Cat Nips

There’s an unfortunate man who comes to the ED a lot. He has terrible heart failure, and isn’t a clinical candidate for a heart transplant. Most of the time he stays alone in his room, keeping to himself, simply waiting for his time to end. When he feels especially lonely, he calls EMS and comes to see us. It’s what passes in his life for a social call.

So we’re trying to figure out what we can do to help this man, to help him build a relationship with someone or something other than the health care system of this fine community.

“He needs a kitten,” says the Unit Clerk.

The Tech shakes her head. (Brace yourself, and remember we are in the ED, not a place for normal humans.)

“No, that’s a bad idea. When he dies, the cat’ll eat him.”

This was new knowledge to me. I had no idea that cats ate dead people. That being said, the story of Oscar, the cat that sits by dying residents in a Massachusetts nursing home, makes a lot more sense. Oscar’s not there to provide comfort to those heading towards the Great Beyond. Apparently, he’s out looking for a snack.

Because this is the ED, however, the conversation doesn’t stop just because it’s breached the limits of decency. The Nurse pipes up next.

“You know, if he got several cats, he can save on funeral expenses.”

“So he would be consumed by pussy,” says the Tech.

Metaphorically, I hope.

Counting Down

Some years ago I learned that if I count backwards, visualizing the numbers while I count and matching each number with a deep full breath, I can often get myself to sleep. It doesn’t always work, and if I hit 70 before feeling that disjunction that happens just before nodding off I usually give up. Patience has never been my strong suit.

(Numbers are easier to count than sheep. I used to try to count sheep, but when I did my tangential thinking…helped along by The Bride…meant that suddenly the sheep were being given names, and personalities, and life histories. There was Alice the Sheep, Betty the Sheep, Charlie the Sheep, and so on. The brown sheep was named Pedro. The black sheep was Shaft.)

You would think that counting backwards would be a pretty easy thing to do, and it used to be quite routine. But since I got back into full-time clinical medicine, I notice that no longer do I count down routinely from 100. Some nights it’s everything I can do to not count backwards as follows: 300, 150, 100, 75, 60, 50.

Forty self-esteem points for the reader who can tell me why.

Goin' a-Courtin'

You may have heard that earlier this week, a federal judge in Pensacola has ruled the new Health Care for All Act (or The Job Killing Socialist Manifesto, depending on your political stripe) as unconstitutional. The basis for the ruling, as I understand it, was that there is no constitutional allowance for the federal government to mandate that private individuals purchase a specific product (like health insurance).

I can’t say I’m really upset by this interpretation, especially as the government-subsidized purchase of private health insurance it made very little sense to me. It seems an inherent contradiction that the same insurance companies that have been labeled as significant contributors to the crisis in health care...and reaping massive profits as a result...should be rewarded by an infusion of public dollars. Of course, both Republicans and Democrats were perfectly happy to give public money to the large Wall Street firms that drove the current recession, so I guess I shouldn’t be surprised. And I recognize that both the subsidy and the individual mandate are political compromises made to garner support for passage of the law, and that compromise is the essence of policy. But I’m still not thrilled with it. If health care coverage for all Americans is as critical as we are told (and I personally believe that it is), then the logical solution is to establish a baseline, no-frills, economy-class, bring-your-own-snacks level of care for all. If the private sector can add services on top of this baseline, and individuals choose to make those purchases, so be it.

Commentators on television and radio have made it clear that no matter who won this round in Federal Court…and so far the score is tied at two decisions apiece…the battle won’t be over until the issue hits the Supreme Court. While I understand that the Supremes have an unpredictable streak (and have ever since Diana Ross left to pursue her solo career), unless there is a sudden retirement on the bench the chances are a conservative court will at least hold the individual and employer mandates within the act as unconstitutional. And while technically the rest of the Act could still be legit, in reality the financing for the entire scheme falls through if the individual and employer mandates are not in place.

What I know for sure is that these court decisions are pure theater, much like the show put on by the Transportation Security Administration. They obscure the real issue, which is an irretrievably broken system of care. Nobody has ever denied that fact. I can’t think of any voter who is unaffected by a lack of access to care or runaway costs, nor a policymaker of any stripe who will say the status quo is just fine, thanks for asking. Nor can I, despite all the posturing about keeping government out of health care (and right now between 45- 55% of all health care costs in this country are borne by governmental agents), can I find anyone willing to forgo their own Medicare or Medicaid benefit, nor any policy maker willing to take them away.

(And for the record, and because with my fetish for linguistic accuracy it drives me nuts when people say it, government funded healthcare programs are not evidence of socialism. Socialist health programs involve government ownership and control of all elements of care. Nobody has ever threatened to nationalize the hospitals or make all health care workers government employees. Even the subsidies for health care coverage within the new law go to support vibrant private sector insurance companies. So get over it.)

Last November, Republicans were able to whip up the public against health care reform with a large helping of clever rhetoric and a side of fearmongering. But if the health care reform law is declared unconstitutional, people have a right to expect something else to be offered in it’s place. The GOP may have owned the last election and are drawing even in the legal war. But without a real plan of their own, one that enhances access to care while controlling costs, they are sure to lose the war. Either that, or we as people in need of care most assuredly will.

Mystery Meat

It’s lunchtime, so between patients I skip down to the Doctor’s Lounge for a bite. At this particular hospital, the cafeteria brings up some trays of hot food to supplement the usual assortment of sandwiches and chips.

I walk up to the food bar to find one of our surgeons, a fairly bright guy, looking uneasily at something chunky, pink, and breaded. Hearing my footfalls, he turns and gives me a quizzical look.

“What do you think this is? Chicken or fish, or something else?”

Now let’s get this straight. This is a guy who cuts into flesh for a living, while in general I only look at it from the outside. And he can’t figure out what kind of meat they’re serving for lunch?

I had a piece of cheese and a Coke.

Newton's Tempest

You may have heard several weeks ago about the 5,000 red wing blackbirds who died in a mass extinction event in Arkansas on New Year’s Eve. According to the Arkansas Game and Fish Commission, the official explanation is that they all perished form “blunt force trauma,” which is the clinical way to say they were “…flying into stationary objects such as trees, houses, windows, power lines, towers, etc." These crashes resulted from the fact that, “Arkansas blackbirds have poor eyesight and don't normally fly at night. The AGFC said the birds were probably disturbed by "unusually loud noises" and flew lower than normal due to New Year's Eve fireworks. The rare night flight was even recorded on radar data.”

Personally, I figured that perhaps they had become communally frustrated by the fact that they had been told that they could not migrate north for another few months and were just supposed to wait it out in The Natural State, and so they all flung themselves out of the trees from sheer boredom. (As a loyal Kansan, as especially as I write this on the sesquicentennial of our Sunflower Statehood, I feel bad for the birds. They could either spend the winter in Arkansas, or move north to Missouri. Not a good choice either way, if you ask me.)

However, my ED colleague Jason Hawver has made me aware of a new and even better theory of what did in our feathered friends. It’s called the Gravity Storm, and it’s so common I can’t believe it’s escaped the notice of science until right now. Gravity storms pull people to the ground without provocation. They appear to be localized phenomena, and just as tornadoes show a predilection for trailer parks, gravity storms seems to erupt at nursing homes. They also have a tendency to occur at specific hours, most notably sometime between when the resident was put to bed and when they failed to report for breakfast the next morning.

The results of gravity storms can be serious. Bruises and minor lacerations are common; hip fractures may result as well. I think this is worthy of further investigation, and I’ll need a federal grant to do a proper study. The grant will need to cover the costs of a theoretical physicist, an experimental physicist, an astrophysicist, and an engineer. Oh, and we’ll also need a blonde actress/waitress to provide snacks and a link to the real world. Which is my argument for including a late-forties, vaguely amusing emergency physician within the cast of the Big Bang Theory. And in comparison with the salaries negotiated by the cast in their new contract extensions, I think they’ll find my rates surprisingly reasonable. I’m my own agent. Call now!

Satellite Love: Update

My sister has provided me with an update on my blog about the Top Songs of First Love. She has informed me that Katy Perry’s “Teenage Dream” fulfills the criteria from a female standpoint:

“Let's go all the way tonight.
No regrets, just love.
We can dance until we die.
You and I, we'll be young forever.

We drove to Cali and got drunk
On the beach.
Got a motel and built a fort
Out of sheets.
I finally found you,
My missing puzzle piece.
I'm complete.”

I would argue with her that:

1) Katy Perry is a teenage DREAM, not a real girl actually doing it, so the song doesn’t count; and that

2) Building a fort out of motel sheets is a chaste activity (see Clark Gable and Claudette Colbert, “It Happened One Night, 1934); and that

3) These two kids have a RELATIONSHIP and are in LOVE; and that

4) Katy Perry is from an era of music I don’t listen to, so it doesn’t count, no matter how hot Katy Perry is nor how much I am convinced that while she married Russell Brand and I wish her happiness, I know it’s only because she didn’t meet me first; and that

5) Anybody who sings with Elmo is automatically too pure of heart for this list.

So there.

First Love by Satellite

For those who drive long distances in rental cars, satellite radio is a truly wonderful thing. There is a virtual cornucopia of channels attuned to your specific interests with minimal commercial interruptions and a minimum of chitchat, and if you happen to not like the song that’s on at a given moment it’s easy to flip to someplace where you’re sure to find something you enjoy. Satellite radio also proves The Bride’s contention that I have no concept of music after 1990, as the moment I’m in the hired transport I preset the Sirius channels to 40’s on 4, 50’s on 5, 60’s on 6, 70’s on 7, 80’s on 8, Sinatra, and Laugh USA. The fact that I do not listen to music from the 90’s or the present century also lets me transiently forget most of the Clinton and Bush Administrations, and that’s not a bad thing either.

Because of the nature of the channels, I tend to think that they are likely independently programmed. That being said, every now and then you’ll find some strange overlaps, like the programmers got together and decided on a daily theme. One I was headed down the road in Southeast Missouri and heard “In The Navy” by the Village People, followed closely on another channel by Diane Renay’s “Navy Blue.”

(I may have already told this story, but it bears repeating that my Midwestern naiveté made sure I was well over thirty before I had any clue that “In The Navy” had any other meaning than thinking it was cool to be on an aircraft carrier or destroyer. They’ve got planes, they’ve got missiles, they’ve got torpedoes, and if they work right things blow up. Like there’s any other reason to join?)

So the other day I’m doing an early morning drive across Kansas and heard “This Girl is a Woman Now” by Gary Puckett and the Union Gap” followed by “Tonight’s The Night” by Rod Stewart. This, of course, made me think that the theme for the 5 o’clock hour was “Losing Your Virginity.” Tangential thinker that I am, I then came up with my top eight songs of this genre. Here they are, listed in ascending order:

8. “Girl, You’ll Be A Woman Soon” Neil Diamond

This song should probably be ranked higher, if for no other reason than The Bride, who is both an audiophile and a Neil Diamond aficionado (two things I would have thought were mutually exclusive), will chastise me if this song is not included on my list. That being said, it is ranked lowest because a close examination of the lyrics reveals that while the singer is not imminently about to join his girlfriend in a biblical way, he is making certain to be the first, by dragging her away from the competition if need be:

“Girl, you’ll be a woman soon.
Please, come take my hand…
Soon, you’ll need a man.”

Marking your turf is always a good first step. Just watch out for the claim jumpers.

7. “Summer (The First Time)” Bobby Goldsboro

It turns out that there are two subtypes of this lyrical mode. The essence of the first is "I'm talking you into doing me." The second is exemplified by this song, where the innocent lad is schooled in the ways of love by an older, experienced woman. Here young Bobby is strolling down the beach, having just, “…told Billy Ray, in his red Chevrolet, I needed time for some thinking.” (The rhyming of a proper name and an automotive brand is priceless.) Turns out there was a woman on the beach who gave him a few more things to think about, and “…the boy took her hand, but I SAW THE SUN RISE AS A MAN.” There is no record of if Billy Ray ever stopped back by, or if the now slightly older and much wiser Robert ever got back to town. The song is sappy, syrupy, and incredibly pubertal as he drops his voice to sing the final “AS A MAN.” (The Oedipal issues will remain untouched.) It is also stuck in my brain because I went through a phase in junior high where I was a huge Bobby Goldsboro fan, and I confess to owning his Greatest Hits Volume 1 and 2 on CD. And for this, I’m truly sorry.

6. “That Summer” Garth Brooks

It gets hot in the Midwest, and especially so for a widowed rural wife with a young, sweaty teenaged farmhand. Teenagers are also cheap dates:

“'Til she came to me one evening
Hot cup of coffee and a smile
In a dress that I was certain
She hadn't worn in quite a while
There was a difference in her laughter
There was a softness in her eyes
And on the air there was a hunger
Even a boy could recognize.”

Needless to say, a good time was had by all. Which probably explains why Colby, Kansas, a town of 5,400 people 200 miles from nowhere, has it’s own Starbuck’s.

5. “War is Hell (On the Homefront, Too)” T.G. Shepherd

Another in a series of summer adventures. This time she’s lonely because her man is off fighting for God, Country, and the ability to spend his leave watching the trajectories of ping-pong balls in the military-friendly Phillipines. At some point these songs begin to read like a Penthouse letter. “I never thought this would happen to me, but…”

(T.G.Shepherd gets an extra nod for “Do You Want To Go To Heaven,” where “…those preacher’s words were barely heard as sweet Bunny Lou gave in.”)

4. “December 1963” Frankie Valli and the Four Seasons

Oh, what a night indeed. But have you ever noticed that everyone to this point, with the exception of Frankie Valli, gets laid in the summer? I think it has something to do with a link between the cremasteric reflex (where the testicles move towards the body when exposed to cold) and the timbre of Frankie Valli’s falsetto, but I’m still working that out.

3. “Tonight’s the Night” Rod Stewart

I can’t even talk about this song without cringing. Rod Stewart actually does a nice job on his latest versions of The Great American Songbook. But here, Rod sounds like a chain-smoking drunk trying to seduce my daughter before he hocks up a loogie. And I don’t even have a daughter. I understand Rod Stewart does. I’ll bet he regrets this song now. Maturity brings wisdom.

2. “This Girl is a Woman Now” Gary Puckett and The Union Gap

Up until now, every song has used some assemblage of code words to disguise what is happening, or has a strategic omission in the narrative serve an informative role. This song nears the top of my list for it’s sheer lack of pretense:

“This girl tasted love, as tender as the gentle dawn.
She cried a single tear, a teardrop that was sweet and warm.
Our hearts told us we were right, and on that sweet and velvet night.
A child had died, a woman had been born.

This girl is a woman now; she's learned how to live.
This girl is a woman Now. She's found out what it's all about
And she's learnin', learnin' to live.”

Yeah, I’ll bet she’s learned how to live. Of course, one can’t help but wonder if this is the same Young Girl that Gary sent away before, and if she’s hit 18 by now.

1. “Paradise by the Dashboard Light” Meat Loaf

There are so many reasons I love this song. The driving rhythm and the rocking melody are exquisitely attuned. The lyrics are perfect. The baseball call is priceless. The film version, with The Loaf’s intensity rising as he lifts the microphone stand over his hand, is brilliant metaphor. Even the GoPhone commercial based on the song is worth playing again and again. And it is one of the few songs that my sister and I can sing…badly…together, which greatly distresses my father. I think this is less based on the subject matter or the fact that I sing it with my sister than because he never had that much fun in high school and resents us acting like we did. (I am aware that the fact that I sing this with my sister might have a totally different connotation in Arkansas.)

Have you noticed that all of these are songs are performed by men, either bragging about their prowess in bringing women into the world or proclaiming their newfound status as an adult male through participation in the coital act? You never actually hear woman sing, “Please Deflower Me,” or “I’m Going to Make You a Man. (The only song I can think of with the latter lyric is from the Rocky Horror Picture Show, but this involves an entirely different kind of relationship and also takes a week to complete.) Perhaps this is because women tend to discuss these things quietly with friends rather than proclaim them to the world. Or maybe because as men, we’re just so darn glad to get any that it becomes a red letter event, especially when we’re old enough that singing about it is often the best we can do, and even when luck comes our way a three minute song lasts longer than our maximal effort. And while we’re at it, why are there no songs from the male side that say, “I Really Want to Know You Better as a Person Before We Engage in Intimacy, Because If We Don’t Share a Foundation of Mutual Respect Our Relationship Cannot Move Forward in a Positive and Productive Manner,” while the female literature is rife with them, notably Janet Jackson’s “Let’s Wait a While?”

Oh, wait, I know the answer to that one, too.