Playing Doctor

Initial Visit?

Wednesday, March 30

Uncynical Wednesdays: The Test

Uncynical Wednesdays: The Test
In my office mailbox on Monday there was a manila envelope with a box inside it and no return address.

My name was spelled incorrectly, but, most curiously, it had the initial of my legal middle name, which I haven't used since I was 19 and only shows up on legal documents. The address was geographically correct, but institutionally incorrect. The postmark was March 22 from Pensacola, Florida.

My first impulse was to call the hazmat team and clear the building. But then, something about this struck me as perhaps maybe something other than a biohazard attack.

So I went to the Tuberculosis ward, got an N-95 mask on and opened it in a reverse pressure room.

No powder, thank god. Then, curiouser, a computer generated card that said "Thanks" with a multi-colored background around the letters. Inside in a typed, cursive font, "You're wonderful, Dr. -----!"

The box contained the test: It was a Dove Chocolate Bunny Rabbit.

My first thought of course was, "Who have I pissed off enough to send me a poisoned bunny rabbit?"

There have been a couple of patients who I denied Percocet or MS Contin, but for those people doctors refusing is nothing new.

I have served as mediator for three patients who had fallen into persistent vegetative states and whose families turned ugly against one another. I'm sure I'm on someone's prayer list to get stomach cancer. But, to be frank, those families had difficulty operating the elevator; I don't think they could generate a computer greeting card. (No, I am not using hyperbole.)

Could it have been someone I know personally? Yeah, it could. But two things argue against that. First, it would be weird to send it to my work address and to go through the trouble to find out my legal middle initial. Second, the postmark was from Pensacola. The only person I can think of in Pensacola is a medical student who I like to fantasize had a crush on me, but I don't think that had any basis in reality.

So that leaves you. The most logical option.

I have inspected the box. Factory seal. No pin holes for injecting poison that I can appreciate. It appears to be legit.

(Had the postmark been after last Friday's post, it would have gone in the trash.)

As is, every time I tell the story, the response has been, in a worried tone, "You didn't eat it, did you?"

Of course I didn't.

But that was on Monday.

This is Wednesday. This is the test.

I encourage people to believe in each other. Tonight, I am going to put my money where my mouth is. Or vice-versa.

Tonight, I am going to eat the anonymous Bunny Rabbit.

Tune in tomorrow, true believers...

(While you're waiting to see if I live, you can visit a site Dan created that got him fired from Quikpages.)

Tuesday, March 29

Fist Fights with the Disabled

Fist Fights with the Disabled
On Saturday, I saw a man yelling at my mother.

I walked out of a store, just in time to see a man in a blue Mercedes convertible shouting unspeakably foul things at my mother, who was sitting in her car with the windows up. I take it there had been some disagreement about who had the right of way into their parking spaces before I arrived, but they were both parked now.

My mother could not hear what he was saying, but she could see his hand gestures and that his mouth was opening and closing rapidly. She just looked at him, not moving, not saying anything. He took a break from his rant as he removed his seatbelt, and started to get out of his car, but continued to stare at my mother.

If you have never seen your sweet mother yelled at by a fat, bald asshole, let me tell you it makes the Clint Eastwood aspect of your hippocampus take over the entire brain. And I don't mean the doddering, sentimental Million Dollar Baby Eastwood. I mean the ruthless, violent High Plains Drifter Eastwood.

I have been told that my walk is typically a saunter, but it formalized. My shoulders went back and apart. My chin went upright. I walked to my mother's car with purpose. Not hoping he would say anything, but preparing what would happen if he did. I leaned against the car facing him, waiting for my sister to come out of the store.

Apparently, seeing me against my mom's car took down his resolve to continue his fight with her. I gave him a glare that effectively communicated, "If you say one more word or even look at her, I am going to take that handicapped sticker off your rearview mirror and shove it so far up your ass I'll hang it off the dorsal root of your lumbar spine. You'll gain a new understanding of the word handicapped."

He looked at the ground and walked into the store.

What are you staring at me like that for?

I mean, it's not like he was in a wheelchair or anything. Doesn't the fact that he was driving a Mercedes convertible count against him on some level? Did I mention that it was a natural food store?

Oh, God. What have I done?

But just wait until it happens to your mother. You'll be beating someone's grandmother over the head with her own walker.

Here is your Planetdan link for the day.

Monday, March 28

Playing Planetdan

Playing Planetdan
With all the talk in the media nowadays about the blog wars, with real life violence spilling out into non-virtual reality. I thought I would take a week out from the Silicon Valley drive-by shootings and Microsoft Thug Life, to help spread the peace.

Dan, of got a lot of notoriety last summer by posting a series of high school glamour shoots with appropriate captions. He even got kudos from Cruel Site of the Day. But it is unlike Dan, as far as I can tell, to be cruel, and he even went so far as to pixilate their faces, and posted a note for anyone who saw themselves and was offended, to let him know and he would take their picture down.

I am not sure what happened next, but I do know something about a lawsuit was involved and he had to take down the entire thing.

But while the episode gave him a moment of notoriety, he has been consistently amusing us. His posts range from found internet objects and the misadventures of him and his friends, to confronting his (largely imagined) obsession with cleanliness.

He is from Minneapolis and his writing reads like notes from a warm-hearted friend. Even when he is poking fun, he does so with a distinctly Midwestern kindness.

So for the rest of the week I'm going to leave this stage-set looking like this and each post will include a link to one of his that I have found particularly amusing.

So here's to Dan, who remembers that Blog Violence is wrong, both virtual and non-virtual. Dan, keep keeping the peace.

Public Service Announcement

(Note: But why does Blogger have to hate? My quotes appear like “ in all my archieves. His blogger font does not recognize.)

Friday, March 25

Would You Like To Play a Game?

See if you can match the description with the appropriate image below.

Good luck, and no cheating!

1. 2.

3. 4.

A. Proof that modern science has mastery of life-over-death
B. Technological abomination against God
C. The living undead
D. The logical quarry of pitchfork-wielding religious mobs

(Note: Multiple answers may apply to certain images)

Thursday, March 24


I took my brother Anthony to the race track yesterday. I love it there, because it feels like old-time Miami, with old men in stained guayaberas smoking cheap cigars.

When we got to Gulfstream track, we found the grandstand had been torn down for renovations, and were relegated to a series of tents. We were stepping into the rain to watch the horses being circled in the paddock, then into the tents to place our bets, and then making the 200 foot trek to watch the race itself.

Papa Mark had printed out all the stats for the jockeys and trainers, as well as the favored odds and was explaining different gambling rationales to Anthony. Papa Mark usually does pretty well at the track, given that it is not fundamentally different than what he does every other day of the year: trading stocks. But I was the big winner yesterday, winning on a thirty-to-one longshot. Then I blew my winnings on a series of losing longshots, filled with the hubris that winning a single longshot will give you.

The other reason I love going to the tracks is simply to watch the horses.

I grew up occasionally riding but was never formally trained. My old roommate Tilden used to take me riding with her and would invariably give me this difficult mare. It had thrown a rider once and now had a bad reputation.

“No one has ridden her since the last time you were here,” she’d say.

I thought she trusted me because I had told her my man-versus-horse story.

When I was nineteen, I spent two weeks in South Carolina painting my uncle’s place. He had a horse, but it hadn’t been ridden in a couple of years. In a ‘controlled’ space, I put the brindle on it and climbed on bareback. The horse hated it, but submitted after not too long. I did this a few more times in the controlled space. By day three, I took him out for a real ride in full saddle.

We were out in a field, at full gallop, riding along the edge of the timber, when without warning, the horse turned into the woods still at full gallop, not on a trail, just racing through the trees. I was being hit with leaves and branches and thistles.

I circled the reins in my left hand and pulled—hard. The horse was running with his head crooked at ninety degrees. Still running at full gallop. So I reached across with my right hand, grabbed further up on the rein and yanked laterally, twisting the horse’s neck back and up with everything in me. The horse finally stopped.

Less than an arms-length in front of me, at the height of my chest, ran an eight-inch thick tree limb. At the speed we were going, not only would it have knocked me off the horse, it would have damn-near killed me. My heart was thumping so hard in my chest it was almost painful.

“Fuck you,” was the first thing I said, beginning a venomous diatribe against the now stopped horse.

Though now scared shitless and bleeding on my face and arms, I wasn’t about to give the horse the satisfaction of getting off him and walking home. I turned him around and we slowly made our way out of the woods and—slowly—back to my uncle’s place. The horse never tried that shit again during our daily rides for the remainder of my stay.

Though it’s not a story that I often tell, Tilden knew it. I thought that was why she gave me the difficult horse. One time though, she explained her rational.

“I just don’t know anyone else with an ego bigger than that horse’s.”

Wednesday, March 23


miami skyline

Having a lovely time in Miami.

Ocean Drive

Spending the evenings at Winter Music Confrence events,

lifeguard shack
and the afternoons getting rid of my medical resident pallor.

Crockett and Tubbs
Thinking about old friends.

Wish you were here,


Tuesday, March 22

Las Sucias Primas

It was my grandmother’s 87th birthday this weekend, and we had a party for her.

I was sitting next to Mamita as she opened her cards and was a bit surprised to see A dirty birthday card or, in Spanish, Una tarjeta sucia.

It was signed by my cousins Toter and Sissy. Someone teased Mamita that it was her new boyfriend. She protested, ‘It’s too late for me.’

It was an odd card to give your grandmother. This is the same woman who, when my mother was a teenager and asked about the birds and the bees, told her, ‘It is just something that a woman has to do to keep her husband happy. The best thing to do is to lie there and think about something else.’

This was the sixties, so my mother marched down to the Public ‘House of Filth’ Library, and read a book on the subject. She became well-educated on the matters of anatomy and procreation. She discovered that, when a man and a woman love each other very much, or when two animals, human or otherwise, are adults, a woman’s vagina can envelop a man’s penis, accepting his sperm to fertilize an egg and make a baby.

(Though I doubt the book offered a post-feminist conception of the sex act)

What the book failed to mention, apparently, was that there was motion involved. She believed that the man and woman would simply hold each other like this until ejaculation occurred. When she told me about the birds and the bees, she told me that she freaked out the first time she had sex and the boy started moving. I guess she did not want me to be surprised, thoughtful, but an unnecessary warning.

Anyway, when Toter and Sissy saw the card they were more surprised than I was, apparently my other cousin Pappi had signed their names and thrown the tarjeta sucia into the pile. They were falling all over themselves to explain that it was a ‘practical joke.’ Joke is easy to translate into Spanish, but practical joke is a little more idiomatic.

When I could see Mamita was getting ready to start laughing, I hugged her, pulling her face into my shoulder and pretended to comfort her, while my mother mock chastised Sissy in Spanish ‘You dirty, dirty girl!’

Monday, March 21

I Don’t Have To Sell My Soul. . .
He’s Already In Me.

There was much disagreement about where my family was going to church yesterday. Most of the family wanted to go to Unity on the Bay. The music is better, I’m told, and the congregants are enjoyable. Dad, however, wanted to go to the Unitarian church out in South Miami. Dad, can be a pretty vocal advocate of his way, but this time it was me who was doing the advocating. The Unitarian church is near Tropical, which arguably has the best dim sum in Miami.

But in the course of the debate, my sister pointed out we could just go to dim sum, and skip church altogether, which put too fine a point on the discussion, so the Unity crowd won out.

When we got to the church and were waiting for my sister, my dads started talking to a friend of theirs. The friend was telling a story about someone in Minnesota who told him that there was a real problem with a chat room in St. Paul called ‘the crystal room’ where people would find others on crystal meth and have sex for thirty-two hours.

‘In the chat room?’ Papa Mark asked.

Apparently not. The story ended with someone having to go to the emergency room after having so much sex that their penis was rubbed raw.

‘If it happened in Minnesota it was probably just frost bite,’ I said, quietly.

Dad heard me and repeating the comment louder. Then everyone started talking loudly about chat rooms and sex, and I reminded them that we were in the sanctuary. My sister arrived and the service started.

Now, for all the talk of the music being exceptional, and having a six-piece band with a choir that looked like they were dressed for a Genesis reunion tour, the sound mixing was unbelievably bad. The bass and organ were mixed high, and the choir was muddied. It sounded like it was mixed by a hung-over Bob Mould. This sounds vaguely interesting, but it was not.

The soloist, a black gospel singer, had an impressive voice and wore a pretty pink sundress, but had a wrap that looked like it was a macramé made of kelp.

A woman read a mediation, which started with a long section from—what I swear was—The Hobbit, with mentions of ‘the middle realm’ and 'the race of man.' It segued into the Book of Matthew, and finished with a poem from Kahlil Gibran, if I recognized everything correctly.

I read the title of the sermon as ‘The Gelding Christ’ but re-read it and saw it was the ‘Guiding’ Christ. While meticulously written and having a couple of good quotes, it was rambling and did not have much point, except that Christ’s peace makes you forget your worries.

Yeah, well, vodka gets the job done too.

At the end, everyone stood up and started swaying back and forth. When everyone started singing hand-in-hand, the lesbian next to me tried to take my hand.

‘I’m sorry,’ I whispered, ‘but that isn’t going to be happening.’

When the children’s choir came out, I looked around and saw all the couples arm-in-arm, others holding hands. Boy couples and girl couples, and boy and girl couples. I saw some couples looking with pride at their children; others looked with the yearning of childless nesters. They didn’t seem to notice that the sound was mixed like shit.

I saw all these gay couples and was not thinking of how much money could be made in ministering to them. In meeting the spiritual needs of people who have been rejected by the churches that they grew up in. The churches they considered home.

Instead, I focused on the joy on their face. Worshipping hand-in-hand. They didn’t seem to mind that the sermon was theologically conservative. Rather, they embraced it.

I’d have a hard time denying that I felt Christ’s presence there, but He’s such a cheese monger, he probably didn’t mind the shitty soundboard either.

Friday, March 18

Three Steps to a Cynical Friday

This post has a soundtrack. You can stream it or download it.


I worked overnight on Saturday night and a woman came in with a blood pressure of 230/135. For those of you who don’t know what a normal blood pressure is, the upper number—the systolic pressure—should be less than 120. Once it hits 140, every single digit higher puts you at higher risk for a heart attack and stroke.

She had a history of coming into the emergency room with blood pressures above 200. Usually she was complaining of a headache that would resolve when the pressure was brought down. She had been given multiple prescriptions for blood pressure medications, been given multiple appointments to a regular doctor. She said the medicines were too expensive. She could not say why she did not keep her doctor appointments.

She came in to the emergency department on Saturday night, not having taken any medication since the last time she was admitted to the hospital three months ago.

The only difference was now she was partially blind.

She reported her vision started going bad a month ago, along with a headache that had slowly progressed until she could not take the pain anymore. The CT scan confirmed she had infracted a good portion of the left side of her occipital lobe. A couple of old small strokes were also seen.

She was saying that it was too late now, that there was no use in pursuing treatment. She was right; she would not get her vision back. But it was difficult to get her to appreciate that she still had her kidneys, her feet, her heart, and most of her brain. That as bad as the situation seemed, she had many body parts left to loose.

Now I know, like any good liberal does, that it was Phillip Morris’s fault that she was still smoking. I know that it’s Reagan fault she doesn’t have a decent education. Nixon’s fault that Medicare pays for emergency room visits but does not pay for the pills to prevent the visit. And W. Bush’s fault that the economy is so bad that she works at Joe’s Sub Shack.

But like an even better liberal, I don’t want to give her any excuse in the world to continue smoking. She could use the ninety dollars a month she saves on cigarette money and spend the forty dollars on her medications and use the remaining fifty dollars for a gym membership and fix her morbid obesity so she could get off the medications.

I spend twenty minutes talking to her. Explaining that while she has lost some of her vision, there is still much to loose and therefore much to save. I explain that it is important to control her blood pressure every single day from here on out, not just when the headaches are bad. It’s my ‘Come to Jesus’ talk. We map out the different prices of drugs. I explain that I can create a cheaper regimen but that she will have to take pills more frequently. She chooses the cheaper option in the choices I present to her.

As I am walking away, a nurse tells me, “If I came here, I’d want you to be my doctor. You take the time to explain things to your patients in a way they can understand it.” Nurses are usually not so forthcoming with their compliments, especially with medicine residents, so I feel good about my exchange with the patient.

Then yesterday morning, I am told that she came back to the emergency department in the early morning hours having a heart attack. Her blood pressure was 215/128 on admit. Apparently, instead of filling the prescriptions, she mailed them to a company that had a two week turn around time.

I try to blame Benjamin Franklin’s Pony Express and the US Postal Service, but my efforts are lackluster.


Later in the afternoon, I’m working with a 22 year-old who, several years previously had been an architecture student when he jumped into a shallow pool and shattered his vertebra. Being an intelligent young man who had the world going for him, he was delighted to now be a quadriplegic whose weekly outing was playing checkers with his aunt.

He had debilitating nerve pain that required huge doses of not only narcotics but anti-epileptics as well. A side effect of the anti-epileptics was migraine headaches whenever he tried to read.

The attending and I discuss with him the particulars of what we were doing to fight the infections in his skin. When one cannot move, holes begin to burrow in the pressure points of the body. Infection can set in easily. We were treating the infection, and the holes were closing. We tell him we can give him medications, but his role in the treatment was to not give up. The young man and his father begin to weep when we said this. We talk serenely and give him and his dad some encouraging words and comfort, I hope.

The attending and I then walk back to her office. By the time her door is closed, she was trying to prevent herself from sobbing, while I go into her bathroom and begin vomiting.


Last night, I’m in my bedroom putting my clothes back on and I can hear [name deleted] from the bathroom telling me: “I love [name deleted], but we have not had sex in over three months. I just needed a release tonight without any emotional entanglements. You’re safe. I knew I didn’t have to worry about any emotions coming from you. I learned that the hard way.”

I am standing in my boxers, alone, but not, wondering if my life has really become such a soup opera cliché that these words are warranted. I am trying to think of something to say that is honest but not hostile. But I can’t. I can’t think of anything to say.

I can’t even think of anything to think at this point in my day. In this point in my week. In this point in my life.

I need a vacation. Tonight, I’m going home to Miami for a week.

I’ll try and send a postcard.

Thursday, March 17

“For Reasons That Will Be Made Clear Later…” an associate of my sister likes to say.

For reasons that will be made clear later, I am under contractual obligation to not discuss certain aspects of my personal life.

Apparently, some of my recent posts have been edging close to violating that. The post that I had planned for today, I am told, would have gone over that edge.

This whole thing will loosen up in late June, and it will be cleared up at that point.

For today though, a reprint from The Onion, which is free every week and you should read it. If you find it funny, it’s worth the $39.95 subscription price to go through their archives.

As a side note, the reason mouth-to-mouth was eliminated from CPR is they found that Americans have become so fearful of touching other Americans (Thanks Jane Pauley and Catie Couric!) that they were ignoring their countrymen as they lay dying.

It was decided that if we could at least get them to do the cardio aspect of cardiopulmonary resuscitation, it might have better results then treating our fellow man like diseased dogs.

(I guess it’s Cynical Thursday.)

Wednesday, March 16

Uncynical Wednesdays

Two years ago, my aunt had a lovely party for my sister and I. She had just seen a Disney ‘documentary’ on ‘Searching for Atlantis.’

She talked about the search around the world for the lost city and how they had found it. At first I was going to challenge her, but at my first objection, she countered: ‘Erik, Disney is a huge corporation. They are not going to put this on the air if it isn’t true.’

I thought about pointing out they had just released an animated film about Atlantis, but saw that would go nowhere, so I decided to sit back and just enjoy the ride.

She was telling us that satellite photos had now confirmed Atlantis’s location between Cuba and the Yucatan Peninsula.

I was saying, “Really? I had no idea!”

She showed us clippings and articles from newspapers and magazines.

She’s so intelligent, loving and trusting.

Though Cognitive Science is not advanced enough to prove it, I suspect there are neurotransmitters in our brains that cause us to doubt the veracity of information we recieve.

I clearly have an excess of it.

I wish I could donate some of mine to the needy.

Tuesday, March 15

Favorite Lines

Favorite Line in Music History

Joni Mitchell~ A Case of You

Just before our love got lost you said,
‘I am as constant as the northern star.’

And I said,
‘Constantly in the darkness? Where’s that?
If you want me, I’ll be in the bar.’

Favorite Line in Movie History

Alien vs. Predator

“The Aztec calendar was based on the metric system. I suspect the pyramid is going to change every ten minutes.”

(Apparently they used a metric system based on sixty-second minutes.)

Favorite Line in Television History

NewsRadio~ The episode where Andy Dick becomes super intelligent, reading six textbooks simultaneously and writing comments and corrections in the margins while doing so.

Andy Dick: I understand public radio now.

Dave Foley: Oh my God. You understand everything they talk about on NPR?

Andy Dick: No. I understand that it’s bourgeoisie crap masquerading as intellectual discourse and I don’t have to understand it.

Monday, March 14

A Different Kind of Home Depot

Yesterday, my friend Cecil called and asked if he could borrow my lawn mower.

“You could,” I reminded him, “ except you’ve had it since last November.”

“You didn’t come and get it back at some point?” he asked me.

“No,” I said.

“Okay, well I’m heading to Home Depot.”

Cecil and I like to hang out at Home Depot. We have some of our best conversations arguing over which herbicide to use (Ortho Weed•B•Gon) or whether the Black & Decker cordless is really worth that much more money. (It is.)

The invite always starts that way “I’m heading to the Home Depot.” The refrain is “what are you getting?”

“What are you getting?” I ask.

“A lawn mower,” he said. “I was hoping you had picked up yours. Someone must have stolen it.”

Friday, March 11

Who Doesn’t Love a Good Doughnut?

Here’s the hat and delicious doughnut I enjoyed last Saturday in Atlanta.

The past couple of weeks I’ve told some rather long and involved stories. Y’all’ve been pretty good sports about all that, so next week I'll give some fast and funny stuff.

Punch things up a bit.

See you then...

Thursday, March 10

I'm Paul Harvey and this... Is the Rest of the Story.

Woke up at 10.

Go to Starbucks, which everyone on the internets has been badmouthing lately. There is a man there who looks like an extra from Braveheart. He is this huge burly man with a plaid kilt, scraggily hair and beard. And a fanny pack.

I am trying not to laugh as I watch him handing out cards to his website. He is telling a man from Scandinavia about how he is walking from Georgia to Maine, the Appalachian Trail, over 2000 miles. I am thinking he should be telling the Swede how many kilometers it is.

Then he takes off his shirt to show him his huge tattoo with a ribbon that takes up most of the right side of his back. I think it had an American flag and names listed and it looked like a memorial of some kind, but I averted my eyes when it started, so I can’t be sure. He then threw his shirt on, ran outside, and started jogging down the middle of a four lane street.

I don’t see him making it to Maine unless he learns some road safety.

I thought I would find his website for you, but it turns out he is not the only nutcase walking from Georgia to Maine in a kilt. So the next time you feel like you will never meet someone with your own particular form of crazy, you can feel even worse knowing that this severe form of crazy has a Folie à deux, while your penchant for Orwell, buffalo wings and Woodford Reserve makes you an island.

Toph and I meet up with his ‘friends’ Joey and Chandler for lunch at Gladys Knight’s Chicken & Waffles. Dan is also there, but I called him Ross. (I had the malted with a breast, black-eyed peas and collard greens. I drank the uptown—sweet tea with lemonade.) Then they had to go buy an iPod for Monica, so I went back and took a nap.

That night, we went to Decatur by train. Joey is an Ob/Gyn, so we tell a few med stories. He tells a great one about a woman who presented to his clinic complaining ‘her dog has worms, and now she sees them in her vagina.’ Delicious! But I’ll let him tell the whole story in the comment section, should he choose to do so.

I told him one of the few jokes I know, because it is an Ob/Gyn joke.

Q: Why do they call it PMS?

A: Because mad cow disease was already taken.

As I was telling the joke, the train went entirely quiet. I became nervous that the other people on the train would not find the joke ironic. I’m not sure why I even told it. To be honest, I don’t really find it funny. What I do find funny is that jokes like that still exist. It was so vaudeville. Set-up, punch-line, rim-shot!

But enough with the frog dissection.

We went to a Belgian Bar that served the first decent blonde beers I have found outside of Europe. Everyone drank a lot. I met their friend who is a blogger, Byron of Bitterbug. He uses Typepad. I wasn’t sure if they were Blogspotter’s rivals and I was supposed to feel some sort of animosity, but he seemed pleasant enough, though his beer smelled like maple syrup.

We hit some other bars and on the way home got some doughnuts and hats.

Had lunch the next day and headed home. On the way back I listened to The Moon and Antarctica by Modest Mouse, The Baja Sessions by Chris Isaacs, and Being There by Wilco. (both discs)

Q: So the verdict on Atlanta?

A: Atlanta is My-Lanta!


Wednesday, March 9

Uncynical Wednesdays:
Atlanta Edition

I went to Atlanta this weekend, my first time back since the early eighties. My dad, sister and I drove from Iowa to Miami about once a year back then, and we stopped in Atlanta once. We ate at a revolving restaurant at the top of the Peachtree Plaza Westin. So I’ve seen Atlanta before, but from very high up and from very long ago. I was looking forward to seeing it again.

Once clinic finished on Friday afternoon, I started the drive. It was a nostalgic drive; I-75 through Georgia brings back those childhood road trips. I listened to Gold by Ryan Adams again and again as I drove along the darkend highway, and he makes all these musical references to seventies style music, which furthered the aura of the memories. I also listened to Liz Phair by Liz Phair, and The Big Express by XTC. It was a good road trip.

When I got there, I met Toph and we went to Hoedowns, a country gay bar. Now, I grew up visiting Key West guest houses, cleaning up after coffee socials for ‘Coming Out Support Groups,’ and chatting politely with drag queens at Sunday picnics. I have been around the city block with such things. I have even seen gay line dancing before, but this was different.

I think when I had seen it before, the boys were doing it as a lark. But these boys believed in what they were doing. They were not beautiful and svelte models playing shitkickers. They did not look like they were dressing down and in costume.

They looked like, frankly, country folk who got dressed up to go out. Some were in t-shirts with un-ironic logos, but mostly they were dressed nicely: Jeans with big buckles and plaids with shiny-snap buttons. Cowboy boots were de rigueur. Many were portly. Their hair didn’t have product, or at least looked natural. The scents were subtle, understated, and I doubt name brand.

But here’s what struck me. These men were happy. They had carved out this niche of a place for who they were: Gay cowboys. Not in some hypersexualized hypermasculine ideal—boys were getting twirled and do-se-do’ed—but a successful hybrid of gay and southern cultures.

I was rather delighted for them. I watched them do the Barnstormer and the Two-Step. The caller reminded people ‘if you are free stylin’ get to the corner and out of the way’ and ‘if you’re holding a drink on the dance floor, hand it off to a friend not on the dance floor.’

Later on that night, at some mid-town bar I can’t remember the name of, I met Harriet Tubman’s great-great-grandson who was so nice and likable that I wanted to like him for himself rather than being Harriet Tubman’s descendant, but honestly, I couldn’t really get past being a bit star-struck.

How can you possibly get past Harriet Tubman?

Somewhere else, a tall blonde girl was promoting Southern Comfort and offered me a t-shirt if I bought a shot.

I don’t really remember what happened to that shirt.

I went to sleep around 3 am.

Tomorrow: The rest of the trip.

Tuesday, March 8

Old Masters 2002

Matthias Herrmann is very German.

But I thought this piece was a funny, modern take on the Old Dutch Masters aesthetic best exemplified by Jan Davidsz seen here, here, and here.

And if they were anything like their modern Amsterdamer counterparts, and I know they were, they would think so too.

Friday, March 4

I Got Called an Arrogant Asshole Last Night

I was saying goodnight to a group of people I had met last night, and one of them did that bar thing when they imagine no one will hear them.

‘Good night.’ Then as he turned said, ‘now go away.’

‘Excuse me?’ I said.

‘Oh, I said I hope you don’t go away.’

‘No. You didn’t.’

‘I’m glad you’re leaving. You’re an arrogant asshole.’

Now, just so we’re clear. I didn’t have any argument or disagreement with this man. I didn’t hit on his wife. I was actually pretty quiet all night.

‘I’m sorry. Have I done something to offend you?’

‘It’s your whole manner. It’s your whole Northeast attitude and you don’t respect people beneath your station in life.’

I am not from the northeast, but I thought that would be pointless to explain. The whole 'station in life' bullshit occurs when people know you are a doctor. Someone typically has to ask what I do three times before they get that out of me. One of his friends asked three times, so they did know. I handled it the way I usually do.

‘Well, I’m sorry if I offended you. Was there anything specific I did?’ I asked. He started going on and on about my ‘manner’ and then finally said I talked over someone’s head. I didn’t remember talking about anything that could even vaguely be construed as over anyone’s head. So I asked if he meant literally, which—I confess—I sometimes do. He said no.

The only thing I said that might be over someone’s head was when he said that Maxwell House, which does its roasting here in Jax, missed a tremendous opportunity by not advertising during the Superbowl. I said that national companies probably wouldn’t have that much to gain by advertising that they are housed in the Superbowl town, because Superbowl advertising is so expensive. He responded, ‘think of all the Superbowl fans who drink coffee.’ I changed the subject after that. So I only made one comment, and advertising and marketing are not exactly rocket science.

Still I apologized one more time.

His friends had all abandoned him. He started again telling me about ‘my whole manner’ and I cut him off.

‘I apologized if I offended you three times. Now, I’m done.’ I said and walked out, like the arrogant asshole that I am.

Wednesday, March 2

Uncynical Wednesdays:
Doctor Erik’s Science Project

Hour five through seventy

Since making it to the ICU the girl has been in and out of consciousness, groggy, then asleep, then groggy and moaning, but this morning she’s out. She’s no longer protecting her airway and needs to be intubated.

Yesterday, when we delivered her dead fetus, we’d hoped that doing so would lessen the stress on her body, that she’d start to improve. But she has worsened instead.

I try to call her husband to tell him about what’s going on. But the person answering the phone tells me he’s at work and cannot be reached.

“He needs to be reached,” I said. I had already identified myself, “Now.”

“Is everything okay?” the person asked, crying.

I typically defer on this question, this time I said, “No, its not. He needs to call me.”

By the time he called back, she was intubated.

I explain to him that the liver failure was fulminant. A word as ominous as it sounds. Her liver was so badly damaged that it was not clearing the toxins from her body and her mental status was continuing to deteriorate. This could signal that her liver was on a downward slope toward rapid destruction and might require a liver transplant.

The one good sign we had was that her liver enzymes were returning to normal, but there was debate among the physicians.

Enzymes can return to normal for two reasons. Either the liver damage is resolving or it has simply burnt itself out. I argued the former, pointing to other labs that did not suggest a burnt out liver: her coagulation studies were only mildly elevated. But the other physicians on the team felt that it was simply too early to see the effects in the coags. That the mental status was worsening supported their interpretation.

I continued to argue with the team against transplant. If she could make it through this without one, she would live a lot longer than with someone else’s liver, which would require her to take a lifetime of complicated and potentially hazardous drugs.

“This woman isn’t competent enough to handle Tylenol for Christ’s sake; can you imagine what she’d do with immunosuppressants?”

But I called the transplant team and presented the case, explained the other physicians concerns as well as my own interpretation of the labs. The transplant surgeon and I decided to keep her where she was for now. We would continue monitoring her and inform them of any changes.

It was a busy day for me. But thankfully, by the next morning she was doing better. The coags not only were not worsening, they were improving. The liver had not, in fact, burnt out. It was recovering.

The day after that we were able to extubate her, and return her to the OB/GYN floor.

I recommended a Hepatitis Vaccine series in the future and a psychiatric consult in the present.

The funny thing is that she was mostly unconscious for her stay in the ICU, so though I had delivered her dead baby, kept her alive and was her advocate in allowing her to keep her own liver, if we ran into each other on the street, she wouldn’t recognize me.

Her entire extended family would know me. I had held their hands and handed them tissues as they sobbed in fear and mourning.

But she would not.

I am just another face in the crowd.

Tuesday, March 1

Dr Erik’s Science project

Hour two through four

I am explaining to the girl’s husband that the ultrasound did not see any motion in the heart of the fetus.

I continue, saying that it also showed ‘a lack of fluid around the baby. Suggesting that your wife’s body is reabsorbing the fluid.’

I am torn about the semantics of the situation. Should I be saying ‘baby’ acknowledging the loss he will be feeling? Or should I opt for the technically correct ‘fetus’ perhaps softening the emotional impact?

The girl has been brought up from the Labor and Delivery floor and is now in the medical Intensive Care Unit. This reassures me.

Labor and Delivery nurses are superb at what they do, bringing new life into the world. But when things go bad, they can get emotional. They are used to seeing life begin, not end. I have left codes on their floor to see the nurses crying in the station. I thank them for the help they gave during the code. I try not to show any scorn for allowing their emotions to frazzle them ten minutes previously when I needed a well-oiled machine.

Thankfully, when a code is called in my hospital, ICU nurses are also part of the code team. As soon as they arrive, I excuse the L&D nurses and let nurses from my team take over. They can operate a code flawlessly. When I call for a drug, they respond by verbally confirming the dose they already know that I want. They call my attention to things that I might miss. They suggest plans of action. When the decision is made to intubate, they have everything ready without me saying anything but ‘miller three, seven and a half tube’ often they are the ones who say that, simply confirming what they suspect I will use. With them there I can think about the patient, rather than the process.

So with the patient in the ICU, I breathe a bit easier, knowing that if things head south for the girl, I have flawless support. Though the fetus inside her is dead.

‘Your baby is dead,’ I say.

‘It’s probably for the best,’ he says.

I try to read him. Is he affectless? Is he just numb from the news? I don’t know how to respond to what he’s said.

I have to admit I have a flash of anger. Had she taken the Tylenol intentionally? Was this all a botched attempt at a self-induced abortion? I start to feel…what? Angry that abortion isn’t safe and legal? It is. So am angry that it isn’t an emotional option for people so they commit stupid atrocities to their own body? I start to feel… Well, I start to feel period.

So I find that little box inside me and put my feelings in it, and there we go…All better.

‘We’re going to give your wife some medicines to induce labor,’ I say reassuringly, ‘to expel it.’

It’s a busy day in the hospital. Though the OB/GYN comes up to check on the woman occasionally, a dead fetus does not require the close monitoring that a live one would. So it largely falls on our team to monitor her progression. We are simply trying to rid this woman’s body of what ails her.

My attending starts referring to her room as ‘Doctor Erik’s Science Project.’

After an hour or two, her heart rate increases to about 150 bpm, and her blood pressure climbs significantly. I suspect she is in pain, so I order some morphine. It does not help. I talk to my attending. He points out the obvious.

‘Erik,’ Dr Pasteur drawls, ‘you’ve induced labor, what did you think her cardiovascular response was going to be?’

My intern comes up to me. ‘Something’s going on in her room. The nurses said they don’t want me. They want you.’

I go in and see there’s a bloody pool of fluid between the patient’s legs. The head of the fetus is already out. The placental sac has not ruptured and the head is obscured through its thin lining with a small amount of fluid surrounding it. I ask the nurse to page an OB/GYN physician. I lift the head slightly, and the rest of its body slides out easily. The bleeding continues. I examine the fetus and the placenta. The placenta is in almost a single piece, but there is some missing.

And she is still bleeding.

There is much activity in the room. The nurse, the flawless ICU nurse, is hyperventilating. A second nurse sits her down and puts her head between her legs.

I introduce my hand into the uterus, feeling along its sides for a piece of retained placenta, which can cause hemorrhage. There is one sizable chunk, about the size of a cafeteria’s slice of pumpkin pie. I remove it and massage the uterus from the outside with my left hand and from the inside with my right hand. After a bit the bleeding slows considerably, but I am relieved when the OB/GYN arrives and confirms that the uterus does not have any retained placenta.

I see the OB/GYN look at the ICU nurse, sitting on a step stool with her head between her legs. Neither of us say anything, but it is the same look I give the Labor and Delivery nurses when I leave a code and see them in the station crying.

We examine the fetus.

‘What do we do with this?’ I ask.

‘It goes to pathology.’ She tells me.

‘In what? I don’t have a specimen cup big enough for that. And it’s too small and slimy for a body bag’

It turns out they have a kit designed for fetuses. We get one from the L&D floor and send it to pathology.

With most patients, the worst case scenario is 100% mortality. With pregnant patients, there is the possibility of 200% mortality. We already had 100%. The next step was preventing doubling that percentage.

Tomorrow, hours five through seventy of...

Doctor Erik’s Science Project

And here’s a hint about the outcome, it’ll go up on Uncynical Wednesdays.

Medical Records

Season Three

Season Two

Season One