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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    Thursday, August 28, 2003
    I'm Talking About The Cat!

    Because I have an immature sense of humor, I thought this was hilarious. It's also cute.

    Oh, and I felt compelled to explain that the headline from this post is taken from an old Steve Martin routine, in case you don't remember.

    Wednesday, August 27, 2003
    Movie Review

    Why yes, I am back. I had a lovely four days off, thank you, doing absolutely nothing. Now let us return to a sorely neglected feature of this blog: the gym movie review!

    Let me recommend They Won't Forget (1937), starring Claude Rains with Lana Turner and Elisha Cook, Jr. I caught this on TNT Tuesday morning; it's the story of a murder of a young girl in a small Southern town. Until I checked IMDb, I didn't realize that this is a fictionalized treatment of a real-life murder: the murder of Mary Phagan. (The victim is named Mary Clay in the film.) From what I have read on-line, in the real-life case the defendant was basically railroaded because he was Jewish. In the film this is played down; the town is prejudiced against the defendant and his wife because they're "Northerners." I didn't pick up on this code while I was watching the film.

    It's a good movie with an excellent perfomance from Claude Rains as the district attorney, firing up a cigar in almost every scene. His Southern accent isn't bad either. In the film, the victim is a student at a local business college and the defendant is one of the professors; in real life, she was a factory worker and the accused man was the manager of the factory. The acting was good all around, and Rains is better than good - you see his ambition to ride this case into a political career, but he also seems to be making an effort to arrest the right man.

    Unfortunately I can't tell you how the film ended, as I had to hop off the Precor machine and go do something else - but I plan to catch it next time it's on TV to find out. Recommended.


    Robert Frost greeting cards.

    (via Bookslut)

    Friday, August 22, 2003
    Walt Disney: Alpha Male

    Thanks to Instapundit for directing me to this hilarious essay on how guys can learn to be alpha males from watching Walt Disney cartoons. It's worth reading. In fact, follow the Instapundit link and read the entire series - this is your weekend blog roundup, folks.

    Oh, here's a good one from Medic Mom: idiots who call 911 for a seven day old skinned knee!

    I'm taking Monday and Tuesday off work, thank God. A chance to rest! Not sure if I'll be posting or not, but feel free to stop by and check.

    What Next? Canonization?

    I like Harry Potter as much as the next reader, but this is going a tad bit too far.

    (via Bookslut)

    Tuesday, August 19, 2003
    Doctor Slang!

    Thanks to MedPundit for these stories about medical slang/acronyms: a marvelous BMJ article, and one from the BBC. I don't know of any doctors in the States that use slang like this in their notes, though it often surfaces in medical conversations. Except for one: "FLK" or funny looking kid, which pediatricians use a lot. It sounds awful, but what it really means is a kid who doesn't quite look right, who you suspect may have some genetic or metabolic problem but you aren't sure. "FLK with GLM" is even more worrisome - that's a funny looking kid with a good-looking mom... if the kid's parents don't look weird, that's another indication that the child may have a medical problem.

    Check these out:

    PFO (Pissed [i.e., drunk], Fell Over)

    GPO (Good for Parts Only)

    Oligoneuronal - of low intellect; literally means very few neurons

    PRATFO - Patient reassured and told to "go away" (HA!!)

    Rule of Five - If more than five orifices are obscured by plastic tubing, the patient�s condition is deemed critical

    Monday, August 18, 2003
    Another Oddball Site

    You asked for a site that rates restrooms at Disneyland -- and you got one!

    (Well, no you didn't, but you got one anyway.)

    Think I'm kidding? Check out The Happiest Potties on Earth.

    Sunday, August 17, 2003
    We Already Have This:

    From Ananova, a story: Hi-Tech Changing Room "Will Tell You What Not to Wear"

    I already have an application that does this. It's called my sister.

    Psalm 39, Verse 12

    Early this morning I received a call from the daughter of one of my patients. He's an elderly man with dementia, and has been my patient for about eighteen months. In the last two weeks or so he has been declining very rapidly, has become paranoid and insists that his family is trying to poison him, and is refusing to take his meds. The daughter has called me several times and I have tried to intervene and reason with the patient, to no avail. (I could have told you that would happen, but if the family asks me to talk to him, what am I to do?)

    This morning the daughter called me, clearly at her wits' end. Because my patient's wife (who had been taking care of him) had to stay in the hospital overnight after a minor surgical procedure, my patient stayed with his son last night. This minor change in his surroundings completely threw him off; he walked out of the house, refusing to return. They had to coax him back inside. He became even more paranoid, refusing to eat. We are making arrangements to get him into the geropsych unit at the hospital. ("Geropsych" is the shorthand for geriatric psychiatry, or psychiatric problems of the elderly.)

    I found myself in church later in the morning, reflecting on this family drama. After hearing all this, you may understand why the reading from the Psalms for today affected me:

    With rebukes for sin you punish us;
    like a moth you eat away all that is dear to us;
    truly, everyone is but a puff of wind.

    If that isn't a first-class description of Alzheimer's, I've never heard one.

    Tuesday, August 12, 2003
    Strangest Site of the Week

    It's the Octodog! A useless kitchen implement that juliennes ordinary frankfurters into eight-legged monstrosities for only $16.95!

    (via WhackingDay)

    I wonder if I could cook an Octodog on my George Foreman grill...

    Hey dicasoin is done, lets tacos!

    No, I'm not typing drunk: I am just alerting you to the fact that Ilyka has yet another hilarious post about doctors who dictate incoherently. I lifted my title from a phrase in her post. Enjoy.

    Monday, August 11, 2003
    A 365,000-Year-Old Headache

    I kid you not. Ananova News Service has an interesting article about a skull found in southwestern Germany with a fossilized meningioma tumor:

    Because skulls of Stone Age people were smaller than human skulls today, the researchers believe the person may have suffered chronic severe headaches and partial paralysis, and likely died from the tumour.

    Ugh. What a way to go. At least he didn't get eaten by a saber-toothed tiger.

    Funniest Opening Paragraph Ever

    Berkeley, the world champion of mass lactation, defended its crown Saturday against the upstart Australians in what has become something of a transpacific nursing grudge match.

    For further information, you can see this article. It's all part of World Breast-Feeding Week, which I consider to be a good thing.

    (via Dave Barry)

    Entertaining and Useful, Too

    And even a touch scientific. It's the Table of Condiments that Periodically Go Bad! (Thanks to Ernie.)

    I have a TV viewing recommendation for you tonight, if you're in the States. Go watch "Storm of the Century" - it's on ABC tonight and concludes on Sunday. The first installment was last night, but it's still worth tuning in: I enjoy Steven King miniseries no matter what - they're my favorite "trash TV" - but you are in for a treat with this one. Colm Feore plays the demonic villain Andre Linoge and he is phenomenal. I had never heard of the guy before seeing this, and since then he's turned up in "Pearl Harbor," "Face/Off" and "City of Angels," among other movies. I'd call this a career-making role.

    Thought for the Day

    You know you're living in a wacky time in a wacky state when your best friend from work calls up on a Sunday afternoon, tremendously excited, to tell you that her patient is running for governor and that her (the patient's) picture is in the Sunday L.A. Times photo spread next to Arnold Schwarzenegger.

    And it's even worse when you hang up the phone and realize that you've lost face because none of your patients are running.

    ADDENDUM: Scrappleface nails it as usual. After yesterday, this story makes perfect sense.

    Sunday, August 10, 2003
    Malawi and Other Matters

    Hello. Welcome to my very dull Sunday afternoon, which I am spending at the office. I'm not studying at the moment, just trying to clean up a lot of administrative paperwork that I didn't get the chance to do this week.

    It's been a busy July and August, for several reasons. Sadly, we have lost some of our staff over the last couple of months, including our office manager and a nurse practitioner who ran our diabetes clinic and did an excellent job. They decided to move on to other things, which is good for them but leaves me and the other physicians with less support; we're having to take care of more things on our own. We will eventually hire replacements, but I have no idea when that will be.

    But I have other things to share with you. Let's see, there is Chuen-Yen's final email from Malawi, a link to satellite sightings of the orbiting space station, and a link to a couple who moved to Rarotonga in the Cook Islands for a year. They're writers and they moved there with their children - a new baby and a five-year-old! Amazing. I found their story in the L.A. Weekly, and of course as soon as I'd read it I started fantasizing about moving to the South Pacific. But I think the novelty would wear off fast, and I hate mosquitoes.

    Chuen-Yen's email is appended below.

    Hi there. I�m leaving on Weds. So, here are few last thoughts:

    Malawi isn�t a big place. Nor is it very well known. However, it has become my universe. As I confront quietus of this watershed year, I can�t help but wonder how the memories will transform. To preserve an accurate framework for them, I�ve recorded some statistics. This year�s highlights are revealing.

    In terms of toiletries, I used 1 bottle of shampoo, 8 toothbrushes and 200 meters of dental floss. I also bathed nearly every day.

    Dabbles in media were consuming. I had thirty television programs aired; twenty were repeats. I also gave three radio interviews and wrote 22 newspaper articles. Small town publicity forced me to disconnect the phone, ignore the door and even flee Blantyre on numerous occasions.

    BAH�s religious affiliation undoubtedly colored events. I attended church a dozen times, mostly at the beginning of the year. Innumerable engages bogarted me about faith, or lack thereof. I acquired one Bible and nine weighty devotionals.

    My first servant was an antebellum experience. Gift cost about $20 per month plus food. He pilfered 2 kilograms of sugar, a liter of oil, 8 Larium tablets, 1 kg of salt, 1 towel, 3 forks, numerous writing implements and many undetected items. His antics were ample compensation for my losses.

    What about big city life? Blantyre boasts zero movie theatres. Zero stores open at night. There exists one Chinese restaurant, one Italian bistro and myriad Indian eateries. Pets, particularly Testudines, are a foreign concept. Medical facilities are few. Qualified doctors are fewer; four internists, including myself, practice in the country.

    For Malawi, where average life expectancy is 37 years, per capita income is US $120 annually and >15% of the population is HIV positive, numbers don�t tell the whole story. Laughter is ubiquitous. Hospitality is infinite. And friendship is non-quantifiable. This truly is the warm heart of Africa. Though Blantyre�s simplicity contrasts sharply with Los Angeles� sophisticated alterity, distances in our in our global village seem very small when you get to know your neighbors.

    See you soon.


    Wednesday, August 06, 2003
    Cartoons Under Communism

    I just thought this was a cute post. Even Bulgarian television had cartoons before the wall came down, apparently... and they called this guy "Pinko!"


    How cool would it be to have the Terminator as governor?

    LOS ANGELES - Arnold Schwarzenegger ended the suspense Wednesday and jumped into the race for California governor, instantly becoming the best-known of the declared candidates seeking to replace Democrat Gray Davis in a recall.

    The surprise announcement by the "Terminator" actor, a moderate Republican, capped a day of fast-paced developments in one of the most unpredictable political races in recent history.

    Maybe he should go after the position of Episcopal Bishop of the Los Angeles diocese instead. (Heck, why not be as inclusive as possible? So his movies advocate violence. So what?)

    I know, I know... he has no political experience, he's trying to parlay his fame into a political position... just let me have my fun for five minutes, OK? I need something to smile about.

    Curse. Bang Head Against Wall. Repeat.

    I have a story to share with you, courtesy of one of my partners.

    Last week she got an urgent call from a patient complaining of a drooping eyelid. My partner sent the patient to the ophthalmologist, who was concerned (appropriately so) and spent quite a bit of time taking a history and doing an exam. He also ordered an MRI to evaluate the possiblility of nerve palsy or neuritis.

    The ophthalmologist called my fellow MD the next day to inform her that the patient had called him back, to tell him that she'd had Botox injections the day before she developed her palsy -- "could this have anything to do with my drooping eyelid?"

    It's a wonder to me that more doctors don't murder their patients.

    Rumble In Minneapolis

    For those of you following along at home who are Episcopalian/Anglican, you are probably aware of the developments of this week in which an openly gay man was confirmed as bishop of New Hampshire at the General Convention of the ECUSA. Jack and I have been emailing each other about the convention all week, and I can recommend his multiple links to Episcopalian websites if you're interested - just go to his site, they're listed on the left. Jack aptly described the convention as "a knife fight in a phone booth."

    I'm going to admit that my feelings about the election are ambiguous. Don't hit me: my church benefits from the presence of many wonderful members of our congregation who are gay and lesbian. They donate their time, energy, money and creativity to the church, and I don't know what we would do without them. I also know two gay priests who are outstanding people, committed to serving God. I firmly believe they are following their true calling, and the thought of one of them not being able to be a bishop because of their sexual orientation really bothers me.

    But when I read these words, from the Bishop of Pittsburgh's statement following the election, they struck a chord with me:

    Those who rejoice at this moment will, I pray, at least understand what has been stolen from us: unity with the One Holy Catholic and Apostolic Church ecumenically; unity with our brothers and sisters in the Anglican Communion across the globe; unity with the Faith once delivered to the Saints.

    Tradition isn't everything, but it is meaningful. The reaction of Gene Robinson and his backers has been, "We don't want anyone to leave the ECUSA, but if they do it's their decision, not ours." I don't think that's good enough, and I don't think it's an attitude that bodes well for the future of the Episcopal Church.

    The bright spot for me this week has been this article, which I found via VodkaPundit:

    The Archbishop of Canterbury, Dr. Rowan Williams, today responded to efforts by the American members of the Anglican Communion to elect an openly gay bishop by declaring the Episcopal Church of the United States of America to be in schism with the Church of England and ordering its members to be arrested and burnt.

    "The old sweetie's really got a bee in his mitre over this one," said Canon Douglas F.X. Ramsbottom, a Lambeth Palace spokesperson. "It's not so much the gay thing, I mean we are British clergy, after all; it's the power thing. Rowie doesn't like the Americans thumbing their noses at him. Deep down, he really wants to be like the pope, you know, infallible and everybody kissing his ring, so every now and then he's got to flex a little muscle."

    Whether based on scripture or the worst case of papal envy since Archbishop Thomas Cramner went one-on-one against Clement VIII and wound up being burned at the stake for his trouble, the directive to begin burning Episcopalians as heretics has the full force of canon law and is expected to result in somewhat of a strain in the relations between England and the United States. Indeed, two American tourists have already been arrested while touring the Tower, imprisoned in one of its unused cells, tried, and condemned.

    A quick-witted Beefeater spotted Mr. and Mrs. Peter Fairworthy as likely Episcopalians when they appeared to be the only middle-aged Americans tourists in London who were not dressed in tee-shirts, shorts, and shower clogs. Under questioning from the Archbishop of Canterbury's Inquisitors, Mr. Fairworthy seemed somewhat vague as to whether he in fact belonged to any church, until his wife reminded him that the answer to their enquiries might well call for the place he intended to attend every Christmas, when they were not visiting St. Barts, and every Easter, when the weather was not suitable for golf.

    The Brits do religious satire better than we do.

    Sunday, August 03, 2003
    Malawi Update

    I found this email very interesting. Chief Tione's tribulations sound remarkably familiar.

    Greetings! Here's your penultimate memoir. See you soon.

    Chief Tione looked tired this afternoon. Dark circles surrounded his eyes; he was slouched against the wall; and alpha waves periodically interrupted his thoughts. Nonetheless, Tione�s door was open for impromptu visitors.

    As we chatted, Tione digressed to the trials and tribulations of chiefdom. He complained that people materialize at his house during all hours of the day and night. He grumbled that most concerns could be addressed at more convenient times. He denounced his job as mentally and physically exhausting. Lastly, he lamented the lack of individuals qualified to assist with his workload.

    Tione is Group Village Headman for Makungula. He oversees thirteen communities. Thus constituents trek great distances for consultation. As chief, he cannot refuse.

    In order to fulfill his obligations, Tione has made several sacrifices. He has abandoned canalicular pastimes, including painting and carving. He frequently delays meals and toileting to care for his people. And he doesn�t take days off.

    It seems that doctors and village chiefs share the same call schedule.

    Friday, August 01, 2003
    Friday Roundup

    Remember my post on formication awhile back? (Sorry, I can't link to it. You know how Blogger is.) Quick refresher: formication is sort of a cross between obsession-compulsion and tactile hallucinations, in which patients are convinced that their skin is infested with bugs - when it isn't. Well, apparently some people are so convinced that they have a real problem that they have founded the National Unidentified Skin Parasite Association. Sad, really; the descriptions listed at the website are classic for formication. I found myself wondering for a minute whether the whole site couldn't be a satire, but evidently not.

    Next, go here to see the Single Bitter Announcement Weblog. I got a kick out of this one. And you really must see the Harry Potter Double Entendres List - it's hysterically funny, consisting of quotes taken out of context from Order of the Phoenix.

    For all you Southern Californians reading this, I have perhaps the ultimate time-wasting site for you: Yesterland. Remember those old Disney attractions circa 1972? The Chicken of the Sea-sponsored Pirate Ship Restaurant that served tuna sandwiches? The PeopleMover? They're all here. I have spent an embarrassing amount of time at this website, reminiscing.

    And lastly, Ilyka was kind enough to recognize my blog (glad you like it!) and has yet another post on doctors' dictation styles - this time, the good ones. It's hysterical. I especially liked Dr. Why-Must-I-Get-All-The-Freaks and Dr. Formal.

    Thanks to Dave Barry, Bookslut and Ernie for some of the above links.