $25 premium every month if they want to stay with us, plus no brand name drugs will be covered - just generics. I think we're going to lose a lot of patients, some of whom have been with the group for ten years.

I will keep you updated on this situation as it develops. We have begun to refer to this particular company as "Insecure Horizons."
posted by Dr. Alice at #

 
Here is another of Chuen-Yen's vignettes of life in Africa:

Happy 3rd week of December!

I just returned from mushrooming. The impetus for this outing was that I impulsively purchased a finicky tortoise.

Two days ago, I spotted a feeble old rogue waving the little reptile wildly in the air. Sensing my curiosity, the salesman approached, shaking it even more violently. After learning how to stew tortoise, I bought the tasty creature for 150 Kwacha. In reference to the reason for her (three out of five voted that it is female) purchase, she will be known as �Enigma.�

Once home, Gift promptly informed me that the �kamba� (Chichewa for tortoise) should only cost 50 Kwacha. As usual, I was ripped off because, �Madame, the dark ones see that you are White and know you have very much money.� He then asked how I would like the kamba prepared. To his dismay, I instead converted the bathtub into a temporary testudidine habitat, which I lined with a smorgasbord of food. Being a true Malawan, she voraciously consumed a lump of mgayiwa and nothing else. After getting over his incredulousness that the non-human had a name, Gift hypothesized about my new pet, �Madame, I think you have malaria.�

Mushrooms, apparently the favorite delicacy of kambas, are a rare commodity in Blantyre. Gift and I just made a two-hour mushroom mission through brush and garbage dumps on the outskirts of town. Our tenacious efforts paid off when, 1.5 hours into the trek, we discovered 3 immature tan boletes. We gently extracted the precious fungi from some waste, wrapped them in large leaves and, with satisfaction, headed home.

Back at the hospital, the dentist reported that mushrooms are easy to find. They grow in front of the union headquarters adjacent to my house. Amused with our endeavors, he scolded us for not asking him where to hunt before embarking our low yield quest. I still don�t know why I should have known to ask him. Across the parking lot, we found, as described, a plethora of boletes. We picked a few and laid the offerings in front of Enigma. She lunged, as fast as a tortoise can lunge, for the local mushrooms and glared disdainfully at the laboriously imported ones. Gift silently potted the rejects and placed them in the window.

Merry Christmas from Enigma.

CY


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MST fans will love this (from Shauny, who runs, I kid you not, the most awesome weblog. Please go and check it out right now):

We were equipped with only an apple, a bottle of water, a dog, and a warning to watch out for snakes. Then we were dumped at the railway line with a few hundred sheep.

In case you're not an MST fan, the key phrase is "watch out for snakes."



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Hamsters. Mmmm.

On cold nights like this, I agree with Rebecca:

Would you not like to tumble into a pack of sleeping Huskies and cuddle up and be all warm and toasty in their dogpile? That is where I need to be at this moment. Sleeping with dogs. Or a bunch of hamsters, if they moved as a single group consciousness wave whenever I moved so I wouldn't squish one by accident. Mmm, hamster duvet.
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Today I am going to share one of those special, warm holiday moments you only get when you have two doctors in one family.

My father was helping me set up my Christmas tree recently. For the record, I have an artificial tree - I got it several years ago. I have taken plenty of guff from my siblings about my "fake tree" - they still swear by the real thing - but when you live alone and you have to maneuver a tree up a steep flight of 20 or so stairs, you quickly learn the merits of having the other kind. I can set it up as early as I choose and leave it up as long as I want, and I don't have to water it.

Anyway, this particular tree has flexible metal strips covered with fake greenery as the branches. As you set the tree up you bend each large branch away from the trunk and then manipulate the smaller branches into the shape that you want.

As my father and I struggled with the tree, he said:

"Kind of like a penile implant, isn't it?"

"Yes," I said, "exactly."
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The perfect gift for someone you don't like: the body fat analyzer from Red Envelope. And it's only $64.99!

Let me append to this that if you have a health and fitness fanatic in your family, it might be a great gift. But that wasn't my first thought as I contemplated this entry in the online catalogue.
posted by Dr. Alice at #

 
Games?

Anybody out there got any favorite computer games that they would recommend? I'm thinking of buying some for home entertainment purposes. Or, if you have a game system like PS2 or something, what do you think of it? Do games systems hook into your TV, your computer or what?

As you can see I know very little on this subject, but I'm redoing my basement and a home entertainment system is going to be part of what goes in there. I am not planning to spend a fortune or to end up with a home movie theater, but any info you can suggest I'd appreciate. I am not a fan of the shoot-'em-up type games, if that helps any. I love Freecell and I used to be a big fan of Minesweeper and Taipei - still am but I got tired of them. I have a PC, not a Mac.

OK. Let the advice pour in.
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Tonight I called a patient of mine about her mother, who is also my patient. I'd seen Mother (age 85) last week for a blood pressure check. Her BP was sky high as usual. I asked her if she'd been taking her medication and she admitted she hadn't been. I asked her why not: "Well, doctor, I have to confess I've been a naughty girl. I just stopped taking it."

Internal monologue: "I asked you WHY NOT, you wizened elf, ANSWER ME!"

Out loud: "Well, when did you stop taking it?"

Mother: "Oh, it couldn't have been that long ago. There's still four in the bottle."

I look at the bottle. I last saw her September 20. I gave her 30 pills. That means she's only taken 24. She's been out of it for a month and a half. To doublecheck, I call the pharmacist (the number's on the bottle) and he confirms no refills.

IM: "You stupid widget."

OL: Firm lecture. "I'm calling your daughter. I want her to make sure you take your pills from now on."

Mother: "Oh, doctor, that really won't be necessary."

OL and IM: "Oh, yes it will. Now I want you to get back on these pills and I'll recheck your pressure in a month."

Not mentioned above is the fact that Mother is deaf as a post, so I have to repeat all of my remarks at least three times in a very loud voice.

So tonight I finally reach Daughter and tell her this story. She reacts with shock. She tells me she's asked her mother every morning if she was taking her pill and her mother told her yes. I believe her - I think Mother just doesn't want to take the stuff.

Daughter: "Do you think there may be some problem with confusion? Her memory?"

I tell her that whether there is or not, we have to get her mother's blood pressure under control before we do anything else. Interesting medical fact: a large percentage of dementia cases are not Alzheimer's but seem to be related to uncontrolled BP - multi-infarct dementia from multiple strokes is one such scenario, but hypertension alone over time seems to have damaging effects on the brain. One study took Alzheimer's patients with high blood pressure, treated their blood pressure and their confusion got better. So did their memory.

So always take your blood pressure medicine, boys and girls!

I have to admit, though: as I hung up the phone some part of me felt like I'd won, like when you get the last word in some petty argument. What kind of bitter, burned-out bitch of an internist would exult in scoring over some old lady?

I WOULD.
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Music To Get Your Groove On

This is a list of the top ten songs that the British like to make love to:

Death metal, gangsta rap and contemporary Christian were not represented in the top 10 songs British people like to make love to, according to a survey released yesterday.

Someone must have had a lot of fun writing that sentence.
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This Guy Is an Idiot, Part Deux

I can't believe a vicar did this:

Youngsters at a Christmas carol service were devastated when the Reverend Lee Rayfield told them Santa Claus was dead.

Even parents at the service in Maidenhead, Berkshire, were shocked to hear Mr Rayfield say it was scientifically impossible for Father Christmas to deliver so many presents so quickly.

He said this to an audience of FIVE-YEAR-OLD KIDS. Say goodbye to ever becoming Archbishop of Canterbury, pal.

(From Instapundit.)

posted by Dr. Alice at #

 
"These Guys Are Idiots"

No argument here:

IRVINE, Calif. (Reuters) - They thought they had stolen vicious pit bulls but instead they wound up with purse-sized Chihuahuas known for their timidity.

The men were caught after bringing the dogs, which had ID microchips implanted under their skin, to an animal clinic in a PetSmart pet supply store for an examination and vaccinations.

The store manager said she sensed that the pups were victims of a severe case of mistaken identity. "They asked me, 'What is this?'" Morgenthaler said. "I told them it looked like a Chihuahua mix. They said, 'No way, it's a pit bull.' They didn't believe me. They wanted to ask the veterinarian."

When the men brought the puppies back to the clinic for an exam and shots two days later, Morgenthaler was prepared.

"We said we were going to take them into the back to cut their nails and take their temperatures, and we called the police," she said. "It was pretty scary."

During the examination, the men repeatedly asked the veterinary staff what breed the puppies were, and again insisted that they were not of the diminutive Mexican breed.

"They were pretty perturbed that the puppies they stole were not pit bulls," Morgenthaler said. "They thought they were stealing pit bulls. These guys are idiots."

This sounds like a pretty good argument for implanting microchips in your pet to me. But who could look at a tiny tremulous yipping puppy and think "pit bull"?


posted by Dr. Alice at #

 
Chuen-Yen sends her latest update from Malawi:

Greetings!

Another Malawian week has elapsed. I now have a bad haircut, compliments of my houseboy Gift. And with this coif, I will appear on Television Malawi tonight.

My folly was to seek a local coiffure in the open-air market, not an expatriate salon. I enlisted Gift to take me to �the place where black people go.� He said it was �close, very close.� The half hour short cut passed by Gift�s house, which he shares with two brothers. The house is a room, about 8 feet by 8 feet, divided in half by dismantled cardboard boxes suspended from the roof. Magazine images of ideal White people plaster the walls. On one side of the cardboard divide is the boys� bed, a bamboo mat sans linens. On the other side is an all-purpose crate / table and a line on which their wardrobe hangs. The kitchen, communal with two adjoining one-room abodes, is an even smaller, unventilated room. When I visited, it contained a bucket of water and a fire. Suffocating smoke was wafting into every living space, obviating the source of many people's scents. A typical heap of garbage, waiting to be incinerated, loomed over two short rows of immature maize plants. The brothers, feeling luxuriant in their domicile, are expecting another sibling to move in soon.

From the house, we traversed a steep dirt trail, darted across a major two-lane thoroughfare and descended into the dusty Mbayani Market. Gift promptly warned me, �White people (I am considered White as the only other option is Black) never come here.� We slid down several rocky paths, passing innumerable rickety wooden stands, piles of waste and hordes of languid people, to the heart of Mbayani Market where a cluster of hair-cutting stands summoned. Stylist after stylist refused my business. Most stated that my hair was �too soft.� I also heard, �I cannot cut White people hair.� And, �My tools will not work on your kind.� Back at home, Gift cut my hair.

Later in the week, the TV Malawi people called to inform me that we would be shooting our Children�s Broadcasting Day show in less than 24 hours at some local school. When the time came, the pupils were suddenly unavailable. So, we opted to use my stuffy little exam room as our backdrop. And I borrowed a seven year old from the hallway. Due to the changes, we discarded the intended script and brain-stormed up some health questions. A cursory search for props ensued. Then I looked into the camera and answered our queries with whatever came to mind. After this, we demonstrated how to wrap an ankle and sling an injured arm. No second takes. I think the finished product will be worse than a home video.

I�m glad none of you can get TV Malawi.

CY

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Today I heard on the radio that Saturn has come out with a new model, the Ion. Excuse me, the ION (that's how they spell it). I was delighted to hear this - finally, a good, 21st-century, vaguely-sounding-sci-fi-ish name for a car! Isn't it about time? Enough of these outdated, mid-century Mustangs, Pintos and Chevettes!

Just hearing the name evokes the opening of a second-rate science fiction story: "It was after the Apocalypse. I was chugging along in my beat-up old '03 ION, hoping I had enough gas to make it home, when I spotted the Martian hitchhiking by the side of the road, twelve miles up the coast from Santa Barbara."

You take it from there.
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Aftermath

I am filling out a discharge summary for a patient at one of our SNFs (skilled nursing facilities, also known as "nursing homes"). This particular patient had end-stage cancer and died of pneumonia while at the SNF. She had a long and varied history with our group: I only acquired her as a patient about three years ago, when she decided she had tired of her original physician (whom she had been seeing for several years) and wanted a change. I think she was also annoyed with this other physician when she developed lung cancer, just as the other doctor had told her she would, after smoking for decades and refusing to quit. She was a rather difficult woman, but as seems to happen with any patient I have who is dying, I developed quite a bit of respect for her. Stubbornness is not always a bad character trait - it's helped a lot of people survive major illnesses.

At any rate, she had a lung resection, which appeared to be curative, and did well for a few years before developing back pain about a year ago that just wouldn't go away. I thought she had a disc problem, but the MRI showed nothing. Then in April her blood tests came back markedly abnormal, and we finally diagnosed multiple myeloma. This is a cancer of the white cells in the bone marrow, similar to leukemia but not the same thing. She didn't handle chemotherapy very well, was admitted to the hospital for dehydration, generalized weakness and low potassium and calcium in September, was finally discharged and then developed pheumonia three weeks later. Her blood counts remained extremely low from the chemo and finally she was made a hospice patient and died a week later.

So now I have to fill out this piece of paper - not an unusual task. Admitting diagnoses are listed. I have to fill in the discharge diagnoses (pretty much the same), summary of course of stay, and condition on discharge. It's this last category that suddenly gives me the mad desire to write something surreal. The fact that she's deceased is already listed at the top of the page: so what IS her condition at discharge?

"Pretty good, considering."
"More pleasant than when she arrived."

And her prognosis? "Swift decomposition" comes to mind. I find myself seized by hysterical giggling... then I chicken out, quickly write "Deceased" and get the form off my desk before I can change my mind.
posted by Dr. Alice at #

 
Full body scans, I have always felt, are not a good idea. It's nice to see someone backing me up:

Full-body CT scans -- widely promoted in advertisements as a way to give yourself peace of mind -- frequently find harmless abnormalities that lead to invasive, anxiety-producing follow-up tests, researchers say. And they may be a waste of money for patients under 40, who run a low risk of serious disease, the study suggests.
"This got pushed to the public before any of the research was done," said Dr. Giovanna Casola of the University of California at San Diego. "They're saying do it for your peace of mind, do it for your wellness, for your family. Nobody's saying, `Half the time we're going to find things that you're going to worry about,"' sometimes needlessly.

The article goes on to say that 46 percent of all scans done showed abnormalities (this could include some innocuous cyst somewhere or something similar) and that 37 percent of all participants were advised to have follow-up tests! That's a lot! In other words, to use the language of statistics, these tests are quite sensitive but not very specific. Most of their findings turn out to be benign. Also, it's easy for the imaging centers to blithely advise their clients (I refuse to call them "patients") to go back to their primary care doctors to get these abnormalities worked up... they aren't the ones who have to bear the expense of ordering these tests and chasing down all the results. And thus the cost of medical care goes up due to these unnecessary tests, and the cycle continues.

I think that for someone who has a strong family history of coronary artery disease, especially before the age of 50, the high-speed CT scans of the heart are a good idea. This is a high risk population. When you screen a cohort of people for a given disease who are at greater than average risk for getting that disease, the sensitivity and specificity of any test will increase. On the other hand, high speed CT scans of the lung to screen for lung cancer are not as good an idea. Quitting is better. The scans do pick up tumors at a smaller size, but you need to keep getting the scans year after year, even after you quit smoking. The people who continue to smoke and get these scans as a prophylaxis, and I know they're out there because I see them, are kidding themselves.

Rant over for today.

posted by Dr. Alice at #

 
How British Are You?

According to the Britquiz, I am 100% British. Take the quiz yourself and find out!
posted by Dr. Alice at #

 
World AIDS Day

December 1 is World AIDS Day. Please don't forget.

I never really saw AIDS until I landed in San Francisco for my residency, in 1990 - when the epidemic was at its height. I went to med school in Philadelphia in the mid to late 1980's and we just didn't see much of it there at that time. It's a horrible disease.

Here in the US and other industrialized countries, we have the benefit of advanced retroviral therapy and effective AIDS prevention programs. Not every place is so lucky. The average person who is HIV positive is now an African woman. AIDS is now running rampant on the African continent; if you don't believe me read Chuen-Yen's posts.

There is a program called GAIA, which stands for Global AIDS Interfaith Alliance, which is trying to combat AIDS in Africa. If you are looking for a good end-of-year charity to donate to, I would recommend them.

And please remember: SAFE SEX.
posted by Dr. Alice at #

 
Black Beans and Rice

Mmmm. One of my favorite things.

Today I decided to do a little experimental cooking based on a recipe I found in "Outlaw Cook," a book by John Thorne. This guy knows his food; he and his wife have run a subscription magazine called "Simple Cooking" for about 20 years now.

This particular recipe was for black beans and rice. The kicker was the side dish served with it. John Thorne and his wife adapted a recipe for beans and rice which originally called for baked deviled eggs served on the side - they simply chopped hard-cooked eggs and put them in a curried white sauce, served with the beans and rice. Me, I love deviled eggs, so I thought that simply serving chilled deviled eggs alongside the main dish would work. It did.

The recipe:
Soak 2 cups of black beans overnight, then put them to boil in 10 cups of water (I used 8) with a bay leaf, 2 stalks of celery cut in large chunks, a bunch of parsley and a ham hock (I used a cup of ham scraps/pieces donated by someone who had ham for Thanksgiving along with their turkey). Skim off the scum from the beans in the first 10 minutes before adding the celery, etc. Then turn down to a simmer. Cook for one hour, or until beans are tender. It may take longer. Then fish out the bay leaf, parsley and celery and discard. If you used ham pieces, chop them up and return them to the soup. If you used a ham hock, cut off the meat and dice it, then return meat and bone to the soup.

Now add the following flavoring mixture: 1-2 onions (depends on how large), chopped; 3 cloves garlic, chopped; 1-2 tsp each of cumin and oregano (I used 1 of cumin and 2 of oregano); and one dried hot red pepper, seeded and minced, or a tad of cayenne pepper if you don't have a dried one (I used about 1/2 tsp of cayenne). Saute all this in 1-2 tablespoons of olive oil and then add to the beans. Now add salt to the beans - 1/2 tsp at a time, be careful. Then let simmer another hour.

While the beans are simmering, get the rice ready - cook as usual: 1 part rice to 2 parts water is the rule. Also, hard cook 6 eggs and devil as follows, once they are cooled and peeled. Slice eggs in half, remove yolks and sieve or mash. Add 2 tablespoons mayonnaise, 1 tsp vinegar (distilled white is fine), 1/2 tsp or less of salt (be careful here too), dash white pepper, 1/4 tsp paprika, and 1 tsp prepared mustard (dijon is nice if you have it). Blend and stuff back into the egg halves.

Put the cooked rice into hot bowls, add beans and cooking liquid, and serve the eggs on the side. This is GOOD.
posted by Dr. Alice at #

 
HIPAA & Fraud & Ted & Alice

Urg. I'm at the office - yes, on Saturday - and I've just spent roughly the last two and a half hours completing a multimedia educational module on the subjects of coding, chart documentation and fraud awareness. The deadline for completion of said module is November 30. In case you hadn't noticed, that's today, explaining why I am spending a large chunk of my Thanksgiving weekend here.

Welcome to the face of modern medicine.

The old fantasy of a doctor hanging out his/her shingle and going into business for himself/herself is now just that - a fantasy. Between the requirements of OSHA workplace safety regulations, ever-evolving legislation on billing fraud, and chart audits/office inspections by managed care programs, operating a physician's office really requires a large, full-time administrative staff to keep up with everything.

One of the physicians who recently resigned from the group is going into practice for himself. From what I've heard secondhand, his goal is to operate a cash-only practice (yeah, like cash patients are just lying around on the ground waiting to be picked up). The only way to avoid this bureaucratic avalanche, however, is to operate that kind of practice. The minute a physician accepts Medicare or MedicAid/MediCal, or signs a contract with a managed care organization, he has just let himself in for more audits and second-guess management than you can possibly imagine. There's no way out of it.

My father, now retired, operated his own practice for thirty years; he took it over from an elderly, well-established local physician who had practiced since the Thirties (maybe even before that). There are many great stories about his practice I'd like to tell later when I get the time, which I don't have right now. The point I'm really trying to make though can be epitomized in something Dad told me about ten years ago when the new OSHA regulations went into effect: he said there was no way he could comply with all the new requirements and continue to operate his practice; he couldn't afford it and it wasn't physically possible.

"So what are you going to do?" I asked. In case you don't know, OSHA (stands for Occupational Safety and Health Administration; it's a creation of the federal government to ensure safe workplace conditions) inspectors can walk into a physician's office for a formal inspection at any time, and are not required to supply you with any sort of warning beforehand. Being found in violation of OSHA can result in being fined up to $10,000. Per day.

He said, "I'm going to keep going for now, try to sell the practice, and if they audit me before I sell it I'm going to close it down." And he meant it. For the last two years before he sold it, he ran his practice on a knife's edge, knowing he might have to quit forever on a day's notice. He didn't have cockroaches in the exam rooms or anything blatantly dangerous or unsanitary - my dad has always been proud of his office and tried to run it in a professional way. He just couldn't keep up with the huge costs and/or investment in equipment mandated by the new OSHA requirements.

So for all of you out there, if you want to know why visiting the family doctor isn't the small-town, intimate experience it used to be, if you feel like you're just another patient on an assembly line when you go there - this is why. We can't practice medicine like that any more because documenting the physician-patient encounter is now more important than the encounter itself. The code we select to describe your visit may require more thought from us than which antibiotic or high blood pressure medicine we choose to give you.

And in case you were wondering, HIPAA stands for The Health Insurance Portability and Accountability Act of 1996. Everything clear now? Good. There'll be a quiz later. Sorry, I just took about six quizzes getting through that damned module and I can't get it out of my system.
posted by Dr. Alice at #

 
Mildly Naughty

Things You Can Only Say at Thanksgiving, from Shellshocking. (Thanks to InstaPundit.)
posted by Dr. Alice at #

 
Quote of the day, from Rebecca:

"I think I need to go make a gingerbread mansion/townhouse and then eat it."
posted by Dr. Alice at #

 
Parrots!

The parrots have returned! Every year around this time, we get flocks of little green parrots passing through - migrating possibly, or maybe they're just on some sort of social circuit. This morning as I pulled into my parking spot I saw a whole flock of them land on one of the eucalyptus trees that grows outside the parking structure. The trees flower and produce seed pods this time of year, and the birds seem to like the seeds.

These birds are quite small for parrots; they may be descendants of escaped parakeets or budgies, I don't know. But they're pretty green birds with red caps on their heads; they used their beaks as grips as well as their feet to move around the branches. The tree was literally dripping with birds as they fluttered from branch to branch or slid off a too-small twig trying to get to the seeds. They're loud, too. They chattered away as bird after bird (late arrivals to the feast) flew into the tree trying to get in on the action.

Finally the whole flock burst out of the tree in an instant, off to South America perhaps, or just trying to find another meal in a tree. I headed downstairs to the ground level to walk over to my office, and as I stepped outside, I saw the ground covered with red seed pods jettisoned by the parrots. I felt that I had been transported to a tropical, exotic location instead of midtown Los Angeles - for about fifteen seconds. Still, that's a pretty good feeling for a weekday.
posted by Dr. Alice at #

 
Thanksgiving

The folks are late, Dad had to run to Home Depot before they head over here for dinner (long story). Looks like I've got a little time to blog after all!

Heather Havrilevsky has an essay on Thanksgiving that I thought was worth reading; James Lileks has a wonderful one. If you're killing time while dinner gets ready, check them out.

Speaking of dinner, I am doing a turkey breast in the Crock Pot, since there are only three of us (it's really good and astoundingly easy). Also, baked potatoes and broccoli. It is a bit stripped down, but my folks are grateful not to have to cope with cooking the meal; I really don't think they'll care.

I went to church this morning with my friend Jim. St. James', my church, is Episcopal; we have a 9 am service every Thanksgiving. I try to go for several reasons: because this really is a religious holiday, or at least it started out that way; to see my St. James' friends who have gotten me through some hard times in the last six years; to remind myself that this holiday is NOT about food and it is NOT a license to pig out.

I am grateful for my family and their continued good health. My father had a stroke a year and a half ago and has made a wonderful recovery. My sister now has three terrific kids; my newly engaged brother and his fiancee are spending the holiday with them.

I am grateful for my job. Yes, I really am, most of the time. My last patient of the day yesterday was a woman whose mother died suddenly on November 24. I saw her for some grief counseling and to give her some time off work. Both her parents, now dead, were my patients. It really is special to take care of an entire family, and to be able to really understand where a grieving person is coming from when she talks about her loss.

I'm grateful for all my friends, on-line and off, and for all the encouraging emails and feedback I've gotten from you. Thank you!
posted by Dr. Alice at #

 
Here is Chuen-Yen's latest dispatch from Malawi. If you like dogs, you won't like this post:

Greetings! Here is some Houseboy Wisdom:

�Dogs, cats and chickens can go on the bus.But if you want to take a goat some place, you must hire a taxi.�
-- On transportation of animals

�I cannot wash it in your bathtub. It is a dog and you are a person.�
-- When asked to wash Molly and Notti in the bathroom with human shampoo, instead of outside with laundry detergent

It�s hard to be a dog in Malawi. When I took Molly and Notti for a stroll, unarmed people avoided us by crossing to the opposite side of the street. Several tentative machete-wielding field workers braved passing on the same side, though safely out of reach. A few people pointed to the dogs and mimed bites to their extremities.

Later in the day, Gift informed me that burglars had killed a neighbor�s dog. His friend, their gardener, found the dead dog with three bloody gashes on its shoulder. Gift demonstrated the locations of the wounds and how they were most likely inflicted. He also noted that the neighbor�s two other dogs were still alive, but would probably be poisoned by thieves in the future.

Unlike obsessive-compulsive dog pampering Americans, few Malawans understand the concept of dogs as pets. Dogs protect property and are universally mean to strangers. A few crazy foreigners are known to let them in the house, feed them table scraps and take them into town on leashes.

With the help of several little Adventists, I bathed Molly, Notti and three unclaimed puppies yesterday. This event consumed nearly two hours, an entire bar or soap and countless liters of tepid water. To Gift�s dismay, it all occurred in the bathtub. I have never heard Gift laugh so heartily. Incredulous that anyone would share space with an animal, his response was to thoroughly disinfect the bathroom. I wonder if it�s harder to be a person or a dog in Malawi.
posted by Dr. Alice at #

 
It's my birthday today. My "Jack Benny," as one of my friends referred to it (one of Mr. Benny's running jokes was to claim his age as thirty-nine for his entire career).

Last night my office mates gave me a nice little surprise party after hours, complete with champagne - woo hoo! - and white Zinfandel. For those who don't like champagne. Some of the office staff preferred it. Cake, flowers. I really hadn't expected it, and a lot of people showed up - in fact almost everyone from all four offices here. Seeing all those people wanting to wish me a happy birthday meant a lot, almost took the sting out of this particular birthday.

I spent some time trying to remember what I did last year for my birthday... finally I remembered. It was a cold, windy Monday night. We were having Santa Anas, just like now, but it was much colder. I met two friends at the Formosa Cafe in Hollywood for drinks and dinner. It was quite fun. The Formosa is one of those old Hollywood dive landmarks that's been around for almost seventy years, I think. The original eating area was made out of a boxcar, which is still there as part of the restaurant.

Today is our big annual office Thanksgiving potluck, so I will go to that and have a nice lunch. Tonight is a school board meeting which I have to attend; I'm one of the trustees for the St. James' parish school and we have just finished our search for a new head of school, so I have to be there (oh, the decadence). Then I'm stopping off at a friend's house for a quick drink, and so the day will end. I think this is the best kind of birthday. I usually don't take the day off for my birthday - I work, but it's nice to have these little celebrations scattered throughout an ordinary day.

At least it's not on Thanksgiving this year. I hate that.
posted by Dr. Alice at #

 
Another day, another movie.

I was at the gym again, watching TCM (Turner Classic Movies cable channel). At 5 am it's either that, the news, or the Andy Griffith show. As an aside, did you know that Don Knotts won five Emmys during the run of that show? Five? It's true. I mean, one Emmy I can see, but five?

Anyway. This movie was called "The Bad Man." It involved a young, heroic Ronald Reagan and his uncle (Lionel Barrymore) on a ranch. They owe ten thousand dollars on their mortgage and are about to lose the ranch. A beautiful married woman and her dastardly husband come to the ranch - a dude ranch? who knows why they're there - and Ronnie and the young woman fall in love. A Mexican bandito, the "bad man" of the title, shows up to rob everyone but then decides to make things nice for Ronnie; apparently they're pals from way back when. I didn't get that part clear.

Some local hick girl is in love with Our Hero, but the bandito palms her off on the ranch foreman. This other girl is the daughter of the local banker who holds the mortgage on the ranch. (Confused yet?) The bandito extracts $10,000 from the banker at gunpoint (I guess bankers just carry around $10K in spare change), gives it to Uncle Henry (Lionel Barrymore) and then orders him to give it to the banker in exchange for the mortgage. (Bandito to banker: "You got paid, didn't you?")

So the bandito and his gang take off with the dastardly husband, who is to be killed so that Ronnie can marry the girl; but the husband escapes, sneaks back to the ranch, struggles with Ronnie while trying to kill him, and is finally shot dead by the bandito who just happens to show up at the right time. I could almost hear the plot points screaming in agony by this time.

I forgot to mention that Uncle Henry can't walk and spends the entire movie in a wheelchair. The film ends with the bandito taking Uncle Henry for a thrill ride by tying his wheelchair to his horse and going for a gallop. (I swear this is true.)

Lesson to be learned? The next time you put down the current crop of movies and say, "Oh, they made them so much better in the old days" - THEY DIDN'T.

Be that as it may, I still had fun watching "The Bad Man" [1941] (UK title: "Two-Gun Cupid" (ugh)). The cast was memorable. As mentioned above it starred Ronald Reagan, who I always find fascinating to watch in films, just knowing what lay ahead of him in his career. Lionel Barrymore - what the hell was he doing in this thing? Probably paying the rent. The dastardly husband was played by Tom Conway, best known for starring in a series of B mysteries in which he played a character called "The Falcon" (a low-rent version of Leslie Charteris' character Simon Templar, "The Saint"). I'd recommend any of the "Falcon" films if you happen to run across one on late-night TV. The ranch foreman who got the hick girl was played by Chill Wills; the bandito was Wallace Beery, clearly playing a watered-down version of his famous Pancho Villa role in "Viva Villa!" (1934). The neglected wife who falls in love with Ronald Reagan was played by Laraine Day, who later turned up in the Dr. Kildare film series as the nurse love interest for Dr. Kildare.

As I said, analyzing the cast was more interesting than the movie. I could do this stuff all day.
posted by Dr. Alice at #

 
Lately I've been stopping by to visit our office manager almost every day. Her office is across the hall from the patient care area, in the administrative section. Sometimes we chat about non-work-related topics like food, holidays, and weekend activities but more and more often we sit and dissect the workings of the group.

This week I came back on Tuesday from a couple of days off and was greeted by our manager with the news that one of our doctors is quitting the group. He's the second one in two weeks to announce that he's leaving. A third initially threatened to leave but later changed his mind and elected to stay. For now. I, for the record, have no intention of leaving. I like it here, and I really don't think things are going to be that much better anywhere else I might try to work. We are constantly pushed to work hard, be more productive, etc. but in this managed care climate, I imagine every medical group, and for that matter, every solo physician, is faced with that dilemma. The insurance companies have pretty much exhausted any merger possibilities and now are trying to tighten their belts, raise premiums and do anything else they have to do to survive. We, and the patients, are feeling the pinch.

On my good days I look at this as a challenge, like learning to juggle. I try to see if I can do things a little faster, squeeze in one more patient or one more phone call. One more ball added to the workload, requiring a little shift, a bit of an adjustment, and then things will keep spinning along. Join another committee? Another ball. Get assigned to reviewing referrals? Another ball.

The problem, if you will allow me to continue the metaphor, is that the balls are being taken from a shrinking pile marked "Personal Life." Dating? Forget about it, I haven't been on a date since I moved to Los Angeles eight (Eight! Jesus!) years ago. Weekends? If I told you how many Sunday afternoons have been spent here you'd scream at me. Weeknights - spent here.

(Above portion of post written at start of working day... terminated till after hours to avoid seeing patients in tearful mood of self pity...)

I'm not the only one in this dilemma, I know. And doctors aren't the only ones feeling pressure to perform either, this happens in every profession - I know that too. But lately it seems we get no good news, only bad. I present you with an email I got from my good friend who works down the hall from me; she practices endocrinology and internal medicine, and is supposed to be working part time. She seems to stay just as late as I do though, and she has two small children. (How do people with kids do this job? Damned if I know.)

At the Friday meeting [which I missed - A.] we got appointment scheduling guidelines...their "expectations" include
- "comfortably" seeing 3 pts/hr (FTE = 31.5 hrs = 95 pts/wk)
- given a 10% no-show rate, should book 105 pts/wk (23/d) (figuring I book 2 hrs less per day, I figure I should book 6 less - 17/d - I'm there!!)
- frozen slots (in my practice, that means lunch & after the end of the day)
- see other folks pts & all schedulers should have access to all schedules
- review your schedule 2 days in advance
- call your patients to ask why they're coming in & forstall unnecessary visits or be better prepared
- review master schedules q 6 mo

It irritated me, but then I think I'm doing my job. Tho, according to my eval, I'm only doing about 97-103% of expected, which is 'adequate'. Sorry, I can't walk on water with these shoes. Come another day.

Enough. I don't think anyone can work well under this kind of constant pressure. It really got to me today; I wound up blowing up at a patient who walked in, without an appointment, at 12:55 and insisted on being seen immediately. We offered her an afternoon appointment and she started yelling at my receptionist. I stalked out and called her a spoiled brat - yes I did - in front of a waiting room full of patients. And I'm not sorry I did it, either. I did wind up seeing her, just to get her the hell out of the office.
posted by Dr. Alice at #

 
Suddenly I'm Channeling Jane Austen

This morning I was seeing a patient, who is pregnant, for an exam (for an unrelated issue). When I asked for her due date she replied that her "estimated date of confinement," a term she'd clearly picked up from her OB, was in May of next year. I suddenly realized that the term "EDC," which is an abbreviation doctors use all the time, stands for just that - "Estimated Date of Confinement." It's one of those acronyms I got into the habit of using without thinking about its meaning.

The patient: "I thought 'estimated date of delivery' would make more sense, but that's the way they [the OB] said it."

I responded: "Medicine has archaic terms that still crop up even when you don't expect them. 'Confinement' used to be the term they used for delivering a baby. We still say 'EDC' even though it doesn't really make sense anymore."

We both laughed as I added: "It's like, 'She's pregnant. Confine her!'"
posted by Dr. Alice at #

 
Last of the Leonids

For those of you who have an astronomical bent, the peak of the Leonid showers for 2002 and, in fact, for most of the century will be tonight (or rather, early tomorrow am) from 2.30 to 2.45 PST. Go here for further information. I would love to see this shower, but living in the middle of LA can cramp one's observing style due to light pollution. I may get up and trek off somewhere isolated so that I can get a better view - and wind up getting assaulted, no doubt. But be that as it may, I have seen a meteor shower or two and I can vouch for the stunning effect of watching many little fireballs streaking through the sky. The only thing I'd like to see more is the aurora borealis, which I have not yet managed to see - but hopefully someday I will (around the same time as I compete in the Iditarod).
UPDATE:
My father considerately called me at 2:30 am asking if I wanted to get up and see the Leonids; I opted out. (For the record, I did ask him to call me.) The moon was too bright to see much of anything.
posted by Dr. Alice at #

 
PETA, PETA, Pumpkin Eata

It's amazing what a little creative digital picture altering can do...

The good folks at PETA won't be very happy about this. (snicker)
posted by Dr. Alice at #

 
Whew!

I will never try to add anything fancy to my template again. I didn't get any email help from blogger and finally had to print out a sample template and go through everything line by line... but at least it's working again.
posted by Dr. Alice at #

 
Here again is a post from my friend Chuen-Yen in Malawi. She has just been to a wedding, which sounds more entertaining than your average American ceremony (or at least different):

Greetings!

I have finally experienced one of the most popular Malawan events � a wedding. The bride was the granddaughter of a non-compliant patient. She was marrying a local grocery boy. I showed up only 15 minutes late (far too early) with my gift wrapped in a big brown x-ray envelope. The venue was the bride�s family�s house. In their dirt courtyard, surrounded by crumbling walls with projecting shards of glass, rows of hot metal chairs faced a decaying concrete structure. Colored toilet paper and a few
balloons decorated the porch, where the couple would be displayed on the family�s couch. An unsteady table displayed gifts wrapped with newspaper, plastic bags and one with an x-ray envelope. A few chickens and a goat picked at a pile of nearby refuse.

As everything was in Chichewa, I probably misinterpreted most of the ceremony. But it was clear that some of the ritual revolved around soliciting frequent donations from guests. There were even �cahiers� to tally the gifts and make change in case you didn�t bring the right denominations. The bride and groom were showered in small bills every time the announcer gave a certain cue, which always stimulated lots of hooting.

Between fund raisers, candy was passed around (one piece per person please), people feasted on rations of oily salted rice and then had a sliver of cake. No utensils were involved. Hence, buckets of water were provided for sanitation. There was also some dancing � shaking of the butt without
moving the upper body � which I am told one can become proficient at in about 3 months.

During the celebrations, many people approached me for medical evaluation and a chicken flew into my head. Just after that, with much hooting, it was announced that 4,500 Kwacha and 12 gifts had been collected. Everyone had a great time. I admitted the bride�s grandma to the hospital the next
morning and saw a few of the guests in my clinic. Everything is amusing here.

Hope all is well over there.
Chuen-Yen
posted by Dr. Alice at #

 
Well. Here's an interesting story: Gun-toting Gomer Gets Ground Squirrel. Apparently the rodent in question was in a state of permanent rage and was hassling the town of Knutsford, England. Perhaps it was Irish:

LONDON (Reuters) - A squirrel which terrorized a British town by attacking people has been shot and killed by the grandfather of its latest victim.

Geoff Horth, enraged by the squirrel biting his two-year-old grand-daughter Kelsi Morley on the face, took up his airgun and hunted down the rogue rodent, the Sun newspaper said on Friday.

"When I tracked him down I was surprised how big he was. He came down a tree and headed for me, but I shot him before he jumped," the 61-year-old school caretaker told the newspaper.

The bad-tempered squirrel's reign of terror in the town of Knutsford in central England had made parents frightened to let their children out to play.

Somehow it all sounds like a third-rate horror movie.





posted by Dr. Alice at #

 
Bwahaha!
Australian journalist Tim Blair, freshly returned from a coast-to-coast trip to the US, does a first-rate job of trouncing Michael Moore and his column regarding this week's elections. I've never been able to stand Moore, but in this column he was even worse than usual. I wonder what jerry-rigged theory he's going to come up with to explain why Bush was supported in these elections rather than "shellacked" (as Moore would have it).
posted by Dr. Alice at #

 
Which Founding Father Are You?

Try this quiz to find out. I'm George Washington!

You are the most reliable creature on the face of the planet. You're not the most creative, but inspire great loyalty because you are physically incapable of not keeping your word. People set their watch by you. You are often the one friend in common between two blood enemies.

Thanks to The Fat Guy for the link. (Really, that's what he calls himself.)
posted by Dr. Alice at #

 
The Many Faces of Alice

Check out googlism.com to see who you might be. It's fun!

Here is who Alice is, among other things:

alice is alice is not alice and
alice is all broken up
alice is stage struck
alice is surprised by tweedledee & tweedledum
alice is pressed for an answer
alice is talking again
alice is home
alice is currently under construction
alice is on the ball
alice is changing all the time
alice is probably the most unpredictable game available today
alice is wonderful
alice is sometimes a film student
alice is in unix land
alice is dead
alice is back
alice is active in the hospitality industry and has spoken at many industry highlights including mufso
alice is a department head at acme fabco whose business has been adversely affected by competition from imports
alice is nothing more than a gigantic pattern
alice is open source
alice is stunning
alice is back from canada? but not separated from husband
alice is a comedy about the shaky relationship between an incorrigible scoundrel of a novelist and his devoted fan
alice is a giant and stuck in the white rabbit's house
alice is an alicebot engine written in c++
alice is trying
alice is gaining importance
alice is the leading character of the book
alice is several years older
alice is one of the smallest commercial wheeled autonomous robots in the world
alice is bored and a bit sleepy
alice is a strong advocate for farmer's markets and for sound and sustainable agriculture
alice is back in wonderland
alice is almost too much
alice is one of the most anticipated games of the year and will surely be a competitor for the game of the year award
alice is also os x compatible
alice is the name for ohio university's library catalog
alice is 5�" tall

posted by Dr. Alice at #

 
Arrr!

I have to confess. I have a secret crush on Robert Newton - a not-so-well-known British actor who starred in various films from the 1930's through the 1950's. He had a respectable stage and TV career as well; his film roles include Inspector Fixx in "Around the World in 80 Days," a co-starring role with Burt Lancaster in "Kiss the Blood Off My Hands" (ugh), one or two Hitchcock films, and a ne'er-do-well who goes good in "The Beachcomber" - but his best-known role was as Long John Silver in Disney's 1950's version of "Treasure Island." He hammed the hell out of Long John, but he did such a good job that viewers for decades have associated him with piratespeak. Every "arr, matey" you hear originates with his performance.

Why do I bring this up? Because Robert Newton recently impacted my job. No, really. I ran across a column by Dave Barry promoting National Talk Like a Pirate Day and got carried away.

Ask the average person to talk like a pirate and what will you hear? What do you hear in movies and on TV?

"Belay that, ye scurvy swab!"
"Avast there, ye landlubber!"
"The whiiiite whale!" (No... wait... that was another movie...)
I even heard this line delivered by Anne Heche in "Six Nights, Seven Days": "Pirates? As in 'Arrr'?"

At any rate, Dave Barry did a marvelous job of painting the attractions of using piratespeak on the job. I quote:

BOB: Avast, me beauty.

MARY: Avast, Bob. Is that a yardarm in your doubloons, or are you just glad to see me?

BOB: You are giving me the desire to haul some keel.

MARY: Arrrrr.

I immediately vowed to institute Talk Like a Pirate Day at my office. I recruited a willing crew after I sent some emails around and did my best Long John Silver imitation for the staff. Once they'd heard me describe a recalcitrant patient as "a scurvy landlubber," I found lots of willing participants. Even our dermatologist got into it; it's been nearly two months since Talk Like A Pirate Day and she still sends me emails addressed to "Matey." It was quite therapeutic to spew some nautical expletives at the HMO's and still say nothing that was obscene.

So here's to you, Robert Newton! Your legacy lives on. Arrr!



posted by Dr. Alice at #

 
Go here for more information on Measure 23 in Oregon. This weblog is run by an internist (like me) who has far more info and links on his/her blog than I do. I don't know yet whether the measure passed, but if you're interested in the overall debate this is a good place to start.

Having a busy week. More later.

No, I haven't made any progress on my writing. But thanks for asking.

ADDENDUM: Measure 23 was defeated.
posted by Dr. Alice at #

 
Tomorrow the state of Oregon is voting on an initiative designed to provide the entire state with free health care - Measure 23. This measure supposedly will cover the state's healthcare costs by raising business and personal taxes to add to Oregon's share of the Medicare pool (the drafters claim that this will be offset by the fact that businesses will no longer be obligated to purchase health insurance for their employees, and that individuals will not have to pay co-pays or their share of insurance costs). The measure states it will cover everything. EV-ERY-THING. This means massage therapy, acupuncture, hospitalization, mental health, drugs.

Let me just say this, people: it won't work. It will not work. I can give you a few reasons:

1. In Europe, with similar plans, drug formularies are somewhat restricted, and, more importantly, national healthcare systems can drive hard bargains with pharmaceutical companies, which keeps their costs down to a certain extent; the US pays more for drugs than anywhere else on earth.

2. Corporations will hightail it out of Oregon faster than you can possibly imagine - there goes your tax base.

3. Everyone on the West Coast at or below the poverty line will move to Oregon ASAP.

4. Everyone in Oregon will immediately start requesting counseling, acupuncture, massage therapy, etc. They will start requesting the most expensive drugs on the market - granted, they work and work well, and they often keep people out of the hospital, but I really think the expenses of this project will balloon faster than anyone backing this measure can possibly imagine. I can hear the patients now - "Hey, doc, I pay my taxes. I've already paid for this. Why can't I have acupuncture for my (hangnail, stress, weight loss, back pain, etc.)?"

5. Get ready for long waits. The truth is, you always pay with health care. You either pay with money or with time. Look at the UK health system if you don't believe me, or Canada's. I have several physician friends who are Canadian and chose to come down to the States because of their frustration with the Canadian health care system. You may be able to get acupuncture or massage therapy, or counseling, for free - but if you have to get on line and wait three months for it, is it really going to help you?

Don't get me wrong, if Oregon wants to experiment with this system, go for it. You go first, guys. We'll be standing on the sidelines watching. If this measure passes it will be implemented in 2005; it'll be interesting to see what happens over the next five years.
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Got a blog recommendation for you. Check out Ernie Hsiung at his blog site Little. Yellow. Different. This guy is Chinese, he is a computer programmer, he lives in the Bay Area, he is gay and he is frickin' hilarious. Four out of four stars.
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Dancing Pirate??

Well, it is now National Novel Writing Month and, no surprise, my attempt at participation isn't going very well. It seems you can't just sit down and write a novel. I never really expected to get through 50,000 words, so I'm just trying to look at this whole experience as a writing exercise and to get some writing done every day. (Apart from this blog, which is a hell of a lot more fun.)

I set aside all day yesterday to write, only to find myself discovering more and more ingenious ways to pass the time doing other things. One thing I did last night instead of writing was to sit down and watch a movie called "Dancing Pirate" that I bought from Sinister Cinema some time previously because it starred Frank Morgan - one of my favorite character actors. I'd never gotten around to watching it, but with a deadline hanging over my head, what better way to waste 90 minutes?

Well. "Dancing Pirate" turned out to be an early Technicolor musical starring a dancer I'd never heard of named Charles Collins. It was not very good. In fact, it's pretty bad. The movie is set in the 1820's and starts out in Boston, but ends up in Old California. How does this happen? Strenuously. In the first fifteen minutes we get Mr. Collins (who plays a dancing teacher) doing a silly little dance around a room putting candles out at the conclusion of his dance class (he's teaching the waltz), after which he steps out onto the city streets and promptly gets knocked over the head and press-ganged onto a pirate ship. We then see the old routine of a ship model sitting on a map, followed by a moving line that tracks south to Cape Horn and up the other side of the Americas to California in fifteen seconds flat - that must have been one fast pirate ship.

At this point, Mr. Collins jumps ship to get away from the pirates and walks into the town. Unhappily for him, a local shepherd has seen the pirate ship and warned the town, so first he nearly gets his head blown off and then the town wants to hang him as a pirate. I had mental whiplash at this point from following the guy's adventures. But, as with most musicals, having laid the situation in place the action comes to a screeching halt for several dance numbers. The mayor's daughter wants to learn how to waltz, so he teaches her. At first she is affronted, but then she figures out that she likes to, uh, waltz. The stage is set for a happy ending at this point but we've got another 45 minutes to get through, so the Bad Guys from Monterrey down the coast (up the coast? I don't know) show up. Their leader, the Capitaine, wants to marry the mayor's daughter and get control of the rancho which her father, Frank Morgan, owns. They arrest Our Hero under the pretext that he's a pirate - again?? - but the heroine, Serafina, offers her honor to marry the Capitaine on the agreement that they will release Mr. Collins. Our hero (that would be Collins), having had the forethought to befriend a local Indian in the prison, leads his friend and fellow tribesmen in a remarkably fey wardance and thus incites them to overpower all of the Capitaine's militia so that he can break into the church, stop the ceremony, overpower the Capitaine in a swordfight despite the fact that he has no sword (I am not making this up), lead the town in one more samba dance and then lead the heroine into the church. End of movie. God Almighty, what a mess.

A few postmortem comments here. First, Charles Collins, as you will see if you check out the IMDB.com link above, starred in a few movies but not many. From having seen his dance numbers in this thing, I can tell you with a fair amount of confidence that he was being groomed as a Fred Astaire wannabe. He didn't quite cut it, mainly, I think, because the choreography just wasn't up to snuff. I'm no judge of these things, but the guy seemed to be a technically adept dancer. The first two numbers here, though, were enough to put paid to his film career: in the first one (I alluded to this above), he tapdanced around the room to the tune of "Yankee Doodle" (his signature tune throughout the movie) snuffing out candles. Actually, he PRANCED around the room - he didn't dance. Then, when he's pleading for his life in California and trying to prove that he's a dancer, he dances around the gallows where he's about to be hung, with a noose around his neck and his hands tied to his sides. Again, I am NOT making this up. Blair Witch has nothing on this, people. But for those MST3K fans reading this - and I know that you're out there - you will no doubt be pleased to know that Mr. Charles Collins surfaced playing a role in Master Ninja I in 1984 (at the age of 80). He died in 1999.

Two further notes: First, in this film Frank Morgan played his patented blustering ignoramus character that he was to repeat to greater fame, three years later, in "The Wizard Of Oz." I would just like to say that, if you want to see him at his best, rent "The Shop Around the Corner" and watch him do his thing opposite James Stewart. This is one of my very favorite movies and you will NOT be disappointed. Second, one of the chorus dancers in this film was a Rita Cansino dancing with her father, Eduardo Cansino, and their family dance group the Royal Cansinos. She was later to achieve much greater fame as Rita Hayworth. Unfortunately, the print quality was so bad that I couldn't tell which of the chorus dancers she was.

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Gather round, boys and girls. I have a mildly ghoulish story for you, appropriately as today is Dia de Los Muertos (Day of the Dead) here in Los Angeles. This is the Story of Why Alice Named Her Blog "Feet First."

Years ago, when I was a high-school student and trying to figure out what I wanted to do when I grew up, my father (also a physician) figured he'd try to help me along by arranging for a tour of the hospital where he was on staff. A primary care doc himself, he wanted me to consider something in medicine where I wouldn't actually have to deal with people - thus he sent me on a tour of the pathology department.

It was more fun than you'd think. The doctors were rather social actually; not wildly busy, they seemed to enjoy a chance to talk to an appreciative audience about what they did. I've liked pathology ever since - this came in handy when I got to med school - but still I wound up in primary care, same as Dad did (I just liked it better). The day of my visit I got to wander around, peer at slides, and look at a couple of specimens and hear the patient stories behind them. You know, mildly gross-out stuff but not that gross. I got my first smell of formaldehyde (ugh), listened to the head pathologist bitch and moan about hospital administration, procedures, and policy (I was no stranger to this either, as I got a lot of that from my dad every dinnertime), and finally they showed me the morgue.

"Morgue" was an overstatement, as most hospitals don't have that much body storage space - they don't need it unless you're in a trauma center or a big academic hospital. Unless you're doing an autopsy, and most patient deaths don't require one, the mortuary will trot along and pick up the body right quick. What I recall is seeing a few storage cases where bodies are kept until picked up or the autopsy is completed. These were cold storage, as usual, but they weren't fitted with drawers as you often see in TV shows; instead they had hatch doors like you'd see on a submarine. They opened one, I peered in (there was no body resident at the time), and then I saw a small label posted just above the door.

The label read:

FEET FIRST

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R.I.P. Peggy Moran

Don't know who Peggy Moran was? Well, neither did I:

CAMARILLO (AP) 10.31.02, 8:15a - - Peggy Moran, who made more than 30 horror and Western films in the 1930s and 1940s and was once dubbed one of Hollywood's top "shrieking violets," has died. She was 84.

Among Moran's handful of horror movies were "The Mummy's Hand," "Horror Island" and "Ninotchka," starring Greta Garbo.

While under a six-month contract to Warner Bros. and three years with Universal, Moran made dozens of "B" films that were made every two or three weeks.

The thing I like most about this obituary is that it lists "Ninotchka" as a horror movie! Which it is not (it's a comedy), unless you find Greta Garbo scary.

When you live in Southern California, you see these stories a lot. Somehow it underscores how much a part of daily life here the film industry is; an old-time "working class" B-movie actor who never became well known and may not have made a film in decades will still merit a respectful mention at his or her passing. I like that this community respects the profession and cares about the people in it enough to do this, no matter what their ranking. And, of course, I like the sense of history that goes along with it. The old "contract system," which obligated actors to sign with a single studio and to commit to a certain number of films over the life of the contract, no longer exists in Hollywood. Imagine cranking out a film every two to three weeks for five years straight.
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Check out this clock, it's great. (Via Instapundit.)
posted by Dr. Alice at #

 
I Think They Should Ask San Francisco

The town of Biggs, California, which has no dairy industry whatsoever, is considering changing its name to Got Milk? at the invitation of the California Milk Processors Board. This organization is trying to find a town willing to make this change to mark the tenth anniversary of their advertising campaign, which of course features that phrase. The town wouldn't get any monetary benefit from doing so:

"First and foremost the benefit would be in the publicity and notoriety in changing the name to Got Milk? We are not cutting a check," [the Board's executive director] Manning said, although he added that the milk processing board would be open to helping Biggs establish a "Got Milk?" Museum or to do something for the town's children.

The mayor of Biggs, Sharleta Callaway, must have been short on sleep the day she decided to take the Dairy Board up on their offer, or hung over, or something. Then again, she may want to emulate the town of Truth or Consequences, New Mexico, formerly known as Hot Springs, NM, which changed its name to match that of the old quiz show.
posted by Dr. Alice at #

 
Some Good News

Disaster averted, if only temporarily:

Los Angeles County Supervisors have decided to delay a vote on closing two more medical centers, although the health care system remains in grave fiscal shape. KFWB's Steve Kindred reports there are signs of hope for the ailing health system and other solutions to the crisis may emerge in the three weeks before the next vote. A property tax hike goes before voters on Nov. 5, and federal involvement or a special legislative session dealing specifically with the issue are still a possibility.
The board has already shut down nine of the county's 18 health clinics to trim the budget. The budget deficit is due largely to a phase-out of federal funding. Officials had planned to vote Tuesday on closing Harbor-UCLA and Olive View-UCLA, the largest trauma center in the San Fernando Valley. However, there was mounting political pressure to hold off on further cuts.

Lawmakers say they are holding out hope for the passage of Measure B on the Nov. 5 ballot. Board Chairman Zev Yaroslavsky believes voters will approve the measure, which would increase property taxes by $168 million to provide funds for trauma care. Also, the president's envoy on health care will have visited Harbor-UCLA on a fact-finding mission by the time the board takes up the issue again on Nov. 19.

Well, we'll see. If Olive View and UCLA-Harbor are shut down, we'll be in deep trouble - and that means anybody who's in a automobile accident, who gets shot or knifed, who falls off the roof while doing home repairs, or who has any other sort of bad luck. Other information relating to the proposed health care system cuts is here in the L.A. Times (use password and keyword "laexaminer" if you can't access it) and an article explaining the problems the trauma system, in particular, faces is here. It's amazing to me that there has been relatively little attention paid to this issue, but if B does not pass it will probably get a lot more - after the county winds up in crisis. Cross your fingers.
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My friend Anna has a blog which is her journal about preparing for the Vancouver marathon next year. If you go here you will see my pledge (she is raising money for charities) - which is $2 per pound that I lose between now and the race. This should provide me with a little impetus to get back on the health wagon. The more public I go with this, the more I am committed to it.
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NaNoWriMo, Here I Go

November is National Novel Writing Month. Really. The NaNoWriMo.org website runs an annual novel-writing competition encouraging people to produce a novel in one month. The rules are that you have from midnight on November 1st to midnight November 30 to write a 50,000 word novel. You are not judged on quality, just quantity. The idea is that the pressure of a deadline will loosen people up enough to just sit down and write and not worry about whether their output is any good or not; if you like what you've done you can always go back and polish it up later.

I registered today. I am sure I have 50,000 crappy words in me somewhere... I have no idea what I'm going to write about yet, but I figure it doesn't hurt to try. I will keep you updated.

ADDENDUM: As I was on the phone with a patient last night, I was absentmindedly doing the math and figured I would have to write an average of 167 words per day to finish by month's end. No problem, I thought, I can do that. As I was driving home later, I realized I had skipped a decimal place and that I'll need 1670 words per day to complete 50,000 words in a month. I almost lost control of the car ("NO WAY!!") I'll give it a try anyway.
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Stamp Act

A few months back, around the time that the cost of a first-class postage stamp went up to 37 cents, I was cleaning out my desk drawers and found a collection of old, unused stamps now well out of date. Being in an organized mood that day, I made a list and took it down to the post office so that I could buy enough supplementary postage to actually USE these stamps. After doing a little research I realized that some of these stamps had been hanging around well past their sell-by date. To wit:

1. One G stamp, dating back to 1995 (!) and worth 32 cents. (For those of you not familiar with US postage, the Postal Service inaugurated a series of stamps with letters instead of monetary value which were used when postal rates were changed. In this way, the stamps could be designed and printed early in the process, often before the Post Office knew what the new rate was going to be.)

This site has some interesting info about the lettered stamps, including their dates of issue. After dithering around for awhile, the postal service finally decided to match the picture on the stamp to the letter - in other words, the E stamp showed Earth, the F stamp a Flower, the G stamp Old Glory and so on. Unfortunately they stopped this system after the H stamp. Too bad we'll never get to see a Yak or a Zebra on our stamps.

2. Some leftover Chinese New Year stamps from the Year of the Rabbit (1999), bought by me because I was born in that year (1963, if you must know). These were worth 33 cents. I love the Asian zodiac system, possibly because the Rabbit is described as being "the luckiest of all 12 signs."

Apparently many countries got into the idea of issuing Chinese New Year stamps; here is a page of the many Year of the Rabbit stamps that were issued. Some of them are really beautiful. I love the different graphic design approaches.

3. A 32-cent stamp from the "Celebrate the Century" series - the Monopoly stamp from the 1930's stamp series. This stamp series was a great idea. To celebrate the end of the century, the Postal Service asked people to vote on the standout people/achievements/books/movies/ideas/etc. of each decade. The 1930's stamps included Superman, the Golden Gate bridge, the WPA, Snow White and many more. These stamps came out in, I think, 1998 and were promptly rendered useless by a rate increase at the beginning of 1999 (that would be the H stamp). Way to go, guys!

I got a lovely glow thinking of all the money I was saving by using up my old stamps. I had quite a few left over, so this exercise turned out to be worth while financially, not to mention the esoteric stamp knowledge I've picked up by surfing around the Web to research these things. The moral is, go through your desk drawers early and often... you never know what you will find or where it will lead you. (Nowhere much, in this case, but at least it gave me something to post about.)


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Oh, hallelujah. The Angels just won the World Series. Or to put it another way: we beat the Giants. Ha!!
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Constant Reader

This week I found an article in the Tech section of the Wall Street Journal that I just had to share. Titled �Constant Reader,� it profiles a woman named Rebecca Johnson who has become one of the best-known book critics for Amazon.com. She reads, it appears, a dozen books a week, has written more than 1200 reviews for Amazon all told, and is the third most highly rated reviewer by Amazon users. She is not paid for doing this.

I quote:

The 35-year-old, who writes and reads from her home near Issaquah, Wash., doesn�t have a full-time paying job but occasionally makes some money doing Web research. Ms. Johnson estimates she spends three for four hours a day writing reviews. She�s been known to take a break from reviewing for a couple of weeks, but Ms. Johnson says she finds it hard to stop reading.

Damn. Does this woman have an independent income? How the hell does she manage to exist doing nothing but read all day? And, most important, why can�t I have this job?

Alas, there is a dark side to Amazon heaven. As per the Journal:

Being a successful Amazon reviewer brings a kind of fame of its own � and the problems that come with such recognition. Ms. Johnson says reviewers will occasionally go on negative vote campaigns against their rivals to try and knock them down in the popularity rankings (she recalls one instance when her reviews received 10 negative votes in a single day). An Amazon spokesman says the company has systems for identifying customer �abuse of reviews.�

I guess we all have our crosses to bear. Who knew that reviewing for Amazon could be such a rat race? Not to mention the fact that, if these Amazon flunkies feel impelled to go out and malign their fellow reviewers in order to move up on the ratings totem pole and validate their existences, in a job they're not getting paid for and that no one asked them to do, they�ve really got problems.

To prove that this is a blog, I will link to Ms. Johnson's reviewer's page on Amazon here. Enjoy.

ADDENDUM: Ms. Johnson's reviewer page at Amazon states that she is married and that she has a lot of time to read "because my husband plays golf a lot." Well, I suppose this IS a healthier outlet than getting it on with the pool guy...
...still, the pool guy might be more fun.

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More from Malawi

*Whew* Thank goodness. Something on-topic I can pinch from someone else (Thanks Chuen-Yen!)

If you think AIDS is a problem here, you're right. But it seems it's even more of a problem where my friend Chuen-Yen is. I had no idea that the disease was still being denied so powerfully by the culture there, and even by the local hospitals, who ought to know better:

Mwadzuka Bwange. (Good Afternoon)

Thanks for the messages. Hope you will visit.

It has been another amusing week of adjustment to Malawian perspectives.

One of the most sensitive, as well as common, issues is the taboo topic of HIV. At least 15% of the Malawi is infected, people are constantly bombarded with awareness programs, and everyone pleads ignorance when the topic arises. So, when I proposed doing an anonymous survey about HIV testing, the native general practioners told me that I was delusional if I thought I would get answers. The basic message was that people don't want to hear about HIV and will circumvent the topic if it arises. The project would undoubtedly cost our hospital coveted business.

Within a day of this meeting, my clinic was flooded with HIV patients referred by physicians who had deemed me so insensitive to the very issue. I even had patients referred because their anonymous (that's the euphemism docs use when they don't tell the patient the test is being run) HIV tests came back positive. Though clearly out of touch, I am now the chosen one for management of this delicate topic.

As THE HIV DOCTOR, I took the liberty of writing "HIV" as the diagnosis on a chart after extensive discussion with an agreeable patient. Subsequently, the business manager of our capitalist mission hospital curtly informed me that I was not to use the terms "HIV" or "AIDS" on any documentation; patients were upset.

A few days after I had upset other physicians with my proposed project, then become the person to talk with about HIV, then offended patients with my handling of the "immune problem" topic, I found myself on the phone with Television Malawi. The station had sent a letter to our hospital requesting an interview with a medical professional. Certainly, I, the new American Internist, would provide good publicity for the hospital. In discussing the interview logistics with Television Malawi's "Your Health" program coordinator, I revealed my background and that I would be in Malawi for a year. The coordinator ascertained that I could be available one afternoon every week, lamented that the previous "Your Health" host had recently left the country, then genlty eased me into the position of the new "Your Health" host. Starting sometime in November, I will have a weekly half-hour show on TV Malawi. Perhaps you can get it on satellite if it really happens.

Who knows how the HIV epidemic will play out in Malawi? But, an anonymous survey on the topic will be handed out to all the Blantyre Adventist Hospital patients for now. And, Malawi and its neighbors may get to deny hearing anything about HIV on "Your Health."

Good-bye for now,
Chuen-Yen

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Uhhh. So tired. I had a busy weekend (well at least Sunday was busy), so will recap.

Got up, did AIDS Walk. This is my third year doing the walk and I do enjoy it, but I've been a little lazy with collecting pledges. Fortunately I still have a few weeks to collect my checks and send them in so I can get that T shirt that I covet. It's not about helping society, people, it's about the prizes.

Get home, shower, change, go to nursing home to see my new 96 year old guy that I picked up when I was on unassigned call recently (unassigned call is like Russian Roulette but less fun). He's not eating, so I had the "shall we give him a feeding tube?" talk with the guy's son. They're both really nice, and I enjoy taking care of this patient - he is a very cute little old guy with beautiful manners. Nevertheless it's never fun giving relatives this sort of news, and I'm not crazy about sticking a tube in his nose anyway because it automatically means he'll have to have his hands tied down. (Stick a tube in a confused person's nose and what's the first thing they'll do? Pull it out.)

Then... off to Encino, where my friend Jim was giving an organ recital - he did a great job - then dinner at Jim's. He has just acquired a pair of Jack Russell terriers, which are very sweet, and a good time was had by all playing with the dogs. Lots of church and musician gossip ensued, as three of the five dinner attendees are church musicians. The best kinds of gossip, in my opinion, are church gossip and hospital gossip, especially church gossip where you get to dissect bad sermons!

So that was my Sunday. Sorry for the brief shallow post, will try to do better next time. I do have lots to tell you, just haven't had time to post.
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Forgive my whining. I just got off the phone with Airhead Patient. I had called to tell her that her lipid levels had increased significantly from the previous year and to review her diet.

Me: "You need to watch your diet and cut back on your fat."
Her: "Like what?"
Me: "Like red meat, dairy..."
Her: "Oh. Well, but I don't eat red meat and I don't drink milk."
Me: (becoming exasperated) "OK. You need to cut back on olive oil. Mayonnaise. Cheese. Ice cream..."
Her: "Oh, I have been eating a lot more ice cream. But it was all-natural ice cream."

WTF??

Me: "It doesn't matter. Fat is fat, it doesn't matter how organic it is."

This is what I deal with every day, people.
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