Playing Doctor

Initial Visit?

Friday, December 31

The Kind of Act Of

Giving oneself to the dentist or doctor who is a good one,
to take the complete
possession of mind, there is no

giving. The mind
beside the act of any dispossession is

lechererous. There is no more giving in
when there is no more sin.

~Robert Creeley

Thursday, December 30

Venn Diagram of the Week

Wednesday, December 29

Uncynical Wednesdays: Christmas on Fire

I got called down to the ED around five in the afternoon for a patient who had arrested in the field. At his family’s post Christmas celebration, someone had started a fight with their cousin. In retaliation, the cousin had thrown gasoline onto him and set him on fire. The police were called and in the ensuing melee my patient had tried to break up the fight or put the fire out or something. He then dropped over and quit breathing. Fire Rescue brought him back in the field, and he was doing pretty well, all things considered. He was on a breathing machine and unconscious. He was critical, but not actively dying.

His sister keeps asking me if she should call his children to come and be with him. I keep telling her that she should.

But she keeps qualifying her question saying they had a complex family situation and being all cagey. Finally I say, “Look, He may very well die tonight. If the children would want to see their father before he died, then I would call them.”

“The reason I am asking about his kids,” She tells me, “is because he was convicted of sexually molesting them. They have not spoken to him in seven years.”


“Look,” I say, “I don’t know what you want me to tell you. You know the situation better than I do. If you think they could handle it, let them know their father might be dying. Or call their mother. I don’t know. Youre going to end up being the bad guy who didn’t give them the chance to say goodbye to their father if you don’t make a phone call.”

I, frankly, did not really know what to tell her. I missed the day in medical school when we covered: “patient dying, estranged from children (secondary to sexual molestation).” But I knew that if she didn’t tell the kids, they stood a pretty good chance of blaming their unresolved feelings on her.

The nurses, when they found out what was going on suggested the best solution might be to throw the patient out the window of his seventh floor room.

I reminded them that not only had he served his prison time, per both the sister and the prison tattoos, but that we did not know his sister was telling the truth. I couldn’t think of a reason why she would make that up, but I figure a family that sets its own members on fire probably has some peculiar dynamics.

Beyond which, I don’t really care what my patients have done. It is not my position to weigh in on their worth for health but to restore it.

I guess the real question is, are you going to pray for this man's health?

Tuesday, December 28

Things Not to Say

Or, things I have learned the hard way.

In ascending order of disastrous consequences:

6) At a junior-high talent show, not noticing the resemblance the couple in front of you has to the child on stage, “I would be so embarrassed to be that kid’s parents.”

5) When leaving a patients room, “Well, that isn’t going to last long.”
(A candy striper started crying.)

4) During sex with a one-night stand, “I’m so bored.”

3) At 14 years-old, angry at your father and hearing what you assume to be your sister coming into the garage, “Why is he such an asshole?”

2) In the first week of a relationship, before realizing you were falling in love, “I don't really see this lasting long term.”

1) Six years into a relationship, after being told you have gained some holiday weight, “You got fat two years ago, and I haven’t said one word about it.”

Monday, December 27

Christmas in the Cardiac Critical Care Unit

Last year I spent Christmas Night on-call in the cardiac critical care unit. The charge nurse, as she was leaving at noon to be with her family, gave me some advice, ‘don’t let anyone die until midnight. Don’t make families remember Christmas as the day their mother died.’ But we had a woman in the unit who was very sick and twelve hours was a lot to ask.

She had a myocardial infarction several days prior and was not doing well. She was on a breathing machine with a tube down her throat and was bleeding from her gut. Her heart was not strong enough to maintain her blood pressure, so we had her on IV medications that were flogging her heart to work harder.

By early evening she was worsening. She had been bleeding previously, but now blood was pouring from her rectum. The vent settings were not adequately oxygenating what blood she had remaining in her vascular system. Her blood pressure was falling. It was only eight o’clock. It would have taken many units of blood to keep her around until midnight. I would have to retool the vent settings to keep her breathing. This was simple enough to do, but I would have to force the air down her throat with such high pressures I risked popping her lungs and causing a pneumothorax. I would also have to add more medications to flog the dying horse that was her heart.

I called the family into the quiet room. I explained the futility of what we were doing. I explained that though we had been extremely aggressive already, I was going to have to become so aggressive that I felt we were crossing the line into pointless torture. The patient’s family and I spoke at great length. When they understood it was not an issue of whether or not she was going to die, but how she was going to die, we arrived at a decision. We were not going to advance her care. We were going to attempt to salvage some dignity for her in her final moments.

I went back into the patient’s room. The sheets covered her, but I knew what was going on under them. The smell of blood mixed with shit is distinct. If you smell it once, it’s easy to recognize. It’s not pleasant, and the room reeked of it. I had four or five machines attached to her. The machines were noisy: whirring and chirping and heaving and blinking. The exact picture of how most of us would not want to die.

The nurse cleaned the sheets, as I removed the blood pressure cuff and the pulse ox monitor. I removed the restraints from her wrists.

The restraints had been placed to prevent her from removing the breathing tube that went down her throat, the feeding tube that went down her nose, the central IV line that went into her chest, just above her right breast.

I turned off the IV medication pump that was maintaining her blood pressure. With the blood pressure lower some of the bleeding would slow. Maybe stop. The blood in her colon would likely continue to seep. But the morphine we were now hanging would help slow some of the seepage.

With that done,I removed the breathing tube from her throat.

Her mouth was suctioned and the sputum that she gagged up was cleaned. A fresh blanket was placed over her torso and she was tucked in. Her breaths were shallow, regular, and—most importantly—not agonal. I turned off the overhead exam lights. The room was dimly lit now and quiet.

Her family was brought back in. They went into the room and surrounded her bed. They took her hand. They stroked her forehead. They kissed her cheek. At this point, they looked at me with that awkward look families always have right before they ask, ‘how long will this take?’ I usually give a very honest but non-commital response because patients can surprise you. With her I was able to say, ‘not long.’

I had turned off the monitor in her room, but from the monitor in the nurses station I watched as her heartbeat slowed. Over the next hour the pace slowed more and more until it stopped. I went in and told her family she was dead.

This was a fairly good death. She was too young, only her early seventies. It was unexpected. But in her final moments she was with people who loved her. They were tender with her. And she went peacefully. Her family will have to deal with the association of Christmas and her death. But, at least in the last hour, she went with grace. She went with dignity. She was without pain. She went with the people who loved her at her side.

Sometimes that is the most that I can offer a patient.

Friday, December 24

Bearry Christmas

bear dance

Hope your family has as nice a time as these bears. Such fun they have in the forest. So much more fun than those booze hounds playing poker.

Thursday, December 23

Litter Makes Us Bitter

I got this in the mail. This is what was on the flip side.
What was anyone involved in this project thinking?
Are they like a blue collar version of Sparkle Motion?
I do like the matching orange shirts, or would you call that tangerine?

Wednesday, December 22

Uncynical Wednesdays: A Musical Venn

Tuesday, December 21

The Blog So Boring It Broke the Internet

So last week I joined a service that counts visits to my site. It gives impossibly intricate information: How much time is spent on each page; Country, state, and city of the viewers’ connection; ‘Referring’ page; as well as things about the internet and connections that are too technical for me to bother to explain. Well, things that are too complicated for me to bother to understand.

It also tells me what keyword searches brought people to the site. Let me apologize to all the parents that found their child 'playing doctor' and were looking for advice. I would have told you to just relax, that it was a normal for kids to do, but then I read some of the details of what they caught their children doing. So sorry, here have some chamomile tea.

And to the other group of people who used the same keyword for other purposes, I believe what the British call ‘Peodophiles,’ Shoo! There will be no lascivious stories here. I will not even use the word h0t, l1ck or l3sbo in my entries for fear of attracting more of you. Go on now.

Some more amusing key word searches are:

Woman asshole boarding
Dumpring recipe
Christmas ornaments on women

Watching all this information was fun for the first 24 hours, but then their entire website went down for two days. When it came back up, there was no record of my account. Oh, they give a good story of ‘hacker attack,’ but you and I know they were just being kind.

Sorry Internet, I will try harder in the future.

Monday, December 20

spent the weekend teaching myself html and css

So this site is going to look a little funny until I smooth things down.

Last Night I Dreamt That Somebody Loved Me

Last night was the Luminaria.

As the Riverside Avondale Preservation Society writes in their newsletter, Luminaria is a Christmas celebration where candles are placed along roads of a neighborhood while people carol and visit. It originated in Mexico, they write, but now has become 'universal.' By ‘universal’ they mean celebrated by upper-middle class whites.

Many people have their Christmas parties that night. Visitors from outside the neighborhood have a lovely drive to your party. And people who live in the neighborhood don't have to watch their own homes burn down when a stray candle sets its bag on fire, sending sparks and flaming wisps of paper into their eves.

So my friend Cecil throws a party and I go, mingling with people I half-know. The doorbell rings and we have carolers.

"This story is old," they begin to sing. The hodge-podge of well-groomed people in their thirties wearing red sweaters seem a little unusual for a caroling crowd. And the song seems both familiar and foreign, like a jazz version of a familiar tune. It sounds like Christmas and it isn't until the next line that I can place it. "I know but it goes on."

Beautiful. I had never thought about it before, but it works as an agnostic Christmas carol. Who would have thought of that?

Last night I dreamt that somebody loved me
No hope, no harm
Just another false alarm

This story is old,
I know but it goes on.

So at the party there was a seventeen year-old girl who knew the surest way to a man's heart was to appear stupid and beautiful. To that end, she was regaled in Gap wear and spent a considerable amount of wit and guile appearing stupid. She won my heart with the line of the night. She asked my friend what he did for a living.

"I work for Charles Schwab,” he said.

"Is he a lawyer?" She replied.

When the party ended a group of us went to Cuba Libre, a Cuban nightclub in San Marco. We were having a good time as we entered and when the doorman asked to see my ID, I said, "I'm old enough to be your father, ya mothafucker."

Logically, I should have been thrown out right there, but apparently last night some unseen force really did love me, because the situation was smoothed over with a smile and a quick apology. Smoothed over enough that I ended up wearing his cowboy hat home which, miraculously, had not burned down.

Feliz Navidad!

Friday, December 17

In/Out Fallout

I was surprised at the anger about the In/Out list.

I have one friend who has stopped speaking to me. One who is still bringing it up in—what I would consider to be—unrelated conversations. And I have heard from several people who, I guess, consider themselves to be arbiters of taste.

People, I am only the messenger here. I don’t make this stuff up. I live in Jacksonville, Florida for Pete’s sake. How am I going to influence such things?

Let me tell you how this worked last time. (It never works the same way twice, so I am allowed to talk about previous methods. Nobody is violating anything here.)

I started hearing that buzzing in my head a lot when I went home for Thanksgiving. When the headaches and vomiting started, I gave the signal that I needed information: I put the Lazarus statue in the kitchen window. The statue was broken, missing his head and most of his crutch. Only two of his dogs remained to lick his wounds.

The next night at two in the morning, I went out to the creek in front of my home with a flashlight and waded in. Duct taped to the underside of the bridge I found a Ziploc bag with a manila envelope inside.

I chucked at the thought of the Illuminati buying Ziploc bags (“Should we get the freezer safe ones?” I pictured the junior one asking. But then I pictured him asking those two women from the commercials, as they were strapped down naked with red plastic balls in their mouths and dental procedure lights blinding them and only seeing his silhouette as he approached with an obscured whirring instrument in his hand and I stopped chuckling.)

So hate not the messenger. Hear and obey. A lot of people in the Western Time Zone are still watching Desperate Housewives. The headaches start just after midnight on Sunday. Maybe it’s TiVo, I don’t know. Just stop. Please. I hate that whirring instrument.

Thursday, December 16

Is This Going To Be Multiple Choice?

The other day, a friend asked me, ‘What kind of an asshole are you?’ So that got me thinking, ‘What kind of an asshole am I?’

The good thing, I suppose, is that I have a lot of options.

Am I the kind of asshole who thinks he knows more than you? The kind who thinks his refusal to correct his—major—flaws is charming evidence of his humility? The kind who was a single course short of a minor in five pretentious and useless subjects? (Sociology, Philosophy, Psychology, Art History & Theater) The kind that would still mention the five subjects after saying they are pretentious and useless? The kind who took a job that was a six-hour drive from anyone he cares about?

But more than all those, I think I am the kind who pretends that admitting all these things means that he is not really an asshole.

Coming Soon: Actual response (hint, it begins with: ‘I am not an asshole, you asshole.’)

Wednesday, December 15

Uncynical Wednesdays

Yesterday I was driving to work and Stephen Bishop was playing on the radio and I was thinking about how impossibly sentimental his songs seem today, but maybe that’s because I don’t listen to music on the radio much. I’d never even heard of Delilah until a few years ago, when I did a brief stint in a prison hospital, and one of the doctors was listening to her show while we played Risk in the double-wide trailer the state provided us. But that’s another story.

Looking back as lovers go walking past...
All of my life
Wondering how they met and what makes it last
If I found the place
Would I recognize the face?
Something's telling me it might be you
Yeah, it's telling me it must be you

I was trying to remembering the first time I heard music that moved me. There is a super 8 of me at four years-old singing ‘I think I love you’ with a ukulele, jumping around the Christmas tree. I can also remember ‘Seasons in the Sun’ when I was six years-old and my father telling me what a cheese-eating song it was. But at the time, I was moved by the romanticism of knowing one was dying and wanting to live for a few more seasons. I have no idea how I escaped being a Goth kid, but it is Uncynical Wednesday, so we won't discuss that.

I started thinking about being a sophomore in college and listening to the Dire Straights. The nature of being up at five in the morning listening to songs that were, frankly, musically and emotionally more sophisticated than anything I had experienced. It’s difficult to articulate what made that song different, because the nature of the song was not—at face value—different. It was another song about love and loss.

But it was different, wasn’t it? You remember it, don’t you? That song you can point to and say, ‘that’s it, hearing that song changed the way I listened to music.’ I remember being so filled with awe for whoever introduced me to those songs that finding the line that separated respect and lust was like untangling a fly fishing line after a bad toss. That led to a few odd mornings waking up in a dorm room, using stale beer to clean the blood off the tiled floor. But that, also, is another rather complicated & involved story.

Juliet the dice were loaded from the start
and I bet and you exploded in my heart
and I forget I forget the movie song
when you gonna realize it was just that the time was wrong Juliet?

I can't do the talk like the talk on the tv
and I can't do a love song like the way its meant to be
I can't do everything but I'd do anything for you
can't do anything except be in love with you

And now many years later, I’m often the one playing music that unravels and reveals what a song is capable of and have those curious audio intimacies. I can still feel my blood thicken and my hackles rise when I hear those songs.

Listen. Sit. It’s dark, and we’re back from the bar, and you’re not going to believe this fucking song. Do you hear that? The way that bass is just a little off tempo, just a little behind? How can a hesitation do that to your chest? Damn it, it’s a good life.

It’s a damn good life.

Tuesday, December 14

Stone Cold Healthy

I was evaluating a 45 year-old woman with chest pain in the emergency room. Obviously, one of our major concerns was the possibility of a heart attack. So I was asking her about things that might put her at higher risk for having a heart attack.

Has she ever had a heart attack before? Does she smoke? Does she have high blood pressure or diabetes? Every question the woman answered a reassuring ‘no.’

I asked her if her parents had any heart problems.

‘Oh, no,’ she said, flatly.

I asked if they had any health problems.

‘No,’ she said.

I asked how old they were.

‘They both died when they were in their forties.’

I asked how they died.

‘Heart Attacks.’

Monday, December 13

Five Things About My Mother

It’s my mother’s birthday today. Here are five things about her:

1) From the time I was seven, my mother and I played chess about once a week. She never let me win, though she would let me take some moves back and from time to time point out her strategy before she executed it. By the time I was 13 and—occasionally—winning, it actually meant something.

2) My mother was nine when the Communist Revolution in Cuba occurred. My grandparents sent her away to boarding school in America before Castro seized their assets. I don't think she fully appreciated the concept of ‘better separated-from-your-parents-and-in-a-foreign-country than red.’

3) When the James Bond movie ‘Licensed to Kill,’ came out. I told her that the title had been changed from ‘License Revoked,’ after marketing surveys revealed that a substantial portion of the U.S. market did not know what the word ‘revoked’ meant. My mother said that not recognizing a word in the title would make her want to a movie. She actually meant that.

4) She has terrible luck with plants. No one knows why, but when she figured out that she did well with orchids, her house filled up with them, making it appear as if she has an amazing green thumb.

5) When I took some time off from college and went to a writing program in Chicago, I was living off cigarettes, coffee and bread pudding. (A loaf of bread, a pint of milk, 4 eggs, and a cup of sugar: you won’t feel hungry for five days) I would make these terribly depressing phone calls, convinced that I had Cancer or AIDS or Lou Gehrig’s disease. (Why else would I be losing all this weight?) She would somehow walk an impossible line of indulging my paranoia without being condescending, and bring me back to reality. I would then get an extra check in the mail with a card telling me that I needed to eat better. Which is a roundabout way of saying that she loves me and has always made sure that I knew I was loved.

Sunday, December 12

Christmas in Avondale

I have been rather critical of this town lately, looking forward to June of 2006, when I finish my program and leave it. I want to like it here, I really do. So when my friend Robbie calls me and says he’s working the charity beer tent at the “Christmas in Avondale” block party and I should come, I agree.

I’m a fan of beer, tents, Christmas, and block parties, so this sounds like a particularly good idea. Avondale is the historic district. It’s a fairly nice area. Not too posh, just nice. When I get there, something bothers me about the crowd, but I am trying to have a good time, so I try not to think about it. Something’s old fashioned, like a Frank Capra movie, but it’s out of place, out of synch. Invisibly so, but still, its there. I try not to notice it. But this Christmas festival looks like the backdrop for a movie where a fiery disaster is about to strike and Ben Affleck or Bruce Willis need to move fast to save us all.

Preciously groomed children are listening to a Christmas poem. An acting troupe dressed in Victorian garb is singing carols. A horse and buggy is circling the block. A group of seventh-graders dressed in black with faces in white pancake makeup are miming, badly.

The mimes are an obvious choice for what’s bothering me, but that’s not it.

When I see one of the hospital administrators on stilts and the chief of surgery wearing tights and juggling, things get a bit more surreal.

I avert my eyes and try to find the beer tent. A disappointment: It’s not a tent, but a beer trailer, and the “Charity” is the Avondale Business Association. Since when is a business association a charity? But if you’d like to donate to the American Medical Association, every little bit does help. “Somewhere in the Lower Catskills there’s a doctor who cannot afford his golf dues. Won’t you please help?”

Miller Light on tap in big red plastic cups and we're back in the crowd. There are too many kids at this thing. Running and screaming, good lord they’re making a racket and one almost spills my beer. I try telling Alex that people shouldn’t bring their kids to these things, but he says they organize these things specifically for kids.

“I can’t even climb on the fire engine, it’s swarming with them,” I say, ignoring him.

We go to the R Roberts Gallery next door that has a recurrent exhibit called “The Secret Art of Dr. Seuss” that is interesting and fun. But I am incredulous of the myth they tell about it.

“Only he and his wife knew about these paintings and sculptures until after he had died.” The gallery lady says, while standing in front of a four-foot-tall professional magazine photo of him doing one of the paintings. His wife was apparently quite the photographer.

The non-Seuss paintings are—as usual—disappointing crap.

So we leave and are walking by The Brick and I see some of the oral-maxillofacial guys at the bar. I wonder in and say hello. From the bar, I see two guys from my department, The Marquee and Casanova, having drinks with Amy, a pharmacy student.

They call me over and buy me a Pinot Noir. I am not sure which one of them is with Amy, and their suggestive banter seems to obscure rather than illuminate who is coupling with whom. I lean in to Casanova and whisper, “Who is she here with?”

“We don’t know yet,” Casanova says.

I toast Amy’s glass.

Earlier in the day The Marquee and I took some prospective interns to lunch to tell them about the program, the hospital, and living in Jax. When they asked what I liked about living here, I had to pause.

After thinking about it quickly, I said that I really liked my neighborhood. I love my little brick bungalow house. I like that there is a creek that runs down the middle of my street. I love that the only bridge over the creek is in front of my house. And I love that the bridge being there means that all the people walking their dogs parade them by my home.

I love that I can walk to the area where I am now hanging out with my friends. I am warmed by the conversation, the wine, and the festive mood. I am thinking that I have been too hard on this town. That I could live here for a long time

So we start talking about how much we love our neighborhood. Casanova is already drunk, but pleasantly so, and he asks three well-dressed older ladies walking by what they like about the neighborhood.

“Evenings like this! The sense of community.” They say, walking to our table. They’re right. Everything is quite relaxed and comfortable. We start talking to them and everyone is warm and friendly. This town really is pleasant. These women are charming and lively.

“The other thing that is so nice,” one of the ladies adds, “You haven’t heard any Spanish tonight. And our neighborhood has hardly any black people, either.”

Neither Casanova nor I are sure we have heard her correctly, but in my mind I can feel Bruce Willis cutting the red wire, when he should have cut the blue one, and I can see myself leaping across the street, scanning the crowd in ultra slow-motion, shouting “Nooooo,” as the block party explodes into a moronic inferno.

Saturday, December 11

Venn Diagram Of the Week

Friday, December 10

We Wish You a Merry (Last) Christmas

Yesterday I spent the afternoon in a specialty clinic.

We spent the afternoon telling people that their hacking cough was no longer just their smoking.

They were now graduates of the Marlboro Academy: They had lung cancer.

Thursday, December 9

Is My Refridgerator Running? Well, Let Me Go Check...

I’ve been getting strange calls from Carson Daly’s Dentist. What’s that about?

I’ve also been getting strange calls from Trent Reznor’s Urologist, but I think I know what those are about.

Wednesday, December 8

Uncynical Wednesdays

You know that kind of soft disappointment you feel when someone you just met is on business in New York and has been calling you once or twice a day, just to say hello, and then you get an email saying ‘Lost my phone. I’ll give you a call whenever I get back into town.’ You know that feeling?

Yeah, I do too.

But you know the feeling when, just as you are shutting down the computer, the phone rings and you see the name on the caller ID, and you realize that ‘whenever’ means right now.

I know that feeling too, and it’s a pretty good one.

Tuesday, December 7

The Christmas Tree Is Up, Don’t Ask About the Stockings.

I am finishing putting up my tree, and it looks nice in my home. I didn’t put it up last year, because I was working in the Cardiac Unit and had no time. So this is the first year it’s gone up in my home. I am listening to the George Winston classic December as I hang the lights and feel warm and remember Christmas on the farm. Going up into the timber to cut down a sapling and hauling it back on my sled. Grandpa popping corn to string as grandma and my sister made orniments out of construction paper. We’d sip hot chocolate—grandpa’s had Peppermint Schnapps in it. Maybe mine did too, just a tad.

So I am thinking about memories of christmas on the farm, and now the lights are hung and I’ve finished trimming the tree and am looking at the bottom of the decoration box and see the three stockings. The names on the stocking are mine, my ex’s, and my dead dog’s.

If you’ll excuse me, I have to go write a country-western song.

While I am doing that, I encourage you to visit the very u
rbane Urban’s enjoyable blog, Drunk Monks. He’s written a Christmas letter for all his StarBucks’ customers who have been complaining about the Christmas decorations that went up before Thanksgiving, he quotes them as saying:

"Isn't Christmas like, two months away? It seems that every year they are starting this earlier and earlier. I can't take it! This is ruining my life!"

Please, all of you, shut the fuck up. This happens every year. It has happened every year since I can remember and therefore does not need commenting on like it's some amazing new development. Bitch about something else. Red colored cups don't change your life.Holiday music doesn't change your life unless you work in the mall and then you are 15 and I dont care. So stop. Please. Stop.

Merry Christmas!

And speaking of Merry Christmas, Tim tells us about a campaign to save him/it.

Monday, December 6

Blogger? I Barely Know Her!

Anyone besides me wondering who that Georgia is? Aside from posting kind words for me, she writes novels and has a thing for Irish beef eaters. Or something. But then again, these days who isn’t into carnivores with colorful accents.

Thanks, Georgia! Or should I say, “Cheers, an’ pass me t’ gravy bits, governa’.”

Speaking of accents, last month, when I was having Dim Sum with my friends Dr Modest and his wife Anna, I started ordering things with a vague Chinese accent. Nothing overt. I certainly didn’t say, “I’d rike the steamed scarrop dumpring, prease.”

But still, my speech was shaded in that direction. Echoing people is something I tend to do. When I spend time with my grandmother, who taught English to Cuban Immigrants on Calle Ocho until she was in her early eighties, I end up sounding like Tony Montana. (She would begin every new class with the warning, in Spanish, “Don’t think after taking this six-month class you’ll be able to speak English. I have been in this country 42 years and I still can’t speak English.”)

Before finishing this story in the interest of full disclosure, I should say that after college people frequently asked me if I was British or Australian. I think that was because they heard a vague southern accent—I spent three of my college years in Tennessee—combined with speaking English correctly and using diction that echoed Martin Amis more than Martin Short. That, and my facsination with “crumpets, stumpets and ham.” (For more on the subject of cultural misappropriation, see SeanBaby’s analysis of the Superfriend's Samuri.)

So I said to Anna, “When People go to London for three weeks they come back talking with a full on Brithish accent…”
“Like Madonna,” she said.
“Yes, Anna. Like Madonna.”
“And Kathleen turner.”
“Yes, Anna, like Kathleen Turner, also. Except Kathleen Turner got all twisted around and sounded like she was taught English from a Romanian immigrant. But Anna, my point is no one ever comes back from spending any amount of time in Hong Kong with any accent at all.”

So I was trying to explain, using a dignified Chinese accent, that I had just spent so much time in Chinatown that I had just picked it up and that it wasn’t intentional at all.

What, thankfully, killed this idea was my complete inability to fake a Chinese accent.
“You sound like a Frenchman,” Dr. Modest said.
“With a touch of Romanian thrown in.” Anna added.

Anna, who has a two-and-a-half-hour commute to work each way everyday, has finally had the time outside of her train, ferry, and bus riding schedule, to blog these pictures of our time together in New York.
In addition to photos of Dr Modest, her and me, she makes use a recurrent theme of bronze, including a photo of the above sculpture from the New York Historical Society, which is having an exhibit on the life of Alexander Hamilton. Follow the link, take a quiz and win a prize.

And you can stop your tittering right now because, no, Hamilton was not a founding member of the New York Metamucil society. It was the Manumission Society.

Everyone makes that same joke, Christ.

Sunday, December 5

The Crapshoot

What’s that, kid?

There wasn’t anything about him being a doctor in the last story? Sure there was. He mentioned the phrase “tonic part of a seizure” and “Basal Cell Carcinoma.” What more do you want?

His hospital life? Not a good idea. Not a place for the kiddies.

What? Stop mumbling. Spit it out, kid. You want a story about hospital life anyway? You want to know how doctors think? Oh, all right, let me think. I’ve got one to tell you. Make it funny? You got it. Where’s my scotch? Thanks. Let me take a sip. Ahhh. So do you know anything about Neurology?

Working for a month in Neurology is, number one, boring. It is month of roaming the hospital, trying to talk to patients who are largely confused, disoriented or comatose. It’s not all that different from a Fraternity party, really, but with less beer.

Number two; the most critical patients—the stroke patients—are the patients for whom you can do the least. Control the blood pressure. Keep them alive. Figure out if they have a treatable underlying condition that caused the stroke. Treat the cause. Keep them alive and send them to rehab.

Number three; if those critical stroke patients can get to the hospital, through the ER, evaluated by the ER docs, and see a neurologist within three hours of their symptoms beginning, then we have a chance at reversing the stroke and nullifying the previous two dictums: Neurology then becomes exciting and life saving.

But those patients are few and far between, most wait too long. And I mean way, way too long. There are two extremes in patients. There are those that show up in the ER repeatedly for trivial complaints (stuffy nose, hangnail, or “does my face look puffy?”) and those that aren’t brought in until they are half-dead. The gentleman I have been asked to see down in the ER falls into the latter extreme. He is not in the category of making it within three hours of symptom onset. He is not exciting. He is one of the critical patients for whom I can do the least.

And while I am thinking about it, kid, it is not the ER that he is going to: It is the ED. They get a little testy about that. It is not a room. It is a department. This is not some cheese filled show with billionaire dilatants getting smoldering looks from residents. If their looks are smoldering, it’s because they’ve been up for going on 24 hours and are technically in REM while trying to listen to you.

This is not some little one-story hospital in rural Alabama. The ED has treated, if the infonet home page is to be believed, 242 patients in the past 24 hours. I can hear the helicopter landing on the parking garage right now, bringing some new tragedy to our doors.

I hate helicopters. I loathe parking near the top of the garage for fear one of those swinging blades will—somehow—snap loose and rip through my car and tear me in half, leaving me laying in the trauma unit of—where, kid? That’s right, not the ER but—the ED.

This gentleman I come to see, he is in the resus unit. Resus is short for resuscitation, not a place you want to be. It means you either just got—or are likely to get—resuscitation. I am reading this man’s chart while standing at the foot of his bed. Let me describe what he looks like the way I would to another physician. He is a 55-year-old white male overweight, slightly disheveled appearance, minimally responsive, not protecting his airway secondary to absent gag reflex, GCS of 8 and then I would go on with information that would become progressively more technical and less interesting.

Let me describe what he looks like the way I would for his wife, helping explain to her what she is seeing. He is nearly comatose, but can still talk from time to time. He is snoring, but it is not a healthy snoring. The difference between snoring and the snoring he is doing is apparent to both the trained and the untrained ear. He has many tubes and lines going into and coming out of him. The blood pressure cuff is self-explanatory. The line in his neck is to give him fluids and medications and to draw blood for labs. The white piece of plastic on his finger is to monitor the oxygen content of his blood. The Foley catheter drains his urine through a tube in his penis.

This is the start. These are the lines he has for now. There will be more. Many more.

I ask her the story. What happened, in her words?

She tells me that after dinner last night she found him sitting in his chair complaining of not being able to move his left side. He told her to bring him some aspirin and let him sleep it off. In the morning, he was still in his chair and she was not able to wake him up.

She is telling me this story and I am trying not to cringe at her words. I am trying to think about how to tell her that her husband needs to be put on a breathing machine. That we are going to need to put a breathing tube down his throat and that we are going to need to sedate him even further than he is au natural at this point.

I am trying to think about how to tell this woman she needs to talk to her husband before we do this, to tell her that the reason she needs to talk to him is because there is a real possibility that he will not come off the breathing machine.

I am trying to think I need to tell her that she is getting ready to talk to her husband of 37 years for the last time, that I will not say, “Last time,” that I will not say “this is the last time. Ever.”

I am trying to think of all these things, but I can’t. All I can think of is this man, last night, going limp on half of his body, not able to move, not able to get up. And he wanted to try to sleep it off.

Last month, after Bush won re-election, the Daily Mirror, a yellow rag of a paper in London, ran the headline “How Can 59,054,087 people be so dumb?” I am thinking right now, as I face this tearful woman, that it is no mystery. Politics are complicated and removed. I know that people believe that presidents do not impact their lives and ask only for a likable president. Voting one way or the other is not so dumb.

Having half your body go dead and trying to sleep it off is dumb.

Bringing your husband an aspirin and going to bed is dumb.

Is that unsympathetic of me to say? Unempathetic, maybe. But not unsympathetic because I do pity this woman and her husband, who—frankly—is not going to leave the hospital alive.

But they did a dumb thing, and not dumb like driving after a couple of beers kind of dumb. That kind of dumb is like voting. You think you understand the risks involved and you take them. That’s part of being human, misunderstanding the risks.

This kind of dumb is driving after a couple of beers, hitting an old man and dumping his body in your neighbor’s lawn kind of dumb. It’s a rolling the dice, getting snake eyes and trying to quietly pick up your bet and lurk away from the table without security stopping you kind of dumb.

And now I am playing the role of the neighbor, waking up to get my newspaper and seeing a heap of a figure lying on my lawn. I am the security guard that has to put my hand on her shoulder and say, “excuse me ma’am, I can’t let you walk away from the situation.”

Are they just dumb? Is it simple denial? Maybe I don’t know. I do know it’s nothing new, and I certainly have no time for people who say it is confined to “Americans.”

But after I tell her everything that needs to be told, and I prepare the equipment to intubate this man, this infuriatingly dumb man, I hear them as she leans close to her husband’s ear and they say words that I have no right to repeat.

And I am focusing on the weight of the Miller laryngoscope in my left hand and I am focusing on seeing his vocal cords so I can pass a seven and a half endotrachial tube through them and down his throat and I am trying not to think of the 37 years that this couple had together.

I am trying not to think of the words that this husband told his wife of 37 years while I call out for meds and vent settings and x-rays.

I am trying not to think that they are the last words that this man will tell his wife. Ever.

Saturday, December 4

Venn Diagram of the Week

Gay as in "My name's John and this is my husband George."
Straight as in a girl saying "Have you seen the internet pic of Brad Pitt's Ass?" or a guy saying "Isn't Hiedi Klum dreamy?"
"Gay" as in your eighth-grade sister saying, "OMG!, Did you see Becky's shirt? That's sooo gay!"

Friday, December 3

Texan Women Fight for Family Values

I first heard of Andrea Yates several years ago when a reporter started a broadcast by saying “Many people in this small Texas town are wondering how a mother could possibly drown her five children in her own home.”

I was able to solve this problem fairly quickly, “She probably used the bathtub.”

But it was a different point the reporter was making. She didn’t know it at the time, but Mrs. Yates was the first of a group of Texan women fighting for a return to family values. Fed up with Hollywood and liberals telling rural Americans how to live, these Texan women began a campaign that has extended far beyond Yates’ “Bathroom cleanup.”

Deanna Laney started a garden landscaping project in her own backyard combining “found objects:” rocks and her three sons’ skulls. Unfortunately, the elitist neighborhood association was not impressed with the project—the vindictive neighbors even pressed charges and an activist judge called her project “insane.” Cheer up Deanna; Olmsted and Vaux struggled for years against New York liberals to make their vision for Central Park a reality.

With all this McDonalds and microwave culture, who cooks anymore? This Dallas stay-at-home-mom does, and came up with her very own recipe. While listening to church hymns on the radio, she “Carved the Turkey.” Of course, when I say “Turkey” I mean “her baby,” cutting off its arms, while reciting bible verses. Perhaps she also thought of the words of this old-fashioned folksy poem while humming with the hymn.

A Happy Home Recipe
4 c Of love
2 c Of loyalty
3 c Forgiveness
1 c Friendship
5 Spoons of hope
2 Spoons of tenderness
4 qt Of faith
1 Barrel of laughter

Take love and loyalty, mix them thoroughly with Faith. Blend it with tenderness, kindness and understanding. Add friendship and hope, sprinkle abundantly with laughter. Bake it with sunshine.

Serve daily with generous helpings
Take that, elitist Food Network who always uses impossible to find ingredients.

Finding the spark has left your marriage because of Alec Baldwin’s relentless assault of internet pornography? Take a note from this happy couple who know that the couple who exorcise-their-three-children-by-beheading-them stays together. The children apparently had become possessed by their dead grandmother. Who, we may assume, was a whore. Or at least did not love Jesus enough, because it isn’t heaven one leaves to possess one’s grandchildren, now is it? Tragically, they have had to defend themselves not only from the secular humanists, but even from their own church.

“Beheading?” their minister said, “Too Islamic for my taste.”

Then we have the case of poor Lisa Ann Diaz, who drowned her two daughters last summer. Of course the left wing media undermined her story. “Talk about a day late and a dollar short,” they seemed to say, “Yates did the same thing years ago, with more kids.” Media attention was nearly absent. She’s clearly considered an also-ran, rarely even getting a name mention.

But we must remember for a campaign to take hold, they can’t all have Betty Crocker’s inventiveness and flair. For these women to call their campaign for Family Values successful, they need people to follow in their footsteps. To say, “This is my America. This is my Home. These are My Children. Whether they be in the bathtub, in the back bedroom, the backyard, or garage. They are mine and here they are.”

God Bless!

Thursday, December 2

The Question That I Get Asked the Most...

Well, it happens a lot. Enough that I would remark upon it.

“Erik,” People ask, “What's in right now? What’s out? How can I tell the difference?”

Well, I answer, that’s a complicated question and to answer it, we're going to have to go all the way back to the Treaty of Kent. Fashions can come and go. People and ideas transition in and out of favor. What causes this? Do the Illuminati really dictate our passions and moods in chambers secured far below the Supreme Court, the Hague, the Vatican and AOL Time Warner Headquarters? (That’s right, in the chamber, AOL has not been dropped from the name.)

In a word? Yes. Here is the latest list.

Read it. Breathe it. Live it. Or that chip they’ve implanted in the back of your neck might just start that incessant buzzing again. And I know we don't want that, do we?



"Bubble" Butt"Washboard" Abs
Baretta AL-391Smith & Wesson 317 Kit Gun
KinseyMasters and Johnson
Tharsis RidgeKey Largo
Twin Peaks RerunsDesperate Housewives
Venn DiagramsMatrix Grids
Marketing for the NFL Analysis for the FBI
Meeting for Happy HourCell Phones
Planet DanDrudge Report
Barack ObamaJohn Edwards
Ryan AdamsToby Keith
Alexander HamiltonNoam Chomsky
Aubergine Bisque
Succotash Chili
Christian BaleRenee Zellweger

Wednesday, December 1

Uncynical Wednesdays

Medical Records

Season Three

Season Two

Season One