Calling Rampart

Growing up, I wanted to be an astronaut, a United States Senator, and a doctor, preferably all at the same time. As fate would have it, the chance to be the latter came first. I was a senior at Shawnee Mission East High School just over the state line from Kansas City, Missouri, and there was a new and innovative medical school on the Show-Me side that took you in after high school and six years later sent you back out with a medical degree. And during my interviews I was asked the inevitable questions of, "Why do you want to be a doctor?'' The problem was that I didn’t have answer, and still don’t. It’s not like I was impacted as a child by some friendly family physician that came to my bedside, nor was my life saved by the swift intervention of a skillful surgeon. I was not born into a medical family. The only things I ever remembered (or at least haven’t suppressed) about going to the doctor's office were shots, being bribed to get shots with butter cookies, and reassurance that yes, someday he will hit puberty (it did happen, and last week was a life-changing experience, to be sure). About the best I could do was recall drawing arteries and veins on a Valentine’s Day heart, causing the girl across the street to say she'd never play with me again, and absorbing all the reproductive details in the Better Homes and Gardens Baby Book the adoption agency sent home with my brother. So I gave the admissions folks the honest answer, "I really don't know. It's just something I've always thought I should do.” The answer, no matter how truthful, provoked frowns all around, and I was sure it was time to pack up the bags and head to the closest state university with a drinking age of 18 willing to give me some scholarship cash. (I did have some standards.)

(Frankly, I also had crap answers to other questions the interviewers would ask. One of them, a female psychologist, would have you tell a story about something that happened, and then say “Tell me more.” On several occasions I had to say “There isn’t any more. The story’s done,” which seemed to displease her. A second interviewer, who was an older African-American pediatrician, asked if I ever had any experience being a minority. The only thing I could think of to say was, “Does being a Jew in Kansas count?” Apparently it did.)

So how did I get into medical school? Truth be told, I have no idea. I‘m not sure I would have taken me. Nonetheless, the official reason would be that they saw my potential as not only a physician, but as a person, and wanted to help me fulfill my destiny. To this day I’m convinced that the real reason was simply dumb luck. The University of Missouri-Kansas City School of Medicine was designed to turn out primary care doctors for Missouri, and it had always taken exclusively Missouri residents. However, there was a small, never used clause somewhere in the Admissions Manual that said every year, they could take up to four kids from the Kansas side of the metropolitan area. (Kansas City, Missouri and Kansas City, Kansas, are just across the Missouri River from one another; the Kansas suburbs of KC are separated off from the main city by a two-lane street called State Line Road. When Kansas was a dry state, the police used to sit just over the Kansas side, watch cars with Kansas plates go into liquor stores on the Missouri side, and bust the drivers when they came back into the Sunflower Realm.) The year I applied, the daughter of one of the Vice-Chancellors of the University, who happened to attend high school in Kansas, also wanted to go to medical school. So the clause was dusted off for her, and a few other Jayhawkers were let in for show. They sent me a letter of acceptance, I called my parents who were on vacation in the Caribbean (the message they got from the hotel operator was “Mr. Howard’s in the hospital”), and a mere thirty years later I’m writing about it all.

I have the same difficulty in describing why I chose emergency medicine as a specialty. It just seemed like something I was always supposed to do. Now, with over twenty years of practice under my belt, I can think of a number of reasons I stay in it (and a few more to get out, but until I can convince my son that trade school would make him happier than a four-year college and a graduate degree, I’m still at work.) The truth is I still don't know why I do this, except it makes me happier than anything else in clinical medicine. I suppose that happiness is the only reason you should do anything for a living, and it probably doesn't matter if you know why you're happy or not.

But since there’s a requirement that everyone has to have an anecdote about why they chose to do what they do, here’s mine:

I remember watching the show “Emergency!” when I was eight or nine years old. “Emergency!” was about a group of LA County paramedics who saved lives and stamped out disease. Their medical base was the fictional Rampart General Hospital. Rampart is the only hospital I’ve ever known that was staffed 24 hours a day, 365 days a year, with two physicians (Kelly Brackett, MD FACS and Joe Early, MD FACS) and a single nurse (Dixie McCall, RN), complete with starched white cap and dress. (The nurse, I mean.)

I can remember not being terribly interested in the paramedics. Roy DeSoto was a boring guy, and Johnny Gage was always chasing girls. Who has much use for that when you’re eight? My girl issues back then consisted of making sure I had the requisite shots against cooties. But the doctors really impressed me, mostly because of the initials after their name besides the usual MD. At the time, I though the more letters you have, the cooler you are. I didn't know that FACS meant fellow of the American College of Surgeons, which in turn means you allowed yourself to have the personality sucked out of you during five to seven years of surgical training in exchange for the ability to rummage around someone’s innards, and that you then get to pay a large chunk of money in dues each year for continued use of the letters. And there was no way to know they were surgeons, for they weren’t ostensibly arrogant and could occasionally relate to patients and admit mistakes. But I knew that someday I wanted lots of initials after my name.

I think that the drive to work in the ED was solidified the day that Kelly and Joe saved a goat. For some reason that escapes my memory, Johnny and Roy had brought a goat to the hospital. I suppose the goat was dying of some dread goat thing, and needed immediate goat surgery to save its bleating little life. So they've put the goat under, and Kelly has his hands somewhere within the goat's entrails, and Joe is about to administer some sort of goat drug to do some sort of goat thing when suddenly Kelly has what can only be described as a veterinary version of an LSD flashback. "Wait!” he cries to Joe, who is busily keeping the goat asleep with anesthetic gases and chewed up tin cans and soothing goat noises and such. "Don't give that drug!” Whereupon Joe replies calmly, holding up an uncapped syringe, "Don't worry Kelly. I just remembered my animal physiology."

That was it for me. I can save people and goats, too. If the people didn't make it, I could still have food. And in retrospect, I got my initials. I became a Fellow of the American College of Emergency Physicians, or FACEP. That is, until I got tired of paying over $700 each year for the initials that nobody asked about, and when I realized they were best pronounced in a rhyme with “duck up.”

So with all this being said, what’s the main reason people go into, or stay, in emergency medicine? I think the bottom line is that emergency medicine is fun. We have the wildest stories, the closest sense of family, the highest highs and the lowest lows, the most food per capita of anyone in the hospital, and more laughs per hour than an episode of “Scrubs.” It’s like being in a perpetual amusement park. Sure, you spend a lot of time waiting in line for the fun, but the ride at the end of the queue is worth it. The risk of barfing when it gets too fast or twisted adds excitement and mystery. And always stay away from the deep fried Pepsi.

Bak to Skool

A while ago I went to my 30th Anniversary High School Reunion. I had only been to one previous gathering, the 10th, and had a rotten time. The people who wouldn’t talk to me in high school still wouldn’t talk to me, depriving me of any chance to engage in condescendive posturing at my early successes in life and my collegiate-aged growth spurt. It was also the night that I got a phone call from one Florida girlfriend saying she had run into the other Florida girlfriend asking which one I wanted to keep. In retrospect, I gave the wrong answer, which was confirmed not only by short-term loss of relationship and long-term demolition of any chance of reconciliation with said blonde, but also because I learned that it’s not a good sign when you come into your apartment after a weekend away to find a stuffed brontosaurus hanging by the neck in a noose made of a silk tie, swinging a lazy circles from a ceiling fan. I also fumbled a lingerie-scented pass from a beautiful woman I had a crush on for years, but had suffered in silence while she dated one of my friends. So I really don’t have good memories of the experience at all. The only moments that I enjoyed were found sitting at a corner table with one Laurie Thornton who, while not really close friends in high school, I now had a common interest: I was an ED doc, and she was an emergency veterinarian. So we talked quite avidly about various organs and body fluids possessed by various two and four-legged species, and drove away everyone else at the table. (I personally think it was the topic of why cats hiss when you intubate them that did it. Incidentally, this is why you can always tell the ED people eating breakfast after a night shift at Cracker Barrel. In a room full of tables, theirs is the one that nobody wants to sit next to. )

Anyway, I hadn’t been back for any of the other reunions, but the Magic of Facebook got me in touch with some folks from high school, and though it took some doing I got talked into going. I’m glad I did. If it was pretty clear that if the 10th, 20th, and 25th reunions would be about keeping score, this one was more about survival. We’re all on the back side of forty, pushing the half-century mark. Now it’s all about rejoicing not in our achievements, but simply in our continued presence on this earth.

Overall, it was a very nice affair, and I’m very glad I went. I met up with a few friends for a drink beforehand…Jim Cramer, Roger Ramsayer, Missy Webber, Bill Koch… and we all thought we looked pretty good. This was a test hypothesis, or course, but as we came into the hotel ballroom to see the whole group I was glad to see it was generally true. We did look pretty good, for folks older than our parents were when we got out of school. The only thing that could have been better…and this is a very minor and quite selfish point, for the Planning Committee did a great job…is if they had music and dancing, so this nerd could finally sidle up to the hot chicks. (Would have done it, too...had permission from The Bride to flirt my brains out to make up for lost time.)

Later in the evening I’m talking to Brian Youll, who was very close to a good friend of mine who didn’t make it to the party, and up comes Laurie Thornton. It’s wonderful to see her. She looks great. And within ten minutes, we’ve done it again. We start talking our stuff, soon we’ve been left alone, somehow the traffic pattern has pushed us into a corner, and we’re having a grand time. Later in the evening, we get into a conversation with Steve Silbinger, a former classmate who has made his fortune in direct-to-TV products such as Urine-B-Gone. As clinicians intimately acquainted with the bodily fluids of various species, we were probably his most appropriate audience. (Neither of us remembered it, but it also turns out that Laurie and I sat next to each other in the class picture taken in the gym 30 years ago. So maybe it’s fate, and not just fluids.)

A somber part of the evening came with a slide presentation of the dozen or classmates who have already attended the Celestial Graduation. It was very well presented…high school pictures followed by photos of them later in life as well. A few of the people I knew peripherally, but one I knew quite well. You know how in high school you can have people who are your best friends for a month or so, and then you just drift apart, no harm, no foul? For me, Jeff Serrault was one of those guys. Jeff always carried a brief case to school, and we were all convinced he was going to be wildly rich the right way and we would all come beg him for money. He was the one who took me to get my driver’s license one afternoon my senior year. He passed away, and nobody knows where he was or what happened to him. It’s pretty sad.

But given that there’s humor in everything, a curious pattern began to emerge. With several of the deceased…including my friend Jeff Serrault…they showed old photos of them involved in school activities, such as sports teams or the yearbook. And in every photo they showed, whether it was the Literary Society, Student Council, of the Chorus, someone in the “Roll of Gone Before” was sitting next to Ann Lowry. As was I at that very minute. Coincidence? Maybe. I shifted in my seat.

Ann was my “friend who was a girl but not my girlfriend” in high school, although by all rights we probably should have been (and we were, for about three hours one post-pubertal night in college, but even that only went so far. I mean, it was ANN). Both student council nerds, both literary nerds, both short, both cute as a button. I often went over to Ann’s house to pick her up to do stuff together because, well, we could. Her folks were always great to me, and I still remember they had a small dog named Taffy that, as best I recall, barked and nipped and did very little else, at least while I was around. And so when the plans were made to meet up for the reunion, of course Ann was there, and of course I was going to be sitting next to her, which meant I had unwittingly placed my backside in the Hotel Banquet Chair of Doom. This was confirmed when they handed out a copy of the last issue of the student newspaper of our senior year and there was Ann once again, signing her choral heart out next to another decedent. And as I’m soaking up this tidbit of fate, the evening’s moderator, in a wistful moment, notes that “We’re getting older, so look around because next time some of us won’t be here.”

I had a great time, and I have concluded that I would very much like to attend my 40th high school reunion. But when I do, Ann had better be on the other side of the table.

Washday Blues

This piece is coming to you from the Non-Creepy Laundromat in Hays, Kansas. Hays actually has two laundromats. One is down by the Student Ghetto of Fort Hays State University (home of the Tigers, another school celebrating an animal native to it’s environs just like the Pittsburg State Gorillas) and has been labeled by the natives who are advising me on washday destinations as Creepy. The Non-Creepy one is in the north part of town, where the hoi polloi…such as can be mustered in Hays (one hoi, two polloi)…dwells in placid isolation from the cares of student life. It’s a fairly nice place to spend an hour washing your scrubs, especially if you’re able (as I am) to work through the fact that it’s a Sunday evening of hunting season, and the parking lot is full a pickup trucks with gun racks and men washing their cammos clean of blood and feathers before they bring their outdoor gear into the house.

Anyway, this evening I’ve come to realize that the great paradox of the laundromat, and probably a money- making scheme in it’s own right, is that it’s hard to get stuff out of the washer to the dryer. Here’s what I mean. When you wash a load of clothing, things get tangled together, right? Pant legs get caught in the arms of shirts, socks get meshed inside of sweats, and the whole thing becomes a jumbled mess. It’s nearly impossible to extract one article of clothing from another. And it’s not like the washer and the dryer and next to each other like at home, so you can simply scoop stuff from one appliance to the other. At the laundromat, the washers and dryers and physically separated, washers along one wall, dryers on the other. So when you try to remove the wet and wadded ball of clothes from the washing machine and cart it the ten feet across the room, something invariably trails behind in the tendrils of fabric and falls to the floor.

If this is your floor, the floor at home that you’ve kept immaculaltely clean, or at least has your personal dirt on it, this is no problem. But this is a public floor, full of anonymous sticky stains of God knows what, into which your favorite pair DC Comic Heroes underwear had fallen, and now you have to think if you’re willing to put them in the dryer with all your nice clean non-floor contaminated clothes and get those sticky-old-soda-I-think-but-what-else-could-it-be-after-all-its-hunting-season germs on your other stuff, and then go ahead and wear them knowing that maybe-they’re full-of-disease-and-I’m-pretty-sure-the-dryer-isn’t-hot-enough-to-kill-the-plague, or buying another small box of detergent (75 cents, more for bleach), putting another three dollars in quarters into the washer, one more buck in the dryer, and killing another hour (and $1.25 for a Coke and a stale Lance Peanut Bar) in order to have pure underwear.

Well worth it, I say. Aquaman’s colors have never been so bright.

Eyes Wide Shut?

Best moment of my ER night: A transfer patient arrived from an outlying hospital. He had multiple facial injuries from a motor vehicle accident, and among these were deep abrasions to his eyelids , to the extent that the local facial surgeon thought he might require a skin graft. And where might you get such a graft, he wondered aloud? Perhaps the skin of the penis, he reasoned. It was the only skin thin enough to be appropriate for the eyelids. He even had a real medical word for the procedure, but to be honest I was too busy working through the implications of the procedure to remember what it was called. A phallograft, perhaps. That sounds good.

Anyway, think how this works. You see a hot girl, and then your eyes stay open, unblinking, for a long time. In the short term, you’re a sure bet to win any staring contest. But if your eyes stay open for more than four hours, please call your physician.

Aging with Style

In the past I’ve been guilty of ageism. Before I hit the age of 40, I tended to view my elders as something different than me…not worse, by any means, but just different. Not as up-to-date. Not as funny. Not as earthy. Certainly not as hormonal. Which is why I could never figure out why one of my Dad’s mother would laugh uproariously at my Saturday Night Live Cast Album. I mean, she must have been all of 55 at the time, and we all know that’s old.

I think what finished this illusion once and for all was hanging out with my other grandmother. Grandma Theresa was a social animal, and for a while she dated a gentleman from Belgium we’ll (respectfully) called Nick the Frog. Old Nick wasn’t much to look at, hence his epithet; but Nick had bucks and wasn’t afraid to use them, and Grandma wasn’t afraid to benefit, either. He was good to her, to be sure, and having lost two previous husbands to cancer Lord knows she deserved everything she could get. But it was still kind of…well, creepy…to think of Nick the Frog kissing my grandmother. So one day, when I was in one of those intergenerational-bonding-question-moods, I asked her how she could stand kissing Nick the Frog. “I wouldn’t know, really,” she said with a wink. “He tires easily.”

Theresa was the kind of Grandma who would set me up on a date the same night she had one. Usually her date would come pick her up before I took her car, so I played the role of the father, inspecting the date before she left the house. (And yes, I did reject one.) Before she would leave, she would turn to me and say, “Now don’t do anything I wouldn’t do.”

One night I decided to call her bluff. “And what exactly is it that you do?” I asked.

Her eyes sparkled. “A hell of a lot more than you think.”

Date nights would end when we both got home, drinking hot tea laced with peppermint schnapps. She would complain about how all the men her age were sick with something or another and just wanted someone to take care of them. I would wonder how in the world she could think it was okay to set me up with a seventeen year old no matter what her fake ID, kissing abilities, and breast size had said otherwise. (The answer, of course, is that she was Jewish.)

My grandmother’s comments came back to me a few weeks ago as I went to examine an 87 year old woman who had suffered a fall. The right side of her face black and blue, with a bruise going from just above her eye down to the girlishly prominent cheekbones.

“Hello, ma’am, I’m Dr. Rodenberg. What happened to you?”

With a smiling face and a knowing look, she answered. “Rough sex.”

There was no comeback. I stood there stunned for a good thirty seconds as she laughed out loud and her family stared at her with horror. Finally, I looked at her with all the compassion I hold for those elders who are the kind of old person I want to be: Crotchety, independent, and racy as hell.

“Ma’am, if I was 40 years old I’d date you.”

She eyed me up and down, with special attention to the waistline.

“And then you’d see what I mean” she answered back.

Middle Ground

I’ve often heard the phrase, “If you’re young and you’re not a liberal, you have no heart; and if you’re old and you’re not a conservative, you have no brain.” And I do believe there’s a certain amount of truth to it. One of the reasons I chose Emergency Medicine as a career was that I liked the “White Hat” part of it all…I was the one guy who would take care of anyone at anytime. The Stetson has been solied, however, by years of reality, and so I have begun to morph from what I like to call the Hard Rock Café of Medicine…Love All, Serve All…to a more nuanced view that while there are both people we absolutely need to help and some totally beyond redemption, that personal responsibility is on the wane, and that nobody quite understands the concept of an “emergency,” in general people earn what they get out of life. That’s why I’ve become increasingly fascinated by pundits and politicians, as well as ordinary citizens, who are able to state with metaphysical certitude (thank you, John McLaughlin) that the solution to our social ills is to either throw handfuls of money at more government programs to positively impact more people or to slash every entitlement program out there and let people fend for themselves. They find no room for compromise in between. I have no idea what world they’re living in.

(If you and I are “ordinary” citizens, it’s important to note the policymakers and pundits are not “extraordinary” because, like Superman, they possess “powers and abilities beyond those of mortal men.” Instead, I like to think of them as extraordinary in a Twilight Zone sort of way, as “not like us” but resembling extraterrestrial fully willing to devour the heart and soul of their fellow humans while quoting “To Serve Mankind.” IT’S A COOKBOOK!)

So here’s what I think I’ve figured out. It’s really easy to be an extreme liberal if you live well and don’t see the poor, the abused, and the homeless. It’s easy to see them as the victims of racism, xenophobia, substance abuse, and rampant capitalistic greed. And it is equally easy to be a radical conservative under the same circumstances, except now you see them as abandoning the work ethic that built America for an entitlement mentality and draining the fiscal and cultural life from the land. What they know of the social ills of this land they know mostly from clever statisticians and reinforcing media, supplemented by “listening tours” and the occasional goodwill visit. Both sides are perfectly willing to manipulate the dispossessed as political tools and voting blocks to advance their own agendas. And after their obligatory daytime hours spent in tearful condemnation of or strident fury against the system, they go home to nice neighborhoods, full larders, kids in good schools with every chance to go to college, health coverage, and paid vacations.

The whole thing seems a little hypocritical to me, and I say this fully aware that I’m one of the ones who’s not worrying about my next meal. But if I don’t know how to live in poverty, at least I see it every day. Sometimes I’m sympathetic with what I see, and want to do all I can to help someone; sometimes it makes me furious, and I’m equally enthused about wanting to tell another that they’re abusing the system and they can expect no further handouts from me. But at least I know something of which I speak, and I have some “stake in the game,” as it were. Improving these social ills makes my working life easier. But when problems get fixed, politicians and pundits are out of work, and special interests cease to wield power. So it’s in everyone’s interest to keep the system going exactly as it is. Everyone’s, of course, except those in true need, and those rare individuals in public life actually interested in making positive change.

So what’s really out there? Based on my totally unscientific observational study of the socioeconomic needs of people who drop through the ED. About a third of folks are truly in distress and need all the help we can provide. A third are abusing the system. A final third really have no clue where they fit in and are just trying to get by the best that they can. And as a result of these observations, I have come to believe that our system does often entitle people to services that are undoubtedly excessive, but also places significant roadblocks in the way of those who truly need additional help.

I fully recognize that this subtlety…also known as reality…goes against the current “sound bite” dialogue we’ve come to expect in our public policy debates. And we accept that lack of substance, because these issues are hard to think about and even harder to solve, and if Americans have been trained to do anything in the media age it’s it avoid independent thought. Which is clearly one thing we excel at.

Where in the World?

As some of you may know, I’m currently spending some of my time as a “locum tenens” physician. What this means is “Rent-a-Doc.” There are any number of agencies out there that recruit physicians for short-term assignments in ER’s across the country, and as one of a relative handful of residency-trained, board-certified emergency physicians I’m fortunate to be a relatively hot commodity. This is why, after posting my resume online a few months ago, I had forty-three different recruiters from thirty-one different agencies (believe me, I counted) all vying to be my new best friend. Nice for your ego, but still you can only tell the same story so many times.

As far as I can tell, job requirements for a physician recruiter include amiability, persistence, and an ability to guilt the recalcitrant physician into working places he or she would never care to go. (See Palms West Hospital, Loxahatchee, Florida). The other thing that’s interesting about the process is that knowledge of geography is apparently not part of the job description. I had stated in my profile that I was interested in jobs in Northeast Florida, within about an hour driving distance from Daytona Beach. As a result of this detailed geographic preference, I have been told of opportunities in Ft. Lauderdale (241 miles), Tallahassee (258 miles), Pensacola (451 miles), Alabama, Indiana, Missouri, and Ohio. But perhaps I’m being harsh. After telling one of the recruiters that Miami (260 miles) was not really worth a daily commute, he honestly admitted, “We’re based in South Florida. We don’t get around very much.”

(Interesting note: If you do a MapQuest search for directions from Daytona Beach to Miami, step 13 notes “Welcome to the UNITED STATES,” which pretty much confirms everything everyone up here north of I-4 always suspected about Miami. And while we’re on the subject, a real geography story. Jim Cramer, an old high school friend, posted on Facebook that the soccer team from The Netherlands had a particularly hard road to the World Cup finals because they had to play two extra games against Holland and the Dutch. I’ve had to explain to any number of folks that it’s all the same place. I was not, however, able to pull off a follow-up story telling the same folks that people from Albania are known as Albinos, although on occasion I have been able to stress that people from Belgium are known as the Belch.)

So if you’re a frustrated physician who’s had a rough few weeks and needs your ego stroked, by all means put your name out there on the internet. It’s amazing what will turn up...and that on closer examination, there’s often no place like home. At least you can find it on a map.

"Strictly Speaking"

(Edwin Newman, the former NBC newsman best known for his insisitence on the proper use of the English language, recently passed away at the age of 91. His most popular written work, "Strictly Speaking: Will America be the Death of English? reached Number 1 in the New York Times Non-Fiction Best Seller List.)

I have been known to take things far too literally. For example, last week I was told by a paramedic that a patient’s chief complaint was “being unresponsive.” I couldn’t help but wonder how you did that. It’s not like you can be comatose, suddenly regain consciousness, politely note, “Pardon me, but I am unresponsive.” It’s one of those questions I didn’t think you could possibly answer with a “yes,” like “Are you asleep?” But I’m always surprised in this line of work, and I have seen patients who, when roused from their substance-induced slumbers and holding a rudimentary knowledge of medical terminology, have angrily reminded me, “WHAT’S WRONG WITH YOU? DIDN’T YOU HEAR THEM? I’M UNRESPONSIVE!”

Here’s another one. A paramedic called in saying the patient has chest pain “times 0600.” Now, I know, and you know, what he really meant. But that’s not what he said. So I figure if the patient has had chest pain x 0600, it must be 0600 times worse than anybody else’s chest pain. (I’m not sure how to multiply that one out.) It’s like when the paramedic finishes his radio report with “Do you questions or orders?” and you ask them to name the capital of North Dakota. They never said it had to be a medical question, right? And I’m proud to note that during my tenure a decade ago as EMS Medical Director for Volusia County, Florida, the Paramedic State Capital Identification Ratio was the highest ever recorded in the illustrious annals of prehospital care.

Finally, on a somber note, someone recently asked me the “signs of suicide.” I gave the answer that was needed about the risk factors for suicide, but inside I was fighting the urge to say, “The only really definitive sign of suicide is being dead.” And years ago, during my life in public health, I recall being asked to attend “a conference on suicide” and wondering, based on the way the question was asked, if we were for or against it.

(While we’ve been talking syntax, let me share with you the single most annoying grammatical error in American popular culture. In the song “I’ll Be There,” young Michael Jackson wails:

“If you should ever find someone new
I know he’d better be good to you.
Cuz’ if he doesn’t
I’ll be there.”

Five extra credit points, and full permission to burn the Mariah Cary version with a butane torch, if you can spot the problem.)

Praying for Safety

Every now and then you see something that may have escaped your notice for years. I had one of those moments at the Orlando Airport this week. It turns out that the airport has a very nice chapel. It’s located after you go through Security, on the side of the airport that leads to Gates 1-60.

I am aware that many different faiths use intermediaries between man and God. Catholics can pray to the saints to be intercessors for them before The Father, and Hindus worship different manifestations of the divine in order to approach him. But I was not aware that in America, one also needs to get through the Transportation Security Agency to get closer to God. And if you’re departing from Gates 61-150, you may as well just surrender to fate.

Also, I don’t know if you’re run into this yet, but the latest annoyance provided by your Transportation Security Agency ("Needless Obstruction Since 2001") is the full body scanner. I ran into this in Kansas City. You walk in between two, large metal towers and are instructed to literally put up your hands in a position of abject surrender. Surrender to the feds. As if the process already wasn’t as intrusive, politically correct, and totally unscientific or efficient as possible. It’s enough to make me want to start drinking tea.

Light My Fire

Last week I saw a woman who had apparently fallen into a campfire at midnight. Arriving in the ER about two in the afternoon, she said she only came in because once she woke up and loked in the mirror, she realized it was kind of bad. (Another testament to the amazing anesthetic powers of alcohol.)

She didn’t need to see anyone immediately…there was very little to be done other than make sure she got the right kind of follow-up…and so while we were finishing up her paperwork, she walked out of the ED saying she needed to smoke a cigarette. No, she was careful to explain, she wasn’t addicted to nicotine. It was a “hand and mouth kind of thing.” Which is good for her, because I thought she was addicted to the flames.

Bathday Perils

Let’s face it…we’re not all neat freaks. While the United States may represent the most overwashed, overshaved, and nit-free society the earth has ever known, there remain significant variations on the theme. It’s not politically correct to say that some patients stink, so we have our own set of euphemisms to describe their condition. Terms like “earth-centered” and “someone really comfortable with themselves” are examples of these covert comments. Over the years I’ve favored noting that someone was “allergic to soap,” conveying the hygiene message in a way that medicalizes the condition to free the patient from confronting their real problem, like we do with other stuff such as fibromyalgia (meaning “depression”) and metabolic syndrome (meaning “fat”).

Recently, though, I’ve had to reassess my use of this phrase. Witness the allergy list on one particularly aromatic patient I saw in a small hospital in Missouri (transcribed verbatim, including spelling):

Allergy on Medicine

Asprin
Pencillion
Demroal
Dervect
Sulfer
Keyflex

Other allergies

Tomatoes
Strawberries
Purex
Dail
Joy
Palmolive
Irish Spring
Milkweed
Wasp, bees, misquites, tick bites
Pine sole

Avoiding hives is the best excuse ever for not washing. I stand, adrenaline in hand, corrected.

Musings at McDonald's

I’m sitting at McDonald’s waiting for the car’s semi-annual wash and detail. I’m trying to write, but without much success, for as far as I can tell the soundtrack playing above my head seems to intersperse “Do You Wanna MAKE LOVE or Do You Just Wanna FOOL AROUND?” in between other, perfectly reasonable songs. I’ll hear Journey sing “Faithfully,” or the perennially underrated Lou Rawls will croon “Lady Love,” and all will be right in the world, and then I’m suddenly back in college and trying to decide exactly where the fine line is between making love and fooling around, and exactly how many Long Island Iced Teas it will take at Harry Starker’s on the Country Club Plaza in Kansas City to get the date d’jour to consider the same question.

Oh, wait, the music just changed. Now they’re playing a medley of tunes…and I use that term metaphorically at best…by Bread. I wonder if I can poke out my brain with a spork?

(Sorry to interrupt, but the corporate lawyers at McDonald’s just called. They would have me remind you a spork must be handled with care in order to prevent injury, that the points are sharp, and that if you have questions about the use of the spork you should ask your wait staff for help, call our customer service number at 1-800-OK-SPORK (and rest assured that “spork” is pronounced the same in Bengali), or review the instructions found at www.bereallyreallyreallycarefulwithyourspork.com. If you have any concerns that are not addressed, DO NOT USE THE SPORK. They would also have me remind you that McDonald’s properties do not actually distribute the spork, but that this utensil is available to the public at Taco Bell, KFC, and other PepsiCo-owned entities, and that the McDonald’s corporation would be happy to provide support for your spork-induced injury suit against these dastardly PepsiCo corporate pirates who put their profit before your health and safety. After all, if they cared about you they’d spend the extra dime and get you a separate fork and spoon, right? Let’s get ‘em!)

World Cup Farewell

(This was written during my self-imposed hiatus, so it's a bit dated. But it does provide important follow-up information...)

One last World Cup note before we tuck away the soccer ball for another four years. Listening to the “play-by-play” announcers for the past four weeks have convinced me once again that American culture, while eminently democratic in appealing to the masses (including me), lacks a sense of refinement and grace. It’s not just that soccer…okay, football…is referred to as “The Beautiful Game,” and it’s not only that you win but you lose points if you don’t do so with style. It’s the use of phrases such as “He performed nobly for his country” after a particulary good defensive play, and the liberal scattering of words like “rarified” and “tenacity.” By way of contrast, an American commentator described World Cup Final as, “like putting a pig on lipstick.” (And while it may not represent culture, nobody does enthusiasm like Andres Cantor, the Univision commentator who says the word

"¡GOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOLLLLLLLLL!"
followed closely by Al Michaels asking, “Do you believe in miracles?” during the 1980 Winter Olympics, Russ Hodges shouting “The Giants win the pennant! The Giants win the pennant!” way back in 1951, or Jeff Spicoli letting us know that “That was my head! I’m so wasted!”

A number of us have decided that we love the pig, however, so we’re already planning to head out to the 2014 World Cup in Brazil. It just looks like so much fun…and we have our own vuvuzelas… that it would be wrong not to go. So we started talking about other places you could have the World Cup, and that maybe we could resolve world issues through soccer. Maybe Israel could hold the World Cup, teams could be based on religious preference, and they could duke it out over Jerusalem as a way of brigning peace to the Holy Land. Personally, if we do it that way, my bets are on the Catholics. They’ve got a drawing pool of Argentina, Brazil, the Guays (Para and Uru), Italy, Spain, and Portugal going for them. Second place would be the hard-working protestants of Northern Europe…the Germans and the Dutch. (I would put the English in this category, but I don’t think there’s anything that can make those folks play together. Divine might only goes so far.)

This idea is similar to something my father came up with many years ago. He noted that virtually every athlete will, at some point, thank heaven for the most recent victory, despite the fact that God, being the author of life, death, and the universe, probably had other things on his mind than bestowing his grace on an NCAA Division III contest. But since every victorious athlete believes that God is on his side, my Dad thought that the best way to sort this out is to have a football bracket similar to March Madness, with all the teams from religion-based colleges included. (No secular humanist powerhouses, like Alabama, Texas, Florida, or Cal-Berkley need apply). That way you get tussles like Baylor at SMU, Brigham Young against TCU, and Notre Dame against Brandeis. The winner would clearly be the team that God really favors in the end.

(Personally, I’m not so sure that God doesn’t pay attention to football. I like to believe that the Lord is a long-time Saints fan…it fits…and maybe he does intervene in miraculous ways. I mean, Peyton Manning throws a last minute interception in the Super Bowl? Peyton Manning? How can you not see divine hands at work here?)

I this idea a lot, and I know my father’s willing to put good money out there on the Disciples of Touchdown Jesus. And I’m pretty sure he’s right. After all, Peyton did throw that interception…

(Here's the updates. Paul the Octopus, the Clairvoyant Cephalopod who correctly predicted the outcome of every World Cup match involving Germany, had died. Viewing was held at the Olive Garden in Munich.

Larissa Riquelme, the Paraguayan lingerie model who pledged to run naked in the streets of Asuncion if the national team won the World Cup final, has not let a loss in the quarters stand in her way. As her tribute to the bold Guyanos, she was pictured in various patriotic poses in the 7th issue of the newspaper Diario Popular. They're quite stirring, and bound to engender a significant amount of national pride. Yep, that's the euphemism we'll use for that.)

Cost Containment

The first health care provider a most patients see in the ED is the Triage Nurse. It’s a pretty challenging role. The nurse out front becomes the face of the ED, not only responsible for making sure that patient and their families feel welcome and cared for, but also for sorting out the wheat from the chaff, the patients with true emergencies from those who are simply hangers-on.

The other day I saw a patient who had presented to the triage nurse with chest pain. As the story goes, she had gotten a case of the munchies that morning and, finding nothing in the icebox box save a package of questionable “Brown ‘n Serve” sausages, she popped one into the microwave for a bite. Following the obligatory “ding” from the Radar Range (I’m showing my age here), she grabbed the casing and shoved it into her gullet. However, she had neglected to wait the recommended three minutes for the sausage to cool, and developed a severe burning discomfort in her lower chest as the wrapped pork shards flamed down her esophagus and into her stomach.

In many hospitals, triage nurses are also responsible for initiating medical care protocols based on the patient’s chief complaint. Doing so often speeds care, especially when physicians are busy and cannot get to the patient to order labs, x-rays, and certain medical treatments within a reasonable time. They’re really a very good way to increase both efficiency and enhance patient care. However, these protocols are blind to circumstances and to costs. Which is why, by the time I got to the patient, she had been subject to a full cardiac workup, including an EKG; a chest x-ray; and a complete laboratory profile including blood count, coagulation studies, chemistry panels, and enzyme studies to look for evidence of heart damage. I have no idea how much all that cost the taxpayers, because Lord knows this patient is not paying her own bill.

Being the doctor, who works off no set protocol other than the 10% of medicine that is science, the 30% that is common sense, and the 60% that is voodoo, my workup cost the taxpayers less than a dollar. It was called a cold can of Sprite.

Problem solved.

Holy Cards, Batman!

This past summer I went to a wedding in El Dorado, Kansas. El Dorado is not only home to the Kansas Oil Museum, but is also the childhood home of President Obama’s mother. As El Dorado is good GOP territory, there is not, and will never be, a sign commemorating the event. But the wedding itself was really very nice. The bride was beautiful, the groom nervous, the parents proud, and the priest did a great job of explaining the process of the mass as well as the rationale why only practicing Catholics were able to have snacks in the middle of the service. (No word of what the Catholics who are done practicing and actually good at it are allowed to do.) And like most houses of worship there’s a lot of literature scattered throughout the pews. I was especially taken by a small card with a photo of Pope Benedict XVI on one side and a prayer for his wise guidance of the Church on the other.

I had seen Holy Cards before with pictures of saints on one side (like Saint Dominic, Saint Theresa, Saint Pierre, Saint Thomas, Saint Pierre Thomas, Saint Brees, and Saint Whodat) and appropriate prayers on the other, but the Pope card was a new one. This got me thinking that maybe there’s a market out there for Pontiff Trading Cards. You’d have a picture on the front of the Pope in full regalia, and on the back you’d have his stats and a small vignette:

Leo XIII (Vincenzo “Prayin’ Vinny” Pecci)

Year Team League SS EW SC WB IT

1901 Papal Catholic 4,800 2 18 7,010 0

Leo XIII was the first Pope to have his voice recorded on a phonograph, reciting “Maria ha Avuto un Piccolo Agnello” into a tinfoil cylinder. Or maybe that was Thomas Edison. They looked a lot alike.

(In case you were looking for the code:
SS = Souls saved
EW = Encyclicals Written
SC = Saints Canonized
WB = Wafers Blessed (in thousands)
IT = Impure Thoughts
The latter is the equivalent of fielding errors.)

I see real potential here, especially with the rare and collectible rookie cards.

I’m not sure that this idea translates well to Judaism. We really don’t have designated rabbis in charge of the whole shebang, and while congregations may belong to an umbrella organization for their own theological bent each temple or synagogue pretty much runs its own show. (Old joke: Name the kinds of Jews. There’s Reform Jews, Conservative Jews, Orthodox Jews, Orange Jews, Grapefruit Jews, Apple Jews, Grape Jews…)

The closest thing we have to folks who are “card-eligible” are the leaders of the ultra-orthodox Chasidic sects, who from an outsider’s perspective seem to spend a lot of time out-davening and out-fruitful-and-multiplying each other. I’m thinking that while the front of the card would again feature a picture in complete uniform (which, with black coat, long bread, and hat would look pretty much like all the other uniforms), the back might look something like this:

Shmuel “The Kreplach” Kapowitz

Year Sect NC CO BL DPH PS PA

1964 Lubavitch 8 613 11.5 7 3 2

Rebbe Shmuel once smelled bacon, but studied the Zohar to obliterate the memory and then soaked in a mikveh for a week to ensure his place in the world-to-come, Ha-shem be praised.

As usual, there’s a code:
NC = Number of Children
CO = Commandments Observed
BL = Beard Length (inches)
DPH = Davens/hour
PS = Pigs Seen
PA = Pigs avoided

I thought about adding a “Circumcisions Performed” category, but ran out of space and snipped it off at the end.

(One last saint story. I went to ninth and tenth grades at Brebeuf Preparatory School, a Jesuit high school in Indianapolis, Indiana. The school was named after St. Jean de Brebeuf, a Jesuit missionary to the native peoples of Canada who died a martyr. I know this because on the wall of the cafeteria was painted a mural of the saint tied to a stake, flames around his feet, red-hot hatchets strung around his neck, while half a dozen hooting Iroquois danced around him in glee. Forget the total lack of political correctness in the picture…learned white man tortured by savages, that kind of thing. Can you imagine trying to eat lunch looking at that? Understandably, there was no hot lunch line. Hail Brebeuf Forever!)

Excuses

The astute readers of this blog (and by definition that’s everyone, because if you read this blog you automatically fall within the category of “astute”) will have noticed that this writer has been, to put it mildly, dysfunctional over the past few months. Those who know him personally have seen in it his failure to engage in society in any meaningful way save occasional cryptic notices on Facebook (the modern day gossiping fence); those who know him only from afar have probably noticed little change except for a lack of those annoying “New Post up on The Blog!!!” notices accompanied by a proliferation of what Everett Rees, my high school English teacher who had a habit of massaging his male student’s shoulders and whom we used to call eccentric and now call someone who can’t get married in California, would have called “cheerleader exclamation points.”

(I would beg to differ from the venerable Mr. Rees’s contention, though I continue to hold him the highest regard for sponsoring the Categories Team, a quizzical celebration of useless trivia in which I proudly claim two District Championships. The Categories Team was one of the Three Pillars of Dweebness at our high school. The others were the AV Squad, to which I did not belong, and the ZITS team, to which I did. ZITS stood for Zoo In The School, and basically consisted of feeding and cleaning cages for a host of mice, lizards, and snakes that occupied a back room in the biology departure. We would also give monkey chow to a simian named Houdini, which is why I knew before The Animal Planet that bored capuchins have a keen interest in self-pleasure.

But back to punctuation. They’re not cheerleader exclamation points because 1) I have never changed the text color to pink or purple and B) I haven’t figured out a way to make my fonts put a smiley face within the circle below the bottom-pointed oval forming the bulk of the exclamatory sign. And yes, the itemizing was on purpose, ‘cuz it’s a cheerleader thing. Ready? Okay!)

So why the absence of the blog? (This question assumes that you’re wondering why, and have not already concluded that the absence of the blog is my own way of doing a remarkable service to mankind). In short, it’s because the last three months of my life have been an unmitigated disaster. It has been a series of personal and professional catastrophes that has not been a slow progression, but has occurred on specific dates such that one can actually draw a line graph charting the time on one axis and the damage on the other. The details are and will remain mine, but the events are of the magnitude that I am angry…no, that’s too light a word, but it’ll have to do…at the world for what it’s done to me. I think I’ve played by the rules, done the right things for the right reasons, and lost everything. I had a plan; now I have none. I used to be somebody; now I am nothing. I see those of lesser ability succeeding while I drift backwards; I find my fate is no longer my own but is controlled by the insecurities and vicissitudes of others who see me as a source of…well, I don’t know what. Those things that gave me purpose and validation have been taken from me, and what results is the guy eating day-old bologna sandwiches on the airport floor and checking the meat to make sure it hasn’t changed color. (And for what it’s worth, I’m probably not very good at rhetorical hyperbole, either.)

Different people do different things when they fall apart. Some yell and scream. Some are able to refocus and find new challenges. Some count their blessings and accept their new lot in life. Some spend recklessly, drink, or gamble. What I do is nothing. I sit, I brood, I glower, and I don’t talk to anyone. Paradoxically, I talk less to those closest to me, friends and family than I do to the odd acquaintance at Golden Corral. Which is why I haven't been blogging, because blogging is talking to myself, and I’m about as close to me as anyone.

I got to thinking about this a few weeks back during Yom Kippur, the Day of Atonement. There’s a wonderful prayer in the holiday liturgy called the Al Cheit. (Don’t worry about how you say it…Hebrew doesn’t transliterate well in to English, and if you’re not semetic in some fashion you can’t pronounce it anyway.) It can be very roughly translated as “all sins,” and depending on who’s counting it reels off a list of 23 or so separate kinds of sin that we’ve managed to stray into over the course of the previous year. Usually I can find at least three that I’ve stayed away from. Not this year, I’m afraid. What I’ve been thinking and feeling over the past three months has gotten me a perfect score. Batting a thousand made me realize it's time to move on, and restarting the blog is one way to forge ahead.

(Okay, one funny story about this prayer. I grew up in a tradition of liberal Judaism. But when I first moved to Florida the only synagogue in Gainesville was a conservative one. Conservative services involve a lot more ritual and Hebrew than I was used to. So when they did this prayer on Yom Kippur, not only was it done in Hebrew of which I had a poor understanding, but it was accompanied by rocking back and forth on one’s heels and a beating of the breast that for all the world seemed like something out of a National Geographic Special on the Plains Indians and had me looking up to the sky for rain. Now, of course, I recognize that the ritual comes from the movie 300, and what I was hearing must have been Hebrew for “We are Sparta!”

By the way, while I recognize that all faiths have some ritual of repentance, I really like the way we Jews do it, and that’s not just saying so as an MOT (Member of the Tribe). It always made sense to me to do all your confessing on a single day and with all the other Jews at the same time. That way, the chances of God singling out your sin for punishment amidst the cacophony of guilt are relatively less.)

So for those of who feel like I’ve done wrong by not blogging, I truly apologize and hope that resuming our online discussion will serve as a small effort at atonement. And for those of you who thought this blog was a load of bull to start with…well, I suppose I’ll just keep on sinning. I’ve got to have something to repent for next year.

Larger Problems

Have you seen this new piece of female lingerie from Victoria’s Secret? It’s called the “Bombshell Bra,” brassiere, and it raises the lucky purchaser two breast sizes when worn. It’s really quite remarkable, even if counterintuitive to the old adage of not making mountains out of molehills. But it makes me think of one of my favorite ED tales.

I had just started working in Daytona when a very attractive young woman came into the ED with abdominal pain. This was back in 1996, when I had first come back to the USA from working overseas, and this was my first job as an ED doc in the private world outside of academia. What that meant is that I was still trying to figure out how to best use my time to get in and out of the patient room as fast as possible, which is a skill that you acquire only in the world of community medicine. When you’re learning medicine, like in medical school and residency, that’s not an issue. You’re expected to be pathologically complete and glacially slow. And when you’re teaching medicine as I did at the University of Florida, that’s not a problem as there’s always someone lower on the totem pole who’s already asked all the right questions for you.

Even with the merciless push of technology, each medical encounter is still based on the patient’s history and physical exam. Each of these segments has it’s own constituent pieces. The history begins with History of the Present Illness (HPI), where you ask about whatever it was that brought the patient to the doctor. (This is actually often the trickiest part in the ED setting; patients have multiple problems, and you have to be able to politely tell them that, “Here in the ER we only deal with one problem at a time, so if there’s one thing that made you decide to come here today would that be?” You have to do so or you’ll never get on with the rest of the work.) You then ask about the Past Medical History (PMH), Medications, Allergies, Social History (SH), Family History (FH), and finish up with a series of general health-related questions called the Review of Systems (ROS). The ROS is really designed to uncover other related symptoms or problems you haven’t thought about before that might be related to what’s going on. However, if used incorrectly and not focused on the problem at hand, it provides you with far too much information to be really useful. (Have any problems with headaches? I had one last week after playing the Wii for three hours straight. Any chest pains? I climbed to the top of the Washington Monument two months ago and got short of breath. Difficulty with urination? Well, no, but they tell me that urine smells funny after you eat asparagus. I don’t like asparagus, but why is that? You get the drift).

The final piece of the history, at least according to those medical sociologists who never actually see patients and exist under no time constraint other than the time until tenure, is to ask an open-ended question such as “Is there anything else you’d like to talk about today?” to allow the patient to express their own concerns and expectations for care. This is a great question in a primary care office. It’s a rotten question in the ED, because getting the answer and trying to figure out where to go from there is often the kiss of death to any kind of efficiency in the ED.

But I hadn’t figured this out yet the fall day in 1996, and so when I asked if there was anything else bothering this particular patient, she replied, “Ever since I got my breasts done, I can’t sleep.”

This was new one on me. I knew that large implants can give women back pain; I knew about the alleged dangers of silicon implants; I had taken care of wound infections and even dealt with what happens when you get a blow to the chest and the implants pops. (It’s kind of funny, to be honest). And of course I had been party to discussions, usually…well, always…over beer about personal preferences for real or fake breasts, and had thought that women with well-crafted implants probably don’t need to worry about knowing if their airline seat can be used as a flotation device. But implant-induced insomnia was breaking new ground.

So I had to get more of the story. Turns out she was a dancer at one of our better men’s clubs here in town. (That’s not a joke…it was actually pretty nice in there.) In order to maximize her income, she had to maximize her assets. This was working out well for her, and she figured that in three years time she’d be able to quit. But in the meantime it was hard for her to sleep. She usually slept on her stomach, with her head turned to the side. But with the new, improved, and greatly enlarged breasts, when she tried to sleep on her stomach her head was too far off the pillow, and when she drifted off her head fell down, blocking her airway, and she would wake up with a start over and over and over again.

The problem was easily solved by asking her to use three pillows for support at night…we trialed this in the ED for her, comprehensive folks that we are…and while I have been telling this story for years, I didn’t really understand it until last month. The Bride, who is fairly well put-together to start with, got one of these new Victoria’s Secret bras to see what it would do. (To be fair, I certainly encouraged her in the shopping.) Let’s just say the effect was an impressive demonstration of textile engineering. But we’re out late one night, and we’re both a little beat so we’re having a late night cup of tea at a seaside coffee shop. She’s so tired she starts to put her head down on the table. But she can’t, because…yeah, I finally got it.

Plumbing Surprise

Here’s the weird note for the day. The bathtub wouldn’t drain after my shower yesterday morning, so I got a handy guy to come look at it. Turns out that when he removed the stopper and the supporting grill, there was big ball of hair blocking up the drainage pipe.

Talk about mixed feelings. On one hand, I’m supremely embarrassed that a total stranger is extracting huge plugs of hair form my shower. One the other, to be 47 and be able to spontaneously shed that much hair from my head and still need a thinning out and a cut every month just to keep things manageble...we’ll, that’s just something to be proud of.

Soccer News

World Cup Update: Paul the Octopus is now six for six. Having predicted German victories over England and Argentina, the clarivoyant cephalopod correctly selected Spain as the winner of today’s semifinal match. Congratulations to Paul for finally making the right choice.

That being said, I’m kind of dissapointed that we’re not having The War of the Guays (Para and Ura) in the World Cup Final. But as they say, you go Uruguay and I’ll go mine. (I’ve been waiting for years to use that line). But fortunately, as we learn from Ryan Wilson at BackPorch.com:

Despite Paraguay Loss, Larissa Riquelme Will Still Run Naked Through Streets

Paraguay made it all the way to the quarterfinals of the 2010 World Cup before losing to tournament favorite Spain, 1-0. Not a surprising outcome...but upsetting nonetheless, particularly for those individuals who were looking forward to lingerie model Larissa Riquelme's naked romp through the streets if Paraguay had won the whole thing.

All is not lost, it turns out.

According to Metro.co.uk: "Riquelme has confirmed she'll go ahead with her promise - even though her countrymen fell a couple of wins short of the target she'd set them."
"It will be a present to all of the players, and for all the people in Paraguay to enjoy,' she said. "They tried as hard as possible and gave it their all on the field." That's called taking pride in your country.

In related news, Diego Maradona will be forced to run through the streets naked as punishment for Argentina's no-show effort against Germany in the quarterfinals.

(And from my own visits to Buenos Aires, I know that the Avenida 9 de Julio is one big street.)

Higher Power

There’s this bit from the Bob and Tom Radio show about getting on in years. I forget his name, but one the featured comedians notes that one of the signs of age is that when you’re checking out hot girls at the Food Court in the Mall, they run to security because there’s a creepy old guy looking at them. This is why I’m now publically declaring that when I pace the floor at Barnes and Noble, Borders, Starbucks, or an airport staring at your feet , I am not a frustrated late forties guy with an unsatisfied fetish or hoping to spy a reflection off polished leather. I am instead a frustrated middle-aged guy searching desperately for an outlet in which to plug in my laptop and feed my Facebook addiction, because the child has burned out the battery playing Civilization IV in the car, having named his four cities Hamburger, French Fires, McNugget, and Happy Meal, and hoping to build combat units called Big Mac and Mayor McCheese. (I understand he’s saving Filet-o-Fish for the first city he builds near the coast.)

Thank you in advance for your understanding.

Set 'Em, and Forget 'Em

The fear of missing something weighs heavily on every doctor's mind. But the stakes are highest in the ER, and that fear often leads to extra blood tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomachaches.

Many ER doctors say the No. 1 reason is fear of malpractice lawsuits. "It has everything to do with it," said Dr. Angela Gardner, president of the American College of Emergency Physicians.

The fast ER pace plays a role, too: It's much quicker to order a test than to ask a patient lots of questions to make sure that test is really needed.

"It takes time to explain pros and cons. Doctors like to check a box that orders a CT scan and go on to the next patient," said Dr. Jeffrey Kline, an emergency physician at Carolinas Medical Center in Charlotte, N.C.

Patients' demands drive overtesting, too. Many think every ache and pain deserves a high-tech test.

"Our society puts more weight on technology than on physical exams," Gardner said. "In other words, why would you believe a doctor who only examines you when you can get an X-ray that can tell something for sure?"

Refusing those demands creates unhappy patients. And concern that unhappy patients will sue remains the elephant in the emergency room.

Associated Press, June 21, 2010

Lots has happened in medicine in the 21 years since I finished my training in emergency medicine, but the changes in our field are probably less than in other medical specialties. Because of the limitations of the ED setting, we most often don’t have access to all of the advanced tests, tools, and techniques that can be used in diagnosis and care during normal daytime hours. But that’s okay, because with the exception of emergency cardiac catheterization for heart attack and drug therapy for early stroke, things like MRI’s, serum levels of just about anything, and advanced surgical techniques rarely make much difference in the care we provide. Lives are saved by doing old-fashioned stuff like giving oxygen, keeping airways open, and use of fluids and maybe a dozen select medications which are essentially the same as they were two decades ago. One of the fun things about ED work is that there’s still some room to be a medical detective, as long as the investigation is limited to looking for an emergency and not definitively diagnosing everything else.

But that doesn’t mean technology isn’t invading our practice. It’s more than just tests and x-rays we do for medicolegal purposes, although that’s one of the most commonly held notions. (And realistically, while extensive lab tests and CT scans may find more things might expect, they often don’t affect the actual disposition of the patient; you usually already knew what needed to be done. A surgeon I respect…and for me that’s saying a lot…once told me that CT scans in trauma patients find a lot of injuries, but nothing you’re going to do anything about.) The article cited above is one of the few that talk about other reasons for excess testing, including effects on workload and patient demands.

Here’s an example of what I mean. A couple of weeks ago I saw a very pleasant 28 year old woman with pain in the right lower part of her abdomen. The basic approach to the problem…a history and physical exam…haven’t changed. You ask a set of questions, listen to the answers, and then poke, prod, and have a look around.

During my residency, the initial workup after exam would have consisted of a urinalysis and a urine pregnancy test. The one major emergency you always watch out for in a woman with one-sided lower abdominal pain is an ectopic (tubal) pregnancy. If the pregnancy test was positive, the patient had a possible ectopic until proven otherwise. Ultrasound was relatively new, and even when available you weren’t going to get one in the middle of the night. So you’d next get a blood pregnancy test, because most of the time levels of the pregnancy hormone b-HCG don’t rise above 2500-5000 with an ectopic pregnancy. If your clinical suspicion was still high, and if the b-HCG level was very low considering the date of the patient’s last period, you would call up the obstetrics resident who would come down to the ED and explain to the patient the need to do a culdocentesis. A culdocentesis is a needle puncture through the back wall of the vagina just under the cervix to see if there’s any free blood floating around the pelvis suggestive of a ruptured and bleeding tubal pregnancy. If it’s positive, the patient needed to go to the operating room for repair. That being said, most women would understandably decline the procedure (I’m not a woman, but it just sounds painful), and there would be some extensive patient education and counseling about the uncertain nature of her pain and the need to return immediately if worse in any way.

Today it’s different. Same patient, same presentation. But now once the pregnancy test is positive, we get an MRI to look for an ectopic (and avoid radiation exposure to a potential fetus). If it’s negative, we get a CT scan to see what else might be going on. Most of the time, we find nothing, and the patient is discharged with a diagnosis of “pelvic pain of unknown cause.” It’s a more definitive process to actually be able to visualize the area of pain. But is it better medical care?

There is no question that a CT scan or MRI is less invasive and less painful than a culdocentesis. Direct imaging does take the guesswork out of medicine, which is probably a good thing as well. Perhaps it provides a more definitive diagnosis (or at least a more definitive way to say there’s nothing wrong), and maybe there’s some reassurance value in that. There’s no question that medicolegally, you’ll be taken to task for not getting a test no matter how much time you devote to patient education and discussion. (And this is in a sample case where the test might actually be indicated, but physicians run the same risk if patient demands are not met regardless of clinical need. And believe me, it’s easier to give in to testing than explain why not.)

But sometimes I wonder if the sheer ease of getting tests and scans is a way of excusing ourselves as clinician, making us sloppy, and makes us really unable to communicate and talk with patients in the ways we used to do. Maybe we use the medicolegal excuse as a crutch for not wanting to make the physician-patient connection, but I doubt it. I don’t know anyone who went into this business purposefully to not talk to people. I think what testing does allow us to do, especially in high-volume ED’s where speed of patient turnover is often prized over compassionate and personal patient care, is to allow us to keep the system moving. I can spend twenty minutes talking to you, or I can order a CT scan and your case becomes a Showtime Rotisserie Oven. I set you and forget you until the timer on the CT scanner dings and then we sample the results in front of a studio audience. And all for three easy payments. But wait! There’s more…

Pet Sounds

Ms. Wilson was a 54 year old woman who, by her overall appearance, looked as if she had been walking on the wild side of life for quite some time. (The politically correct term for this is “looks older than her stated age.” The Joplin, Missouri term, taught to me by my old friend Dr. Michael Joseph, is “rode hard and put away wet.”). When someone looks that way, you never know quite why. Maybe it was a life of hard luck, of working two jobs and barely scraping by. Maybe it was selfless service to those in need, of bearing the pain of others on her shoulders. Maybe it was living like Bike Week was a full-time job. But regardless of the cause, with folks like this you know there’s always a story out there somewhere.

She had come in complaining of left rib pain. The pain had been present for two days since she fell out of bed and landed on a toolbox. The reason she fell out of bed is that she rolled onto her pet who was on the bed, the pet yelped, and she was startled.

Up until now, I’m with the story. I’ve had a pet sleep on the bed (most notably the late lamented Jimmy Leemer the Dog, aka The Amazing Furry Walking Garbage Disposal.) Indeed, this is a fundamental part of The Second Axiom of The Dog Rules of a Relationship, which are:

1. You must love my dog.
2. The dog is going to sleep anywhere it wants, because the dog was there first.
3. If we get into a fight and you ask who I love more, you or the dog, you don’t want the answer.

But here is where the story changes, because the pet in this case is a rat. A domesticated white rat, she was quick to point out; a dear member of the family that has been scurrying about the house and climbing into bedclothes for the past two years.

And you do you get a rat for a pet? Well, they were going to feed it to the snake, but it just gave her this look…

Pain, Drugs, Rock 'n Roll

The woman in Room 34 has been here 27 times this year alone for the same abdominal pain, and it’s only June. I asked one of our nurses what was wrong with her as I strolled towards the room. The nurse struck a pose, hand on her hip, hand grasping the stethoscope and holding it close to her lips.

“She’s a drug seeker!”

Her smile turning into a rocker sneer, another nurse stood to mirror her and grabbed her own stethomike.

“Narc eater!”

Together they swivel on the balls of their feet, pop their hips, and swagger around the desk.

“I’m the nurse so you don’t mess around with me!”

Suddenly we’re all rock stars, as the ED choir…two sopranos and me...begins to wail.

“Hit me with your best shot! C’mon, hit me with your best shot. Give me some Diluadid! Fire awaaaaaaaaaay!”

(Pat Benatar is not the only musician we adapt in the ED. For psychiatric patients, we usually bring in Gordon Lightfoot:

“If you could read my mind, Lord,
What a tale my thoughts could tell
Just like a schizophrenic
On some Haldol and not too well.”

He’s also good with bowel issues:

“Sundown, you’d better take care.
“Cuz when I’m constipated I ain’t goin’ down there.”)

ABC ETOH

Mr. Frisen was found lying on the sidewalk outside the ABC Liquor Store. I’ve always thought that they should put a bench outside of ABC, because it seems to be a favored place for some of our ED clientele to relax and recline. Perhaps they could even build a small, self-service hostel as a way of building customer loyalty. It makes sense to keep your best customers close at hand. You could call it Motel 6 Proof.

(By the way, have you ever noticed that you never see an ABC Liquor Factory Outlet Store at the Outlet Mall? Is there no such thing as seconds or overruns? “By gosh, we put just a bit too much alcohol in that bottle. Maybe we can sell it at half price?”)

However, the passers-by tend to frown upon live bodies obstructing the sidewalk. So the police brought Mr. Frisen in to see us to make sure he was okay. They left him in our care, but with a note to please contact them before he was to be released. This is the polite law enforcement way of saying “We’re not leaving an officer here with you, but when you’re done he’s going to jail.”

Unfortunately, Mr.Frisen was not a patient man. He had people to see, places to go, and things to do, and apparently all of them were quite urgent matters for 2:27 AM on a school night. So when he demanded to leave, it was with great regret that we informed him that this was not really going to be possible, as the police wanted a word with him after we were done. He must have been displeased with the news, because he decided to tear out the plexiglass walls of the exam room.

When someone goes ballistic in the ED, there is generalized bedlam. The charge is led by well-muscled young guys seething with vital hormonal secretions, who are able to secure the patient from harm by subduing them with gentle, patient-friendly techniques learned from watching cage fighting. But these are social occasions as well, where every free staffer gathers to offer commentary, complement particularly creative holds, gossip, and generally observe the fun. In fact, when we know of an upcoming event (such as when we hear security paged to certain room), we all tend to gravitate towards our next shared experience.

This happens on a reasonably frequent basis, and is not really news in and of itself. But what makes Mr. Frisen’s case worth noting is the sheer volume of good lines that came out of it, and the large number of staff who got in on the act.

There’s the nurse apply leather restraints, saying “Most of the time I get paid for this.”

There’s the tech who has one knee on the small of Mr. Frisen’s back and his arms engaged in holding down his right wrist, noting “If I stay here, I can’t send you any more patents from triage.” Mr. Frisen utters a profanity as he tries to wriggle out from under him. The tech tightens his grip and smiles. “Sure you wouldn’t like me to stay here for a while?”

There’s our registration clerk, who pops into the struggle to notify us that he has spoken with Mr. Frisen's sister and has been told 1) If he needs life support, don’t do it; and 2) If he dies, we should call her in the morning.

Once in restraints, Mr. Frisen calms down. (They most often do.) His alcohol level comes back at 398, almost five times the legal limit in our fair state. This prompts someone to note that he should have his own liqour license. In turn, our female-unit-clerk-in-a-committed-relationship-with-another-woman notes, “Hey! I want one of these!”

(It’s a sound-alike joke. Keep working on it. Thank you.)

The jail won’t take him until his alcohol level drops below 200, which is about eight hours away. He’s asleep, and I think we’ve run out of one-liners for the evening. Besides, it’s close to 7 AM, and Waffle House is calling my name.

Sleep well, Mr. Frisen. But come back tomorrow night. We’re here all week. And be sure to tip your techs. They’re out there working hard for you.

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

A few other quick takes on a very slow night…the kind where you’re paid to socialize (and the kind I can never get enough of):

“Mrs. Payne is 88 years old. She’s been a pain for a long, long time.”

Phone call taken at 6:30 AM by our Unit Clerk. “You said you need a wheelchair to be waiting for you when you get here? I’m sorry, but we can’t have someone sitting outside just waiting for you. We’ll be happy to help you if you need it when you get here.” A pause. “And you’re driving yourself?”

“I’m looking forward to July 4th. It’s Redneck Natural Selection Day.”

Catching On

Every now and then you realize you’re way too deep in what you do for a living…

Have you ever played Catch Phrase? It’s a great game. The electronic version is a fat disc that shows unusual word or phrases on a screen, and teams of two or more players try to guess the word or phrase. When one team gets it right, the disc is passed to the next team. There’s a timer in the device that beeps with ever-increasing urgency, and the team holding the device when the buzzer goes off loses the round. You can guess that this leads to the disc being flung about like a hot potato as time grows short. It’s kind of like Password on steroids.

Anyway, I’m over at a friend’s house the other night, and a bunch of us ED folks are playing Catch Phrase. It’s my turn to guess the answer, and my partner Kristin is looking at the screen. She turns to me and says “People do this all the time in the ER,” and she starts to gag and make a gesture with her hand like things are coming out of her mouth.

I knew exactly what she was doing. It is something people do all the time. It’s one of my least favorite bodily functions that expels one of my least favorite bodily fluids. (Blood, urine, lung stuff I can handle. GI secretions? I’m outta there.) But I know too many words for it, including:

Vomiting
Vomicking
Nauselated and Vomicking
Barfing
Upchucking
Regurgitating
Worshipping the Porcelain God
Producing the Technicolor Rainbow
Aspirating
Aspiration Pneumonia
Aspiration Pneumonia in a Nursing Home Patient
What you do when Administration Comes by

After about a minute and a half of this, with the beeping growing more intense and frantic, she grabs me by the collar. “WHAT AM I DOING?” she shouts?

“You’re throwing up, right?”

“RIGHT! IT’S THROW UP. THROW UP! LIKE NORMAL PEOPLE SAY! THEY THROW UP!”

And the disc was passed.

True Creepy Story

This is absolutely true. I’m driving down the street taking my son for an overnight visit with his grandparents. As I pass by one of the homes on their street, I noticed there are huge black birds circling over the house. I slowed down to find that they were also perched along the eaves, standing on the concrete facing of the garden wall, and even pacing up and down the driveway, driving their hooked beaks into the pavement with a mixture of determination and boredom. It was like something out of a Hitchcock film, but all the more scary because you knew…beyond a shadow of a doubt…that there was neighbor inside who hadn’t been seen in quite a while.

Don’t look for a punchline here, because there isn’t one.

A Soccer Suit

…I am the armchair fan who desperately wants to love this game, and, like untold thousands (millions?), had no choice but to curse it out, turned off by incompetent refereeing, a situation exacerbated by a governing body so intransigent and arrogant it makes British Petroleum look like a warm and cuddly quilting circle. "I am very, very satisfied," Jose-Maria Garcia-Aranda, the head of FIFA's referees, said of the quality of officiating in the World Cup matches…

…Even the most tradition-bound purists must agree that a goal should be a goal. So when referee Mauricio Espinosa mistakenly disallowed Frank Lampard's goal on Sunday, a score that would've enabled England to tie Germany 2-2, it was a very big deal. And when FIFA general secretary Jerome Valcke all but ruled out the use of video replay that would correct such situations, it exposed a sport crying out not just for visionary leadership but for leadership with some grasp of reality. Not counting a goal for fear of dehumanizing a sport with replay is not in the tradition of anything besides the tradition of ignorance.

Jack McCallum, sportsillustrated.cnn.com, June 28, 2010

The Fédération Internationale de Football Association (FIFA) officiating problem is really pretty easy to solve. Take a lesson from American medicine and make both the referees and the governing body legally liable for bad decisions. After all, it’s not like the actions of the referee go without consequence. A decision to allow, or disallow, a goal has a major impact upon the ratings of individual players and their ability to make a living at their chosen sport. Similarly, football clubs depend on proper officiating to ensure that both game results and overall standings are true and correct. With low-scoring games, a single inappropriate goal can cause a large change in the standings, which in turn affects a club’s ability to attract players, fans, and advertising. In addition, many football leagues feature end-of-season “relegation,” in which the lower performing teams and sent down to a lesser level league, and the best of the minors is promoted to the big time…and big money. The revenue impact of relegation on a team, let alone the psychological hot on a community, is staggering. If doctors can be sued for errors in decisions that affect the livelihood of others, even in those cases when these decisions can’t be made on any objective evidence at all, why shouldn’t FIFA?

The threat of liability, of course, will drive a headlong rush to embrace as much technology as possible to put error out of the realm of possibility. That is the current unreasonable standard in medicine…that there is perfection in an inherently unstable art…and one of the main reasons why doctors do so much testing and imaging and so little talking and educating. But if referees knew that they could be held personally liable for a missed goal or allowing an illegal play, I don’t know any that would participate at the sport’s highest level. They might if they were indemnified by FIFA itself, but would the organization want to take on the question of liability? I don’t think so. Like medicine, they will rush to a technologic solution and install goal cameras, mandatory instant replay of all scoring plays, and maybe even a coach’s challenge to eliminate their own risk. Because World Cup soccer is not about fair play or making sure that the better team wins at the end of the day, but all about FIFA.

FIFA president Sepp Blatter has apologized to England and Mexico for the refereeing errors that helped eliminate them from the World Cup…

The English said 'thank you.' The Mexicans, they just go with the head,'' Blatter said, indicating that they nodded. "I understand that they are not happy. It was not a five-star game for refereeing.''

England was denied a clear goal that would have leveled its match against Germany at 2-2, while Argentina took the lead against Mexico with a goal that was clearly offside.

Associated Press, June 28, 2010

If you still had any doubt about the arrogance of FIFA, this should resolve that quandary. I would think that the Swiss Mr. Bladder (intentional error, because the lines he spouts sound a lot like the organ’s contents) would be grateful that he got a “Thank you” from the English. It would have been a lot easier, and probably more appropriate, for the Red and White to say something like “Still got those hidden Nazi bucks bankrolling your election?” (Blatter’s 2002 election to the Presidency in FIFA was surrounded by charges of bribery and corruption.) And as for the Mexicans, I think a head nod was the most gracious gesture possible to someone who clearly feels he lives on a plane far above these mere dark-skinned colonials. I can think of a few other motions that might have gotten the message across more clearly. I’d probably even be willing to help.

In the early 1970s, Blatter was elected president of the World Society of Friends of Suspenders, an organization which tried to stop women replacing suspender belts with pantyhose.

“Sepp Blatter,” Wikipedia, June 28. 2010

Ah, well, that explains it all. If you can’t talk a woman out of her pantyhose, you’ve got to find something else to screw.

Newtonian Sex

There were plenty of starry nights, but a NASA commander says there was absolutely no sex in space during a mission that brought three female astronauts to the International Space Station.

Space Shuttle Discovery commander Alan Poindexter spoke definitively today on the outer space romance ban during a trip to Tokyo, where he and his team discussed their two-week resupply mission in April.

"We are a group of professionals," Poindexter told a reporter when asked about consequences for space sex. "We treat each other with respect and we have a great working relationship. Personal relationships are not ... an issue. We don't have them and we won't."

Michelle Ruiz, AOL News, June 28, 2010

At one point in my life, I played Professor at Embry-Riddle Aeronautical University here in Daytona Beach. I taught a couple of courses, most notably a three-hour extravaganza called “Human Factors in Space.” The course was designed to explore the physiologic and behavioral aspects of space flight for budding engineers and, like most university courses, I was able to take twenty minutes of material and turn it into twenty weeks of work, plus papers and a two-hour final exam.

(As you can guess, the ERAU curriculum is aviation-focused, with most students getting degrees in aeronautical science…pilots…aerospace engineering, aviation management, meteorology, that sort of thing. It’s a very good school, and if The Child chooses any of those career fields I’d be happy to have him go there, despite the added burden of doing his laundry for yet another four years. But knowing the students well does create some problems when they graduate. About eight years ago I was on a commuter flight from Daytona to Atlanta when I heard a voice in the cockpit say, “Hey, doc!” It turned out that the First Officer was one of my students, one who had gotten a C minus only out of my good graces because I figured he was such as slouch that he’d never wind up in a position of responsibility and he was so good spirited about the whole thing that I felt bad giving him a D. To his credit, the flight was about as tranquil as it could have been. It was also the most unnerving fifty-two minutes I’ve ever had in an aircraft.)

Being that the class is full of hormone-addled collegians, it was obvious that they were going to ask about sex in space. That’s why I made sure the lecture was noted on the syllabus, so I could avoid having to keep answering the question until the appointed time. But Isaac Newton could have predicted all you have to know about having sex in space.

Think about sex. Now wipe the smile off your face (assuming you are smiling…I do extend my best hopes for you) and think about the mechanics of sex. Not only do two people have to come together in an intimate way, but they have to be able to stay together and they have to be able to move against one another. On earth, that’s not a problem. If one partner is on top of the other, in whatever configuration might be, gravity keeps them in place; and even if the partners are on the same level, if you will, gravity keep them pinned to whatever surface they happen to be on, whether it’s a bed, a floor, or the backseat of a 2003 Saab 9-3.

In space, gravity is not a factor. (Technically, it actually is a factor, but not to the extent where it’s noticeable on most routine activities. If gravity weren’t in play at all, spacecraft wouldn’t orbit a planet, but would just shoot straight out into space. The more appropriate term is microgravity, not “zero-G.”) So if two people come together, they will not do so on a surface because there is no gravity to keep them there. Instead, they will tend to “float” within whatever enclosed space they inhabit at the time. Floating sex sounds like a lot of fun, and I suspect that it would be. However, if you’re floating abut, and one partner thrusts forward, Newton’s Third Law (the “equal and opposite reaction” one) suggests that there will be a corresponding movement in which the other partner will be pushed backwards, not only seperating themselves from their desired but also slamming against whatever wall, container, or overhang happens to be nearest in the direction of flight. They way to avoid this, and biomechanically the only way to have efficient sex in space (this was a human factors engineering course, after all) is to indulge in a bit of goal-oriented bondage play, restraining one partner to a solid surface with straps or tapes while the other secures his or her position through the use of brackets, handholds, or some other way to hold the body in place.

So what’s the real answer to the question, “Has anyone ever had sex in space?” We know the official answer, as well noted by Commander Poindexter. The real answer, of course, is “Not that we know of.” Let’s be frank…there have to have been times when there was some definite attraction between members of mixed-gender flight crews. (I’m excluding pathological attraction involving cross-country drives and the use of astronaut diapers to stalk your beloved.) So if I’m really attracted to the girl working the robot arm (and you can take that any way you wish), do I want to give it a shot, especially with the radio to Houston off and the good graces of my crew members? You bet I do. And if I was not one of the involved parties, would I be willing to go down to the middeck, close the hatch, and put on some earplugs so my colleagues could have a half hour to themselves? Absolutely. (Although the ear plugs might prevent me from hearing some really good lines, like “I felt the earth move,” because it is, and “I feel like I’m floating on air,” which you are. Which are better lines than “I hope this duct tape peels off,” and, “Gee, when we’re locked up here together for two weeks without a shower, you do pretty much smell like a gym locker.”

I think we should explore these issues with the same intensity we devote to learning the hidden story of Jake and Vienna (whom I do not know personally, but have seen on three magazine covers this morning at the local bookstore and found myself intrigued that a girl should be named after a sausage). Personally, I want to know these things not because I am a voyeur, but a scientist. When our sun goes supernova in a few billion years, the continued existence of the human race may depend on our interstellar procreative prowess. And how else to you learn stuff besides experiment and observation? I hereby volunteer to go up and try it. I’ll take notes. You can even make a video. But that astronautess had better be smiling.

Basic Instinct

A 2-year-old octopus oracle — born in England, but raised in Germany — has predicted a German win over England in Sunday's World Cup game.

The mollusk named Paul chose a mussel out of a water glass marked with the German flag over a mussel in a glass with the English St. George's Cross, said Tanja Munzig, a spokeswoman for the Sea Life Aquarium in the western city of Oberhausen, on Friday.

Paul has proven to be a reliable oracle in the past — he predicted Germany's win over Australia and Ghana and its loss to Serbia. During the 2008 European Championship, he predicted 80 percent of all German games right, Munzig said.

Associated Press, June 26, 2010

Being of a medical mind, this animal prognosticator made me think of Oscar the Cat. As you may know, Oscar has been written about in the New England Journal of Medicine:

Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families.

David Dosa, MD MPH, NEJM, July 26, 2007

Oscar is even the subject of a book which not only tells his story, but also offers lessons in caring, compassion, and end-of life care. That being said, I think the best end-of-life lesson I can learn from a cat is not to smell like tuna, and I will shortly be adding to my medical power-of-attorney form a codicil specifying that should I be placed in a nursing home, an attendant will be paid to place an open can of Little Friskies at the other end of the hallway three times each day (once per shift).

Oh, wait, back to the AP article:

Other animal oracles in German zoos cannot claim such a strong track record.

Nineteen-year-old hippo Petty falsely predicted a German win over Serbia last week. She had to choose between two piles of hay with red apples on top at the Chemnitz zoo in eastern Germany and nibbled from the wrong pile.

Tamarin Anton, a monkey at the same zoo, chose the wrong raisin a few days ago, incorrectly claiming that Ghana would beat Germany, kicking it out of the World Cup.

Not to mention the schnauzers that predicted the outcomes of the last two World Wars. As memory serves, Germany didn’t fare too well in those matches, either.

Rule Britannia!

A Lego Note

Yesterday in the car The Child was telling me he had read that if you have 16 Lego bricks, each of them a little square with four studs on the top, there are enough combinations to keep you busy for a lifetime. So I’m not surprised by the infinite variety of things he comes up with given his three full drawers of pieces and parts collected over the past decade. In fact, this weekend he built a Lego museum, complete with exhibits on zoology, the wild west, life on Mars, an armory, a pirate ship, and a gift shop.

Yesterday he was puttering around with his toys…actually, he was stalling because I had asked him to clean up his room before going on a mission to seek pizza…and he brought out a small pink and yellow helicopter to show me. “What do you think, Dad?” he asked. “I call it the Chopper of Doom.”

I looked at the model, which was indeed a very convincing helicopter. He had, however, constructed it from pink and yellow bricks that I think came to us as some kind of Happy Meal toy. The sloped brick that represented the front window of the cockpit had an imprinted picture of a female being with blond pigtails, yellow flesh, and a bill.

“Son, you can’t call it a Chopper of Death. It’s pink and has a girl duck for a pilot.”

“What can I call it, then?” he asked, whipping it up and down in a flight path designed to poke out an eye.

I thought for a moment. This is a formative stage in his life, and I don’t want to say anything negative about the female end of our species. I want him to inculcate a sense of respect towards women, as well as a secure sense of his own gender identity. So I settled on something that I thought was pretty clever.

“You can call it the Chopper of Feminine Quack.”

He liked this a lot, and soon we came up with a theme song for the inevitable television show that will result when news of his creation spreads to the coast:

It’s the Chopper of Feminine Quack!
It’s the Chopper of Feminine Quack!
It’s pink and it’s yellow and it’s flown by a duck.
It’s the Chopper of Feminine Quack!

Because this is Lego, however, the chopper soon became boring. Which is why, within minutes, there was also the Killer Robot of Feminine Quack, the Airplane of Feminine Quack, the Speedboat of Feminine Quack, the Other Slightly Different Helicopter of Feminine Quack, The Seaplane of Feminine Quack, and the Guided Missile of Feminine Quack.

Thank the Lord there were only 9 pieces in his model, or this could go on forever.