“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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Weird Wedding Stuff


Wedding planning seems to bring out any pathologic personality traits people possess. Have you ever noticed that? I can understand that people want their wedding to be personal, but I really think there is a case to be made for standardized wedding ceremonies. (When I run the universe, the standard will be the Book of Common Prayer.) Engaged couples want their ceremony to be "unique," whatever that means. Truth is that all weddings merge together into one hazy, pastel colored, church/beach/garden-at-sunsetty memory within a couple of months...

Unless some horrible disaster takes place during said ceremony. Or unless the couple's plans are outstandingly strange. Like a wedding at McDonald's. Or a Hello Kitty themed wedding. You think I'm joking? Click on the links.

Perhaps you'd like this Super Mario-themed wedding cake?


Why? Why??

I have no wedding on my horizon, but if I did I'd plan something more tasteful and dignified. Like getting married in Las Vegas by an Elvis impersonator. (My mother would pitch a fit. This is sounding better and better!)

h/t Instapundit for the McDonald's link

Labels: If I Ran the Universe, Random Thoughts

posted by Dr. Alice at #

 
Sutton's Law Strikes Again


"Go where the money is," said Willie Sutton, famous bank robber. So they did:

A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program's history, U.S. authorities said Wednesday.

Now tell me again why single payer health programs are a good idea. We're talking about what, a seventh of the U.S. economy? That's a hell of a lot of money. And where there is money there will be fraud.

The defendants...had stolen the identities of doctors and set up 118 phantom clinics in 25 states, authorities said.

Here's my favorite part:

Prosecutors said the phony paperwork showed eye doctors doing bladder tests; ear, nose and throat specialists performing pregnancy ultrasounds; and obstetricians testing for skin allergies.

Dudes didn't even try to make it look kosher. How did they ever get this far? Blatantly phony medical bills being sent in from 25 states and 118 clinics? Why weren't they caught after five, or ten, or 25 clinics were set up? Answer: because Medicare is a gigantic operation and a great deal of its employees know virtually nothing about medicine. They don't know enough to realize that an ophthalmologist doing bladder tests is unheard of. Now if the program gets even bigger, just imagine how ripe for fraud it will be.

On second thought, don't. I don't want to be responsible for your high blood pressure.

Labels: Medicine, Money, Politics

posted by Dr. Alice at #

 
Perry Mason: Memories of a Mystery Addict


Once upon a time there was an attorney named Erle Stanley Gardner who was based in Ventura, California. He got tired of practicing law and started writing pulp mysteries instead. His most famous creation was the crime-solving criminal attorney Perry Mason. Mason, unlike most criminal attorneys, never seems to have a client who is actually guilty; when he takes the case he takes the responsibility of finding the guilty party upon himself. Usually he unmasks the murderer in court during the preliminary hearing, though sometimes the case actually goes to a jury. I've read most of Gardner's books. Though they are pretty much alike, they are as addictive as potato chips and the plots are rather ingenious.

The same can be said for the television adaptations of Gardner's books, starring (of course) Raymond Burr as Perry Mason. The only other time I can recall seeing Mr. Burr was in Alfred Hitchcock's Rear Window - he turned out to be the murderer in that one. Filmed in glorious black and white, the show premiered in 1957 and ran for a decade. It is still in reruns here and there around the country and spawned multiple TV movies, also starring Burr, in the 1980's. Perry Mason became available on DVD a few years ago; I've been getting the episodes on Netflix and got hooked all over again.

These days I watch the show as a time capsule. The men all wear suits and hats and look like handsome Sherman tanks; the women wear gloves and pearls. The cars are to die for, classic 1950s Cadillacs and Fords. The phones are rotary and in some cases have actual operators plugging in the lines. Here and there we catch glimpses of the Los Angeles of fifty years ago (motel rooms for five dollars a night? Be still, my heart!). Apparently all middle-class homes of the time had overstuffed furniture and huge living rooms with oil paintings crowded together on the walls. Did I mention everyone smokes?

Perry Mason was my gateway drug, so to speak. It hooked my entire family as well: we're all TV mystery addicts. I have fond memories of watching the NBC Mystery Movie back in the 1970's. It was what's known as an "umbrella show," with rotating episodes of Columbo, McMillan and Wife, McCloud and other mysteries. Then came Murder, She Wrote. My sister and I still enjoy watching this show, though it became more and more formulaic as the years went on. (My brother-in-law refers to it as "Murder, She Dorked.") But how can you not love Angela Lansbury and the hammy, we're-supposed-to-be-in-New-England accents of the regular cast? And I really enjoyed In the Heat of the Night, with Carroll O'Connor as the chief of police. Set in a Mississippi town, it was more successful in evoking the atmosphere of the South than many other shows were, and had a great supporting cast to boot.

My dad like myself is a Perry Mason fan. He prefers mysteries with male leads and more action, like Magnum, P.I. He also likes Matlock, which is sort of a male version of Murder, She Wrote starring Andy Griffith and set in Atlanta: I was never a fan of this show. We're both hooked on Law & Order, as long as it's one of the episodes with Jerry Orbach. During a recent visit to my sister's, Dad was flipping channels on the TV and ran across an episode in mid-broadcast. Immediately we found ourselves fixated on the couch, chatting between scene changes (that "ching-ching!" sound is as essential to L&O as Perry Mason's theme song is to that show), and admiring Orbach's performance. Some things never change.

Labels: Los Angeles, Pop Culture

posted by Dr. Alice at #

 
No Wonder They Call Him 'Moonbeam'


Per the website Politico, Jerry Brown doesn't believe mammograms are effective. To back up his claim he cites a study in the British science journal Lancet, which has a long and honorable history but in the last few decades, frankly, has taken a turn more in the direction of the Weekly World News. (By way of example, consider its infamous 2004 "100,000 Iraquis killed since the invasion" claim, which has been debunked.)

So what's your alternative, Jerry? MRIs, which cost five to ten times as much per study? Self exams (which women were recently instructed NOT to do)? Hands-on exams by doctors, which can only pick up tumors large enough to palpate? The whole value of mammograms lies in their being able to screen for tiny tumors which can't be felt.

I'm going to make a rare political statement here. If you live in California, please do not vote for Jerry Brown. I remember his last stint as governor and it was a disaster. Write in Mickey Mouse if you have to, just don't vote for Brown. The state will thank you.

(h/t Instapundit)

Labels: Medicine, Politics

posted by Dr. Alice at #

 
Ah-HA

I knew it, I knew it, I knew it. Cathy Guisewite, author of the "Cathy" comic strip for the past 35 years, ended the strip today with its main character getting pregnant.



I've had rather a fondness for "Cathy" over the years, despite its overall predictability. (I lost count of the number of strips that showed Cathy trying on swimsuits and breaking down in hysterics.) When the strip broke ground in 1975 it was in fact unique, rather resembling "The Mary Tyler Moore Show" in that it dealt with the life of a single working woman. Her best friend Andrea was originally a strident feminist and was a prominent character in the early years, though she faded out later. Andrea got married years before Cathy did, promptly got pregnant and turned into an overachieving soccer mom - a piece of satire which further endeared me to the strip.

Irving was Cathy's off-again-on-again boyfriend for decades, doing all the things that women stereotypically accuse men of doing... yet somehow she hung on to him and they eventually got married. One plot I still remember with glee dealt with Irving gaining weight. One day he appeared in the strip back to his old, semisvelte self. Cathy gasped, "What did you do?"

"I skipped lunch and lost 25 pounds," Irving responded nonchalantly. Cathy responded with a shrieking, "AACK!" Women all over the country must have identified with that.

Farewell, Cathy, and may you have a stress-free pregnancy and tranquil motherhood.

...oh, who am I kidding? AACK!

Labels: Comix

posted by Dr. Alice at #

 
FB Does WWII

This is very funny and a pretty accurate parody of Facebook. Take a look and notice the timestamps.

Labels: Pop Culture

posted by Dr. Alice at #

 
Minor (or not so minor) Problems

I have this bad habit of putting up indefinitely with things that would send other people mad. Truly, it's amazing how many times I will step around cardboard boxes in my hallway without moving them, put up with a freezer section which is so frost-encrusted you cannot fit a thing in it, etc. A similar problem would be the pager with an unreadable display which I have ignored for perhaps a year. Finally this week I sent this email to our medical director's secretary, a wonderful woman who sadly is in charge of crap like this.

I’d like to get a new pager if possible. The LCD display on my current one has become steadily more unreadable and I am now keeping it in the fridge because that’s the only way I can read it. As a result my family is now beginning to question my sanity, as there are only so many times you can explain why your beeper is in the fridge. Can you help?

Her answer was "Yes." God bless her. I have a new readable pager now, and it is wonderful! Makes me wonder why I spent so much time wondering whether that display was a '3' or an '8'.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
Medicine Vs. Surgery

An instant classic.



(I first saw this at Head Nurse. She is awesome; go read.)

Labels: Medicine

posted by Dr. Alice at #

 
Portrait of Dysfunction


There's an age-old debate: Is medicine an art or is it a science? It is, of course, both. The science without the art is research; the art without the science, faith healing. I can state one thing for certain, and that is whoever takes the practice of medicine halfway seriously will be forever changed by it. The Hippocratic Oath, one of the most moving and inspiring pieces of writing ever, makes this clear. I am not the person I would have been had I not become a physician. Left to my own devices, I believe I would have turned out to be the isolated mad scientist type. The blessing of my profession is that it forces me to confront, observe and understand humanity on a daily basis. I have learned from this and (I hope) have become a better person, though I undoubtedly have a long way to go.

To be a good doctor, you have to do two things: Listen and observe. It is amazing how much you can learn from body language and from watching family dynamics. I was reminded of this basic fact this week in the split second of observation that came when I walked into an exam room to see an elderly patient.

Every primary care doctor deals with gerontology (medical care of the elderly) though most of us are not necessarily specialists in this area. In case you were wondering, gerontology is now its own specialty and requires board certification. This fuels my belief that medicine is being fractured into smaller and more senseless specialties every day, but we can go into that some other time. (Just to give you an amusing side story here... many years ago my father, a family practitioner, took the gerontology boards when this first became a recognized specialty, hoping to get grandfathered in. He did not pass. With smoke emanating from his ears, he declared this was because "the only answer they want is 'Don't give them medication'! That's bullshit!" Shortly afterwards my grandmother's doctor, a boarded gerontologist, lost his license for drug abuse. My father's response: "Can you find out what drugs he was taking? Because maybe if I take them I can pass.")

Though I am not a gerontologist I certainly see my share of the elderly. One of the saddest things I see with aging patients is the conflict which so often develops between elderly patients and their concerned children/nieces and nephews/neighbors. Frightened aging people, feeling their autonomy slipping away, will defend it with everything they have. This holds true even for the most minor details of their lives. It's as though they are going through the Terrible Twos all over again, and for a similar reason. It's all about control.

To come to the point: this week I saw a longtime patient of mine with her daughter. The patient's health has been worsening for a long time and she is not the most compliant patient. The daughter often gets frustrated with her. As I opened the door to the exam room, what I saw was the patient clutching her cane and staring straight ahead while the daughter, arms wrapped tightly around her chest, stared angrily out the window.

Sometimes that's all you need to see.

Labels: Medicine

posted by Dr. Alice at #

 
Oh, Dammit.

Farewell, Nero Wolfe:

Maury Chaykin Passes Away on 61st Birthday

Pfui (as Wolfe would say). He was a terrific character actor. If you watch "Eureka," on SciFi, you may remember him as the sheriff of the town in the pilot episode.

Labels: Pop Culture

posted by Dr. Alice at #

 
150 Angry Potential Jurors [Prequel to Twelve Angry Men]

So last week I had jury duty. Again.

I don't know what it is about Los Angeles, but they are perpetually jury hungry here. After getting hit up four times in fifteen years I have learned a lot of dodges. I always postpone jury duty as much as I can (up to six months without requiring a note from your doctor) which stretches things out a bit more; I also recommend picking a week with a national holiday in it if possible. This year I picked the third week of July because currently California has a court furlough day the third Wednesday of every month. This is because we are broke. I could go on at great length about the pack of clowns who run this state, but I will spare you that. (Except to comment that the libraries are now closed two days out of the week to save money, which infuriates me. I love to go to the library.)

As you may know, to find out if you are going to have to go to court on a given day you have to call in the night before. This flat out ruined my schedule; I had to close it for the week every day but Monday and despite my best efforts wound up seeing only five to seven people per day on the other days.

I evaded the clutches of the court for a few days, but my luck ran out when they nailed me on Thursday. I did get lucky, though; I was not called for any jury and was let out early. It was a very unproductive day. I read the newspaper and some outdated magazines (I forgot my CME journals I had meant to bring) and wandered around reading exciting stuff posted on the walls. Even the bus schedule for Culver City was an object of fascination, to say nothing of the posters of various celebrities who had done their civic duty by obeying the call of the Los Angeles Superior Court. (Sadly, neither Harrison Ford nor Edward James Olmos, both of whom apparently have done jury duty in the past, was attending that day.)

After sitting all morning, going to lunch and returning in the afternoon, an announcement was made at 2:45 that one of the cases scheduled for that day had settled without going to trial. Therefore some (not all!) of the jurors would be let go. The iron-fisted ladies running the jury program began calling names at random, and you could almost hear the prayers ascending around the room. Just as I had given up hope I heard my name called and I felt like I'd won the lottery. You never saw such a giddy bunch of people as my fellow escapees and I packed ourselves into the elevator and got the hell out of there.

I realize this isn't a very exciting story, but it's the only one I've got. After my dearth of posts I figured I might as well tell you what I've been up to.

Labels: Los Angeles, The Doctor's Life

posted by Dr. Alice at #

 
I'm Going to Break Down Into Gooey Stuff For a Minute


It's been awhile since I posted... since the end of vacation, in fact. Things are happening, as they tend to do, but I have just not felt like blogging. Here at The Firm we have had the Drama and the Bad Stuff. This month has been rough; I diagnosed one patient with acute leukemia and lost another to ALS (Lou Gehrig's disease). The ALS patient was only 34 years old. Last week I had another with newly diagnosed gastric cancer. Suffice to say I phoned my mom and broke down sobbing. I had to call her twice this week to reassure her that I was not ready to head off to Bellevue.

But I saw a movie this week that punched my spirits back up. You may or may not feel like seeing it, but I personally would recommend it if you are feeling sad and down.

The movie in question: Despicable Me. Yes, it's an animated feature. (Or to put it another way, a cartoon.) It ain't Pixar, but it's really good. Apparently this is Universal's first entry into the animation market, under the banner of Illumination Films. The main voice actors are Julie Andrews and Steve Carell. You've probably heard at least something about this film by now, but just to recap: Steve Carell plays Gru, a supervillain with a Russian accent, a subterranean lab in his suburban home and an army of minions. He's been at this gig for awhile and is slipping into middle age. A newer, younger, hungrier supervillain named Vector has just stolen the Great Pyramid and Gru has to fight this fellow for funding to steal the moon.

Did I mention he has been fixated on the moon, and on gaining his mother's approval, since early boyhood? This fact is neatly established in the movie by way of flashbacks to the original moon landing, which will resonate with those of us who are of a certain age. At any rate, in order to steal the shrink ray which he needs to get the moon, he has to adopt three adorable orphaned girls - the reason why will become apparent when you see the film. Suffice to say that he plans to temporarily adopt and then dump them, but quickly changes his mind and winds up becoming their adopted father.

This sounds corny, but there is more to the film than you would think from this recap. The minions are adorable, I have heard them described as "animated Twinkies." Although they look almost exactly alike, Gru clearly recognizes them as individuals and addresses them by name. Their shining moment comes during the credits and is reason enough for seeing the film in 3D - although I think 3D adds quite a bit to the whole movie. The orphan girls are played by quite good child actors and have plenty of spunk and personality. There are neat little hat tips to adult viewers throughout the film (references to The Godfather and Airplane!, not to mention a reference to a certain defunct banking firm).

But what about the acting? Well, Steve Carell does a fantastic job with Gru. He revels in the character's evilness, but also makes him sympathetic. And his relationship with the girls evolves believably, to the point where he's gnawing his nails about the conflict between stealing the moon and going to their dance recital. (What dad can't relate?) His best friend and right-hand man Dr. Nefario is played by Russell Brand, who played the rock star in Get Him To the Greek. Brand is excellent.

The little touches are also fun. To hide the pyramid, Vector puts it in his backyard and paints it sky blue with a few clouds on it. No one questions it. Agnes, the youngest orphan, has a fixation with unicorns - this joke is revisited several times in the film and is both funny and cute. And when Gru reads the girls a bedtime story... well, if you don't melt you have a colder heart than I. All I can say is, Go see this movie. I don't think you'll regret it.

Labels: Pop Culture, The Doctor's Life

posted by Dr. Alice at #

 
Vacation, All I Ever Wanted...


I have to go back to work on Monday. DO NOT WANT. Since I got home I've not done all that much: went out to dinner with my parents, spent the weekend with them, spent way too much time on the Internet pontificating, and got a lot of pesky errands done. I also went cherry picking. No, that's not a euphemism for anything. It is cherry season, and if you are willing to get in the car and drive out of Los Angeles, you too can have fresh picked organic cherries from the Leona Valley. They are delicious. In short, I have enjoyed myself no end.

Did I mention I have discovered eBay? Perhaps I should go back to work before I spend my life savings on things I don't really need. Like rabbit figurines. (I can explain!) I was born in the Chinese Zodiac Year of the Rabbit, and have been collecting the odd rabbit figurine here and there for some time now. Well, at some point I realized that I could get online and check out the offerings: Some are wincingly cute but some have character and personality. I seem to have found quite a few that fall into the latter category. In case you are wondering, by "quite a few" I mean "less than ten."

I have done a bit of cooking as well but had to limit myself to items that could be frozen such as meat loaf and soup. Otherwise I would be faced with an uneatable pile of leftovers. I meant to set up my sewing machine for some as-yet-unrealized craft project but have not done so.

It's been nice to have an undirected vacation for a change. I haven't done this in a long time. I just hope I can continue occasionally taking little trips around the city to see things without saving it up for some vacation time to be determined later.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
Meat Loaf


I have this theory about meat loaf. It's one of those foods people imprint on, like Thanksgiving stuffing or deviled eggs. Once you've gotten used to "your" version, no other will taste right. I also think it's one of those foods which is better made at home than served in restaurants. For some reason most restaurants serve it drenched in brown gravy, which is absolutely the worst thing you could possibly do to meat loaf. It calls for something tangy, tomato-ey and mildly spicy to balance what is essentially ground meat and breadcrumbs. Also it's best made in bulk; I am immediately suspicious of any recipe billed as "meatloaf for one."

For all of these reasons I rarely make meat loaf, preferring my mother's version. I have her recipe somewhere but it's rather complex. Recently though I came across a recipe which sounded promising, and I am here to say that it lived up to the promise. It's from Jill Connor Browne's Sweet Potato Queens' First Big-Ass Novel. (Ms. Browne is the head of the organization known as the Sweet Potato Queens, headquartered in Mississippi. Her books are fun to read and, best of all, contain some great recipes.)

Some pointers: I like this recipe because it calls for ground beef only, as opposed to the esoteric veal/pork/sausage meat/beef combinations you find in some recipes. These combos sound good, don't get me wrong, but to be honest I am not prepared to go to that kind of trouble or to spend extra money on ingredients for meat loaf. Use beef containing not more than 20% fat; 15% would be better, but the 20% was on sale so that's what I used.

Use a food processor to chop the vegetables. You want them finely minced for textural reasons. Otherwise you will end up, as I did, with little chunks of veg in your loaf. It still tasted good but the texture was a little weird.

For "breadcrumbs," you can use cracker crumbs, stuffing mix or crushed cereal - use what you have.

Mix an egg with a little bit of milk - a few tablespooons' worth. Chop about 1 1/2 stalks celery, half a bell pepper (green or red), and 1/2 to 1 onion (depending on the size of your onion). Mix the vegetables, egg and milk with 1 1/2 to 2 pounds ground sirloin. Sprinkle 1 cup breadcrumbs over this mixture and mix all together with your hands, handling meat as little as possible (so it does not get dense and tough).

In another bowl mix 1 cup barbecue sauce and 1/2 cup salsa - the jarred kind, not the fresh (or you can use 3/4 cup each, depending on your taste - you could also use Heinz chili sauce). Add 1 1/2 T. Worcestershire sauce and 1/4 tsp ground red pepper. Take half of this and mix it into the meat. Then form your loaves and paint the tops with the rest of the sauce.

The original recipe suggests using a big muffin pan for mini meat loaves. You would bake these at 450° for 18 to 20 minutes. I don't have one of these pans so I formed mine into five loaves (four small, one larger) and froze the small ones. I baked the larger one at about 415° for 45 minutes.

I think this meat loaf is great. The vegetables keep it moist and lighten it as well as boosting the flavor, and the savory sauce/topping is perfect. It also meets the ultimate test of meat loaf, namely, Does it make good sandwiches? The answer is a definite Yes! Yes, the sandwiches are very good. I don't think this recipe needs additional salt, due to the barbecue sauce, salsa and Worcestershire, which all contain plenty.


And my freezer is now well stocked with meat loaf for future dinners.

Labels: Ingestion

posted by Dr. Alice at #

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


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

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

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

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

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

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

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

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

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

Labels: Ingestion, Los Angeles, Pop Culture, Travel

posted by Dr. Alice at #

 
When It Was Good It Was Very, Very Good


....and when it was bad, it was horrid. Farewell, 24, the show I couldn't stop watching no matter how silly it got. Much of Season Eight was excellent, but I really didn't like the last few hours when Jack became a one-man vengeance machine. The finale was wonderful, though.

• Smarmy President Logan got his comeuppance. (Greg Itzin, I hope you win the Emmy this year that you should have won for Season Five.)


• The emotional goodbye between Jack and Chloe allowed the series to end on a good note. The relationship between these two has become the heart of the show.


• No Aaron Pierce this season?! What were they thinking?


• I'm really going to miss Dave Barry live blogging the show.

On the bright side, I suddenly have all this free time now.

Labels: Pop Culture

posted by Dr. Alice at #

 
*Sigh* Sorry guys, seems like all I can come up with to write about right now is recipes. I'm a little brain dead due to my ongoing wrestling with the New Computer System and the upcoming end of 24 (the last broadcast begins in 48 hours!)

At any rate I credit this post to my aunt, who is doing extremely well healthwise, I am happy to say. It's not just a recipe, it is an entire dinner and can be expanded to feed as many as you would like. Basically the dinner is hamburger with grilled onions, mashed potatoes and broccoli - it's easy, delicious and works even for one person. Here we go:

Hamburger Steak Smothered in Onions


Ingredients:

Hamburger
Onions!!
Worcestershire sauce
Garlic or onion powder
Potatoes
Milk, butter
Salt, pepper
Green veg: broccoli or similar
Lemon

Take the hamburger and season it well with Worcestershire, pepper and garlic or onion powder. A pound of ground meat will make three to four patties, depending on appetites and what else you are serving. (If you are adding salad and dessert, a pound will serve four, no problem.) If you are feeding fewer than three or four take the excess patties, stick each one in a Zip-Lock bag and put them in the freezer. They will keep handily for a month or two.

Chop the onions and set them aside. Prep some broccoli, green beans or whatever you like and get the steamer ready. Peel and chop the potatoes and hold them in cold water in the cooking pot.

You should start the vegetables first. Once they are cooking, turn the heat down and start cooking the hamburger patties. They will take about four minutes per side. Once you have flipped them, throw the onions over the top and stir gently here and there to get them cooked. If the vegetables aren't done by the time the burgers are you can take the patties out, cover with aluminum foil and let them rest while you finish everything else.

Season the broccoli or whatever with lemon, salt, pepper and a little butter. Mash the potatoes. Plate the dinner and throw the grilled onions on top of the hamburger patties. Eat.

Labels: Ingestion

posted by Dr. Alice at #

 
A Sense of Perspective


I highly recommend the HubbleSite if you're looking for a background image for your computer desktop. They have great pics of planets, nebulae and galaxies for you to get your geek on, it's easy to use - and all free! Plus on a bad day at work, gazing at the wonders of the universe may put your bad day in perspective. Unless you're Zaphod Beeblebrox, of course.

Labels: Science

posted by Dr. Alice at #

 
Russian Potato Salad


It has been a crazy two weeks at work. The Firm finally switched us all over to the new completely unnecessary EMR system. This was an en masse switchover: All nearly one hundred of us docs, plus the front and back office staff, started using a new dysfunctional and inefficient system on the same day. I will leave you to imagine the madness that ensued.

Our old system was rather basic but by comparison, easy and quick to use. Two examples: To print lab results takes about four mouse clicks and we can only print one result at a time instead of highlighting all of them and printing them out together. In other words, if the patient has four labs drawn it will take 16 clicks to print out the results. Also, the old system would allow us to fax results to any doctor in the Tertiary Medical Care system straight from the desktop without printing them out first; new system? Oh, I'm sorry, we can't do that. Grr.

So this weekend, seething in frustration, I have fallen back on cooking some basics which don't require a lot of thought as I don't really feel up to thinking right now. One dish I made today is Russian Potato Salad, a recipe I got from Arthur Schwartz's What to Cook When You Think There's Nothing in the House to Eat (a great cookbook, BTW). Russian potato salad calls for diced pickle, diced onion and peas as well as potatoes. If you think potato salad is okay but sort of bleh, this is the recipe for you - it has a lot more flavor than your standard potato salad. You don't have to measure anything. Proportions are based on how much you want to make and what you personally like. I tend to go heavy on the pickles and onion.

I use russet baking potatoes for potato salad, myself. You don't have to, you can use red potatoes or whatever you like, but I like the mealier texture of the russets. Plus they soak up dressing as they sit so you get some lovely, high caloric potato salad. You can also add chopped ham or chicken, but I don't recommend this as it really pushes the salad into the too-heavy range. The original recipe calls for hard-boiled egg as well. You finely dice the white and add it to the salad, then sieve the yolk over the surface of the salad when you are done. I made it this way the first time, but then never bothered with it again as I think it is fine without egg.

So. Boil your potatoes, then cool and peel. Make sure they are cooked through: With large russets this may take up to 30 minutes. Then dice the potatoes, chop your pickle (you can use sweet or dill, I like dill pickle with this) and onion. Cook some frozen peas, drain and add them. Just to give you an idea, today I used three russets, three dill pickle spears, about a cup of peas and 1/2 cup of chopped onion. For the dressing, I mix mayonnaise (Best Foods or any good brand), mustard and black pepper and thin it with lemon juice. You will need plenty of dressing, so don't skimp. Mix it separately to combine the dressing well without mushing the salad ingredients. Then gently fold the dressing into all of the above ingredients.

You may not need any salt as the pickles, mayo and mustard all contain plenty. But potatoes do need salt, so add it if you need it. Just taste it first.

This is a great side dish with baked chicken or hamburgers and will last for several days in the fridge. Don't be afraid to make more than you need, as it is a great leftover.

Labels: Ingestion, The Doctor's Life

posted by Dr. Alice at #

 
The Aesthetics Fairy

Los Angeles has a problem called "teardown chic." Basically it involves the destruction of perfectly nice homes which were probably built 50 to 70 years ago, measuring under two thousand square feet on relatively small lots. People buy these homes, tear them down and build huge, garish two- or three-story replacements that cover the entire lot like frosting spread to the edge of a cake. These structures are usually some sort of indeterminate pastel color and have overwrought iron fencing with gilt details. They are hideous.

Yesterday as V. and I went on our 1.2 mile fitness march around the neighborhood after work we saw several of these ghastly structures. I began to fantasize about a being called the Aesthetics Fairy, who would punish homeowners guilty of erecting these crimes against good taste. Might he or she look like... Simon Cowell?

Right, that's it. You have been voted out of this neighborhood.

Or perhaps Nurse Ratched? (A terrifying thought.)

There are rules here, Mr. Homeowner. If the rules are not obeyed you will be punished.

And of course there's the obvious, Jorgen von Strangle.

Were it up to me, I'd sentence them to two weeks in a mud hut with no indoor plumbing followed by six months in a condo with noisy neighbors overhead. It's nice to fantasize about, anyway.

Labels: Los Angeles, Pop Culture

posted by Dr. Alice at #

 
ANZAC Day


In 2002 I took a six-week break from work and spent some time traveling through Turkey and Bulgaria. I had planned to visit Troy and on a whim I decided to go to Gallipoli as well, thinking it would be historically interesting; the battlefields there are very well preserved and the entire area of Gallipoli is a national park. I shortly found myself in a hostel in the town of Canakkale, which is near the battlefield.

I had no idea that I was in for one of the more memorable experiences of my life (I should confess here that my history knowledge is not the greatest and I really had no idea what to expect). My first hint that this was not going to be your average museum-type tour came when I arrived at the hostel; nearly everyone there was either Australian or a New Zealander. I wasn't the only American there, but it was close. I know you're probably thinking "Duh," but again, I was incredibly naive and had never heard of ANZAC Day or the facts behind Gallipoli. I learned from my fellow tourists that it is like Pearl Harbor, only more important, as Gallipoli had a great deal to do with Australia and New Zealand forming their national identities apart from the British Empire.

The evening before the tour the hostel showed an Australian-made documentary about Gallipoli, a recap of the history behind the battle (believe it or not, I had no idea that Winston Churchill had masterminded this colossal disaster) intercut with scenes from the film Gallipoli. As we watched I suddenly realized that a woman behind me was weeping. My God, I thought. What have I let myself in for?

Two buses packed full of people left the hostel the following morning. Our tour guide was a charming Turkish man whose grandfather fought and was killed at Gallipoli. He told us that his knowledge of the battlefield came from his father, who had not yet been born when his father was killed, and who had made trip after trip to the battlefields trying to find where his father had been buried (he never did; it was an unmarked grave). There was a lovely elderly lady on my bus who was there to look for her uncle's grave. As young men, her father and his brother had both fought at Gallipoli. Her father survived the battle, his brother did not. She had promised her father before he died that she would some day visit her uncle's grave, as he had never had the chance to do. She had been told that he was buried at the Lone Pine cemetery.

The tour of Gallipoli takes the entire day; the site is huge. We visited every cemetery, stood in the trenches and saw the dugouts, which are still there (although we were warned not to go in, due to the danger of collapse). The entire site is incredibly well preserved. The trenches of the opposing sides are literally feet apart at some points. Today Gallipoli is beautiful and peaceful. I stood in what had been "no man's land" and tried to imagine what it would be like in the middle of a muddy battlefield with constant gunfire, barbed wire and mortar shells raining everywhere.

As I wandered around the Lone Pine cemetery later that day I saw from a distance the elderly lady from the bus kneeling beside a grave. Our guide stood by her, his hand on her shoulder.

She had found her uncle.


In 1934 Kemal Atatürk, leader of Turkey, said these words to the Australians and New Zealanders visiting the battlefields:

Those heroes that shed their blood And lost their lives. You are now lying in the soil of a friendly country. Therefore rest in peace. There is no difference between the Johnnies And the Mehmets to us where they lie side by side Here in this country of ours. You, the mothers, Who sent their sons from far away countries Wipe away your tears, Your sons are now lying in our bosom And are in peace After having lost their lives on this land they have Become our sons as well.

I do not think that there is anything else to be said.

Labels: The Doctor's Life, Travel

posted by Dr. Alice at #

 
To Boldly Go Where California Has Gone Before


Okay. This picture



And this site made my day. William Shatner as Governor General of Canada? You know you want it. If he ran Canada in full-on Denny Crane mode, think of the fun that would ensue.

That is all.

Labels: Politics, Pop Culture

posted by Dr. Alice at #

 
Losing Our Religion?

When I read this post on Twitter it made me start thinking: When people say they don't trust "organized religion" but do respect spirituality, what exactly does that mean? Do they know what they mean? And how is organized religion controlling? Is it because it confronts people with difficult ideas like self control and self-sacrifice, challenges them to move beyond their boundaries?

Certainly religion can be used as a controlling force, particularly when mixed with politics. For two examples I direct you to the present-day Middle East and the struggle in Tudor England between Protestant and Catholic factions. It can also be a stabilizing force. I think controlling and stabilizing are opposite ends of the same spectrum. Anything can be good or bad depending on how you use it.

To me, saying you believe in spirituality but don't trust religion is like saying you breathe air but don't believe in oxygen. Doesn't make a lot of sense. Without a framework to build on, too often spirituality leads absolutely nowhere. I was impressed by the section in "Eat, Pray, Love" in which Elizabeth Gilbert spent time at an ashram in India, culminating in a significant spiritual experience in which she felt at one with God. But she did not have that experience until she had spent months praying, meditating, following a strict schedule set by her spiritual mentor, and performing tasks including scrubbing the temple floor. If that's not organized, I'd like to know what is.

I believe there are people who can manage an impressive dimension of spirituality in their lives without going to regular worship services or following the tenets of a specific religion. I loved this post from Head Nurse in which she addresses exactly that. But I think they are few and far between, because spirituality - real spirituality - takes work and practice. Religion is a framework, providing the opportunity to practice, providing reminders to keep your mind on the higher things. You can view it as a cage or as a support; it's really up to you.

Labels: Random Thoughts

posted by Dr. Alice at #

 
Inventing Dinner.


Lately I've been playing the "what can I make for dinner tonight without going to the store" game. Some nights you lose... such as when I have oatmeal or cold cereal for dinner. Some nights you win. Tonight I won, thanks to a weekend shopping trip in which I took advantage of the coupons my local store had mailed me. I made a batch of Spaghetti Sauce from the cookbook Frozen Assets and bought some (cheap) shredded mozzarella and parmesan thanks to the coupons.

With the sauce in mind I found a half box of mostaccioli in the pantry and threw together the following. Cook the pasta and drain. Mix with a cup or so of mozzarella, a drained can of sliced mushrooms and as much spaghetti sauce as you need. Top with parmesan and bake at 375º until done. Excellent.

Here is the recipe for the spaghetti sauce - I made a half batch and there's plenty in the freezer now.

Two lb Italian sausage or ground meat (beef, chicken, turkey)
2 C. chopped onions
1/2 C. chopped bell pepper (red or green)
1/2 C. chopped celery
2 tsp minced garlic
4 large cans tomato sauce - these would be about 28 oz each
4 16 oz cans Italian style diced tomatoes (undrained)
1 large can sliced black olives (I omitted this and used some chopped mushrooms instead)

Brown the meat and the next four ingredients. Add the sauce and tomatoes. Simmer for an hour or so, then add olives (if using). If adding mushrooms, brown with the other vegetables.

Labels: Ingestion

posted by Dr. Alice at #

 
A Fearless Friday Recipe

Home Ec 101 has a great feature known as Fearless Friday. The idea is that you are supposed to stretch your boundaries by trying something different - no matter how big or small the recipe. On Easter Sunday I tried a recipe for a beef roast that sounded rather odd, but I had come across an eye of round roast on sale and was trying to figure out what to do with it. Roasting beef always makes me nervous, probably because I can't stop thinking about the cost of the meat I'm shoving into the oven. It's like throwing ten-dollar bills in there. But I found this suggestion on the internet and several posters swore it worked, so I tried it.

Take a three-lb (approximate is fine) eye of round roast. Let it come to room temp, or at least let it sit out for 45 minutes or so. Rub with your seasonings of choice - I used Lawry's Lemon Pepper which worked great. While you are doing this, preheat the oven to 500º F. Then put the roast in a baking dish, put it in the oven and turn down immediately to 475º. Roast for seven minutes per pound. Then turn off the oven and leave the roast in for 2 1/2 hours without opening the oven. I mean not even for a second or so. Don't cover it with foil or a lid, don't put any liquid in the pan.

It works. The meat will be done but rare. If you want it a little more done you can either leave the oven on for another seven minutes or you can turn it back to 350º after the 2 1/2 hours are up and leave it in for another 30 minutes. Bring the meat out, slice it thinly (thinly is important!) and seve with the rest of dinner.

This recipe is a piece of cake and it forces you to plan ahead, which is a good thing if you are serving a group of people. And if you are roasting three pounds of meat, you probably are; or else you are me and this will feed you all week for lunch (a good thing, you have great lunches to look forward to all week!) The other good news is you can't overcook it, i.e., ruin it. If you like it more well done, that is easy to remedy - see above. Should you come across an eye of round roast on sale, I heartily recommend this recipe.

Labels: Ingestion

posted by Dr. Alice at #

 
The Rev. Barbie

Apparently Barbie has now become an Episcopal priest. She's prettier than the Presiding Bishop Katherine Schori, and a better theologian to boot!

(via Christopher Johnson)

UPDATE. There is an excellent Sunday column addressing the state of the American Episcopal church, and what the existence of Rev. Barbie symbolizes to same, here. Hat tip to Instapundit.

Labels: Episcopaliana, Pop Culture

posted by Dr. Alice at #

 
Can't Win for Losing

For the past few months The Firm has been preparing us to switch to a new EMR system. This thing is complex and all of us are dreading it. The Big Switchover is scheduled to happen this weekend, and our current system will be offline as of Friday as we prepare to upload to the new system.

Did I mention I was scheduled to be on call this weekend?

So I was delighted when I got an email from one of my partners asking to switch call weekends with me, as he wanted to go out of town to a conference the following weekend. I did warn him in my answering email ("Caveat Emptor!" I replied), but he accepted anyway.

So you can imagine my reaction to the following voicemail I received last evening:

"Hello everyone. After a lot of thought we've decided to put off our switchover for one week. We will be taking the system offline on April 16th, not the 9th..."

*facepalm*

Labels: Medicine, The Doctor's Life

posted by Dr. Alice at #

 
This Urologist Has, Um, Cojones

A urologist in Orlando, Florida has made no bones about telling his patients what he thinks about Obama's healthcare plan:

A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."

This is legal, as far as I can tell. The doctor in question has made it very clear that anyone who wants to see him won't be turned away. The sign he posted says:

"If you voted for Obama… seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."

He's right. My patients are all complaining about their drug copays being jacked up, increased fees to be seen by a doc, and so forth. I explain to them that the insurance companies raised their rates proactively, expecting the healthcare legislation to pass, and that the result will be higher fees for everyone. C'est la vie.

(via JammieWearingFool)

Labels: Medicine, Politics

posted by Dr. Alice at #

 
Grand Rounds is Up

This edition focuses on health care reform. Check it out.

Labels: Medicine

posted by Dr. Alice at #

 

Labels: Ingestion

posted by Dr. Alice at #

 
Sob.


It's officially official: 24's run on television ends in May. [Warning: if you aren't caught up on the show, spoilers to follow!]

I have been watching the show since Day Five (haven't yet watched the previous four seasons) and thoroughly enjoyed it, even when the show was not at its best. That would be Day Six, in case you were wondering. The news that the show is ending kind of makes me sad, but on the other hand I have to admit that 24 has run its course. Day Eight has been better than either season six or seven, but the writers are definitely in the recycling-old-plot-lines phase. For example, this season I had been mentally awarding kudos to the writers for avoiding the timeworn "mole in CTU" plot line. This past week we learned that Katee Sackhoff's character is - surprise - The Mole in CTU! ::headdesk::

The 24 producers have a gift for landing wonderful character actors for the show, which adds greatly to the fun of watching it. On the other hand it's frustrating to see said really good actors mouthing bad dialogue and playing cardboard characters whose function is to develop a specific plot point and then get killed in some fashion or other. Usually in their last fifteen minutes or so they are allowed to flash an intriguing bit of character development, only to get killed off or erased from the show just as the viewer starts to get interested (see also: Kurtwood Smith as the Senator in S7, Sean Astin as Lynn McGill/CTU head in S5, Jurgen Prochnow as the head of the Russian crime syndicate this season). Sometimes though the show excels itself and we get great actors who are allowed to go to town. Season 5 was perhaps the last time this happened. It featured Gregory Itzin as slippery President Logan, Jean Smart as his crazy-but-not-really-crazy wife (some reviewers compared her to the prophet Cassandra), and Peter Weller as Jack's former boss gone bad, Christopher Henderson. It rocked, and that was the season I got addicted.

Are the plots ridiculous? Yes they are. Of course they are. As I said when I first started watching the show, 24 is basically an updated version of the cliffhanger serials from the 1930's. This is what makes Dave Barry's real time blog posts poking fun at every episode so much fun. The first season started with Jack protecting a senator who was running for President - reasonable. But the plots escalated and every season since has involved a sitting President and the White House; in fact, last season involved terrorists swimming the Potomac, breaking into the White House (from the river, through the foundation of the White House) and taking the President hostage. This is impossible as the Potomac River doesn't run anywhere close to the center of Washington, D.C. Stuff like this is unnecessary. You could put a strong character like Jack Bauer anywhere in any situation and the show would still be good.

My final recommendation is this. When it comes to TV I have the attention span of a gnat. Usually even when I find a show that I like, I'll watch a few episodes and then quit. This has not happened with 24. I've seen every episode of the past four seasons, and for me, this is unheard of. When this season is over and the show ends I plan to log on to Netflix and start renting the previous four seasons. No other TV show has grabbed my interest like this one. If you've never seen it, give it a try; start with Season 1 and go from there, or at least start with Season 5 as I did. You won't regret it.

Labels: Pop Culture

posted by Dr. Alice at #

 
Thursday



I have two meetings later today but I'm enjoying my Thursday morning immensely, reading blogs and my Amazon recommendations and checking lab results. I slept in till 7:15! (Two hours later than usual.)

I love having a four day workweek. I don't spend my Thursdays sitting around and watching TV though. Usually I do paperwork, call patients with lab results and/or attend meetings. Last week the Sears repair guy came to fix my oven (the door handle was falling off); the week before that it was the plumber. It's much faster to get service on weekdays than it is on weekends.
********

Speaking of Amazon, this book was recently recommended to me in an email from their salesbot. I think it may win the title of Most Useless Craft Book Ever. "25 Bread Cloths for the Holidays"? Do people even use bread cloths anymore? I can see having one bread cloth for, perhaps, Thanksgiving and Christmas; those seem to be the only times anyone serves hot bread these days. But embroidering one of them, let alone several, is completely beyond me.

As to why it was recommended, I do have a thing for craft books. I love reading them though I rarely make any of the projects. I find them soothing reading last thing at night. Some are more practical than others, like the ones that explain how to sew curtains and pillows. When civilization collapses it might be useful to know how to knit a sweater, but I don't think it will help to be well stocked with bread cloths.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
The Future of Healthcare: One Doc's Opinion


So, looks like the healthcare bill is passing. (I am writing this on Sunday afternoon.)

My feelings are mixed about this. Over the years I have seen many cases of patients who have lost their health insurance and come to me in flat out panic. If applying for individual coverage, they have been denied due to their health history or even, in some cases, incredibly minor things. If the bill will solve their problems that is a good thing but I'm not so sure it will. Plus it comes with a lot of baggage, not least the fact that nobody knows WTF is contained in the bill. Congress now faces the challenge of thrashing this thing into shape after passage, since they had to rush it through sloppily to get it passed at all. Even Obama doesn't know what all is in the bill and what isn't: see this interview. This procedure makes about as much sense as a museum buying a chunk of marble and then hiring someone to sculpt the Venus de Milo out of it.

Also, as I mentioned previously, there aren't enough doctors/healthcare providers to provide care to all these newly insured patients who presumably are going to sign up. Check out this Newsweek article, which I think explains rather well what is going on. The process of finding a doctor is going to be like musical chairs: when the triumphant "We Passed Healthcare" music stops playing, a lot of potential patients are going to find themselves with no place to go. Though I will report one piece of cheering news. The number of students entering family practice residencies has picked up this year. Perhaps, in a recession, med students have finally figured out that if you go into primary care you will never lose your job.

Prices will be higher for insurance all the way around. Employers will either go out of business (if they're small) or fire part of their staff and insist that those who are still employed pay a higher share of the bill. Your taxes will go up, I guarantee it. National debt will also skyrocket. If we - the employed/insured - are willing to put up with this, then so be it.

Why do I say all this? Can the government provide good, basic healthcare for less money? They probably can. Unfortunately nobody wants basic healthcare. My definition of basic healthcare is the following: Infertility isn't covered. Viagra and similar drugs aren't covered. Organ transplants: may or may not be covered, but the antirejection drugs you'll need probably won't be. Breast reconstruction after mastectomy? Not covered. You get a beanbag to put in your bra. Seeing a dermatologist for acne: not covered, your primary care doc can do that. And so forth. Most of this stuff won't shorten your lifespan if it is not covered, but my impression is the American public will be pretty pissed off to hear this.

The other issue is the iffy circumstances under which the bill was passed. A large portion of the population is against the bill, will remember who voted for it, will do their best to vote those who did out of office. Many states are preparing to sue the Federal government to fight the passage of the bill. They may well lose, but the money spent and the bitterness engendered will leave a lasting legacy.

The next few weeks are going to be a bumpy ride.

Labels: Medicine, Politics

posted by Dr. Alice at #

 

Week In Review


In honor of the L.A. Marathon today, I'm doing... nothing. As little as humanly possible. I don't mean to claim laziness is healthy, mind you, it's just that the marathon is being run very near me and traffic is a mess as a consequence. I'm not sorry to have an excuse not to stir from the house as it was a busy week. In no particular order, we have:

• A case of domestic violence. For obvious reasons I'm not giving any details here, but it gave me a chance to brush up on the details of reporting such incidents. I am so grateful that The Firm's risk manager is right down the hall; he was extremely helpful. The Beverly Hills police were also accommodating and sent an officer to take a statement from the patient. The one thing I will say is that no one should ever be afraid to report such an incident even if you started it. If someone responds to a relatively mild push, let's say, with significantly more force and intimidation, that is a serious problem.


• Getting peed on while trying to perform a pelvic exam. No big deal: the patient in question is demented so naturally I cut her some slack, and I was of course wearing gloves at the time. Still, it was worthy of note as that hasn't happened to me before. I learned that golden showers are not my thing.


• A truly awesome St Patrick's day party. V. and her spouse have an annual tradition of throwing a corned-beef dinner, with pizza for those who don't like corned beef, and it gets bigger every year. She called me the next morning and invited me to guess how many people attended altogether... there were 87 guests. I brought my green cheesecake and it was much appreciated. Also I lent her my slow cooker for the beef: they had six or seven cookers going. It's good to know mine still works, as it has to be at least 35 years old by now and it's still going strong. (I swiped it from my mother, who never uses it.)


• A training class for our new EMR (electronic medical record) system. The Firm has been using our current system for over three years now, and we're switching to a different one - mostly, I guess, because Tertiary Medical Center is implementing this particular system and since we're joined at the hip with them that means we have to switch too. The Firm is lauding the flexibility of this particular program, and it does in fact have many ways to enter information. You can use a point and click menu, or you can use a slightly different menu, or you can free text. The thing is there are so many different options that it's rather confusing. Still, I think in the long run we'll manage quite well and our current system has a nasty habit of freezing and crashing, which drives me nuts. I do need to spend more time practicing in the "playground," as the system personnel call the training area. I wish they'd chosen a more grown up phrase for it.


• A board meeting. Again, I'm not giving details here, but at every meeting I learn a lot about the issues our administrators have to deal with. As a doc it's easy for me to grouch and complain but I am trying not to do so much of that. I have sent more than my share of flaming emails about a problem, only to get embarrassed when the recipient responds with additional information about the problem that I did not know (funny how that works, isn't it?)


• Which brings me to the last event: I got an anonymous letter. I won't give details here except to say that it consisted of a series of complaints about one of the administrators, and it purported to be from one of the medical staff. I'm quite sure no doctor wrote this letter. I debated it, ran it past V. and decided to inform the medical director. I have passed it on to him. The weird thing is, it clearly had come through the mail - canceled stamp and all - but someone put it in my desk drawer. I wouldn't be surprised if it came from one of my office staff, though it could have come from any of the more than 200 personnel employed by the group. I may have gotten it because I have been known to complain about this particular person (who I believe is quite competent), which makes me feel lousy. If so it serves me right and gives me a reason to bite my tongue in the future, or at least not go off half-cocked.

At any rate, that was my week. How was yours?

Labels: Los Angeles, Medicine, The Doctor's Life

posted by Dr. Alice at #

 
Housekeeping


Haloscan went kablooie a few weeks ago, so now I am going with Blogger's comments. Sadly, there was no way for me to transfer the old Haloscan comments into Blogger, so your old bons mots are no longer available. View this as a chance to write some new ones.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
She Could Cook and Act



As you may know by now I like to collect cookbooks. I got an early start thanks to reading our local paper, the Los Angeles Times, which for many years (though it's not as good these days) had a wonderful food and cooking section. One of the Times' great strengths was its ability to draw on the L.A. Public Library's wonderfully detailed cookbook collection. It was thanks to the Times that I first read about one of the all-time great celebrity cookbooks, ZaSu Pitts' Candy Hits. Most celebrity cookbooks are mediocre, a here-today-and-gone-tomorrow collection of ordinary recipes with famous people's names attached to them as if by glue. ZaSu Pitts actually was a candymaking enthusiast - and I mean candy cooked the old-fashioned way, with a candy thermometer, the kind where you had to pay attention to "soft crack stage" and "hard crack stage" if you wanted your candy to turn out edible. Her cookbook also contains a fair amount of autobiographical detail, which is especially interesting today: she started her career during the era of silent movies. In a stroke of luck she, an unknown actress, was cast to play Mary Pickford's sister due to their resemblance; she never looked back. She played in Hal Roach comedies for years and then graduated to character roles once sound pictures came in. If you remember her at all you will probably remember her as the spinster aunt in Life With Father (starring William Powell).

The chapter she wrote on chocolate dipping is both funny and educational, especially when describing her failed first attempt to work with chocolate. Chocolate is a temperamental ingredient to work with and she makes no bones about it (quote: "Chocolate is the devil incarnate.") No cheating with paraffin for her. Her list of ten lessons for mastering chocolate dipping begins as follows: "1. Pray." By a stroke of luck she wound up taking candymaking lessons with the staff of Littlejohn's Candies in the Los Angeles Farmer's Market - the store is still there, and I think of Pitts every time I walk past it.

I found this interesting piece of trivia on Ms. Pitts from the IMDb website: When the "Thimble Theatre" comic strip became the "Popeye" animated cartoon series, the producers used ZaSu's hand-wringing and nervous speech pattern to characterize the on-screen persona of "Olive Oyl."

This means that when Shelley Duvall was playing Olive Oyl in the film version of Popeye, she was actually imitating ZaSu Pitts. I wonder if she knew that? What a pleasing irony for Pitts to have her trademark acting style pop up onscreen fifty years later.

Labels: Ingestion, Pop Culture

posted by Dr. Alice at #

 
Irritating Overrated Writer Dies; World Continues Spinning on Axis



You weren't that good, Salinger. I've read his stuff and never really saw the point.

Though I will say I respected him for never selling "Catcher in the Rye" to Hollywood. He felt film would never do the story justice. Were it me, I would probably have gone along with Zane Grey who I believe is said to have said, "When you sell your story to the movies, take the money, turn your back and walk away," or words to that effect. You've got to do one or the other unless you are one of the very few writers who has enough clout to oversee the film (the only one I can think of offhand is J.K. Rowling).

Labels: Pop Culture

posted by Dr. Alice at #

 
OW OW OW


I spent all of today in pain, feeling as though construction workers were drilling a hole down through my maxillary sinus and into my upper jaw. Funny thing is, though, I don't feel sick - it just hurts.

This started a few days ago with pain in my neck. Not my throat; just the front of my neck. I drove V. crazy Friday after work by persistently feeling my neck and remarking how tender it was.

"Does it hurt when you do this?" she queried.

"Yes."

"Then DON'T DO IT!"

Right, right, I know; but easier said than done.

"I think I'm developing a carotid aneurysm. What do you think?"

"It's possible," she answered straight faced. I think I went home at that point.

Over the weekend, ibuprofen helped but the pain kept returning, then it traveled to my middle ear. Today I noticed the sinus pressure. No congestion or runny nose. I got another one of my partners to look in my ear, and she said everything was normal. I combed the office for antibiotic samples; none to be found. (Yes, I know you aren't supposed to self-treat. Shut up.) V. kindly called in a prescription for me tonight and I will pick it up tomorrow.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
24

"24" still brings it. Yes, it's the eighth season and the whole concept is getting old. Yes, the writers recycle plots more than the most earnest environmentalist recycles his garbage. And when I mentioned the show to a friend of mine a few weeks ago he sputtered in righteous indignation: "It's violent! It glorifies torture! It's xenophobic!"

Yes, yes, and... well, I'd debate that last one, but for the sake of argument let's say yes. I don't care; I love this show. Last weekend, feeling somewhat jaded, I sat down to watch the beginning of Season 8 and got sucked right back in again. Keifer Sutherland just rocks the house as Jack Bauer. The poor guy, after surviving the Neurologic Virus of Death last season and enjoying a little down time with his granddaughter, had a wounded terrorist knock on his door and got pulled back into the mess again within an hour.

A few thoughts: After viewing the first four hours, I have to say that S8 holds promise for being the best season since S5 - though of course it's early days. Season 6 was, frankly, terrible. S7 was better, silly but fun (the White House was invaded by frogmen swimming up the Potomac River, and Jon Voight chewed the scenery to splinters, plus we got lots of heroic Agent Aaron Pierce who was back from retirement).

Jack just wants to get on a plane to L.A. and get the hell away from CTU. Former FBI agent Renee Walker has gone, to put it bluntly, completely batshit - she cut the thumb off a guy under house arrest so that she could liberate him from his tracking bracelet. The President of Unnamed Middle Eastern Nation is played by Anil Kapoor, the game show host from Slumdog Millionaire, and Cherry Jones is back as the U.S. President (I thought she was great last season). I am hoping that her loyal sidekick Ethan will get to make some time with her now that she is divorced. Chloe the geek genius is still around with the New York branch of CTU and strangely is not completely conversant with their current computer system - I guess this passes for character development on this show.

As of Hour Four we have the Russian Mafia working with the Mideast President's traitor brother and a plot involving U-235 fuel rods. But who knows where it's going to go from here? Hang on for the ride! And maybe if we're lucky Jack will kill another guy with a fire ax to the chest (as he did in the second hour). We can only hope.

Labels: Pop Culture

posted by Dr. Alice at #

 
I Dreamt About Bugs

I realize it signals that you're pretty much scraping the bottom of the barrel when you blog about your dreams, but whatever. My dreams freaked me out so much last night that I simply have to post about them. Bugs, my friends. I dreamt about bugs, all bugs, all the time.

I don't remember the dream in detail but it took place in a house that was not my own. First I was watching two spiders spin a web, viewing from up close; then for some reason I was (I think) in a basement, watching beetles and grubs digging in the dirt. Ick.

So I got online and looked up dream interpretation. I mean, what would you do? I was happy to see that bugs don't signify death, or bad luck, or decomposition or what not. Instead, spiders signify that "you may want to stay away from a tempting situation" or perhaps might stand for feminine power. (Awesome!) Beetles indicate "that destructive influences may be at work in your waking life" or that "your values and beliefs may be being compromised." Apparently they do not stand in for John, Paul, George or Ringo. Insects generally mean that there are minor obstacles in one's life that must be overcome, or may be symbolic of precision, alertness and sensitivity.

Overall this does not sound bad. Perhaps it all means that I need to stay on my diet, or maybe it relates to work. At any rate, it sounds like a healthy challenge rather than something out of Edgar Allan Poe. Let's see what I dream about tonight.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
Peanut Butter: My New Best Friend



A peanut butter sandwich, it turns out, is worth 6 points on Weight Watchers (if you use their bread). This has become valuable information.


If you exercise enough, you get point credits and can eat more. This is also valuable information. I actually got to the gym yesterday for the first time in a long time. I have been frighteningly sedentary and there is really no excuse for this, as I realized doing twenty (not very demanding) minutes on the elliptical machine that my arms were beginning to hurt. Today they are mildly sore. This is ridiculous.

And now for some medical stuff. My last workday of 2009 ran the gamut from high to low. High: a blessing from a patient of mine who's a priest. He came by to tell me he had to switch medical plans and couldn't stay with me, which made us both sad, but the blessing was his parting gesture. Maybe it'll help me out this year.

Then later that same day I was evaluating a patient brought in by family for memory loss... did a mini mental status exam, on which the patient didn't score too well. Then I froze as the patient humbly apologized to the other family members "for embarrassing them." Time for Kleenex, and reassurance, and a referral to a neurologist.

Last week I was confirming a pregnancy and gave the patient her estimated due date. She stared at me and said, "That's the day my mother went into cardiac arrest." I know that joyous events don't erase the memory of tragic ones, but somehow I hope she does give birth on that day.

Labels: Medicine, The Doctor's Life, Weight Loss

posted by Dr. Alice at #

 
New Year, New Fridge


My old refrigerator came with the house when I bought it, which was 15 years ago. It was noisy and didn't have a lot of room and the door didn't seal very well, but I hung on to it longer than I should have - inertia, I guess. Even when I redid the kitchen (ten years ago? well, close, anyway) it was the only appliance I didn't replace, though I probably should have. I did a little browsing in the Sears appliance department about six months ago, decided I'd like a freezer-on-the-bottom model instead of a side-by-side freezer/fridge but took no further action.

A month ago my fridge rattled noisily through an entire weekend, then suddenly got quiet. Too quiet. The freezer side was still working but the refrigerator side wasn't. Then, ten days ago, I realized that food was thawing in the freezer.

I hit the Internet running and picked out my new fridge/freezer in less than fifteen minutes. It was delivered yesterday and I am oh, so happy. My new fridge is nearly silent, larger than my old one and will use much less electricity.

Today I went shopping and filled it with healthy things. The arrival of my new appliance coincides with my determination to eat healthy - oh, let's face it. Lose weight. Yes, I need to lose weight and quite a bit of it. I've joined Weight Watchers online and everything. Luckily I have three friends who also use the WW online program and I have been hitting them up for advice. I'm not going to let the topic of weight loss take over the blog, as I know there is nothing more boring than reading about someone else's diet, but I do plan to put down thoughts and ideas as they occur to me. If nothing else it may keep me on the plan.

In other news, not much. I hope your holidays were good. Mine were very quiet. I spent Christmas and New Year's with my parents and my aunt. A big family Christmas was out of the question, as my aunt still cannot be around young children (due to their high rate of getting sick). However, she has been out of the hospital for six weeks and has regained about five pounds. Her energy level is much better and her optimism is back. That's the most important thing of all.

Labels: The Doctor's Life, Weight Loss

posted by Dr. Alice at #