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

Email Dr. Alice

    follow me on Twitter
    This page is powered by Blogger. Isn't yours?
    Monday, May 23, 2005
    Silver Anniversary for the Torrances

    Stanley Kubrick's film The Shining was released 25 years ago today. Yes, I'm sure you're all happy to know that. I am, because I was trying to figure out how to post about it without sounding like an absolute idiot. Gee, I just saw this movie last weekend and it was unbelievable! Oh yeah, and it's a twenty-five-year-old classic and I never saw it before.

    I've never read the book - I'm not that much of a Stephen King fan, though I generally enjoy his TV adaptations that pop up every once in awhile. I caught the end of the miniseries version (sanctioned by King, who wanted it done His Way) several years ago and was unimpressed with the gooey ending. Dad comes to his senses at the last second, dies a heroic death, goes to heaven and gets to come back to see his kid graduate - I swear I am not making that part up. Fortunately, by the time his next miniseries came along a couple of years later King must have learned from his error and presented us with a really good story I've posted about before, ages ago: Storm of the Century. He had the guts to write a downbeat ending for that one. (Off the point, SotC will be rerun over Memorial Day weekend: keep an eye out for it.)

    So, anyway, back to The Shining. The Stanley Hotel in Colorado, site of the wedding I mentioned a few posts ago, runs the film nonstop on their in-house TV channel. My brother and I started watching it the night we checked in, like idiots; I basically did not sleep that night. I haven't been able to get it out of my head since.

    I don't think I've ever seen a Kubrick film before. I was impressed by his attention to small details (like the scene where Danny is riding his trike over alternating rugs and parquet floors, and all you can hear is the changing sound of the trike wheels while the camera is zooming along behind him). His decision to change to the hedge maze for the climactic scene instead of messing around with topiary animals coming to life was a smart one. Basically, Kubrick's motto seems to have been Less Is More, or should I say, Less Is Scarier. Make no mistake, this is a terrifying movie. He tweaked the plot points to good effect: no redemption is to be had for Jack here and the good guys don't necessarily survive, unlike King's book. (I'm trying to avoid spoilers.) Kubrick doesn't spell out every single thing that happens in the hotel or the meaning of the picture we see at the end. Was Jack there before? Did he get trapped in the picture after the incidents in the movie? We just don't know, and the more we speculate, the freakier it gets.

    Working with Danny Lloyd, the actor who played Danny Torrance, Kubrick had to keep within certain restrictions so as not to terrify the poor kid. He succeeded brilliantly - the actor has said that he didn't realize The Shining was a horror film until well after shooting was completed. This also gave power to the "Room 237" scene: We don't know what Danny encounters in the room. We only see him afterwards, so traumatized that he's sucking his thumb and unable to speak; "Tony" takes him over shortly afterwards. You can't say that's not scary... and when his mother assumes he's been brutalized by his father, that's even scarier. The way Shelly Duvall and Jack Nicholson play their roles, you just know they're in an abusive relationship before they even get to the hotel. The scene where Jack is unable to work and lets off steam by hurling a tennis ball at the wall, over and over again, lets us know right away that we're dealing with an angry guy.

    Anyway, see the movie. It's brilliantly done and there's a lot more to it than blood and guts - in fact, there's a surprisingly small amount of violence in the film; it's the buildup that gets you. When a director can make you jump just by flashing a cue card at the screen that says


    that's when you know you're in the hands of someone really, really good.

    Garfield: Actually Funny

    Go here: The Garfield Randomizer

    Thanks to some commenter on Josh's blog; I'm too lazy to go back and figure out who it was.

    The AV Guy

    Thanks to GruntDoc for providing the link to this hilarious article. It's a first-person essay written by a fellow who provides AV services at lectures and has been sitting in on maybe one medical presentation too many. Do read, it's very well written.

    Sunday, May 22, 2005
    Be Happy You Will If You Read This

    ...because I sense a funny and medical disturbance in the Force.

    via Ilyka it is. (OK, enough of the inverting clauses already.)

    Crazy Rabbi

    That's what we all call him. Yes, the whole of The Firm, fifty-odd physicians strong, knows him. All the local ERs know him. The outside docs that cover the weekend night call shift know him.

    He calls himself a rabbi, and he's definitely crazy. Ergo, the Crazy Rabbi.

    Typical encounter goes like this. STAT page. Voicemail message: (nervously, rapidly) "Please call xxx-xxxx. I am in pain, please call. Thank you."

    No name, no explanation. At this point, we don't need one because we KNOW who it is; we all recognize his voice. Yes, he's called that often.

    When you call back, you get this. "I am in pain, I need antibiotics." (Or, variant: "I have a shot of Rocephin and I need you to give it to me.") He always states he has either a urinary tract infection or a prostate problem or, my favorite, "something is wrong with my rectum."

    "No," we respond. At this point he either goes ballistic on us or he hangs up and goes to the ER. We have received several irritated messages from the ER - in fact, multiple ERs - about this guy; every hospital for ten miles around knows who he is. We have tried to get him to come in to the office for evaluation (he has claimed to be the patient of about five different MDs in The Firm) but he almost never does; he no-shows about 75% of the time.

    I once called the number he left and got his mother, who promptly screamed at me, "He's crazy! Don't call him!" - but if we don't, he will call back within fifteen minutes leaving an even more hysterical message than the first time. (As an aside, I would mention that having the patient's mother tell you he's crazy is not a good prognostic sign.)

    Lately the calls have tapered off. Of course - we doctors being a superstitious lot - the mere act of my posting this entry may be enough to bring him back down on our necks, but I will hope for the best. I could not resist telling you about this fellow, though - he is definitely one of the most memorable patients we've had recently.

    Saturday, May 21, 2005
    Never a Dull Moment

    Today, Saturday morning at 9:00, I was in church because it's my week to do Altar Guild. I was trimming the tapers on the candle snuffers and inserting new ones, closed the knife I was using to do the job and, in a classic mistake, failed to move my finger off the end of the knife holder. The blade came snapping down and got my middle finger just below the nail bed. After dropping a few choice curses (in the sanctuary!!) I dashed to the sacristy, rinsed it off and decided it might be deep enough to merit a suture. I know I'm due for a tetanus shot, so I headed over to our Urgent Care, just ten minutes away.

    I was prepared to get teased by the staff for my clumsiness, but not for what I saw when I stepped off the elevator: the resident whose turn it was to work and three or four patients waiting in the hallway. (It was fifteen minutes past opening time at that point.)

    "Nobody's here," explained the resident. Neither the medical assistant nor the receptionist had yet shown up, and she didn't have a key to get in.

    After dropping another curse or two (I am so going to hell after this weekend), I let everyone in and started looking up phone numbers after checking the schedule. Ten minutes later, the staff showed up (one had gotten stuck in traffic coming down from Palmdale, the other had locked her keys in the car and had to walk home).

    I didn't need a suture. Got my tetanus shot and left. Not such a bad thing I wound up cutting my finger this morning.

    Patient Safety: Or, the End of an Era

    Recently there's been a big campaign in many hospitals to change the way doctors write orders, the goal being to eliminate medication dosage errors and improve patient safety. At the hospital across the street from my office, every nursing station is plastered with posters showing the wrong and right way to write orders. The traditional, esoteric Latin shorthand is being kicked to the curb; now we have to write everything out longhand in plain English. The mystery is gone. (sigh) In all seriousness, I can't object to anything that reduces iatrogenic errors or that improves patient safety, but I admit to a gentle nostalgia for The Way It Used To Be. It's just so much fun to use a secret code, and it's much faster to use the shorthand when you're writing order after order...

    For example, we can't write "QD" anymore, it has to be "daily". The shorthand for left eye (OS), right eye (OD), or both eyes (OU) is verboten; likewise for ears (AS, AD and AU respectively). QID (four times daily) is too easily confused with QD, so it's out too, though the last time I checked BID and TID (twice or three times daily) were still OK (permitted).

    So where I might once write:

    i-ii gtt OU TID-AC &HS

    I now would write "one to two drops in both eyes three times daily before meals and at bedtime."

    Doesn't it just look better the other way?

    Friday, May 20, 2005
    Breathing Room

    I've been busy in the office playing catchup after the last few weeks. I went to a wedding in Colorado a week ago, held at the Stanley Hotel (famous as Stephen King's inspiration for The Shining). The wedding was great, and I got a chance to see my sister and her kids. The hotel is beautiful. My room was right down the hall from Room 217... saw no blood under the door or twins in the hallway, though.

    I have to tell you about the First Communion I mentioned a few posts ago: it was held at a church in Sherman Oaks (in the Valley). As I got there and hugged V.'s husband, he murmured, "Look behind you. It's Norm."

    Do we know a Norm? I thought.

    I slowly turned around and there behind me was George Wendt. Norrrm! I wound up sitting right in front of him during the service. As we left, V.'s husband shrugged and said, "It's always somebody around here. At David's christening it was Rob Lowe."

    I gotta start attending services there more often.

    Thursday, May 19, 2005
    Here's a Concept

    I seem to be on a roll of smartass links here. Too wrung out to post anything of substance, I guess. Anyway, via the Kitchen Geek, I give you chocolate Russian Roulette.

    Chocolate. Russian. Roulette. (V., I smell a birthday present...)

    Wednesday, May 18, 2005
    Cooking with Altoids

    For what to do with Altoids and their tins, click here. My "favorite" is the suggested recipe for sea urchin sprinkled with crushed Altoids. (But I do like the crafty ideas for the tins.)


    Darth Vader, conservative.

    Thursday, May 05, 2005
    Tired, So Tired

    This is Day 6 of seven days as hospitalist. Under our current system, this means that I spend half-days in the office seeing patients and the other half as the roving internist, seeing patients and doing admissions. It is magically designed to piss everybody off. The patients are upset because I'm working half days and can't fit them in for appointments, I'm late returning their phone calls because I've got to bail out at noon to get to the hospital, and the docs are upset because I'm not seeing their patients fast enough (hello? I'm not in the hospital at ten in the morning, you idiot, I'm in the office!) I feel like I've got one foot on the floor and one foot on a skateboard, and the skateboard is slipping out from under me. A most undignified position.

    I will have to spend this weekend picking up the pieces. Mother's Day will be reduced to a ritual phone call, I'm afraid - fortunately Mom is visiting my sister out of state, so the onus is on my sister to come up with a good gift idea this time (I've done it the last several years). V.'s son is celebrating his First Communion this weekend, and I am really looking forward to seeing him in his new white suit (all the girls have to wear white dresses and the boys white suits; I suggested adding a top hat and tap shoes to the ensemble but was voted down).

    Tomorrow ends the week with a bang. It's my last day as hospitalist, plus I'm on call that night. If I drop dead of fatigue they can sack me up and combine my funeral with the First Communion. More later...

    Tuesday, May 03, 2005
    This is Just Ridiculous

    I'm anticipating Star Wars III as much as the next fangirl, but I think the Lucas marketing juggernaut has gone far enough.

    I give you - Star Wars M&M's. Be very afraid.

    Sunday, May 01, 2005
    And More New Links

    For caffeine-oholics - see the sidebar in the food section. Pro: Starbucks Gossip, Con: the Delocator.

    If I may digress for a moment, I really don't get the "I hate Starbucks" meme so popular in blogs today. You hate them for what - because they're successful? A company that makes money and goes out of its way to do the right thing - offers health insurance to every employee (and let me be the one to tell you I see a LOT of Starbucks employees as patients), encourages cultivation of organic coffees and land conservation (i.e., shade-grown coffee) - sure their prices could be lower, but other than that I don't see the problem. If you don't like their roast, fine, go somewhere else.

    Is Starbucks the Terminator of independent coffeehouses? There is no direct evidence that such is the case. In fact, there is some evidence that Starbucks has actually encouraged the growth of independent coffehouses, rather than discouraging them.

    How to Make a Business Decision

    Christie's uses Rock, Paper, Scissors -- and wins. (via Instapundit)