Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, May 30, 2003
    "The artistic mission was to create programming you could watch with your cat."

    Yes, Meow TV is here, featuring songs like "Spay You, Spay Me" and "Mice, Mice Baby." And footage of fish and squirrels.

    Isn't it cuuute?

    Kill me now....

    Wednesday, May 28, 2003
    Chuen-Yen Is Back!

    In which Chuen-Yen describes her recent trip to Zimbabwe and the effects of market restrictions...

    Every country has pros and cons. Zimbabwe has Victoria Falls, metropolises, mega-malls and movie houses. It has nightlife. Stores open on weekends. However, a petrol shortage hinders this once prodigal community from frequenting its local attractions. Furthermore, embargoes on necessities such as rice, flour, fruits, meats and vegetables mean shops are poorly stocked. Even if supplies were available, costs would be prohibitive due to the Zimbabwean dollar�s rapid depreciation; bread prices rose 40% during our first day in Harare.

    Amongst restricted goods, fuel provided the most amusement during our foray into Zim. We passed an ironic Harare evening by strolling along blocks of parked cars heralding deserted gas stations. On the morning of our departure to Vic Falls, attempts to call an operative taxi company were unsuccessful. Eventually a scarce combi transported us to the town center. There we located an exorbitant hire whose driver expounded that black market fuel commands four to five times the government mandated 450 Zim dollars per liter. Thus, a full tank runs about one hundred US dollars. Furthermore, this expensive petrol is usually watered down and transported in filthy jerry cans. When the taxi puttered to a halt, our cabby nonchalantly leapt out to demonstrate the petrol�s inferiority by removing the filter, blowing out chunks of mud, then lurching the last kilometer to the airport.

    Transport was less of a problem at Vic Falls. People simply drive to Botswana where they are allowed to purchase up to 200 liters of gasoline.

    Fuel queues are Zimbabwe�s contemporary cultural icon. Having taken an interest in them, I attempted to photograph an exceptionally long one. However, shady �government officials� occluded my view and demanded the film, an impossibility with my digital camera. After a brief quarrel, they insisted we proceed to the nearby police station. I immediately resorted to the traditional defense of insulting President Mugabe, initially causing consternation. But as I persisted, the pseudo official and his assistant pocketed their handcuffs, chuckled and wished us a pleasant journey. A few meters away, I photographed another fuel queue without incident.

    Later we peregrinated to the Zambian side of the Zambezi where truckloads of consumables are waylaid. Rather than navigate import restrictions, merchants have abandoned their cargo, which is being steadily decimated by well-nourished baboons.

    Malawi may not have theatres, decent shopping centers or evening events, but at least food and transport exist for those with resources. What use is money when the goods aren�t available?

    Tuesday, May 27, 2003
    Hi, Nice To Meet You. Did You Bring the Rope?

    This is the most chilling story I think I've seen recently:

    Three people were found dead in an apartment in western Japan in what appeared to be the latest in a series of group suicides linked to the Internet, police said Sunday.

    More than a dozen people have died so far this year in group suicides in which participants are believed not to have known each other before meeting online.

    I don't know whether to be more horrified or saddened. Even when depressed or desperate enough to consider suicide, people don't want to die alone, it seems. The article goes on to blame the extended downturn in Japan's economy... but to me it seems this could happen anywhere. The Internet can connect people, but it can also be a powerful enabler for folies a deux like a death wish. Why go to the trouble of seeing a doctor, taking meds, and working to get well when you can find a buddy to off yourself with?

    (via Little.Yellow.Different, which supplied the original info about this phenomenon)

    Judge's Order Blocks County from Making Healthcare Cuts

    The Department of Health Services of the county of Los Angeles has been trying to cut 100 beds from L.A. County Hospital and to close the Rancho Los Domingos Rehab Center in Downey (it's a county center for chronically disabled patients).

    A federal judge on Tuesday extended a temporary order barring county officials from cutting 100 beds at County-USC Medical Center.

    U.S. District Judge Florence-Marie Cooper said the temporary order will remain in effect until she can issue a preliminary injunction.

    The cash-strapped county Department of Health Services was set to eliminate the beds by June 30th, but the American Civil Liberties Union of Southern California and other groups sued to prevent the cutback.

    Well, in one way this sounds like good news, but make no mistake, the county is facing a desperate financial situation or the Health Department would never have considered such a move. It is very unlikely, to my mind, that more federal funds will become available for the county health care system (though we were bailed out with federal funds three years ago). What this probably means is that, if the county is forced to keep the hospitals open, cuts for city services, libraries, and the educational system will become even more drastic than they already are, and/or a special tax will be levied on all county residents to pay to keep the system open.

    I don't see an easy answer to this one.

    Monday, May 26, 2003
    No Time To Read?

    I used to read the book review section in the Sunday paper so I could pretend I was well-read, but this is even easier. And funnier.

    (thanks to Dave Barry)

    Got Eggnog?

    Hi, back again. I hope everyone had a nice Memorial Day weekend.

    I have a relative coming to visit, so have been running around trying to get the place looking decent for the past few days. In the course of all this activity I uncovered a book which had been buried on my desk under a layer of papers. It's part of my cookbook collection - one of the oddest cookbooks I've ever seen. It's called Food 'n' Fun for the Invalid, publication date 1942.

    The book's first half consists of recipes and definitions of various diets (the full liquid diet, soft diet, etc.) The second half describes ways to make the sickroom more pleasant and various games to keep the sick person entertained (remember, this book predates the television era). The book assumes that the caregiver is female, but that seems like a realistic assumption for the time; even today more often than not that is the case. The book also assumes a high level of literacy on the part of the patient - one verbal game suggested is "Poetry," in which the first player quotes a line of poetry and the second person takes the last letter of the last word in the line and uses it as the first letter of the next line. I wouldn't last more than thirty seconds at that game.

    The most interesting part of the book, though, is the recipes. The authors seem enamored of the nutritive powers of raw eggs; they often suggest mixing one into cooked cereals or beverages like malted milk (ugh). Clearly, salmonella was not a problem in 1942. Wartime rationing is not mentioned, but this is not surprising as the book was probably being readied for publication just about the time of Pearl Harbor. Therefore, sugar and dairy products are recommended with abandon. There are quite a few recipes for eggnog, including one for coffee eggnog (a precursor of the Starbucks eggnog latte, no doubt).

    Interestingly, the book includes chapters on diets for patients with diabetes and food allergies. The diabetes chapter is almost unreadable, as it goes into weights, measurements, and food energy units in excruciating detail - much more so, I think, than current diabetic diets do. The allergy chapter seems fairly close to today's approach and has quite a few recipes for egg-free, wheat-free, etc. diets.

    But to be honest, I get the most fun out of this book by fantasizing that I am, in fact, the invalid in question, enjoying an extended convalescence after some unspecified operation (and collecting disability!). My caregiver is named... uh... Raoul. Yes, definitely Raoul. Now we're getting somewhere. Raoul looks the way you would expect a guy named Raoul to look and, even better, works tirelessly to satisfy my every wish. Because it is the nineteen-forties (hey, it's my fantasy), everything has a fabulous retro look right down to the bed tray. I languidly gaze out into the street watching the Studebakers roll by...

    "Raoul! Where's my beef tea?"

    "Coming, my little angel. It's almost ready. Here's a magazine for you, and seventeen get-well cards from all your friends."

    Sigh. Welcome to Fantasy Island.

    Friday, May 23, 2003
    Friday Five

    Friday Five is a website that posts a weekly set of questions for bloggers. Those who participate answer said questions (which are supposed to reveal something about you, I guess) and leave a link to their website. The real function is, for those of us who can't think of a damn thing to blog about, to give us a subject.

    So here goes:

    1. What brand of toothpaste do you use?
    It varies. Colgate usually, but sometimes Crest. Whatever's cheaper or whichever one is at Costco.

    2. What brand of toilet paper do you prefer?
    Whatever's on sale! Also, the Costco house brand - when I get time to shop there. I do insist that my toilet paper be plain white. Those pastel/print papers are just awful, as far as I'm concerned.

    3. What brand(s) of shoes do you wear?
    I haven't the slightest idea. I do like Easy Spirits, except that they make my feet sweat and they fall apart too fast. But they're comfortable. Anything on sale at Nordstrom is OK.

    4. What brand of soda do you drink?
    I trade off between Diet Coke and Diet Pepsi. Lately it's been Diet Coke. I really like Cock 'n' Bull Ginger Beer, but I drink that only for a special treat (calories!) And when I have an upset stomach, it's got to be Coke. The real thing.

    5. What brand of gum do you chew?
    I usually don't chew gum, but when I do it's Dubble Bubble - the pink stuff.

    Thursday, May 22, 2003
    The Enforcer

    Well, enough whining. Here's another partial movie review for you: today at the gym I caught part of The Enforcer (1951), with Humphrey Bogart. This is not one of his better-known films, but I liked what I saw of it. Bogart plays an assistant district attorney trying to crack a case of murder-for-hire (it's based on the real-life "Murder Inc." case).

    There's a nice bit where Bogart's character is putting pressure on the mob, and one of the main killers decides to turn state's evidence. They meet at "Pier 16" (clearly a stage set) on a foggy night, and Bogie's character shows up wearing a bow tie. He achieves something I thought was impossible: he looks tough in a bow tie. The actors who play the killers are good, too - they actually have more of the screen time than Bogart does, and play mobsters convincingly without going over the top. The movie moves fast - it's only 87 minutes long and it's a good 87 minutes. Check it out if you get the chance.

    Gripe Time

    A year ago today, I was in Istanbul.

    For those of you reading this who don't know me, I took a six-week leave from work last year and thoroughly enjoyed it. I got to spend a week with my sister and her kids, and I traveled to Turkey, Bulgaria and Prague. At the beginning of my time off I had hopes that it would be some sort of life-changing experience... but that really didn't happen. I did, however, get a nice rest and did more traveling than I had done in years. I hadn't taken a trip like that since 1990.

    This year, by contrast, is turning out to be Karmic Payback Time. My vacation time is being used almost exclusively on family-related activities (my brother is getting married this year); I have to take the internal medicine boards again this year (I'm due for my ten-year recertification); I just got called for jury duty. Last week I learned that I have to quickly get ten hours of educational credit in radiology, because I hold the radiologic supervisor's license for my office and now they're requiring that all licensed supervisors get ten hours of credits every two years - something they never did before. I don't mind doing it, but the timing sucks as I have to get it within six weeks. Also, I am going through an extremely stressful time at work (I won't go into the details for confidentiality reasons).

    There is good news. Everyone I care about is healthy and functional, thank God. I've drafted an article which has been accepted for publication in an online magazine (I'll let you know when it's published). I am employed by a company that values me, where I'm happy.

    But I'm stressed and I'm tired, and I don't see it letting up until the end of the year. I wish the pressure would just go away.

    Tuesday, May 20, 2003
    Compvter Romanvs

    The official calcvlator of the Roman Empire! Yes, it will calculate in Roman numerals.

    Did I mention that I love the Internet?

    (via Dave Barry)

    He Hasn't Watched Paint Dry Yet

    Go here to read this enthrallingly dull weblog. Watch as the writer adjusts his/her chair... checks the time... walks to a destination unspecified.

    (It's actually more interesting than some I've read.)

    (via Tim Blair)

    Monday, May 19, 2003
    Bicillin Update

    I was telling one of my partners today about my childhood experiences getting shot full of Bicillin. Her response: "Well, that'll teach you to get gonorrhea at age six!"

    Saturday, May 17, 2003

    The main thing I find annoying about medicine is the extremely high number of diseases, tests, and so forth named after individuals. I find it almost impossible to keep them straight: the Hall-Pike test for vertigo, Finkelstein's test for de Quervain's tendonitis... you get the idea. When I'm discussing a case with a fellow MD who starts throwing these terms around, I find myself nodding my head trying to look like I recognize these terms, murmuring vague comments, doing anything rather than look clueless. So, when I got a consultation letter from an orthopedist referring to "Parsonage-Turner syndrome," I first rolled my eyes but then turned to Google.

    My patient had come to me complaining of pain in the right shoulder and difficulty lifting her arm, which had begun rather suddenly and without any history of injury. I had no idea what it was (orthopedic medicine is not my strong point), so referred her to the specialist since her examination did, indeed, show that she could not lift her arm higher than 75 degrees - not even to shoulder level.

    Well. It turns out that Parsonage-Turner syndrome is known by multiple other aliases including "Feinberg�s syndrome," "Tinel�s syndrome" and "Kiloh-Nevin syndrome III." Quite a few clinicians have staked a claim to describing this particular problem. A concise description of it would be muscle wasting and weakness in the shoulder girdle due to neuritis, or nerve inflammation - a rather unusual cause, as muscle weakness here is more likely to be connected to nerve problems caused by herniated discs or arthritis in the neck. At least that's my impression.

    I felt vindicated, however, as the first sentence of the web page describes Parsonage-Turner syndrome as "a now obsolete eponym once used to indicate many forms of cryptogenic neurologic atrophy of the shoulder and cervical plexus". Obsolete! If clinicians would eradicate all such terminology, life would be easier for me and, I suspect, for many other memory-challenged physicians. I have enough trouble remembering the names of actual people I meet, let alone diseases that have eponyms glued to them like labels.

    Thursday, May 15, 2003
    Lite-Brite! On the Web!

    If you, like me, are of a certain age and played with Lite-Brite as a kid, you must go here. At once. I just adored that thing... that and my Easy-Bake oven. And my Spirograph.

    Which reminds me, last year when I was in Istanbul, as I walked across the bridge separating the two halves of the city I saw a man who was making a living drawing Spirograph patterns and selling them. I kid you not.

    (thanks to Venomous Kate)

    ADDENDUM: click on the Spirograph link if you haven't already. It links to an online Spirograph program that's quite fun.

    Wednesday, May 14, 2003
    Don't Try This At Home

    If I ever write my autobiography, the first sentence will probably be "I was raised on grits and expired drugs." The grits are courtesy of my mother, a Southerner; the expired drugs are my father's contribution. He retired from family practice a few years ago, but my parents' house is still full of pharmaceutical samples labeled with expiration dates you wouldn't believe. When we, as kids, got sick we were dosed with Dimetapp from stock bottles and antibiotic samples Dad acquired from his friendly drug reps. I remember with particular resentment the buttock shots of Bicillin (I could expect at least one of these per winter since I got particularly snotty and long-lasting colds). For those of you not familiar with this Antibiotic From Hell, Bicillin is a formulation of injectable penicillin which has to be kept in the refrigerator and is the consistency of wallpaper paste. One of those in your gluteus maximus is an experience you won't forget in a hurry.

    When I left home for college and medical school I did not leave without being well-stocked from my father's seemingly inexhaustible home pharmacy. Dad's infatuation with antibiotics didn't rub off on me; I try to wait out each respiratory infection despite his well-meant urgings before (usually) throwing in the towel on Day Ten or so and beginning antibiotics. The irritating thing is that they usually work, which forces me to listen to his triumphant "I told you so!" I counter with a rehash of the current warnings against overuse of antibiotics, which he waves away with scorn.

    My father's been blithely ignoring drug expiration dates for years (with the exception of tetracycline and nitroglycerin, which do require strict observation of the expiration dates. Interestingly, even the warnings about tetracycline are being called into question now; it may be safe to use after its expiration, after all). I first realized he might be right in medical school, when I called him in a panic over a urinary tract infection. All I had was trimethoprim-sulfa which had expired five years previously. "Use it," he said. My symptoms were gone in less than an hour.

    Several months ago the Wall Street Journal ran a pharmaceutical article which agreed with what my father's been saying for years; most drugs stay viable long after their expiration dates. Of course, a lot depends on the conditions under which they were stored - if kept in bright sunlight and warm conditions, the medication will degrade much sooner than if kept in a store cupboard at room temperature. I promptly clipped the article and sent it to him. He responded with a gift of cough syrup which he'd recently unearthed in storage. The expiration date on this stuff is November 1982. That's right, it's old enough to vote. It packs quite a punch - every 5 cc's (one teaspoon) contains 60 mg of pseudoephedrine, 5 mg of hydrocodone, and 5% alcohol. The manufacturer listed on the label no longer exists as an independent entity... Dow Pharmaceuticals merged with Merrell years ago.

    It still works. I was coughing my brains out last night and it was all I had. It's scary when you realize you've picked up the very quirks that used to drive you crazy in your parents.

    Something Tells Me This Is a Protestant Denomination

    This is too funny. Thanks to Dave Barry for this one.

    Tuesday, May 13, 2003
    Mr. Setzer, Your Guitar Has a Herniated Disc

    Rockabilly guitarist Brian Setzer, formerly of the Stray Cats, had asked makers Gretsch to brace his Gretsch signature series 6120 guitar the original way.

    The Gretsch model 6120 was made with unique bracing from 1959-1961 but was discontinued for no apparent reason.

    Gretsch put a 1961 guitar through a CAT scan machine in Scottsdale, Arizona, rather than taking the guitar apart to study how it was built.

    Plague City

    Canadian writer Mark Steyn has some interesting, not to say scathing, comments about how the Canadian health system facilitated the spread of SARS in Toronto. Give it a read.

    Forever, Darling

    So I'm in the gym this morning and what should come on Turner Movie Classics but a 1956 film starring Desi Arnaz and Lucille Ball called, well, Forever, Darling. Kind of cutesy, but an OK film. The plot was moving along, more or less, until James Mason turned up, playing a guardian angel trying to save Lucy's marriage.

    Yes, you read that last part right. A guardian angel. I really only got to see the first part of the film, but I was glad I had to check out at this point. I found myself theorizing that gooey pap like this is directly responsible for the increasingly violent films of the sixties like The Wild Bunch and Bonnie and Clyde. I wouldn't be surprised if seeing Forever, Darling proved to be a pivotal event in Sam Peckinpah's life; he probably came out of the theater foaming at the mouth and vowing to cram as much violence into films as he possibly could.

    ...But I digress. There were some good points to the movie; let's get back to it. The plot has to do with the fact that Desi, a chemist (!), has married Lucy, who comes from a wealthy family. This difference in their backgrounds naturally creates some strain, exacerbated by Lucy's best friend and cousin, who is a snob. She's played rather well by Natalie Schafer - yes, the very same who was to feature in Gilligan's Island as Mrs. Thurston Howell. Also, Lucy and Desi's maid Amy is a starched-looking type who gets off some real zingers. I knew she looked familiar, but I had to go to IMDb to find out that she was played by Nancy Kulp, who was - aha! - Jane Hathaway on the Beverly Hillbillies! This movie was practically a sitcom in training.

    Desi Arnaz (his character is named Lorenzo Vega in the film) is obsessed with creating a new insecticide, which leads to my favorite line: "This stuff'll make DDT look like talcum powder!" You'd only get that in a 1950's film. So, to recap, I'd definitely recommend the first thirty minutes or so of Forever, Darling. Once James Mason shows up, however, you're on your own.

    Malawi Memoirs

    Here is Part II of Chuen-Yen's recent experience at a Malawi wedding:

    Individual invitations with matching envelopes, as opposed to the customary publicly posted group announcements, foreshadowed that Linda's wedding would be an extravagant affair. As the bride and groom are both well-bred doctors, their guest list was pullulating with Blantyre's upper crust. An English language ceremony further emphasized their families' status. Nonetheless, the program was traditional and performed accordingly in slow Malawi time.

    I made the gaffe of arriving to the officiation only forty minutes late. Thus I obligatorily endured an hour of dissonant solo guitarist entertainment. When the service finally started, each party danced into position and then continued swaying in place. Males entered stoically from the front, females jovially through the main doors. A rhythmic rendition of "Here Comes the Bride" beckoned Linda down the aisle. Stories were recounted, vows were read and the bridesmaids and groomsmen crooned several cacophonous numbers. In conclusion, all scurried out to a brisk jig. The betrothed never kissed.

    Subsequently, the congregation feigned proceeding to the reception. Having learnt a valuable lesson from the nuptials, I went home for two hours, which I suspect is typical, and arrived as the couple entered the Trade Fair's expansive Comesa Hall. Outside the venue, disheveled vendors peddled candies, peanuts and charred ears of corn. Inside, about six hundred people seated themselves in rows of white plastic patio chairs. The floor was covered with a paint-splattered navy blue tarp. A starburst of gold and cream ribbons radiated overhead. Five tiers of impeccable pastry glistened under an arch of color theme balloons. As Linda and Tilende danced up to the vinaceous matrimonial couch on stage, the rest of the wedding party assembled themselves on adjacent lawn furniture.

    Once the couple was positioned, paroxysms of pelekani-pelikani (fund raising) began. Different overlapping groups were summoned to present gifts and shower the newlyweds with cash every few minutes. I sashayed awkwardly to the front of the room with general guests, Linda's friends, Tilende's friends, BAH staff, doctors and White people. Totals for each faction, as well as individual contributions, were announced with bravado. All the while a deafening band screamed relentlessly in the background.

    In keeping with the classiness of the occasion, guests were allocated two sodas instead of the usual one and boxed snacks, consisting of a greasy samosa, two bony chicken fragments and a bite sized muffin, included a napkin. After the meal, pieces of cake were auctioned to hungry guests. Overall, it was a very rich experience.

    Now This is Good Medical Poetry:

    "Roses are red,
    Violets are blue,
    Wake up right now
    Or I'll intubate you!"
    (via GruntDoc)

    Monday, May 12, 2003
    I'd Share My Last Organ With You

    Wow. Here's a fairly unbelievable story:

    Chicago Doctor Donates Kidney to Patient

    CHICAGO -The case of a doctor who donated a kidney to one of her patients is raising new ethical questions about the doctor-patient relationship and organ donation.

    For Dr. Susan Hou, donating a kidney was something she had thought about since her days in medical school where she had a friend with kidney disease.

    "I can't bring about world peace, I can't eliminate world hunger, but I can get one person off dialysis," said Hou, 56, medical director of the renal transplant program at Loyola University Medical Center in suburban Chicago.

    But medical ethicists, who say they know of no similar case in the United States, believe such a gift complicates the relationship between doctors and patients, and raises the issue of how a doctor decides which patient gets their life-saving gift.

    The ethicists have a point here, but I'm mostly amazed by the altruism that could impel this doctor to this act of generosity. Still, one wonders what could happen in the future:

    ::Nurse Ratched voice:: "Are you taking your pills? Are you taking care of our kidney?" And what if she threatens to take it back?

    Nerves of Steel

    The week I was working in the hospital I ran into our Infectious Disease specialist on one of the wards. Overhearing his telephone conversation, I realized he'd recently seen a SARS patient in his office. When he hung up I asked for the details. He'd known about the patient in advance, so he arranged to see the patient early (at 7:30 in the morning); everyone wore masks. The history had been suspicious - the right symptoms, recent travel to Southeast Asia - so he was prepared. The tests came back positive for the SARS virus, and the patient made a good recovery. He said, cheerfully, that he'd made it past the incubation period without symptoms.

    Guess he dodged a bullet on that one. Sometimes I think that Infectious Disease specialists have become the plague doctors of our time; first HIV, now this. If I were asked to examine a patient with a history suspicious for SARS, I would do so, but I think I'd be pretty nervous about it. His sang-froid was impressive.

    Friday, May 09, 2003
    Happy Nurses' Day

    I've been sorta washed out this week, please forgive the lack of posts.

    Today we have the delicate etiquette question of what to get the staff for Nurses' Day (this apparently also includes medical assistants, also known as MA's). Why so delicate, you ask? For one thing, Secretaries' Day was two weeks ago and the staff watches us like hawks to make sure no favoritism is shown. We have a chronic low level of hostilities between the front and back office staff, much like the cease-fire between North and South Korea.

    I exaggerate (slightly), but nevertheless I try hard to make sure that my secretary and my MA get similarly valued gifts at this time of the year. The problem is that this year by mistake only the front-office staff got lunch on Secretaries' Day (I just handed them my credit card and told them to order) and today somebody else is handling the lunch issue and wants to order lunch for the entire staff, front and back office. I hope no one's keeping score.

    Ideally, I'd take my people out to lunch, but I simply do not have time to do that; usually I spend lunch on the phone with patients while chowing down on an apple. Oh well, they're getting some gifts and a nice breakfast too, so that ought to take care of things. We'll see.

    Wednesday, May 07, 2003
    Are You At Work? Are You Bored? Read This!

    I was responding to a post at Shauny's website (recommendation: two thumbs up, by the way) about work boredom and decided to share this story with you. It's one of my favorite recollections from college:

    Back when I was in college, I worked for the University's catering service, which served lunches, dinners, etc. for on-campus functions. I worked as a waitress, and occasionally bartended. For one thing, it was about the only on-campus job open to non-work-study students (i.e., the students who didn't have loans).

    One night we did the annual awards dinner for the campus newspaper, which was/is one of the better student papers in the country and is, as a consequence, quite full of itself. Well, the speeches went on and on and on. We had served, cleared, sat in the back and eaten our own dinners, and there was nothing left to be done until the guests left.

    Two of the kitchen help were so bored that they picked up one of the waitresses, a slightly-built girl, and decided to stuff her into one of the ice chests to see if she would fit.

    Now THAT'S bored.

    I Love the Internet

    Here's yet another fun little time-waster: Fly Guy

    Check it out.
    (via Dave Barry)

    A thought

    You know you're working too hard when you get an email from a patient at 7:00 pm with "GO HOME!!!" in the subject line.

    Monday, May 05, 2003
    This Dog Belongs to Diurese

    This is a great site. Enter any website address and it generates a poem based on the contents. Here's mine:

    Feet with
    a dog, This something is better. communication Between
    lectures, attendees were preventable. Authors also try to
    work Where would
    The question is, a grumbler. been
    to sign into whenever
    I asked pleadingly. I
    especially if this dog belongs to diurese
    means most commonly cited
    in Malawi.

    (Thanks to the rabbit blog for this one.)

    I Couldn't Have Done It

    Lileks choked me up today. Go read him.

    Update From Malawi

    Another update from Chuen-Yen regarding social events in Malawi. She has been to a wedding shower, which in some ways sounds similar to US wedding showers. I especially liked the lyrics of the first song:

    Maswera (Good afternoon):

    Giving lingerie at bridal showers is a serious faux pas in Malawi. House wares and womanly advice are considered more appropriate gifts. This makes sense since the spectrum of guests includes the betrothed's parents as well as every female friend, relative and acquaintance conceivable.

    Like weddings and funerals, bridal showers are ineluctable affairs. Linda Mbekiani's gala event included a conventional program of seminars on hygiene, finances, home management, and communication. Between lectures, attendees were invited to boogie up the center aisle and deposit money into designated receptacles. Cashiers made change and broadcasted totals. Well-wishers periodically hooted for effect. At intermission, each invitee was rationed a snack of one muffin, a meatball, half a piece of fried chicken and a mineral. Chanting, love songs and traditional dances punctuated the program. A few verses were kindly translated for me...

    As Linda was escorted to the front of the auditorium:

    "Your friend is getting married.
    Why are you not married?
    You will be wandering like a hyena.
    You will be taking other people's husbands."

    After the lecture on home management:

    "Sweet potato leaves are good.
    They bring happiness.
    Make them for your family."

    Before introduction of the parents:

    "Where are the elders?
    They are not here.
    They were walking to the graveyard and died along the way."

    When absentees later inquired about the event, I gave pertinent details and mentioned some verses. Several eavesdropping nurses immediately burst out with the familiar Chichewa lyrics. This weekend's marriage is sure to be harmonious.

    Hope all is well,


    Sunday, May 04, 2003
    Cosmic Playtime

    This is, as WhackingDay said, "one of the most delightfully bizarre websites I've seen in a long time." Enjoy. Make sure you have the sound on, and click on the things that come out of the box.


    Okay, I just visited the Onion and I'm in a better mood. One headline on the side reads "Desktop Zen Rock Garden Thrown at Assistant" and somehow that just cracked me up.

    Day Seven

    Friday and Saturday were horrible. Today is better. I feel like a wimp for complaining, though, since my friend Anna has just completed her first half-marathon! Good for you, AJ!

    My bad days came not from admissions, though those certainly happened in quantity, but from ridiculous in-hospital politicking. Let me illustrate:

    Earlier this week a patient was admitted with a huge, horrible ulcer on her lower leg. She has terrible peripheral vascular disease and very poor blood flow to the leg. She and her family had been advised several times to have the leg amputated, but she had refused and the family had backed her up. Well, long story short, both the orthopedist and the vascular surgeon whom I asked to see her agreed the leg had to come off and the son agreed to sign the consent (the patient is not competent to sign). This was Friday morning. I call the orthopedist: "Great news, she's agreed to have the leg off, let's do it today."

    His office calls back: "He can't do it till Tuesday."

    WTF?? I call back and he explains that he doesn't operate on Fridays, the hospital surgical unit is not open on weekends and his regular OR day is Tuesday. He suggests I call the on-call orthopedic surgeon, who is someone different.

    The on-call guy never calls back and three pages later, it's now midafternoon and I am getting increasingly frantic. I call my medical director for some help. The first surgeon says he'd be willing to do it Saturday morning, but the hospital policy won't let him. Multiple phone calls later I am talking with the hospital administration and they say they are willing to book the surgery for Saturday am, as an emergency case (which costs extra), but they also warn me that the anesthesiologist still has the prerogative to cancel the surgery if he/she feels it isn't a true emergency. I resist the impulse to reply that if this happens there will be one fewer anesthesiologist in the world.

    Against all this set the backdrop of three admissions (none of which I have seen and it's going on three-thirty pm) and the fact that I still have six patients that I haven't rounded on yet, and you can perhaps see why I am at the point of tears as I call my medical director for the fourth or fifth time that day. Yes, the patient got her surgery on Saturday, but there is no earthly reason why I should have had to spend so much of my time and energy on such a ridiculous administrative issue when I had twenty patients to see that day. And the patient had a real problem which had to be treated as soon as possible. ("But she's had the vascular disease for years!" came the chorus from the surgeon and the hospital administrators. "Yes, but she's had this ulcer just six days and it's eaten a twenty-centimeter hole in her leg!" I replied.)

    I may tell you Saturday's story some other time, but I'm just not in the mood right now. Sorry. Oh, and I have another admission.

    Thursday, May 01, 2003
    Conversations With My Trainer

    Yes, I have a trainer. Call me effete if you will, but my experience has been that working with a trainer is a great experience if you�re trying to get in shape, even if it�s only for a few sessions (and I say this as somebody who fought the idea for years). I know many mornings I�d never make it to the gym if it weren�t for my appointments, and I have started going to the gym more often � even on days I�m not working with him.

    Part of the fun of working out with my trainer � I�ll call him Dan � is the conversations we�ve had. Dan is an affable guy and always has plenty to talk about. He�s had a varied career; he started out in the Marines, worked as a drug rep (yes, a drug rep!) for several years, and then finally decided to get his certification and work as a personal trainer. I have been entertained with several soliloquies about what it�s like to go through basic training in the Marines as I sweat through my weight sets or run up and down the stairs. Makes me feel like a wuss every time I complain how tough my workout is (maybe that�s the idea).

    Lately we�ve been talking a lot about pets. Dan is a pet owner, with two cats and a dog (a Rhodesian Ridgeback named Grace). I�m considering getting a pet, although I haven�t done anything about it yet. We started on this topic shortly after St. Patrick�s Day, when I told him a story I�d heard at a St. Pat�s party about a particularly nasty dog. This dog belongs to a couple I�d met at the party and is apparently half schipperke and half Chihuahua. It yips a lot, has the temperament of a buzz saw and has bitten its owners at least twice; still they keep the damn thing.

    Dan�s response to this story was: �I don�t know what a schipperke is, but it sounds like some bourgeois piece of shit. And have you seen Chihuahuas? They never sit still! They vibrate!� Did I mention that Dan has strong opinions about dogs? His advice to me on the dog issue illustrates this. �If you�re gonna get a dog, get a real dog. Not some little rat dog.�

    �Are dachshunds real dogs?� I asked pleadingly. I love dachshunds.


    We're still negotiating that one. He's also told me some facts I didn't know about English bulldogs: to wit, that one reason bulldogs are so expensive is that they have been bred to have such large heads that the mothers have to be birthed by Cesarean section, and that because the pups have trouble breathing the breeder has to keep them for three months instead of the more usual six weeks. It's not unusual, apparently, for the pups to die of respiratory failure.

    "When you breed a dog to the point that it can't breathe," I replied to this, "something is seriously wrong with that system." Dan agreed. During that same session I said, "If I were to get a 'real dog,' I think it'd be a golden Lab. They're very sweet dogs and I could probably handle having one of those."

    Dan shook his head resignedly. "I knew it."

    "What?" Good grief, what do I have to get, a pit bull or something?

    Dan launched into his philosophical mode (which I thoroughly enjoy). "When you see a man walking a Lab, you imediately know something about him. He's married."

    "He probably has kids too," I contribute.

    "Yeah. Wife and kids. See, Labs are the only dog a lot of women will put up with, especially if they have kids, 'cause it's the only breed they feel safe with. Yep, when I see a man walking a Lab, I know that man's wife is wearing the pants in that family."

    I laughed so hard I almost dropped my weights.