Thoughts On Social Media

In the wake of the Night of the Long Knives on Twitter (if you weren't aware, Elon Musk deleted several journalists from the website), I have been wondering whether building a presence on social media really has the value it has been credited with for the past several years. Last night's episode, if nothing else, highlights how transient social media presence is. Leaving politics aside, I can think of two major issues that complicate "building a brand" (a term I hate). This doesn't apply to casual fun users, but to those who have made it a significant part of their careers.

First is financial. There are rumors that Twitter is currently in financial trouble, and this isn't the first time that has been the case. If a pundit or celebrity goes to a lot of effort to build a presence on a selected website, and then said website goes bankrupt and disappears, all that work is wasted.  A big part of the reason social media became so popular is that it's simple, cheap and fast to register. The problem is that those factors influence the audience of the site. "Fickle" would be a good word to use here - a reader that may like you today may block you tomorrow, or simply get bored and leave. Plus, a following does not translate to money. For example, Alexandria Ocasio-Cortez has a huge following on social media yet her recent book did poorly. It appears that few of her followers were willing to buy it.

Second is the proliferation of social media websites. One way for a pundit to hedge their bets is to register on multiple sites, but how well does that really work? The more sites there are, the fewer members each one is likely to have. Is it worth it to spend time on multiple sites rather than investing that time in writing, researching or creating product? Plus those sites are not guaranteed to function well. From what I have read of Mastodon, it is more like a series of fiefdoms than an open site such as Twitter. Each node on Mastodon is run by separate individuals or groups, each of which can block anyone they want. Quite a few recent users have found this out to their dissatisfaction. 

I don't have any answers here, but I do think the issues I have mentioned play a large part in keeping analog or "old school" public presence alive. It will be interesting to see what happens in social media over the next few years. 

Labels: Random Thoughts, Twenty-First Century Crap

 Giving Thanks

Nearly a year ago, I began a personal journal. At that time my father had passed away, my mother was still alive and I was not sure where I was going or what I was doing. I left full-time practice in January of 2020 and knew I did not want to go back.

At first I made entries every day, but at this point I haven't made any for several months. Nevertheless it served its purpose. I made the decision to keep working part time; I sold my house and moved into my parents' home; I weathered the loss of my mother; I committed to moving out of state. So for now, I have a new normal. The only thing I really haven't accomplished is to start writing on a regular basis, but I no longer have any excuses. My big test is over and done with (I passed the Boards recertification, hooray!)

I am grateful for where I am and what I'm doing. Grateful for my good relationship with my siblings and their families. Glad that I've made the effort to see my friends more often and that I have the time to help them when they need it.

I'm even grateful for that cat. Gazebo still won't come near me but seems to be slightly more at ease with my presence, and I feel good that I've been able to make his/her/its life easier. And I want to end this post with my holiday advice to you all: Sharpen your knives. 

No, really. The kitchen knives here were the dullest things you've ever tried to work with. Finally I found a sharpener, got them taken care of, and now kitchen prep work is so much easier! It's made a huge difference and I am more inclined to cook now that I don't have to wrestle with trying to chop vegetables. This will, as they say, change your life. 

Happy Thanksgiving and Advent.

Labels: Changes, Holidays, Random Thoughts

The Cat

Cats and I - well, I won't say we've never gotten along, but they haven't been a presence in my life the way that dogs have. Plus, my mother was allergic to them so I had very little interaction with cats as a kid. But I seem to have acquired a more-or-less constant resident of the gazebo in the back yard: a black-and-white feline which I have named Gazebo. (I have no imagination.)

When my parents were alive we did have a shifting population of ferals in the backyard, in spite of my father's best efforts to eradicate them. Now I'm down to one, and I hope it stays that way; but over the very hot summer I began putting water out for it. Then I started putting out food, which as we all know is an ironclad guarantee that the cat will stick around. Then I added a makeshift shelter as we had a hard rain last week. As far as I know the cat has not yet used it, but the nights are cold and I worry less knowing there is a warm place available for it. 

Gazebo still won't come near me, and occasionally hisses when I show up with food, the little ingrate. But it's rather nice to have a semi-pet, and at least I don't have to clean the litter box this way. I still don't know whether Gazebo is male or female, but I am hoping he/she will become more comfortable with me over the next few months. Meanwhile Gazebo continues its reign as Monarch of the Backyard.  

Labels: Kitty

 Picking Up the Pieces

"Well, somebody's got to rebuild Rio!"

I doubt more than a handful of people will recognize that quote, let alone find it amusing, but it perfectly expresses how I feel. My final challenge for the year has been met. I took my Boards test three days ago, and now... what? 

2022 has been nothing but a series of hurdles, with just enough space between them to catch my breath.  It began with my mother's decline and death, quickly followed by my decision to sell my house and move out of Los Angeles. Then came arranging her memorial service while juggling the move, followed by a midsummer trip to Europe (I had booked this two years earlier and could not cancel it), and then studying for this test. All year I've been saying to myself: You just have to get through the next thing. And: Just wait till that test is over with and I can start unpacking! 

Strangely, I now find myself with no desire to unpack. Or to do much of anything, really, except make lists. Big, ambitious lists. I have made a couple of large decisions without too much trouble... I am not going back to work full time but will continue with my part time schedule. I have made a down payment on a condominium in Florida, though the project has not yet broken ground - it looks as though I will be moving in two or three years. But it is the day-to-day decisions that are the difficult ones. Namely, where to start cleaning and organizing? In the kitchen? Master bedroom? My bedroom? Should I be working toward a garage sale, or try to donate everything, or look into selling on eBay? I don't really want to think about any of it. 

Perhaps scheduling my days would help. So many hours per day cleaning and organizing, so many hours per day working on paperwork. None of it sounds like much fun. I did start cleaning out my mother's desk today and made a dentist's appointment, so that is something accomplished at any rate. And I am trying to spend more time with my friends. I am coming to realize, though, that I have been too busy to come to terms with the losses of my parents and aunt; it's catching up with me now, as I am constantly finding little things that belonged to them which keep bringing me to tears.

Exercise helps. And I think I need to go back to church, as I have not been regularly in years. Perhaps plan another trip for next year? Something that is a challenge. I will keep cleaning, contemplating my options, and working on rebuilding Rio.  

Note: Drive-In is a fun, silly comedy from 1976 set in a small Texas town, at (yes) the local drive-in movie theater. I do recommend it if you can find it. [Update: Hey, it's available on YouTube! Maybe I'll watch it tonight!] The parody disaster movie playing at the drive-in is a lot of fun, if you remember the disaster movies that were all the rage during the 70's. 

Labels: Changes, Loss, Memories, Random Thoughts

Scary Story Season

October will be here soon. Time for some creepy reading material, yes? 

Recently I heard about a book of short stories which had been written by AI (artificial intelligence; in short, computer-generated stories). The book is available on Amazon, here. The book is available on Kindle Unlimited and since I subscribe, I took a look at it. My take on the book: although it was interesting to look at, I don't recommend that anyone purchase it. The sentences use proper grammar and word choices, so they are readable, and the premise of most of the stories starts off as interesting (the introduction states that the computer was given an introductory sentence to start off with for most stories, or a selection of scary stories to review). But many of the sentences are repetitive, the plots build no tension whatsoever and they all end on a nonspecific note. In fact, in many of the stories it's strongly implied that the narrator dies but there is no explanation of how they are then able to narrate the story! While it's an interesting accomplishment, all that really has happened here is that the computer has re-invented bad creepypasta. And heaven knows there is already plenty of that to go around.

There is certainly better horror writing on the internet if that is what you are after. I can, for example, heartily recommend the SCP website as a source of good reading. The rationale that fuels the website is this: the SCP is a secret institute tasked with restraining many monsters, anomalies, what have you from wreaking havoc in our world. Each story is framed as a report which includes its restraint requirements, the circumstances under which it was found, its effects and so forth. The danger level of these items does not correlate with restraint requirements; for example, something marked "safe" can drive people to suicide. It simply means that it does not have to be guarded or locked in a cell.

The website has been recently updated, and now in order to access it you have to type your name (or a name, at least). If you click on certain stories, this name will be entered to make it look as if it involves the reader directly. This adds an extra frisson, if you will. I will list two of my favorite entries here. 

SCP-087, "The Stairwell," is very simple but utterly terrifying and is probably the single best story on the site. It's a stairwell. And there's something in it. Just go read it. (ADDENDUM: I just went to reread the story and unfortunately the appended reports are missing. Basically, they begin with mildly disturbing and get scarier... and the final report is [REDACTED]. Sometimes less is more.)

The other is SCP-2521, which was created for a contest on the site requesting a story with the fewest words possible. This submission has no words. It's all done visually and is absolutely brilliant. Interestingly, there were a lot of complaints from site members and the author didn't win the contest, because it didn't follow the "fewest words" rule. This issue is worth mentioning, as the administrators and members of the website are known for their pickiness. On the other hand, that is precisely what keeps the overall quality of the site so high. Mediocre writing is not tolerated. And the happy ending is that the entry was immediately awarded a permanent place on the site (most submissions are severely edited and need to be rewritten before getting a spot, and "newbies" are discouraged from submitting stories until they have been around long enough to learn the site's requirements). 

So if you dare, and if you enjoy scary stories, give this site a try. Just don't say I didn't warn you...

Labels: Writing

The Boards

I'm finding it harder and harder to work up motivation to study for this test. I recently heard from two co-workers that the Boards, which MDs take to certify in their specialty (I'm Internal Medicine), are now open book.  This will make things somewhat easier, though there certainly is not enough time allowed to look up every single answer. Whether or no, I just need to keep pushing through on this and it will be over in two weeks. Then I can proceed to all the other issues competing for my attention... and that queue will soon be as long as the queue to view Her Majesty. 

(off topic: I plan to get up early tomorrow to watch at least part of the funeral.) 

But back to medicine: I have found that the longer I practice medicine, the easier it is to tie certain points to patients I have seen and worked with. Therefore, less rote memorization is required. That said, most of my primary care practice centers around a fairly narrow set of topics and I need to refresh my memory on many others. This is my fourth time taking the test, yet I'm still nervous. I keep reminding myself that I passed the other three times, so surely it won't be that bad this time. 

At any rate. Today is my good friend V's birthday and I need to get going; I am taking her and her daughter out to lunch. I also need to do some pickup and cleaning as my brother will be arriving later this week for the funeral of a good family friend. To be continued. 

Labels: Medicine

 The Ham

Back to the topic of food. I enjoy writing about it and reading about it, but have not really had any recent meals I thought were interesting enough to write about. My standards have declined a bit since moving back to the family home, as my main goal right now is to use what they had in the pantry in addition to what I brought with me. But today, we'll talk about ham. 

It's been said, accurately, that "eternity is a ham and two people." Well, try it with one person sometime. I purchased this ham at Costco back before Christmas, in the hope that maybe I could make my mother a nice New Year's dinner. Sadly her health was declining rapidly at that point and the ham never got used. So I froze it, and when I moved it came with me - approximately two kilos of pork and sodium. Eventually I had to use it, so I thawed it out and heated it in the oven. That was nearly a month ago, and here is what I did with it:

Dinner of ham, broccoli and mashed potatoes, repeated for a second night. I sliced it thin and used it for sandwiches once or twice. Then I decided to try ham salad (mayonnaise, mustard, onion, pickle relish, celery). I've always been fond of ham salad, but it was really too rich to eat for multiple meals and I was very tired of it by the time I finished it up. 

The caregivers had purchased a lot of dried beans (one of them had found a recipe for "chili beans" that my mother really liked) and I decided that next I would use those and the ham for bean soup. It was a success and I wound up making two batches of it. (It's a good thing that ham is preserved and lasts a long time, as it was still edible for all these experiments. Also, bean soup freezes well.) 

Lastly I decided to try jambalaya, a rice dish with sauteed veggies, canned tomatoes, chicken broth... and ham. The very last of it. 

I have no idea how many meals this came to, but it was a lot. Easily fifteen, probably more. The Epic of the Ham was a definite success, but I don't think I will be eating it again for a while. Now it's time to figure out what to do with the chicken in the freezer. 

Labels: Ingestion

 The Gazebo

In keeping with my "The Noun" rut of titling my posts, I will tell you about our gazebo. Yes, we have one. 

I should sort of explain about my dad. He was born during the Depression and grew up on a farm in eastern Pennsylvania, dirt poor. His family home did not have indoor plumbing until he was in high school (and he was the youngest of the family). The house had an outhouse and a pump in the kitchen sink. He once told me the story of how his older brother's dog accidentally fell into the "honey pit" under the outhouse. His brother was able to get the dog out, but the poor thing nearly drowned. What a horrible way to go that would have been. 

There was a local estate owner, a rich man, who went by the name of McFeely. My paternal grandfather used to work there hauling rocks, and my dad worked there too at some point. Anyway, my father admired the estate greatly and one of his motivations for purchasing this home and property was to emulate Mr. McFeely. Hence the gazebo, and a fountain, and a giant garage and a lot of other things. (Incidentally, Mr. McFeely had a grandson who was named Fred Rogers. Yes, that Fred Rogers.)

It isn't that large, maybe 12 feet across, large enough to hold a table and four chairs. The space underneath the gazebo has hosted many a family of feral cats over the years - at one point I started referring to their house as "the cat farm." It's a nice place to hang out after dinner, and the daughter of family friends actually got married in it (she had always loved it). 

My parents' caregivers were invited to their memorial services, both of which were at the house, and collected there to eat and chat. That was three months ago. Once I get the Boards recertification test over with I will wash off the furniture and take some of my meals there. But for now, I look up from my review books and look at the cupola, which is falling apart, and remember the good times that were held there. 

Labels: Family, Memories

 The Car

I'm going to make this brief, because I really ought to be studying, but I also need a break from reviewing diagnosis and treatment of dementia (JUST what I want to hear about right now.) I have to recertify my boards in 45 days, and I cannot wait for this to be over with. 

At any rate, my father was a car man. He acquired cars the way some people acquire cats, and he was vastly reluctant to sell any of them, even when they were no longer being used. The only car I think he ever was eager to sell was a Jag XKE he got third hand, and he only sold it because he was tired of fixing it. (This happened when my sister and I were very young, and we never really forgave him for selling it. Every time he went on an errand we would go with him, and fight about who got to sit in the passenger seat and who had to squeeze in behind the seats - it was a two-seater.) But Jags are notorious for electrical problems, and this was no exception. So it was sold. 

I still don't know why, but a few years later he bought a Mercedes 600 - a limo. Then a second one. He had fun driving them for a few years but eventually they sat and moldered in the oversized garage he built after we moved to the house I live in now. The cars, of course, became nonfunctional after a while. One of them still is, but the other one has been slowly and painstakingly restored for the past three or four years by a local garage that specializes in Mercedes. I took my own car there for maintenance for a while, until I inherited my aunt's Subaru and sold the other car. 

The restoration project took years because that particular model of Mercedes is no longer made. The owner of the garage had to track down parts, remove and steam clean the gas tank as it was full of deposits and corrosion, and so forth. But just as I returned from my summer trip in mid-July I received a message from the owner that they had sold the business, were retiring, and needed to return the car to me. So I got help to clean and reorganize the garage, and donated all the medical equipment that was in there to make room for the car... and it was delivered this afternoon. 

It sat in the driveway and I opened the garage door for it. This car is a tank; eighteen feet long, six feet wide, a true model of mid-twentieth century auto engineering. Sitting in the driver's seat, I actually felt intimidated. It took me a minute to realize that the gearshift was on the steering wheel column and to figure out how to open the car door, even. I eased it in behind its twin, got out and admired it. 

Now, I have to figure out how to get it sold, and the other one too. As I said, the other car does not run. A couple of years ago my brother tracked down someone who specializes in vintage cars. He took a look at them and advised that we not restore them, as whoever buys them would probably like to do that themselves, but Dad really enjoyed the whole process and would have the caregivers drive him down to the garage about every other week so that he could have the owner bring him up to date. They were very kind and patient with him and they have told me more than once how much they enjoyed talking to him. I'm glad to have the car back for the moment, at least, to bring back memories as I drive it down the street to keep it in good condition.

Labels: Family, Memories

The Poem. 

So at ten past five today I got a text from my office manager, which went something like this: 

"Hi! We're starting a newsletter and thought it would be great to include a poem and I thought of you! Maybe something funny and light? We need it by Tuesday [four days from now]."

Well. See what comes of having a reputation as a semi-wit (not to say halfwit)? 

I replied, "Is it OK if it's a limerick? I don't think I'm up to a sonnet. And do you have a theme you'd like me to use?"

"Well, the new doctors are joining the group, so maybe something welcoming them?"

I replied that I would do my best. My mind started percolating. New doctors, huh? I thought. Welcome to the jungle.

And there I had it. I quickly looked up Guns N' Roses lyrics and came up with the following. 

Welcome to the jungle, we got fun and games

Like “Who’s the Doctor of the Day?” and “How do I file these claims?”

The paperwork will haunt you, we’ve all been there before

Feel free to ask unless you see us pounding on the door

Welcome to the jungle, we take it day by day

If the quarterback is freaking out, it’s best to stay away  [quarterback is our term for head nurse]

The patients all have Covid, at least they think they do

If we’re lucky they will wear a mask so we won’t get it too

Welcome to the jungle, it’s really not that bad

The staffing here is all top notch and Urgent Care is rad

We’re here to help, from unknown rash to “Name that Specialist!”

We look out for each other and we’re happy to assist.

Labels: Pop Culture, The Doctor's Life

 The Pool

I have been back at my parents' home for two and a half months now, and for whatever reason despite the summer heat have not used the pool once during that time. I think the last time anyone swam was the weekend of my mother's memorial service. My brother continues to pay for the upkeep of the pool and has been encouraging me to use it; today I finally did. 

The old pool house, which my father built to contain the pump and heater, is falling apart. The doors are too warped to close and I made a mental note to get that fixed as I poked around looking for the pool skimmer, which I was unable to find. I think our pool cleaner must be bringing his own. I had a sudden memory of one weekend morning years ago when my father, in his usual weekend mode of beat-up hooded sweatshirt and work pants torn at the knee, was working on the pump. It was a beautiful sunny morning and he looked happy. On an impulse I quickly ran upstairs to my room, fetched my camera and made him sit for his picture on the low wall outside the poolhouse. 

"Why?" he asked, clearly finding the whole thing amusing.

"I just want to," I answered. 

The picture came out really well; in fact I framed it and gave it to him for Christmas. It graced the mantel at his memorial service. It's so uniquely him and I'm so glad I took that picture. 

Finally, I gave up on the pool skimmer and stepped cautiously into the water, not wanting to slip on the steps. As I did so I had a sudden memory of my mother getting into the pool in exactly the same way, carefully, hoping the water wasn't going to be too cold. She was younger than I am now, I thought. 

The pool was as warm as a tub. I started swimming slow laps, pausing to pick leaves out of the pool and remembering how our dachshund Otto would run around the pool barking at us (he hated the water), clearly wondering what we were doing in there. On very hot days we would carefully lift him into the pool, no lower than the first step, to try and cool him off. He didn't appreciate the gesture. 

The pool is surrounded by postholes in the concrete, put there to hold a safety net to keep the grandchildren out of the pool when they were little. I suddenly remembered my sister holding her baby daughter in her swim diaper, letting her paddle in the water... my niece turned 24 this week. 

I had not expected to be overwhelmed by so many memories; as I swam my tears landed in chlorinated water. But the pool was soothing and was just what I needed on this hot day after studying for several hours (I have a recertification test coming up in two months).

Finally I got out, ready to come back to the silent house and get ready for tomorrow. At the top of my mental to-do list: pool skimmer. And my bathing suit is rinsed out and ready for my next swim. 

Labels: Family, Random Thoughts

Back At the Old Stand

I have been living in my parents' house now for almost two months. We moved here when I was about eleven, and it's a little strange to be back. The house was built in the 1940s; family lore has it that it was based on the blueprints of the home featured in "Mr. Blandings Builds His Dream House," an old Cary Grant movie. I have never attempted to verify this, but it might be fun to research.

It's a five-bedroom house, currently featuring one resident: me. After the years of caregivers, when there were never fewer then four people here, it feels quite empty. That sensation hit me again when I came home late last week after a two weeks' trip to Europe and walked into a dark and silent building. This does not bother me unduly, as I am a major introvert, but it has been cheering to feel that the house has cheered up since my return (if such a thing is possible). 

I hadn't lived here for forty years, though I visited often. I haven't been plagued with constant childhood memories, but I sometimes look out into the backyard and visualize my sister's wedding reception, which was held here; our beloved family dachshund, now deceased many years; and my nieces and nephews exploring the house on their visits. My father loved this house and spent hours renovating it when we first moved in. He did much of the electrical rewiring himself to the point that no one else really understood which wall switch did what. He replaced and stained the wooden floors. 

My assignment is to get the house cleaned out and ready to be put on the market. That is going to take a while - I've made a little progress but not a lot. I am hoping to hold a garage sale at some point. That project, though, will need to take a back seat to my studying to recertify for the medical boards test which will take place in a little over two months. 

When I finally move, it will probably be into a condominium in Florida, which will be very different from here. I am looking forward to living there but the project has not yet broken ground. For now, I will get back to studying and thinking about what part of the house to address first. 

Labels: Changes, Family

Fish Update

Per my brother, the fish my cousin gave him was a combination of trout and walleye (walleye is a kind of pike). Both freshwater. As for the preparation method, he emailed me: "The walleye was the best. Dipped in panko crumbs and fried. Delicious!" 

Labels: Ingestion

"I Need You to Take This Fish," 

...said my brother as we drove to the Pittsburgh airport. It was early November and we had traveled to our father's home town in Pennsylvania to give him the funeral he wanted. His ashes (to be precise, half of them; we still have the other half) had been interred in his parents' grave. The trip gave us a chance to spend time with my father's older sister and our cousins. Our aunt is the only one of the three siblings still alive; thankfully she is still completely alert and was very happy to see us. One of our cousins, a real outdoors type, gave John some frozen fish he had caught for the trip back across the country.

"It'll be fine!" he had said cheerily. "I have an insulated bag for it, just pack it in your suitcase." Not without misgivings, my brother had accepted the gift. But now we were running late and my brother had just remembered, first, that he only had a carry-on bag with him; and second, that he wasn't going directly home but to a sports function for his son.

So guess who got stuck with a bag of frozen fish in her suitcase? But time was short and we had no choice, so into my luggage it went. I had visions of ruined clothing all the way back to Los Angeles. But luck was with me; the early morning Pittsburgh temperatures were below freezing and I changed planes in Denver (pretty cold there as well). When I landed at LAX it was a cool, foggy day. As I stood in the rideshare line, my brother texted me: "How's the fish?"

"Not home yet," I responded tersely. As soon as I made it home I hauled my bag into the dining room, put it up on the table and began digging through it. To my relief it was still frozen solid. I don't know who manufactures that insulated bag, but I need to get one. 

The fish was stored in my freezer for a few weeks, at which point it resumed its journey to my parents' house for Thanksgiving. My brother and his family took it home with them after the holiday. 

And that is my epic fish story. 

Labels: Family, Holidays, Loss

Testing, Testing

Today while going through Twitter I ran across a tweet written by a woman mourning a friend who died of colon cancer at age 39. Her post states the friend's father died "young" (she does not say how young) of colon cancer, and therefore the friend requested a colonoscopy. According to the post, the screening was denied; insurance wouldn't pay for it. The friend was not diagnosed until her cancer had metastasized. The tweet has attracted thousands of retweets and hundreds of comments, many of which give other examples of friends and family members dying early of colon and other cancers. The responders' chorus: "Why wouldn't insurance pay for this? Why! This could have been avoided!" as well as the mandatory curses thrown at the US health system and insurance companies.

Make no mistake, this is a tragedy. Unfortunately there isn't enough information given in the tweet to fully critique what happened. My first question, however, was: was this person offered a FIT test? FIT is an abbreviation for fecal immunochemical test and is a test to check for blood in the stool. More recently, a more sensitive test called Cologuard has become available (it checks for DNA markers in the stool which are compatible with colon cancer or certain types of polyps). It is more expensive than the FIT test and many insurances do not cover it; however, it is still a lot cheaper than a colonoscopy. Either of these tests could have helped diagnose the woman at an earlier stage. If these tests came back positive, it would definitely have influenced the decision to proceed with colonoscopy.

Second: the current standards for colonoscopy in the US are that you begin screening at age 45 or, if there is a family history of colon cancer in a near relative, when the patient's age is ten years younger than the relative's at time of diagnosis - whichever is sooner. "Screening" here refers to colonoscopy, although many people decline them, in which case they can choose to be screened annually with a FIT test or with Cologuard every three years. The US screening recommendations have evolved over the years to become more aggressive, as I will discuss further.

As always, the benefits of the UK health system are being talked up. For comparison I will present the NHS testing policy for colon cancer, as follows: FIT screening every other year, not annually, and screening is recommended between the ages of 60 and 74 (it can be extended beyond age 74 upon request by the patient). The NHS is considering extending screening back to age 50 but this has not yet taken place. Colonoscopy is not part of routine screening. 

When I began my training, screening for colon cancer consisted of sigmoidoscopies rather than full colonoscopies and screening began at age 50. The sigmoid colon is the last 40 cm of the colon, about 25 percent of the entire colon. Initially it was thought that the majority of colon cancers originated in the sigmoid colon, but we now know this is no longer true. Full colonoscopies became the norm after the well-publicized death of Jay Monahan in 1998. He was the husband of a journalist named Katie Couric, and had been screened with sigmoidoscopy but not full colonoscopy; Ms. Couric made it her cause to urge more aggressive screening techniques and this was changed. More recently, the age to begin colon cancer screening has been pushed back to age 45, as noted above. This is due to colon cancers trending at a younger age. 

"Why not sooner?" - in general, colon cancer is not a young person's illness. There are very specific exceptions to this, involving genetic syndromes such as familial adenomatous polyposis, but they are rare. These syndromes have been closely studied and in many cases early colectomy, such as by age 30 or 35, is recommended to prevent onset of colon cancer. Now, screening recommendations can always be changed as I have outlined above; they are not set in stone. But there is always a balance between risks and benefits of screening. Colonoscopy involves anesthesia as well as the risks of perforation of the colon and bleeding. (These complications are rare, but they can happen.) The less invasive forms of screening, FIT and Cologuard, can give false negative and false positive results. This means that someone could wind up getting an unnecessary colonoscopy due to a false positive result, or that a cancer can be missed. Going on a snipe hunt to check a questionable result leads to increased risk and expense. In a very low risk population (such as below age 45), the risks and expense will outweigh the benefits. For every cancer found in this age group there are a lot of useless procedures. It's all about statistics, and this is why doctors as well as insurance companies - and the US preventive services task force, come to that - are generally reluctant to recommend screening at a very early age. 

Symptoms of colon cancer at an early stage are very nonspecific. Constipation, bloating and abdominal pain can all be symptoms; unfortunately the majority of the time, they are not. Functional bowel symptoms are incredibly common, meaning that the patient has symptoms but no disease can be found even with radiologic testing or colonoscopy. It is simply not possible to work up everyone who presents with these symptoms. Of course, trying to point this out to someone who has lost a relative or close friend to cancer is a loser's game. What I try to do is listen, do a good exam, run a blood count to check for anemia and encourage the patient to follow up or email me if the symptoms continue or change. Screening has done a lot to extend lifespan by catching problems early, but it is not perfect. 

Labels: Cancer, Medicine

 You Can Sell Your Soul and Still Lose

One of my longtime goals has been to write mysteries (I do write fan fiction but would like to write something I can sell to the public). In pursuit of this goal, I have started to follow several blogs about writing including According to Hoyt, Mad Genius Club, Robert Kroese, Monster Hunter Nation and Celia Hayes. 

These blogs and their authors have some things in common. They tend to work in the scifi/fantasy genres, though not all of them do; they publish independently, usually via Amazon (some of them also have conventional publishers but do at least some independent publishing); and they trend to the conservative/libertarian side of the aisle, or at the very least they keep politics out of their writing. As a result they have met more setbacks in the course of their careers than one might expect (and Lord knows, most writers face enough of those). They don't whine about it but they do discuss it. Most publishers strongly prefer "diversity" in the works they publish these days, as defined by issues related to race, sexuality or gender. If the author's work checks more than one of those boxes it's even better. That is not to say that the writers I follow limit themselves to tales about strong, silent white men who conquer new worlds and exploit their resources when they are not killing dragons and marrying princesses. Their works are far more interesting than that, often irreverent and tweak quite a few sacred cows. This, of course, is why they keep running into roadblocks. Publishers expect novels to meet certain criteria (see my recent post on Charles Stross and his Laundry Files series, which has turned into a labored metaphor for global warming). The rule for books, I feel, is that the work should be fun and interesting rather than grim and judgemental.

But... denizens of the scifi universe now appear to be turning on even the most rigorously diverse writers. The most recent example is an author named Stephanie Burke. She was a guest presenter at the scifi convention Balticon last month and her bio reads, in part, as follows: 

Stephanie Burke is a USA Today best selling multi-published, multi-award-winning author, master costumer, handicapped, wife and mother of two. From sex-shifting, shape-shifting dragons to undersea worlds, up to sexually confused elemental fey and homoerotic mysteries, all the way to pastel challenged urban sprites, Stephanie has done it all and hopes to do more.

So far, so diverse. I wish to point out here that I have not read any of her works and do not intend to analyze or criticize her writing, as I am unable to do so. My point is that today I learned from Twitter that midway through Balticon she was accused of making "offensive statements" (details unspecified) and was asked to leave. Her presentations were canceled even though the accusation was apparently unsubstantiated. Link is here. Ms. Burke was extremely upset by this incident, and rightfully so.

Example Number Two: right around that same time, author Mercedes Lackey was speaking on a panel for the Science Fiction and Fantasy Writers of America (SFWA) and used the term "colored" when speaking about an author and critic named Samuel Delany. He is well known, well-respected and, yes, African-American. Mr. Delany specifically said that he was not offended by the term or by Ms. Lackey, who was praising his work at the time. Not only was she kicked out of the convention after this incident, but so was her husband. 

Per Wikipedia, [Ms. Lackey] has... published several novels re-working well-known fairy tales set in a mid-19th to early 20th century setting in which magic is real, although hidden from the mundane world. These novels explore issues of ecology, social class, and gender roles.

I'm beginning to discern a pattern here. Are you? It doesn't matter how much diversity street cred you have, if you don't toe the political line your readers and publishers can turn on you in a heartbeat. If you need another example, look at the one everybody knows: J.K. Rowling. Her adoration ratings, already quite high, jumped after she stated that Dumbledore was gay and had been in love with his nemesis Grindelwald - until she stepped up to the plate to support the rights of cis women. Since that time she has been pilloried on social media. (Incidentally, I think this explanation of Dumbledore's motivations is consistent with everything we learn about him in the series. But it was not touched upon because it was a children's book series, and because as a product of the nineteenth century, Dumbledore would have had very good reasons to conceal his sexuality for his entire life.)

So my takeaway from these developments is as follows. Write what you want to write, but don't join the diversity conga line in a misguided hope for success. All it takes is one wrong turn of phrase, or even (as we have seen above) one wrong word. Your career will be instantly trashed. 

Labels: Politics, Pop Culture, Writing

 Mission Accomplished

My move is over, thank goodness. Furniture was moved in an all-day marathon (twelve hours!) on May 31; since then I have made a couple trips back to the house to pick up a few forgotten items and to take my tenant to the airport. She is currently staying in Hawaii with family. She is finally out, which has justified this entire ordeal. I volunteered to take her to the airport to make sure she would leave. A nice enough woman, but she wasn't paying rent for several years and it was like pulling teeth even to get her to pay utilities. I had discussed this with her and we had come to an agreement that she would move in February of 2020... you know what happened then. 

Now the work begins of cleaning, arranging and organizing and that will indeed be a long process. Fortunately my siblings have more or less given me carte blanche to sell, give away or trash nearly everything (the funds will be divided among us). So of course I sat down to blog instead. There are a lot of stairs in this house!

Labels: Changes

Book Review: Quantum of Nightmares

Today I took some time off packing for my upcoming move to finish a book. (Should not have, but did.) The book in question was "Quantum of Nightmares," by Charles Stross. It's the most recent installment in his "Tales of the New Management" series; briefly, back in 2000 Mr. Stross began writing a book called "The Atrocity Archive," set in the UK in a universe where magic exists. Not Harry Potter type magic, but mathematical magic. This book was well received and led to a series known as "The Laundry Files." 

The setting is modern-day UK and, at least at the start of the series, the public at large is unaware of magic; the Laundry is a government organization tasked with protecting the world against Cthulhu-type monsters from beyond the stars. As a government organization, it is also subject to workplace mandates and paperwork that would drive anyone mad. Stross loves to satirize management and the series as a whole is quite fun. It's a mix of horror and satire. 

Early in the series, the reader was introduced to the looming problem of CASE NIGHTMARE GREEN (it's always capitalized in the books), when the Stars Come Right, everyone will be able to practice magic in some form and the world will come apart at the seams. As time went on it became more and more obvious that NIGHTMARE GREEN was a metaphor for global warming, the author's bully pulpit became more obvious, and the series as a whole became less fun. I stuck with it until "Tales of the New Management," an extension of the original series, became the, ah, new normal. This series is set after the Laundry is dissolved, and Nyarlahotep has become the Prime Minister of the UK (trust me, things could be worse than having him in charge). 

Suffice to say that after purchasing Q of N on Kindle, I sent it back within 24 hours and wrote a blistering review on Amazon. Finally, I tracked it down at the library and checked it out in the interest of giving it one more try.

And my review is: nope. Reluctantly.

Mr. Stross has a real talent for juggling multiple plotlines, and this is my weakness. Be it Charles Dickens or Tom Clancy, give me multiple plotlines and I am a happy camper. Q of N has lots o' plot, but... it's hard to explain... the transition from plot thread to plot thread is just too obvious. Sort of along the lines of "OK, here's Character A's viewpoint." Then "Character B, C... etc." with no lead-in. Each section of the book is just plunked down with no attempt at connection. 

But far more important is the fact that not one of the characters in this book is likeable. None of them are nice people. To a certain extent you can empathize with them, but not nearly as much as one would think. This, also, is a habit of Stross. Even in the early days of the Laundry series, he took pleasure in pointing out that the (somewhat more likeable) characters were, in his words, "serial killers" and "unreliable narrators." The characters do kill bad guys in the course of the series, but their reasons are well explained. You can't have it both ways, Stross. Stick a sock in it.  

The book has a great slam-bang finish in which all of the plot threads are brought together successfully, but the overlying anti-capitalist approach, about as subtle as a sledgehammer, takes all the fun out of it. Suffice to say that the meat department of a supermarket chain is the center of the action and the plot recalls Upton Sinclair and Jonathan Swift. They both wrote it better. 

I do recommend the Laundry Files, at least the first five or six books. But as I said in my review, I think Mr. Stross needs a nice benzodiazepine cocktail before going back to his word processor. And the "Tales of the New Management" has had all the fun sucked out of it. 

Labels: Books, Pop Culture

 The Big Slog

My mother's memorial service went really well. Of course, the day after everyone scattered back to their homes. My brother had to fly to Texas for work and I drove him to the airport; my SIL and the kids left separately. My sister and her family left back to their home in Colorado. Then I had to make arrangements for the party tables, chairs and linens to be picked up and for the tree trimmers to come this week (my parents' home got cited by the city due to tree overgrowth to the point that the street signs were obscured). 

That much is done. Since then I have been packing, in a halfhearted fashion. This coming week a friend of mine is hiring a van, for the second time in a month, and we will ship more of my stuff out there. I have so many pictures - too many! - and in the coming year I need to look into selling or donating a lot of my things. 

Yesterday as I was cleaning out desk drawers I found one of the last birthday cards from my parents. My mother's handwriting was so shaky that it was almost unreadable. Poor mom, I used to admire the elegance of her handwriting. Mine is rather esoteric by contrast. I recall once on vacation writing up a list of requests for a takeout burger place and watching my niece and nephews squint at it. 

Old playbills I kept for years, now gone. So many things I just don't need to keep. I have a large rubber stamp collection that I'm contemplating throwing out, but have not been able to bring myself to do it. Maybe I'll hold a garage sale next year. With the threatened shortages for nearly everything I think I could do rather well. 

Back to work...

Labels: Changes

 The Family Gathers

My brother and sister arrive today with their families for my mother's service, which takes place tomorrow. They all have to leave on Sunday; unfortunately we all are too busy for this to be an extended stay. The place looks nice, with flowers in bloom (courtesy of the local nursery; they probably won't last a week after the service) and windows freshly washed. 

This is a large house, and I'm going to be the only one living here. I'm getting used to the little pops and clicks you hear in any house; when the icemaker goes off I no longer assume that there's a serial killer standing behind me, making ice. And I now have a coyote that visits in the early morning. He just ghosted across the patio and up the brick stairs toward the street. I'm going to be living here full-time starting in June, assuming I survive the next two weeks before the move. 

Going back to my mother, her death was both expected and unexpected. She had Covid at Christmas in 2020 and was never really the same afterward, although she did not have to be hospitalized. She developed a terrible, racking cough which improved for a while and then worsened again in the last few months of her life. When she was in the hospital, the respiratory technician looking at her blood gases  kept asking, "Are you sure she didn't smoke?" Finally I explained about the Covid and he immediately said, "Oh, that explains it." This despite her chest X-ray not showing any significant abnormalities.

Then my aunt (her sister) died, followed by my father six weeks later. I have written extensively about my aunt's illness, but not my father's. He had vascular dementia related to strokes and hypertension. The week after my aunt died, with the distraction of her illness gone, I was able to really look at him for the first time in weeks and realized how much weight he had lost due to his dwindling appetite. After a quick family discussion, I put him on hospice and he passed away in his sleep a month later. Mom never really recovered from those twin losses. She was very depressed, but when we held my father's celebration of life in August and she was able to see many of her friends, she did surprisingly well. It was the last real social event she attended. 

Many of her friends offered to take her out for lunch and the caregivers did take her out once or twice, but more and more she slipped into isolation. In December she was hospitalized, twice in January, and then she became more confused and died at the beginning of February when her oxygen level suddenly dropped and she began coughing up blood. It was shocking and sudden; none of the imaging or tests she had indicated that something like this was going to happen. When asked what had happened, my stock answer was "I could give you half a dozen possible explanations, but I don't know exactly what it was." I am sure there was some sort of pulmonary cause, but none of us in the family saw any reason to do an autopsy.

When she died, I had left her just a few hours before to drive back to my house and run errands. I do so wish I had been there when she passed away, but I did get to spend the previous evening with her, and I take some comfort in that. 

I hope to write more about her later, but I can't face it just yet, and there is much to be done before my siblings arrive. Must go.

Labels: Changes, Family, Loss

Journal Post #1

I’m going to try something different here, cross posting pieces from my journal on this blog. At least doing this will ensure that I will be producing more posts to entertain any wandering reader who happens by. Briefly, several months ago I decided to start keeping a personal journal to document my decisions for the coming year. I had retired, or semi-retired, in January of 2020 to take care of my ill aunt and parents. As it turned out this was just in time for Covid to come along. My aunt passed away one year ago, followed by my father six weeks later, followed by my mother three months ago. Now I am in the process of selling my home and moving back to my parents’ to try and get the house on the market. Come along with me, won’t you? It’ll be fun. Hopefully at least engaging, in the way of a train wreck.

Yesterday I was able to get the mirror on my car fixed, and I feel much safer driving now. Did some more packing and moving. My mother’s celebration of life service is in three days, and the other fam members will arrive in two days. So I’m just trying to get the place pulled together, bedrooms ready, food in the fridge. I do wish they could stay longer, but everyone has to get back to school/jobs.

Last night, to distract myself, I wound up looking at housing prices and other facts about Provo, Utah as part of my research for my long-term plan to move out of California (why Provo? Only because I’m thinking of attending a conference there next year). But Utah, like California and much of the western US, is suffering from drought. This has reinforced my vague plan to move to the East Coast. I don’t like floods or hurricanes either, but it would be nice not to have to worry about water.

I also spent some time with my tenant, reading lines with her. She is an actress and currently is auditioning for a Netflix show called “Obliterated.” As far as I can tell it’s about a bunch of Navy SEALS who spend their time cursing, having sex and taking drugs when they aren’t saving the world. Good Lord, I’m glad I’m not an actor; I cannot fathom having to take roles like that.

More later.

Labels: Los Angeles, Random Thoughts, The Doctor's Life

Labels: Family, Random Thoughts

Personal Update 

I am settled in here in my mother's hospital room for her third admission in a month. 

At least, that's what I wrote back on the 22nd of January. My mother passed away on February 4; my father on June 19 of last year. My aunt died May 8 of last year. 

It's been a difficult time. I have been writing, just not on the blog. I started keeping a journal last December with the intention of using it to clarify what I want to do both for myself and for my mother. But my mother never really recovered from the twin blows of losing her only sister and her husband six weeks apart. My siblings and I are planning a celebration of life for her which will take place in about ten days; I am in the process of selling my house and moving to my parents' home so that I can get it into shape to sell. 

I'm not going back to work, at least not full time; I am considering working virtual sessions to keep myself busy when I'm not throwing out junk or battling spiders. (I sometimes think my parent's house is one solid cobweb.) But right now I am packing and sorting, and I hope to put together an estate sale at some point. And I hope to document the process here (at least the interesting part). 

Labels: Family, The Doctor's Life