Monday, December 29, 2014

Hauntings


The first sign of trouble is when the nurse says she needs you in the room NOW.  The second was when I came bedside and saw a scared middle-aged man.  There’s different kinds of scared.  There’s anxious scared.  There’s uncomfortable scared.  There’s “what are you going to do to me?” scared.  And then there’s the “I’m going to die right now and there’s not a damn thing you can do about it” scared.  That was him.

One of the problems about medical writing in the era of patient privacy is that if I tell you too much about the case, someone can figure out who it was.  But here’s what I think I can tell you.  He had overcome significant medical issues to live a happy and productive life, graduating from college, spending time with family, working until his condition no longer allowed him to do so.  And I can tell you he was scared, and he was dying, and he knew it.  So did I, and everyone else in that room.  You don’t come in the slightly off-white color of grade school paste and leave standing.

Over the course of an hour, we tried to figure out why.  Infection?  Nothing obvious at first glance.  Internal bleeding?  Nope.  He kept going downhill, his breathing more labored and his blood pressure falling, until I said, “I think we need to put you to sleep and put in a tube into your throat to make sure you get enough oxygen.  Is that okay with you?”
He nodded.  Scared.  Me too.  I told him we do this a lot, that we’d keep him asleep to make sure he didn’t have any pain, and we’d get him over this.  He nodded.  Scared.  Me too.

I put him to sleep and the procedure went fine.  He started to move after the initial medications wore off, clearly in pain, and for a brief few moments he looked at me, around the room, back to me.  Then, mercifully, the meds kicked back in again, and he was responsive no more.  Or ever again.

Eventually, we found out why he died.  And there was nothing that anyone could have done to stop it.  A long valiant fight had been lost in the same way we’ll all eventually lose.  I sometimes make myself feel better by thinking that in our business, if you even save 1 out of 10, you’re still batting .100 against God, the greatest pitcher there ever was.  Not a bad average in the long run.

Do you want to know what haunts a seen-everything, done-it-all, been-doing-this-far-to-long ER doc? It’s lying to a patient who’s scared to die, and that the last thing they saw before they went to  their forever sleep was your face, and the last thing they heard were your words.  Lying.  And they knew it.

Saturday, December 27, 2014

Rolling Downhill

While I find the practice of Emergency Medicine periodically interesting and it has given me some wonderful opportunities in life, it’s not my ideal job. But since all the astronaut spots were taken, I’ve reconciled myself to my fate. However, one of the inevitable occurrences of doing a job you don’t love are those moments when you’re certain it’s the worst job in the world. I cognitively know that’s not true, so in a perverted version of Thomas Jefferson’s argument between his Head and his Heart l’m often host to an internal debate about what actually is the worst job in medicine. My Heart says it’s always me, especially on one of those days when nobody is really sick but everyone thinks they are, when all problems are chronic but demand immediate solutions, and when pain is ubiquitous but there’s never any good reason for it. But in the midst of my despair, it’s my Head to the rescue, reminding me that the worst job in medicine is…


The Hospitalist.

You probably don’t even know what a hospitalist is. Hospitalists are a relatively new innovation in medical care. A hospitalist is a physician (most often a specialist in internal medicine)who acts as the primary care physician for admitted patients. They do not work outside of the hospital in an office setting, and their efforts are limited to admitting and caring for the patients of private, office-based physicians throughout the community. What hospitalists really do, and their value to the health care system, depends on who you ask. If you’re inquiring of health care theorists, their familiarity with acute inpatient care makes them more likely to provide efficient, high-quality, low-cost care than physicians who only do hospital work part-time. If you ask the bean counters, hospitalists provide a service to the community physicians who will then drive their patients, and their revenue, to that hospital that provides that service and relieves them of after-hours duties. If you ask most physicians (off the record, of course), hospitalists exist so they don’t have to get up at night to see patients nor make hospital rounds during the day, taking time away from the more revenue-friendly outpatient practices and procedures. And if you ask an ER doc, the hospitalist is the one guy thankfully even lower than you on the food chain, the one for whom even your problems roll downhill.

To say that is not to disparage the hospitalists in any way. The vast majority of physicians I know who’ve chosen this kind of practice are good, smart, caring people, who provide excellent care in often the worst of cases and social settings. They accept anything and everything that needs admission. That includes critical patients with heart attacks and strokes, people on ventilators in respiratory failure, those with infections raging throughout their bodies, people needing emergency dialysis or cancer patients burning with fever. But it also means they admit anything we can’t get rid of, even if it doesn’t really need to stay. It’s not surprising to anyone in health care, but there are a lot of people who come to the ER and simply don’t want to go home no matter what. There are patients who are sent into the ER by their own doctor because that doctor doesn’t want to deal with them anymore, but you can’t abandon a patient without warning. So you send them to the ER and request that they be admitted so they become someone else’s burden while you prepare their 30 day notice, copy their records, and place them in a manila envelope by the receptionist desk. (For the record, when that happens and you meet the patient, you usually understand exactly why the doctor did it. ER Rule 84 J, Subparagraph 2: “If your say your doctor “fired” you, there’s usually a good reason for it. Subparagraph 3: “If you say you fired your doctor, see Subparagraph 2.) In both these, cases, the system as we know it doesn’t empower physicians to do what’s clinically right. It instead forces our hand towards doing what’s necessary to prevent complaints and lawsuits. Nobody gets cited for admitting someone who doesn’t need to be there, but paperwork flies when patient are tossed out no matter how valid the decision. One of the nicest things any colleague ever said of me is that I can talk patients out of staying and make them think it’s their idea. I’m kind of proud of that, just as I am for using phrases in the chart like, “tonight’s presentation has a distinct supratentorial component.” (That means crazy.)

So the hospitalist is the final link in the chain. When the patient genuinely needs to be admitted, or else just refuses to leave, they’re the ones who get the call. The great secret of the hopsitalist, however, is that their misery is transient. Usually the guy who admits you will be your inpatient doctor for one or two days, until their block of days on rotation is over and the you’re someone else’s problem…ummm…responsibility….wait…okay, I’ve got it now…and then someone else has the opportunity to help you continue to progress towards health.

Because they are always there for you, and are going to bail you out in the end with both that critical patient who needs hours of one-on-one care as well as that Marvin K Mooney who Won’t Go Now, you want to be their friend. Still, there are tricks. You figure out which ones want what tests done before taking an admission, so you speed up the process when you can. (In truth, most of the time an ER doc can tell you after the initial exam if someone needs admission or not. Most lab tests and x-rays are done for someone else.) Ones who are nicer to you get the nicer or more interesting patient when you have two to assign. If it’s fifteen minutes before the end of their shift, you stall just a bit and give the patient to the next one up. If you get along well with that doctor, maybe it’s twenty minutes. But no matter what, you always apologize profusely for any admission unless it’s so critical a case that you sound stupid in your haste to atone. And whenever possible, make sure to say that it wasn’t your idea to admit the patient, but that of the patient’s own physician and you’re just doing what he said.

Someone told me long ago that ER doctors will never have other physician friends, because when you call another doctor in the middle of the night it’s never to ask if they want a beer over breakfast. Yet hospitalists and ER docs tend to get along more than most. I won’t say we’re all best doctor friends, but if it’s lonely at the top it’s nice to be chummy at the bottom. More layers to dig out from the perpetual downhill flow. Hospitalists need us to skim off the top. We need them to rake out the bottom. And nobody else wants to get out of bed a moment too soon.

Friday, December 19, 2014

Step by Step


(Note:  While I haven’t been blogging much in the past few years, every now and then I still write something for fun.  I think this was sometime last year. I just found it on the my laptop.  Enjoy.)

This past Friday I’m visiting with my son, and like always he hops into the car after school with nothing but his clothes, an oversize parka that would look good in North Korea, and a deck of Yu-Gi-Oh cards with a play mat, which is a really big $40.00 mouse pad distinguished the fact that it’s really big and costs $40.00.  Even though this has become routine, I am persistently surprised by it.  He is now in high school, and when I recall that when I would pick him up from middle school he would emerge with a backpack the size of the Canadian Maritimes full of homework, I am always confused by his lack of gear.  I know they give homework in high school, and I know my kid.  And I know he is not the one who dutifully does his homework at lunch, but waits until 10 PM the night before the paper is due, and then needs a pen with blue ink because black ink or typing it on the computer is NOT what the teacher wants. So it was with great aplomb that, while tossing his clothes in the washing machine, I noticed a neatly folded, and then crushed up, blue piece of paper as it fell out of his pants pocket.  Colored pieces of paper make me nervous, as they’re often associated with nothing good.  Pink slips.  Yellow triplicates.   Black toe tags.  And my anxiety was in no way alleviated when I unfolded it to find it was his birth control homework.

That’s right.  My kid, the one for whom the concept of effective and prolonged toothbrushing is still a puzzle, is taking Sex Ed.  This is the same offspring of whom I have said repeatedly can only entertain the concept of driving once he learns to pick his clothes up from the floor, and therefore for whom I forsee a lifetime of public transport, is now studying sex.  (In fairness to him, though, I should note that in the ER I’ve seen plenty of pregnant people, and pregnancy progenitors, who have had catastrophic issues with oral hygiene.  If a kiss is still a kiss, perhaps a gum is still a gum.) 

I don’t want to get into dealing with adolescent sexuality.  Let’s just say it was not a problem for me because I was a short unathletic dweeb, and while I knew what the bases were the chances of me making the team were fairly slim.  And with The Teen it’s still pretty easy for the moment, because I’m more worried about him actually talking to a girl about anything that’s not a video game than what he would do if he actually touched one.

This particular worksheet was of interest for several reasons.  I was initially struck by the chart where you fill in the non-prescription methods of birth control.  In one of the rows under the heading of “Method,” he filled in “Sexual abstinence.”  Fair enough.  Under “How Does it Work?” he had written “Choosing to not have sex.”  So far, so good.  But in the column entitled “Does it Protect Against STD/HIV?” he answered “No.”

That made no sense to me at all, and not just because I have a medical background.  This kid has known exactly how things happen since age six at which time he was proud to declare he knew about “setual innercurse,” although he wasn’t quite sure how the man and the woman got there in the first place.  His knowledge of these things has only continue to grow as he learned about that “When a man loves a woman, he gets a powerful urge” from Puss in Boots in Shrek 2, and because I once accidentally left my Clarence Carter CD in the car and had to explain what “Strokin’” was about and why he shouldn’t stroke anything until he was married or dead, since both are often the same thing.  So I asked him how in the world he could put down that saying no wouldn’t prevent and STD or AIDS.  I had clearly forgotten about    teenage logic, because the answer, while wrong, made literal sense.  “Words can’t block an infection.  If it could, we could tell a cold to go away and it would.”  Well…ummm…yeah?

(For the record, correction has been instituted, and we are now clear that the word “no” is the ultimate method of birth control.   But, in deference to teen logic, it only works if you actually listen to what anyone else says, which is nowhere in the job description of adolescent.)

Then there was the part where you are to list five key steps in using a condom correctly.  I looked at his answers, and while technically correct, I felt he left out a lot.  For example, Step One is not to check the date on the package, but to actually FIND A GIRL.  Step Two is not to open the package, but to TALK TO A GIRL.  Step Three?  Talk to a girl about ANYTHING except collectible trading card games or League of Legends.  Anything.  Anything at all, son.  PLEASE.  And while I would be happy to educate him on the steps following condom use…like being sure to call and send flowers the next day…I’m not going to push beyond these first three steps, because checking these off the Bucket List is a major accomplishment unto itself.  (Please recall that I’m dealing with a young man who has already concluded that his soulmate will be a “hot” girl who cosplays as Harley Quinn and acquits herself well in both Yu-Gi-Oh and Starcraft.  It’s gonna be a long wait for grandchildren.)

I was also surprised to learn that they did not actually make him put a sample condom on a model.  I think that was a grave error.  Without prior experience, the first use of the prophylactic will come in darkened environment where he’ll be lucky to open the package with the condom rather than the small rectangular pouch of Gray Poupon stashed in his pocket from the college cafeteria.  And I’m pretty sure that condiments are not on the list of nonprescription methods of birth control.

I can barely wait until they watch the pregnancy video and the miracle of birth.  That ought to take some explaining.

Sunday, December 14, 2014

My Son, the Super-Hero


When I was in junior high school I was an avid collector of comic books.  My favorites were (and still are) those starring the Legion of Super-Heroes, a group of teens who banded together to fight interstellar villainy in the 30th Century.  While I’ve been out of touch with the Legionaires since the first of Lord-only-knows how many reboots of the DC Universe in the 1980s. I can tell you anything you want about the Legion from their first story in Adventure Comics #247 (1958) until issue #300 of their own title in the early 1980’s.  Death of Ferro Lad?  Check.  Sir Prise and Miss Terious?  Um-hmm.  Why there’s a Proty 2?  Got that.  Princess Projectra and the pain plague?  Yep.  Radio Roy, whose ears could pick up any radio broadcast in history, with a chorus of “Three-Eyed Sam from the Planet Wham!” eminating from his head?  Sure, know that one too.  I was so into the Legion   that I can still remember lying in bed before sleep and pretending I was Wildfire, a creature of pure energy held together only by a protective suit, having giving up my life for the universe and being consoled as the raven-tressed Shrinking Violet and the winged Dawnstar proclaimed their love for me.  Nowadays Shrinking Violet is in a relationship with Light Lass, and as far as Dawnstar goes I never recognized that intimacy with a being of pure antimatter would probably result in horrific third degree burns at best, if the mixing of matter and anti-matter doesn’t first result in the complete annilhation of the known universe.  Not to mention that those wings have got to get in the way.  Granted, it’s kind of hot when your lover’s hair falls, soaked with the sweat of passion, in your face.  But feathers?  Choke, gasp, wheeze.

So it was with this background of great affection for super-teams that when I stumbled across a weathered copy of Issue #1 of the Jewish Superhero Corps while cleaning out boxes in the basement, I was captivated all over again.  The Corps were the work of  Alan Oirich, and as best I recall the story he was a mainstream comic book artist who returned to orthodoxy (the actual term is ba’al teshuva) and wanted to create heroes consistent with the values of the more traditional Jewish community.  Allow me to introduce you to the lineup.

Menorah Man:  An astronaut who ate a radioactive olive on Mercury, giving him the power to grow six additional arms for a total of eight and to shoot fire from all of them.  Has a talking pet monkey that does the same, just in case you need to fricassee eight bananas at once.

Kippah Kid:  Robin throwing trick yarmulkes instead of Batarangs.  No Speedos, though.  Probably for the best. 

Magen David:  Think Captain American with a shield shaped like a six-pointed Star of David.  Also the Patron Super-Hero of Kosher Wine.

Driedel Maidel:  The power of super-spinning, and probably of super-motion sickness and super-barfing.  No word on which hero holds her hair back.  My bet’s on Kippah Kid.  He’s that kind of nebbish.

Shabbos Queen:  Has a magic wand that can make anything mechanical rest for 25 hours.  The wand has to rest one day out of seven.  So invading Earth on a Saturday morning would be a smart move.

Matzah Woman:  Radioactive Matah gave her the powers of Supergirl.  Her kryptonite?  Being under water for 18 minutes, the time it takes for matzah dough to rise.  I think that’s also called drowning.

The Mysterious Minyan Man:  Can divide into ten six-foot-tall men, or grow to one sixty foot tall man.    (A minyan is a group of ten who form for prayer.)  So two really awkward basketball teams, or the best Jewish big man since Dolph Schayes.    

I should note that all members of the team are, in accordance with orthodox tradition, modestly dressed.  This means that unlike most superhero teams, you cannot be certain that every female has a truly heroic chest or a tight, well-formed…ummm…bagel.  Driedel Maidel spins so fast we’ll never know, and I suspect the blur is a way of hiding her shortcomings.  Since she’s Jewish, we know darn well that Shabbos Queen isn’t a natural blonde.  So that leaves Matzah Woman as the most likely candidate for bodaciousness, and she looks like the kind of girl who also makes a mean noodle kugel. 

You may think these sound silly, and they are.  But is it any worse than the genesis of my beloved Legionaires such as Lightning Lad, who received electrical powers when blasted by a lightning-shooting beast on the planet Korbal?  Shadow Lass, who can invoke pitch-black shades as a result of her encounter with a shadow beast on Talok VIII?  Ultra Boy, who gained his powers after his scout craft  was swallowed by a space whale? Do you see a recurrent theme?  (And for the record, Ultra Boy’s real name is Jo Nah.) 

Not all powers result from animal encounters.  On some planets, everyone’s got something.  Phantom Girl can dematerialize because she’s from the fourth-dimensional planet  Bgtzl.  Stone Boy’s people learned to turn to rock to avoid the six month nights on their home world.  Matter-Eater Lad is from the planet Bismoll, where everyone can literally eat everything without needing to stop for…well…it all goes somewhere.  Later, M-E Lad (he has no cool nickname) becomes President of Bismoll, presumably after an inorganic version of the Nathan’s Hot Dog Contest. Suddenly the Jewish Corps seems more plausible.

For the record, there really are super heroes who are Jewish.  Ben Grimm, also known as the Thing of the Fantastic Four.  (We won’t go into that whole Golem thing).  Kitty Pryde, Shadowcat of the X-Men.    Gim Allon, Colossal Boy of my own beloved Legion.  (His mother became President of Earth, but that was little comfort her boy dated a shiksa.)  And many of the most creative names in comic history were Jewish.  Jerry Siegel, Joe Shuster, Joe Simon, Jack Kirby, Will Eisner, and Stan Lee only top the list.  I’ve recently finished a book entitled “Superman is Jewish?” proposing that many of the comic book heroes are a reflection of the need for Jews to be seen as powerful forces rather than as the victims of history.  Maybe true, but I’m pretty sure Superman’s not Jewish.  I know this as one of the six Jews who live in Supe’s home state of Kansas, and while the Kents are fine people they really don’t drop by for Shabbat.

One of the things that I really liked about the Legion was that they were always having tryouts for new members.  I’d like to see that in future issues of the JSHC.  Because while the current membership is great, I think the Corps could use a little cultural-specific component.  Here are a few suggestions.

     Guilt Woman:  Interfaith sharing is not a new phenomena.  Both Catholics and Jews share a long legacy of guilt, but I would contend that because we don’t have either confession or a savior to take the guilt off our hands, we’ve got a worse time of it.  Guilt Woman’s power is to make you feel bad…not just bad, but rotten to the core…about whatever it is you are doing.  For example:

     Villian:  “I’m going to blow up the word with this hydrogen bomb!”

     Guilt Woman:  “And what would your mother say?  She’d be disappointed.  Imagine, her little        baby, all grown up acting like this?  When was the last time you called her?”

     Villain:  “I’m sorry.  Can I borrow your phone?”

Disaster averted.

Feeding Bubbe:  Patterned after my Great-Grandma Rosie who would give me a dollar to eat a bowl of Jell-O, Feeding Bubbe flings bowls of food at evil masterminds while shouting “EAT!  EAT!  YOU LOOK THIN!”  Compelled to do, the evildoers are then bloated and immobilized. 

(If only Grandma Rosie was alive when I was in college, I would have never had a student loan.  I should note that one of the prerequisites to the fiscal feed was that you had to sit and watch Lawrence Welk with her every Sunday night at 6.  Which is why I still think Anacani is a hot little number.)

Jewdar:  Able to determine with just a glance, or at the sound of a name, if someone is Jewish.  Spent twelve years in the Himalayan Yeshiva learning the skills of Six Degrees from Menachem Schneerson.  Not a particularly useful power, but able to pick out those who might be particularly susceptible to the abilities of Guilt Woman and Feeding Bubbe.

The WonderJap Twins, Melissa and David.  Like Zan and Jayna, their powers activate with a fist bump.  Melissa shouts “Shape of a Charge Card!” and is able to make unlimited purchases and put it on Daddy’s bill.  David yells “Form of an Inert Object!” and becomes a Jewish husband.

Tefillin Lad:  The Lubavitch Hasidim are the closest thing we have to missionairies, but they work only within The Tribe.  For the Lubavitch, wrapping tefillin is the starter mitzvah that leads a liberal Jew back to more traditional ways.   (Tefillin are straps attached to small boxes containing written prayers which the pious wrap around their arm and head while they pray.)  Tefillin Lad will brave aliens, dust storms, and even a herd of pigs to wrap tefillin around the head and arms of an enemy.  Then he will produce a pushkah (charity box) and ask for a donation for the State of Israel.

Hypochondria Girl:  Has to power to make everyone think they have a dread disease.  Kind of like when  you see a patient with scabies and suddenly everyone ER itches.

     Villian:  I’m going to take over the world as soon as I take a Tylenol for this headache.”

     Hypochondria Girl:  “You should see a doctah.  I might be a tumah.”

     Villian:  “You’re right.  I’ll put down the laser and go right now.”

Shiksa Kid:  Consistently drawn to WASPY blondes and petitie Asians, he is a skilled scout, stopping at nothing to track down his prey, shower her with gifts and affection, and marry her no matter what his mother might say.  As a result, he doesn’t get along well with Guilt Woman, and they usually have to kept at opposite ends of the Super Hero Clubhouse.  His best friend is another hero, Family Law Attorney Man. 

Gefilte Fish:  A non-human member, he lives in a jar and only comes out during Passover.  This oozing  gelatinous mass with an odor of adolescent gym socks is the ultimate deterrent.

Your suggestions are welcome.

**************************************

Speaking of interesting Jewish things, the other day I decided I would see what kind of Jewish game apps were out there.  There’s not a lot, and the few that are there are really not much fun.  It’s kind of like when you go to the toy section of the Christian bookstore and find the David and Jesus action figures.  There’s not a lot to do there.  I mean, what kids besides Rod and Tod Flanders want to play crucifixion?  “Look, Rod!  Let’s scourge Jesus with a stick!  Let’s have David kill some guy and sleep with his wife!”    Besides, they don’t come with accessories like water, wine, fishes, loaves, lepers, or Philistines, which clearly limits the play possibilities.  (Although I have seen a Moses action figure that comes complete with staff and tablets.)

I really only have two favorites within these meager pickings.  One is the Hebrew Lite Animal Cards, which comes (as most apps do) as a sample package of five cards until you shell out more money for the complete set.  As a result of careful study, I can now use the proper Hebrew words for bear and hippopotamus.  This is especially important because the bear and the hippopotamus are native animals to the windswept Israeli deserts.

The Teen and I did find another game which we still play.  It’s called “Mendy,” and it features a guy named Mendy (short for Mendel, if you must know) who wants to go to shul (a colloquial name for an orthodox house of worship).  The way Mendy gets there is to cross a bridge made up of ten moving segments, and you have to make Mendy jump between these segments without falling into the chasm below.  If you miss a jump, Mendy falls off and reappears back at the start.  We like to think that the moves you make to get Mendy across the bridge are an allegory for his journey of faith.  For example, when you have to move him backwards, we say that Mendy Runs From God. 

If you reach the shul, the screen flashes SUCCESS! That’s it.  No new levels, no pat on the back from an approving deity, not even a cents off coupon for the local haberdasher.  Nothing but spiritual rewards which, I suppose, is the point. 

Let me end with a personal plea for some good Jewish games.  Or at least add the Israelites to the Civilization series of games, so I can personally wipe the floor with the Germans and Arabs and Spanish and everyone else who has kicked us out and about for the past several thousand years.  I’ll play on the easiest setting so I can have tanks and jets and nukes while they still have sticks and rocks.  Kind of like the Israelis and Palestinians now.

Thursday, December 11, 2014

...And We're Back!

Well, it's December and it's finally time to act upon that 2013 New Year's resolution to finish that book that I started during National Novel Writing Month.  And to blog again.  And to learn Pinterest.  And Twitter.  And to do P90X because I'm tired of having chest pain, because if I get in shape and stop having chest pain,  I don't have to have a stress test which might show ischemia, which might mean I get a cardiac cath, which might mean I get a stent, which definitely means there's no more corned beef hash bowel topped with three fried eggs and melted Velveeta at the Hanover Pancake House. 

So far my record is iffy.  I'm on Pinterest.  I have yet to Tweet or Twit or Twerp. I flunked the "Are You Ready for P90x?" fitness recommendations, so am working instead on Power 90, which includes such helpful advice as Tony Horton saying, "if we're going too fast, it's okay to hit the pause button."  You can hear him whispering "and go get another donut" under his breath.

Blogging and writing have been lagging behind.  Lots going on, but that's not really an excuse.  When things are happening, you should be writing rather than reaching high levels in iPad games like Catan and Great Little War Game and Bloons 4, getting stuck, and then buying another game so that 37 hours and four sleepless nights later you can get stuck again.  Not that I know anything about that.  Or about the Huffington Post Life After 50 pages.  With daily updates.

So, my friends, with your indulgence we'll try once again.  Some pieces may be a lot shorter than others, but we're gonna try to get something up at least every week.  And we will always attempt to address the key issues of the day.  Like what marital aids can be constructed with socks and electrical tape.  And if you say you feel only a little suicidal, what specific bit of you are you looking to hack off?  (See?  That's a shorter piece.)  And is yelling at teenagers to pick up their socks in advance of the actual cleaning moment an easy way to save time when you're going to have to yell at them anyway?

In the meantime, let me refer you to my son's most excellent blog, The Critical Frog (the criticalfrog.BlogSpot.com).  He does movie reviews, comments on video games and television, and occasionally throws a bone of disbelief at the latest antics of his father.  He's really good.  Please read and enjoy.  His blog is the one time in my Star Trek Universe that The Next Generation far and away betters The Original Series. 

Thanks for letting my back into your laptops.  Have your electrons call my electrons.  We'll talk.