Take Two and Call Me

Trompe L'Oiel

2007-03-07T05:57:00.000-08:00

Driving around with a bashed up car for a week now I've noticed that people seem less likely to step out or pull out in front of you when you have visible damage on the front of your car. I've started to imagine perfectly intact and functional car manufactured to look like it's just been in an accident.

Ouch.

2007-02-28T05:10:00.000-08:00

My morning did not get off to a really great start. Neither did Kim's. Kim is a seemingly nice enough woman I met this morning when she pulled out of 44th into Butler Street and stopped causing my car to collide with the front end of her car. I have never ever in my 25 years of driving had an accident so this was a new experience for me. I backed over to the curb and she pulled forward onto 44th and we stood at the hood of her car exchanging insurance info. She was suspiciously knowledgeable about exactly what information we needed to exchange. This took a lot longer than I thought it needed to but Kim is one of those women who keeps so much stuff in her purse that she can't even look around in her bag without taking some stuff out and setting it down nearby. Her wallet was so stuffed it took her several minutes just to pry out her driver's license. Meanwhile I found a tablet of paper and a pen for us and with her permission photographed both her car and mine.

So, with various bits hanging off my car I drove back home in the predawn darkness. For some reason My Beloved awoke when he heard me coming in the kitchen and stumbled sleepily downstairs. "I thought you were knocking" he said not really awake. "I had a car accident" I said apologetically. "Are you okay?" he asked to his credit despite the fact that I'm clearly standing in the kitchen looking just fine. "What do you need me to do?" I knew he really dreaded the prospect of having to drive me the one hour trip up to the clinic where I was scheduled to work so I let him off easy. "Put some pants on and come outside and look at my car." My Beloved had to saw one of the loose bits the rest of the way off the car and defying generations of tradition passed over the duct tape in favor of slip ties to secure my dangling turn signal.

Later, fueling up at the Starbucks in Gibsonia the lady ahead of me said "Well, I'm breathing and walking" in response to the barista's "How are you." I stood behind her nodding.

Thorncrown Chapel

2007-01-09T06:34:00.000-08:00

This will come as a shock to you big city, bi-coastal types but one of the American Institute of Architecture's top ten buildings of the twentieth century is in rural northwestern Arkansas. So can you guess where I went on my Christmas vacation? It was an easy but day long drive down from Des Moines and would be a quick trip from Kansas City. Four lanes almost all the way. Then, boom. There you are in the Ozark mountains looking at a modernist interpretation of La Sainte Chappelle in the woods.

Some fellow from Pine Bluff built his retirement home on a pretty piece of property up in the mountains. He found that a lot of passers-by wandered up his driveway to admire the view and got the idea to build a chapel to inspire and provide respite for these travelers. The chapel opened in 1980 but not before some trials and tribulations that lend themselves well to moral lesions about aligning one's desires with God's plan. The Chapel worked its magic on us. The instant we saw it we went from weary road drones to curious and engaged explorers. Go visit it someday or go to Thorncrown Journal and indulge yourself in imagining the comfort some people must get from having their world ordered and explained by their faith.

Counter Clockwise

2007-01-05T05:54:00.000-08:00

Last year we spent Christmas in Arkansas. We went down and sprang Hazel from the nursing home for a few hours and had a lovely Christmas dinner with the "twice removed" cousins. Then we drove up to Des Moines to see my folks. We had New Years Eve in a rest stop in Ohio.

This year we did it the other way around. We went first to Des Moines where we had a truly tranquil Christmas. A tranquil Christmas is highly unusual. My mother only recently noticed that I am an adult and seems finally to have let go of the need to make Christmas into some kind of an "experience." My family was never that numerous to start with even with the various step-relationships so now that we are all grown up and some of us downright aged we just slap a wreath on the front door and call it Christmas. We exchange gift cards for the most part. The really ambitious among us make charitable donations in each others names. Don't get the impression it was not meaningful. This year I had the deepest sense of gratitude I think I've experienced in a long time. This year no one is actively dying. At least not any more than we each are every day. This year no one was facing prison time. This year no one asked me for medical advice.

In retrospect I suspect we are just gathering our energies for another good go around.

FM Wisdom

2007-01-03T05:49:00.000-08:00

From a country song:
If you're goin' through hell
Don't slow down.

Christmas Road Trip 2006

2007-01-01T16:35:00.000-08:00

For the price of two round trip plane tickets to that holiday hot spot: Des Moines, Iowa we have just returned home from a week long road trip. As usual we left home in the evening and drove all night. When I say we I mean we were both in the car since My Beloved does 90 percent of the driving day or night. As usual we planned to spend the morning in an interesting spot and this time we chose Columbus Indiana. Yes, Columbus Indiana! You mean you didn't know there was a Columbus in Indiana? We'll neither did we until we saw a write up in Dwell my favorite home design magazine. Columbus has quite a collection of modernist buildings and a huge collection of public art in part subsidized by the Cummins family whose deisel engine company is headquartered there.
So we rolled into town around 5am I think and napped in the car for a while. Next we lined up with the locals at a diner which started serving at 6am. I failed to notice the name of the place but had the best road tea I've ever had. Unfortunately the people up at that hour were impressively ignorant about their city so we went over to the Columbus Inn and got a two dollar self-guided tour map. The pictures of Columbus on the Dwell website are probably better but mine have that special quality only the freaking crack of dawn can confer.

A Rat in My Basement or That Pretty Much Says it All

2006-12-16T16:16:00.000-08:00

Greetings from the coffee table. No, I'm not writing as the coffee table. I am actually seated on the coffee table. After moving it what I consider to be a safe distance from the sofa I grabbed the computer and climbed up here. Earlier this evening I was in the kitchen enjoying some silence which is the same as saying My Beloved was not at home when I heard a squeak. It was a whistly creaky kind of squeak. I stood still to listen more closely but needn't have because next I heard a shreaking similar to one of those squeaky chew toys for dogs only one that is being tortured. Worse still it was doing a great job illustrating the doppler effect in a most unfavorable direction on the basement stairs. Next thing you know I'm perched on the kitchen counter thinking "Who's that screaming?"
Not inconsistently Dogzilla and Princess came over to examine me curiously while Killer ran over to the basement stairs to investigate the ongoing sounds of torture. Smidgen I concluded was the one doing the torturing. Thank heavens My Beloved is on speed dial. "Hello?" he answered unsuspectingly from the Corner Bar. I clearly stated: "Come home right now. Smidgen is fighting with a rat in the basement! It sounds like they're coming upstairs." Apparently all he heard was: "AHHEEHOOOHAHHH!" because his only reply was "What?" A couple of blood curdling screams later he finally pulled up in the alley and thundered in through the backdoor to find me still seated on the kitchen counter and waving an accusatory finger at the basement stairs.
This evening My Beloved filled his My Hero roll for the week when he quickly and efficiently rescued all the pets, identified the crack through which the rat had entered, sealed off the basement and moved the cat box to higher ground. I see a trip to the hardware store in his future.

My Antonia

2006-09-22T18:11:00.000-07:00

Recently My Antonia by Willa Cather made it to the top of my reading pile. As I get older and my years growing up in Iowa get further and fewer I get more romantic about life there and My Antonia is nothing if not romantic. I was pleased to see that Cather and I shared some of the same notions about the effect of the wide open landscape and harsh weather on the people there. A shared notion seems more likely to be one of those with a grain of truth in it. Forgive me for providing a few excerpts here since I cannot possibly improve upon her writing.

The landscape:
As we walked homeward across the fields, the sun dropped and lay like a great golden globe in the low west. While it hung there, the moon rose in the east, as big as a cart-wheel, pale silver and streaked with rose colour, thin as a bubble or a ghost-moon. For five, perhaps ten minutes, the two luminaries confronted each other across the level land, resting on opposite edges of the world.
In that singular light every little tree and shock of wheat, every sunflower stalk and clump of snow-on-the-mountain, drew itself up high and pointed; the very clods and furrows in the fields seemed to stand up sharply. I felt the old pull of the earth, the solemn magic that comes out of those fields at nightfall.

The ingenue at the theater:
This introduced the most brilliant, wordly, the most enchantingly gay scene I had ever looked upon. I had never seen champagne bottles opened on the stage before--indeed, I had never seen them opened anywhere... The men were dressed more or less after the period in which the play was written; the women were not. I saw no inconsistency. Their talk seemed to open to one the brilliant world in which they lived; every sentence made one older and wiser, every pleasantry enlarged one's horizon. One could experience excess and satiety without the inconvenience of learning what to do with one's hands in a drawing-room.

Small town pass-times:
Mrs. Cutter painted china so assiduously that even her washbowls and pitchers, and her husband's shaving mug, were covered with violets and lilies. Once, when Cutter was exhibiting some of his wife's china to a caller, he dropped a piece. Mrs. Cutter put her handkerchief to her lips as if she were going to faint and said grandly: "Mr. Cutter, you have broken all the Commandments--spare the finger-bowls!"

Religion:
Mr. Shimerda rose, crossed himself, and quietly knelt down before the tree, his head sunk forward. His long body formed a letter "S." I saw grandmother look apprehensively at grandfather. He was rather narrow in religious matters, and sometimes spoke out and hurt people's feelings. There had been nothing strange about the tree before, but now, with some one kneeling before it--images, candles... Grandfather merely put his finger tips to his brow and bowed his venerable head, thus Protestantizing the atmosphere... As we turned back into the sitting-room, grandfather looked at me searchingly. "The prayers of all good people are good," he said quietly.

Creativity

2006-09-18T07:07:00.000-07:00

One of my favorite things about Blogger is getting to click on the button labeled "create." I don't think most people would consider medicine to be a very creative profession. Certainly I don't very often have a tangible product to show for my efforts unless you count the piles of paperwork. As I bet you can guess I am about to tell you all about how creative the practice of medicine really is. First there is the atmosphere of trust and empathy that must be created. I don't mean an atmosphere created by the color of the walls or the furniture. I mean that little bubble of focus that needs to form around the physician and patient. A really good physician can create this type of therapeutic emotional space standing on a street corner with a patient. Next is the creation of knowlege or understanding. This is a team project. The patient and the physician cooperate to produce an understanding of the patient's experience for the physician and of the physician's interpretation for the patient. This knowlege creates the final product of the encounter: the portable bit of wellness in the form of power over the problem which the patient can take with her when she leaves the encounter. I do this a minimum of 30 times a day.

A Saturday Off

2006-09-16T11:17:00.000-07:00

My first year in practice I applied the headache adage to a patient (see posting on Sept. 10). The patient was a fine strapping young family man and upstanding member of his community. I would later apply another medical adage to him. The worst diseases only happen to the best people. For the last three years he has largely been under the care of his oncologist and neurosurgeon for the god-awful tumor that turned out to be the cause of his headaches. I saw him on the occasions of his gall bladder attack, a bad case of poison ivy and a few other mishaps. It doesn't seem fair but having cancer does not protect you for other illnesses. Lately he has been in the hospital rather a lot. His headaches got worse. He got a blood clot in his leg. His heart rate went up. None of this is particularly unusual for a person receiving active cancer treatment and each problem was being addressed with reasonable success.

Friday evening I rounded at the hospital and saw him last before going home. He was surrounded by family as usual and thanked me for my visit as I was going out. On my way home I spoke with the physician on call for the weekend and gave him my usual telegraphic but droll sign-out on my hospitalized patients. My comments went something like "bad disease, perfectly stable, consults aren't letting on as to their plans, pain control, blood thinners, ride hog on the specialists." Later I was sitting stuporously in front of the television probably watching a pledge drive when my cell phone emitted the special ear-splitting screech I've assigned to certain other doctors. I climbed down from the ceiling and wrestled the phone to the floor thinking "this had better be important." My colleague was audibly upset. Breathlessly but concisely he relayed to me. "Your patient just arrested and died." He repeated this in various ways in response to my disbelief. "I thought you'd want to know" he said before hanging up.

Next I called the hospital and had the "What the Hell Happened" conversation with the tearful nurse. I learned The Oncologist had happened to be there when the patient arrested and that he was still talking with the family. I phoned My Beloved and asked him to return with the car right away and spent the next half hour sitting on the back stoop watching darkness fall in the back yard. He had been dead about an hour by the time I got to the hospital. The Oncologist was sitting at the nurses station staring at the counter top. I'd never actually met him before but at that hour the odds of a middle aged orthodox physician sitting in this particular nurses station being anyone but him were slim. I introduced myself. He had been present for the entire "cataclysm" as he called it. After a clipped and clinical review of the events we established that we were in agreement on the most likely cause of death. As we went down the hall he said to no one in particular "He was the last patient I needed to see before I could go home." According to him the family was still in the "screaming and crying phase" and indeed they formed a crushed and weepy group around his corpse. His mother burst into tears and fell into my arms when she saw me and eventually had to be passed off to the priest. The others spoke with strangled voices and gasping breath. The room slowly filled with people who one by one embraced the man's wife who sat next to the feet of the profoundly still body of her husband and then joined the living tableau of mourners standing around the room.

I don't really remember the transition to the next scene but quickly I found myself in a small conference room listening to The Oncologist discuss the issue of an autopsy with the new widow. She listened intently asked a couple of questions and then dismissed The Oncologist tipping her head towards me and saying "I'd like to speak to Doctor now." "What do you think I should do?" she asked me after he left.

Last for me was the ceremonial paperwork. The autopsy authorization signed and witnessed. The death pronounced and certified for the department of records. The discharge summary dictated although the patient was being discharged to the morgue. Some "nerve pills" called in for the grieving mother. I left the hospital with the knowledge that when I awoke in the morning I would not enjoy the secret pleasure of a Saturday without having to round but would think instead of this devastated family.

Fortune Cookie

2006-09-13T11:05:00.000-07:00

It is much easier to be critical than to be correct.
Lucky Numbers: 8, 12, 15, 21, 24, 34.
Learn Chinese: Squid = You-yu.

The Hour Was Early

2006-09-11T15:14:00.000-07:00

"The hour was early; the morning still, warm and beautiful. Shimmering leaves, reflecting sunlight from a cloudless sky, made a pleasant contrast with shadows in my garden as I gazed absently through wide-flung doors...
"Suddenly, a strong flash of light startled me--and then another. So well does one recall little things that I remember vividly how a stone lantern in the garden became brilliantly lit and I debated whether this light was caused by a magnesium flare or sparks from a passing trolley.
"Garden shadows disappeared. The view where a moment before all had been so bright and sunny was now dark and hazy. Through swirling dust I could barely discern a wooden column that had supported one corner of my house. It was leaning crazily and the roof sagged dangerously.
"Moving instinctively, I tried to escape, but rubble and fallen timbers barred the way. By picking my way cautiously I managed to reach... the garden... To my surprise I discovered that I was completely naked. How odd!
"What had happened?"

The above is not a description of anyone's experience on September 11, 2001. Rather they are the words of a Japanese doctor in Hiroshima on August 6th 1945.
I don't think these events change the world so much as they change humanity and we live in the rush of their consequences.

A Regular Joe

2006-09-10T14:52:00.000-07:00

A headache is rarely anything bad and bad things rarely cause headaches. That is what the neurologists tell us. I take this approach to lots of very anxious people who are convinced that their every headache is a tumor. Recently our newly elected mayor died of a very aggressive central nervous system lymphoma. The death of the mayor is a sad thing for us here. He was perceived as a regular Joe sort of guy which suited us. He was also a genuine true believer when it comes to Pittsburgh. He will be missed. The Mayor's illness started while I myself was in the hospital. He was admitted down the hall in one of the other "nice" rooms. Since then I've gotten so much better that I now tend to give people a puzzled look when they ask how I'm doing with a voice full of concern. As I got better he got worse until his death Labor Day weekend. I expect I'll see a lot more headaches for a while.

Zilla or Dog

2006-08-27T08:34:00.000-07:00

Dogzilla and I have been hanging out whenever possible at a friend's place of business. A rug shop come healing space. I occassionally pass the time while she's with customers playing with the toys she keeps on hand for kids. Recently I built a little block city and tried mightily to get Dogzilla to attack it. Being a peaceable sort of poodle he refused. I envy his simple nature at times. Life is all about the cycle of creativity but I'm spending rather a lot of time in it's necessary counterpart: destruction. Until now I have coped with the destruction by being silent but I intend to begin writing about it somehow. I have only two self-imposed blog rules one of which is not write things that will make my readers afraid to ever go to the doctor again. The other I will not share. If you enjoy reading between the lines I think you may find some interesting reading in upcoming days. If you prefer not to read between the lines, fearnot I will try to keep it interesting for you.

Some Excitement on Marine Way

2006-08-09T07:30:00.000-07:00

Friday evening I was sitting on the couch having some quality time with Killer. When he decides to get some attention for himself I am basically immobilized. He sits on my tummy and stretches up onto my chest. Once in position he ensures constant petting by nudging my chin with his head if ever I dare to stop. While so engaged I heard My Beloved calling from the back of the house. He has a tendency to sound rather urgent all the time so I made nothing of it. He called again. This time I answered "I've got a cat on me." This was enough to dislodge the cat so I decided to indulge him and go see what had him all in a fuss. Imagine my surprise when the smell of smoke met my nose in the kitchen and the crackle of fire met my ears at the back door. In the middle of the alley that runs down the side of our house there was a pile of something black on fire. Little flames danced on the top and ashes surrounded it on the asphalt. It had been a wet day which made it a particularly strange sight in the otherwise dampish landscape of garages and back yards. We looked at one another. What to do first: tell the neighbors, call the police, get the hose? My Beloved decided to alert the neighbors behind whose house the fire was situated. I started to unroll the hose. We have a very small yard but we got the hose at Costco which means we could wrap the hose around our house twice. My Beloved came out with the neighbors and I turned on the spigot. (Lefty loose-y.) While My Beloved hosed down the burning heap and the neighbors talked excitedly I called 911. I thought it was important that a record of the fire exist and I thought it would provide a nice evening's entertainment for the neighbor's nephew.
My last words to the 911 operator was "Be sure they know the fire is out."
Since the fire was indeed out a party atmosphere began to develop.

Wild speculation about who had started the fire and why ensued. A neighbor whose house faces the park remember seeing an unfamiliar woman walking in the park picking up sticks. Someone else later saw what sounds like the same woman in the back alleyway. Next we heard sirens. We listened to them a while as they wound through the net of one way streets and seemed to get no closer. Finally a spectacularly shiny truck pulled up perpendicular to the end of the alley and a number of brawny firemen trudged up the alley looking disappointed. In the blink of an eye the mouth of the alley was all but plugged with a strangely short and fat assortment of gawkers who appeared as if from thin air. "Trash fire" was quickly whispered around and they left dejectedly.

The wet pile of trash was probed and found to have come from a house on our street a couple of blocks and most notably from across a major intersection away. Animated discussion and renewed tellings of the discovery of the fire and the suspicious woman went through the little knot of neighbors like they were singing a round. As I sat on the back step observing the goings on I had occasion to overhear a fireman summarizing the events for a police officer. They story had mutated in the way only frequent repeating and selective listening can cause. The story of the trash fire now went something like this: A crazed appearing unknown women had been seen carrying trash down the street. Subsequently she collected a long fallen branch from the park. She lit it on fire and carried it torch like down the street and into the alley where she ignited the trash. She then apparently disappeared in a puff of smoke. How exciting.

Laughter is Therapeutic

2006-08-07T09:21:00.000-07:00

I'm slowly coming back to life. For a couple of weeks after my surgery I was strangely dull. It wasn't just the boredom of being home by myself all day. I had no desire to do anything. I couldn't even bring myself to leaf through a magazine. If the TV was tuned to a program I didn't care for I had no motivation to change the channel even if the remote were in my hand. Finally the last week of July I started to come out of it. This was fortunate since I had to resume some of my work responsibilities.

I'm still not firing on all cylinders as I like to say. I am incapable of juggling all the tasks I can normally handle. I am however able to read again. My first good read was "What the Dog Did" by Emily Yoffe. It is a hilarious book. I recommend it to anyone who really likes, kind of likes or thinks they hate dogs. It is still painful for me to laugh so reading it was a delightful torment. I laugh like this: "O-ow O-ow O-ow." I try not to laugh at all actually which causes me to shake really hard and make choking noises. More than once My Beloved took the pillow off his head and looked quizzically at me to see if I was having some sort of seizure. Anyway, I recommend the book but consider yourself informed that I will not be responsible for any laugh related injury you may suffer as a consequence.

Tough Cookie

2006-08-06T12:26:00.000-07:00

I finally got out of the house on the second Saturday after my surgery. My tolerance for walking had improved enough that I was less likely to get somewhere and not be able to get back. My first adventure out was to visit My Other Mother. My Other Mother works at the office a few days a week and could be more aptly named Everybody's Other Mother but I don't really feel like sharing. Three weeks prior My Other Mother had tripped over an uneven spot in the sidewalk. My Other Mother is not a dawdler so she was moving pretty fast. Consequently she flew a short distance before skidding onto the cement. As you might well imagine she basically broke herself. She broke her upper arm at the shoulder. She broke her wrist right through the joint. She broke her pelvis. And, you should have seen the goose egg on her head. It took a couple weeks of wrangling and transfer to another hospital to get the surgery done on her wrist but finally she is over at the rehab hospital. So anyway my first time out of the house and what do I do? Go to a hospital and visit someone more messed up than me! Looks like she might get back to work soon after I do. I admire her because she is not a complainer. She gets discouraged like us regular humans, she just doesn't whine about it.

The Bendy Straw

2006-07-19T12:14:00.000-07:00

When I was little being sick meant getting to stay home with Mom. She would make a bed for me on the couch and bring me a drink with a bendy straw in it. I got to watch TV or read. When I wasn't too sick to enjoy it, it was heaven. Beyond the bendy straw being sick comes with certain privileges. The sick person like old folks and pregnant women is excused from certain responsibilities along the lines of hurrying, lifting, being patient and so on.

Last Sunday we did the grocery shopping and I decided to test drive one of those little motorized buggy things. I would have survived the trip walking and pushing the cart but it would have been it for me for the rest of the day so I figured what the hell? Are they going to tell me I look too healthy to ride one of these? I'll just pull up my skirt and show them my incision. I admit I was curious, too. "What's the top speed on this thing?" I wondered as I careened into produce. I think I finished the shopping in less time with this thing not because it whirred along so fast but because people got the hell outta my way. I don't think they were being polite. I think they were frightened.

All in all I don't find the privileges of being sick to be a fair trade for good health. Being sick pretty much sucks. I'd much rather be able to drive, walk as far as I want, and bend over without having to plan it out in advance than be excused from carrying in the groceries. I can't wait to be downgraded to the bendy straw.

knit me a moustache!

2006-07-16T11:49:00.000-07:00

knit me a moustache!
Originally uploaded by splityarn.

This is not my knitting or my photo. It did make me laugh though so I'm sharing it with you.

Bobble Head

2006-07-13T11:26:00.000-07:00

My last posting was written in a burst of happy energy over being at home at last. Since then I've done little to nothing. I feel like a bobble head. My head is light. It feels strangely outsized and if I sit still it seems to sway entirely of it's own accord. I need vast amounts of sleep. 12 hours at night and a 3 to 4 hour nap is not too much.

The hospitalization went smoothly for the most part. Unfortunately waking up abruptly from anesthesia seems to be more about me than about the anesthesia. This time I tried to extubate myself but had enough awareness of what was up that I let go of the tube when told to. I mentioned this to My Esteemed Surgeon on my last hospital day and immediately regretted it. He had seen the whole thing and naturally found it distressing. I think he had been hoping that I wasn't as aware as I had seemed.

Something that was very different this time was the whole incision thing. The first time I had surgery I remember being awakened from sleep on hospital day #3 by the resident ripping the bandage off of my belly in one movement. I also had staples. This time My Esteemed Surgeon instructed me to remove the bandage myself and just work at it slowly. I also have plastics quality stitches closing the broad smile at the bottom of my tummy.

Both in the hospital and at home I am caffeine deprived. I can normally drink hot drinks in warm weather but I don't seem to be able to right now. In the hospital they only served me decaf tea. I finally broke down and got someone to bring over a 2 liter bottle of coke. I'm also hungry all the time. I can only eat a little before I'm stuffed and then shortly I'm famished again. This is a problem since I'm really not up to all those trips to the fridge so I sit around hungry with my head bobbling slowing in the breeze.

Condition D

2006-07-07T16:26:00.000-07:00

There are all kinds of overhead paging codes broadcast in the hospital. Condition A and Condition C are requests for the code team to either an airway or cardiac problem. These are usually called to patient rooms but sometimes the destination will be a testing area or hallway. Condition H is initiated by a patient or family member who feel the patient needs more help than he or she is getting. This condition exists due to true and horrible cases in which patients' needs were not addressed resulting in suffering and even death. Unfortunately some people call a Condition H because they're out of toilet paper. Condition F means a fire alarm has been triggered.
I decided during my recent admission that there should also be a Condition D for when a doctor has become a patient. I did the best I could to let people know I was going to be making an appearance in their department/ward not because I wanted special treatment but to avoid any embarassement. It is painful to watch people shift gears from their canned patient schpeel to their "I'm talking to another physician" stammer. It is also uncomfortable to know things that require them to change their routine. Like "I know this is Same-Day surgery but I AM being admitted after this." This may be said in a couple of situations. It might be the opener for a follow-up comment such as "so you might want to put that freakin' 16 gage IV in my arm instead of in my hand for Chrissakes." It might also lead up to statements such as "Now seriously do you really think my surgeon would send me home after a laparotomy?" You dear reader do not need to know what that is only that my Doubting Thomas should have looked at my chart.
Condition D would serve to shock people out of their drone routines. If the overhead paging system announced "Condition D OR POD A" or "Condition D GI lab" intermittently throughout the day everybody would look a little sharper. It would be at least as effective as the time I saw a hospital administrator in "business professional" dress strolling down the hall saying "The Health Department is in the building" over and over again in a conversational tone to no one in particular.

So You Have to Do a Bowel Prep!

2006-07-01T12:52:00.000-07:00

I understand there are people who undertake colon cleansing processes even when they aren't going to have anyone mucking around up their behinds or in their bellies. I think these are some seriously misguided folks. I don't see how medical science will ever be able to eliminate the delightful process of cleansing one's digestive system prior to certain tests and procedures but our modern consumer culture has managed to make the experience a little easier to bear for the person who plans ahead.

Now seriously doing a bowel prep as it's called is no joking matter. If you try to bend the rules your gastroenterologist may miss a menacing lesion hiding behind some hunk of poo you didn't see fit to expel. If you vary from the prescribed diet that innocent dish of red jello could buy you a work up for GI bleeding. If you aren't spotless in there and your surgeon has to manipulate your bowels whilst redoing your insides you run the risk of a major toxic spill. The ecosystem inside your belly will not take this kindly. That said here is my advice for an almost painless bowel prep.

Make reservations at a really fine restaurant for 36 hours before your test. Eat anything and everything to excess. Most importantly drink heavily. A bottle of wine, some port and some Havana Rum if you can get your hands on it. Feel free to begin you celebration of all things "clear" at this time by having white Bordeaux and white port. If you can't get Havana Rum tequila makes a fine substitute. Be sure and follow dinner with about half a pound of white cherries. This will jump start the process. When you wake up in the morning you will have all day to rehydrate yourself with the ginger ale, white cranberry juice, peach juice, and lemonade with which you have stocked the fridge. Breakfast should consist of poached, or soft boiled eggs and white bread. This will be about all you can handle anyway. When you wake up again around 4pm you have to drink your magnesium citrate or phosphosoda. Chase it with any and all of your "clear" liquids. A routine bowel prep without the debauchery at 36 hours requires that you drink at least 8 ounces of fluid every hour while awake. If you have chosen the debauchery option I suggest you shoot for 24 ounces per hour. At 9 pm it is time to take the bisacodyl tablets. I strongly advise that you have several interesting magazines, perhaps a radio and definitely some "Kandoo" flushable wipes at the ready in your bathroom. Kandoo wipes in case you aren't familiar are "your little one's first toilet tissue." In other words Kandoos are for kids learning to doo doo on the can. Do not get baby wipes. Baby wipes are not flushable and this is not something you want to find out during a bowel prep. While hanging out in the bathroom feel free to take one or several showers with antibacterial soap. I personally recommend Dial antibacterial "mountain fresh" body wash plus moisturizer. Who wouldn't want to smell "mountain fresh"? A last word about fragrance: to avoid any embarrassment once at the hospital I suggest you avoid the fruit-y or "jungle-fresh" Kandoos. Finally, an hour before you leave in the morning do an enema followed by one more mountain fresh shower. Please do not ask anyone to help you with the enema. We are born alone, we die alone and we should always do our enemas alone.

Deja Vu All Over Again

2006-06-29T16:20:00.000-07:00

Almost exactly ten years ago I had to undergo the same surgery I am anticipating having on Monday. I was a medical student and had just enough knowledge to be petrified. I had the surgery the first day of a two week scheduled break from school. Dad came to look after me since I lived alone and all my friends would be out of town on the last vacation before our clinical rotations started. Being a touch hypervigilant Dad makes a pretty good nurse. I thought the worst part was going to be waking up from anesthesia screaming for help and trying to put my abdomen back together. I was sure they'd left me wide open. Worse however was trying to go back to school two weeks to the day after surgery. I had an incision about six inches long across the lower portion of my abdomen. It was not exactly symmetric so it interfered a little more with the forward motion of my left leg than it did my right. My top speed could only be described as processional. With effort I could stand up almost completely straight but I couldn't hold this position for long. My forward progress was slow and loping. It caused people to stare.

Nevertheless I reported for duty on my first day of third year to the department of orthopedic surgery. If you've ever visited a hospital you may have noticed the flocks of doctors in white coats swooping like swallows down the corridors. I was definitely the runt swallow. Outside of the OR orthopedic surgeons see about 10 patients an hour in the office and round at the hospital on untold legions. Hospitals are designed so that the more relevant two departments are to one another the further apart they are. My limping and gimping along caused the entire team to have to ride elevators instead of heroically storming the stairs, pouring out of obscure doorways unexpectedly and causing alarm in hallways all over the hospital.

The operating room was another level of hell altogether. Orthopedic surgery requires fluoroscopy, a sort of adjustable X-ray, in order to judge the integrity and alignment of the bones and hardware being pieced together. Consequently the surgeon and every other soul in the operating room has to wear lead. About 40 pounds of it. Front and back, top and bottom, even a little piece for the front of your neck. I thought I was just going to die right there. Crushed like a soda can. I could feel the adhesions forming in my abdomen. I had no choice but to last as long as I could each day and try to look alert. Any wonder a month off looks like a vacation to me?

Deja Vu

2006-06-28T08:07:00.000-07:00

Spring break my senior year of high school all the cool kids went to Ft. Lauderdale or the San Padre Islands. I had my wisdom teeth pulled. The dentist was Young Dr. McNamara the newly graduated son of Old Dr. McNamara my dentist from childhood. The extraction did not go smoothly. He was probably shockingly inexperienced but also my teeth apparently had really long roots. I remember with great clarity him bracing his foot against the side of the chair I was reclining in and pulling with all his might. He was so delighted with himself when he freed a particularly difficult one he exclaimed "Wow! You wanna see this one?" waving the tooth still clamped in pliers in front of my face. I closed my eyes and said "Ogh Ooh". I hope he's gotten a little more professional since then. Later I rode home in the backseat of mom's Chevy Cavalier with blood I couldn't feel running down my numb face. I was fine when school started a week later. Everyone else had a nice tan and I had fewer teeth.

Surgical Vacation

2006-06-26T19:00:00.000-07:00

I can't wait until my surgery. I'm going to ask the anesthesiologist for a double. I was comparing medical leave notes with a couple people last week and was amused and relieved to find out that I am not the only one that thinks of major surgery as a vacation. A nurse practitioner friend of mine referred to his last hernia repair as "ten days off with pain meds." At the Medical Society Board Meeting one of I mean the other woman doctor told me how much she'd enjoyed having her foot operated on because she couldn't walk for a month. One of the staff members of the Medical Society over heard us and said "You need a new travel agent."

Count Down

2006-06-25T18:41:00.000-07:00

My sister is counting down to her sentencing. I am counting down to my surgery. It's a week away excluding the weekend which is more of a tangent of time than a direct link. The week just finished was my last normal week. I use normal a little loosely here. On Monday I have to have some preop testing done and I see my surgeon for clearance on Wednesday. Meanwhile I will be on a critical mission to clear my desk and shelves of any pending results. I will also try to clear the hospital of my patients. I want everybody tucked in for the duration. This is a fantasy of course. There is no way in hell I can get everybody well or even plugged into a fixed trajectory. I am compelled to try out of concern for them and compassion for the physicians who will be covering me without compensation of any sort. I am on call the weekend before my surgery so when not dealing with patient phone calls I will be desperately shoveling off my desk. Sunday night I sign out. I sign out of all this that makes up my daily professional life. I barely think about the surgery. My preparations now are not particularly different from what I have to do to try and get out of town for a day or two. Maybe I'm going on vacation. My patients very kindly wish me a good time while I'm "off" in July.

Random Recollections

2006-06-24T15:22:00.000-07:00

Some bits of our recent road trip keep floating up in my mind. One is the image of the little Missouri town of Marmaduke. Almost every structure we saw as we passed through was bandaged with blue tarp. Evidence of a tornado which blew through a couple weeks before. Then there's the look on My Beloved's face when he realized the middle aged white guy not 4 feet away from him was the one providing the vocals to "Love and Happiness" as we sat idle after dinner at Josie's in Waldenburg. He had just been speaking mockingly about lousy kareoke singers. The man went on to serenade us with a little more "Memphis music" but I forget now what he sang. I also keep thinking about the photo we have of Hazel as a girl standing on the porch of the bungalow which she showed us last year. She told us that in the picture her fist is closed around a nickel she had just received and prized highly. She could still recall the feel of that nickel against her palm. Finally I remember sitting at the Thanksgiving table next to Hazel. My Beloved's sisters and their mother were trying to drum up some drama around a perceived misdeed of some kind. Not being a fan of drama I sighed and dismissed the whole thing aloud with a "Live and learn." My jaw dropped open when Hazel completed the phrase with "Die and forget it all."

A Shot but No Beer

2006-06-21T16:41:00.000-07:00

I should have taken a picture of it. At the beginning of May I had to have an injection. We already know I'm a geek so let me just say: it was the coolest syringe I've ever seen. It was packaged in it's own little pink box about the size of one of those little pistols for ladies to carry in their handbags. Inside was this giant honkin' thing with a big fat needle on it. I was going to ask sweetie to give it to me but she took one look at it and simply refused. The really intimidating thing was that it had two chambers one behind the other like train cars. The contents of one chamber was powder and the other contained a liquid. I read the directions each step of which started with the words "While holding the syringe upright" and found that I simply needed to twist the plunger and slowly push the liquid into the powder until the powder dissolved. Then it was time to jab myself. In between patients I put a little lidocaine gel on my leg using a couple freckles as landmarks. One patient later I painlessly administered the shot. I was so proud of myself. Now all I had to do was wait for the side effects to start. The first thing was the pain in my leg once the lidocaine wore off. The stuff actually irritated the muscle so badly I limped for two weeks. It's all okay though because it just served to promote the notion that I'm having back surgery.

It's not the Apple a Day

2006-06-20T08:30:00.000-07:00

Ever wonder why doctors don't go to the doctor much? Sure we're busy people. We probably also already know what is wrong with ourselves. But, I think the main reason why we don't go to the doctor when we are sick is because we cringe to hear the words of our patients coming out of our own mouths. "Doctor, it hurts when I do this." Cringe cringe. "All of a sudden I was weak and dizzy all over." Cringe some more. Or better yet: "First it was yellow and sticky. Now it's green, well light green, and kind of runny. I think it smells off too." This will cause cringing such that your head will actually shoot off your shoulders and blow a hole in the ceiling. On the other hand it seems foolish to present yourself to another physician and say something like "I have a migrain." His or her response will probably be: "Unless you want narcotics what are you doing here?" I find it is easiest to see a surgeon. Surgeons are very practical. "Clearly you are here to have me remove that 3 pound growth from the side of your head." they say alleviating all need for discussion. Gotta love those surgeons. Lacking in bedside manner a lot of them but like I tell my patients: "You don't want him to be your new best friend. You just want him to be good with his knife."

What's Wrong with Her?

2006-06-19T12:17:00.000-07:00

"Physician Heal Thyself." This is said to me regularly usually by people with a smart-alecky look on their faces. The other clever statement I hear a lot is "You need a doctor." I usually manage to chuckle as if I've never heard anything so witty before. Maybe it's because I know so much about them but my patients seem to think they have some right to know what's wrong with me. I don't try to hide being human. I'm occasionally observed entering or leaving a bathroom. Once at the grocery store I ran into a patient who exclaimed "You shop?" My patients knew when I got married and they know when I go home to visit my folks. I don't feel the least bit bad about telling half truths to those of my patients silly enough to ask for details about my condition. While I genuinely like many of them and would choose them as friends if only they didn't choose me as their doctor our intimacy is strictly professional. There is no quid pro quo on personal information between patient and physician. I also think it is kinder to tell my patients my back is out instead of the actual truth which might be more along the lines of "She just couldn't bear the thought of listening to all your whining today and is at home with the covers over her head."

Book Notes

2006-06-17T16:38:00.000-07:00

Many years ago I picked up a book called Miners and Medicine: West Virginia Memories by a second generation coal camp doctor namedClaude A. Frazier. He collected recollections from people who had lived in coal camps where he either grew up or worked and compiled them into this book. Well, lots of other stuff got my attention and held it so I never got around to reading it until recently. Earlier this year when there was a mining disaster near by here I started to wonder where this book had gone and with effort finally remembered to look for it on my shelves in the office. Most medical books have been relegated to the office to relieve the groaning shelves at home. Unfortunately it is usually at home that I wish I could consult one of them. So I finally read it and will share a few excerpts from it here.

"The camp doctor treated just about every contingency either in the patient's home or in his office. Anyone needing his help would leave a request at the mine office or the company store. The doctor would pick up the calls around ten in the morning and again at three in the afternoon. He would keep office hours six days a week, and always took night house calls. If a patient needed more medical treatment than could be provided in the patient's home, the doctor would hold night office hours and would stay on duty as late as it took to take care of everyone."

"Littleton remarked that often people would brag with a smile that they never needed a doctor, but that if they did, the expected him to come at once. And he observed that then the smile would disappear and a deadly serious expression would take its place. He decided that they never considered that he might be out on another emergency when theirs arose..."

A nurse speaking of her husband: "As many as five years would go by without his seeing his parents. If he ever left home to go fourteen miles away to the drugstore, he would return to find a dozen patients on our porch demanding to know where he had been and insisting that he was needed immediately."

I don't find things have changed much.

No Place Like Home

2006-06-16T09:56:00.000-07:00

Our trip to Arkansas included some animal related adventures. Dogzilla took a worm bath on the banks of the Mississippi in Kentucky and the cats spent their time installing some yarn art in the kitchen. Once we did get home we all did some chilling out in the back yard and My Beloved finished the huge trellis project he had started Memorial Day weekend. Paul sent us a wonderful gift basket of teas and tea related paraphernalia which we sat on the back porch and consumed. And last but not least we had a surprise visitor come roaring into town on his new BMW motorcycle. Life is grand.

Hazel Put to Rest

2006-06-15T13:05:00.000-07:00

Hazel was laid out at Emerson's Funeral Home and Ambulance Service. (I guess we know what happens to the ones for whom the ambulance is too late.) Her coffin sat in the place were My Beloved's mother's had been 8 months before. It was a simple affair. Visitation started at 9:30 and at 10:45 we moved to the cemetery where Hazel's minister performed a service. In the summer months funeral services are held early due to the heat. The little shelter they'd erected just barely shaded those in attendance and even at that hour the minister had to dab his forehead with a folded white handkerchief while he delivered his eulogy. I've been to a lot of wakes and visitations but rarely have I attended a funeral service that wasn't either Catholic or Quaker. I felt the lack of formal prayer and bible passages. The entire service consisted of the minister's eulogy. A nice man really. Hazel liked him and chose him for this duty. Poor fellow wasted rather a lot of breath exhorting us to find salvation through Jesus though. Hazel would have known this was a wasted effort but she'd have been too nice to point it out. The next day we revisited the grave site on our own and found our wilted roses from the garden at her grave. We never had the pleasure of showing Hazel our little house. I think she would have appreciated the home grown bouquet. I found the sight of her brother Alvis' grave stone spattered with the dirt from her grave touching although I never knew Alvis.

Hazel in Pittsburgh

2006-06-14T21:58:00.000-07:00

Hazel came up to Pittsburgh every year before Thanksgiving and stayed through Christmas. The first time I met her was the first time she flew up instead of driving. This was long enough ago that we were able to go and meet her at the gate. When I saw her I remarked on how like My Beloved's mother she looked. She must have been a striking lady in her time. In her early 80's she was still spry. Indomitable might be more accurate. At the airport gate I made to take her carry-on from her but My Beloved stopped me. He took it from her shoulder himself and I noticed he had to really put his back into it. He carefully shepherded her to the car stoutly carrying the bag the whole time. Later he would set it down with a grunt near the "extra" fridge in the basement. I then helped Hazel unload it and was surprised to find it contained frozen ducks, a ham, and various canned goods not available here in the North. She would spend the Holidays cooking and cleaning and making My Beloved tote items around the house and paint things. He did this happily in exchange for eggs, bacon, and fresh biscuits every morning at 5:30. Usually the first week of Hazel's stay included various shopping trips. Not downtown to Sak's like Lady Tremane and her brood but to the Dollar Store and Foodland. The Giant Eagle down the street was out of the question because their prices were "highway robbery". These trips were rather a trial for My Beloved. Hazel would slowly work her way up and down every single aisle carefully price comparing the sale items and the family size items while sorting through her coupons. Frequently she would send him back to aisles already visited to pick up forgotten items or double check a price. He usually took advantage of these opportunities to run out the front door of the store and have a few drags off of a cigarette before dodging back in and retrieving the item or information pretending he'd gotten lost or couldn't find it right away. I don't really think Hazel fell for this and sometimes I think she sent him on these errands just to get him out of her hair.

Pimento Cheese Sandwiches.

2006-06-14T18:45:00.000-07:00

One striking thing about My Beloved is that he keeps his friends for life. He has friends that go back as far as third grade. One friend who has appeared on the blog in the past in Paul the NOLA conservative. Paul puts up with us despite our unwise left leaning tendancies. I don't know why. Paul was our own personal refugee from last August's Hurricane Katrina and still requires monthly "aid packages" from us. Paul and My Beloved met on the road selling concert t-shirts all over the US. This experience is the reason why My Beloved had actually been inside the Des Moines city limits before he met me. He estimates he's been in every city in the US with a population larger than 30,000. Paul went with him to a lot of those places. At every opportunity the stopped in Jonesboro. Hazel kept a shelf in the closet ready with the extra pillows and blankets for the young men to sleep on the floor of her tidy living room. She did their laundry and mended their clothes. She mended t-shirts I would have tossed out. She fixed them four meals a day starting with breakfast at 5:30. They never left town without visiting My Beloved's Aunt at the nursing home and some other ladies there Hazel introduced them to. There was one in particular who I later met for whom they always brought tacos from Taco Bell. It's a sad statement but Taco Bell is apparently a delicacy when one is shut away in a home. They also never left town without a bag of food. Cold fried chicken, egg salad sandwiches and these frankly awful pimento cheese sandwiches which they only ate if they were truly desperate although they never told Hazel this. I was served a pimento cheese sandwich by Hazel at one time and I managed to get it down but by this time I was already a resident and was conditioned to eat anything that didn't try to bite me first.

Pentecostal Catfish Cafe

2006-06-13T10:10:00.000-07:00

As far as I know you cannot be in the Mid-South without eating catfish. I guess they don't let you leave until you've had some. Usually we go to the all-you-can-eat buffet called Ed's Catfish. It was our habit to sneak out a piece of fish swaddled in napkins to keep our pockets from getting grease stains. The fish was for Hazel of course who didn't get catfish at the nursing home. This trip the cousins wanted to eat at the Catfish Cafe. You get waited on there but they do bring you all the hushpuppies you can eat. I highly recommend that you never, ever, ever under any circumstances eat as many hushpuppies as you could actually fit into yourself. I'm fairly convinced your gallbladder explodes if you do that. At dinner one of the cousins nodded toward the speakers high up on the wall and said "Banjo music. The Pentecostals always play banjo music. You can always tell a Pentecostal place the minute you walk in from the banjo music." Apparently there are several "Catfish Cafes" in the area. All of them Pentecostal. I can tell you this much: we wouldn't have needed as many napkins for Pentecostal catfish since it was considerably less greasy. The Pentecostals also had frog legs on the menu while Ed's does not. So we had a nice dinner but I left dissatisfied because nobody could tell me how they knew which catfish were Pentecostal.

State Road 593

2006-06-12T16:00:00.000-07:00

My Beloved calls this the "new" bridge over the Mississippi. He likes to reminisce about the trips back and forth between Jonesboro and Pittsburgh when he was a kid. His grandmother drove it countless times right up into her 80's. She always drove straight through and just stopped for a nap at a truckstop or rest stop. This scandalized her friends back home who thought she was brave to the point of foolishness. To reach the old bridge one drove straight through downtown Cairo and on the other side worked one's way along the highway to visit downtown Hayti. These towns go by unseen now that there's the "new" bridge and bypasses. Still today the interstate peters out soon thereafter and we connect the dots through the Missouri "Boot Heal" (or "Boot Hill" if you speak Southern) to Kennett, Paragould and finally Jonesboro. This trip we missed Kennett (the home town of Sheryl Crow as I've been repeatedly told) because My Beloved (AKA: Rand McNally) missed a turn. We ended up on State Road 593 and had to pull into Paragould via Highway 49 rather than on the "Kennett Highway" from the east. Paragould used to be a bigger town than Jonesboro but now it is the last place to buy alcohol before entering Craighead County which is "dry" as they so quaintly put it. Whenever My Beloved would visit Hazel as an adult she would get numerous phone calls "Hazel, I saw your car at the county line."

Breakfast in Cairo

2006-06-11T18:00:00.000-07:00

It's strange to have made this trip enough times that we have favorite places to stop along the way. Since we leave Pittsburgh in the evening we tend to need breakfast right about Cairo Illinois. I try to eat healthily but I really look forward to "my" biscuit sandwich at the "Cairo Truckstop." The same woman is at the counter each morning we visit. I've never seen the cook nor have I ever heard a single sound come through the little window connecting the counter area to the kitchen. After my order is taken I go to the cashier and pay then take coffee out to My Beloved. By the time I return breakfast is in a brown paper bag on the counter and I grab it like it's a bag of dope and scoot out to the car to wolf it down. This visit My Beloved noticed a puzzling sign. It read "Escorts Available." We agreed immediately that the most obvious interpretation of this sign was the least probable. We were miles down the road before we realized that the escorts in question were those cars that precede and follow wide loads and slow moving trucks.

King Tut

2006-06-10T16:53:00.000-07:00

Since Cairo, Illinois is not pronounced Cairo but "Kay-Ro" I had never realized there was an actual Egyptian theme in the region. Just before reaching Cairo this trip we had to gas up so stopped early at a truckstop near Marion. I was the first to notice that it was named "King Tut" and pointed this out to My Beloved when he commented on the signage indicating Lake Egypt was near by. We each took a turn inside the place glancing at people and tchochkies en route to the toilets. Back in the car we compared notes and found that each of us had seen the people wearing federal prison guard uniforms. The difference was that My Beloved (AKA Mr. Gift of Gab) had engaged them in conversation. Yes indeed there is a federal prison nearby. Yes it's at Marion. And yes, it is a "supermax." Apparently when he asked if there were any notorious criminals there they clammed up. Can't imagine why.

One Hour into Ohio

2006-06-09T13:30:00.000-07:00

It takes about 12 hours to drive to Jonesboro from Pittsburgh unless you are under doctor's orders to get out of the car and walk every hour. I was feeling about as energetic as a wet noodle when we pulled into the McDonald's parking lot. I was going to just stand up near a bush Dogzilla could use but My Beloved suggested I take my walk into the McDonald's and get him a coffee while he had a cigarette.

So in I went and oh, the humanity! Being tired and in poor physical condition I think I was in a heightened state of sensitivity because what I found was McDonald's a la Fellini. Reeling from the shock of the brightly lit plastic environment my eyes fell upon two horribly disfigured children. The girls were in softball uniforms and I truly believed them to suffering from some dreadful birth defects only before my brain started to generate a differential diagnosis I realized they were just fat. Their deformity was adipose in nature. I looked away more disturbed by the sight than I think I would have been if they'd had two heads a piece.

I studied the floor carefully while I waited and eventually it was my turn. I stepped forward and raised my gaze to the cashier. I was in for another shock. Behind the cash register stood one of those painfully awkward boy-men. Very child like in appearance only tall and adorned with downy whiskers. To complete the effect he was sporting a 2 day old black eye. Before I could stagger back out to the car I received my change in the form of the dirtiest and most worn looking dollar bills I've ever seen that weren't just dug up from a tin in the back yard.

Vignettes from the Road

2006-06-08T18:22:00.000-07:00

Thursday morning I was lying awake in bed pretending to be asleep but actually contemplating the meaning of illness when My Beloved came upstairs. He quietly leaned his face close to my ear and without attempting to wake me said softly "Hazel died this morning." My Beloved called her virtually every morning. Usually before seven. He liked to catch her before she left her room for breakfast. Wednesday she hadn't wanted to stay on the phone saying she didn't feel well. On this morning it was a nurse who answered her phone. They had discovered her dead at 6:30. The nurse had been calling all the contact numbers she had for Hazel's kin but no one was answering so it happened that Craig was the first to know. It seems fitting that it should be so since they were so dear to one another. I'm grateful he got the news from a caring nurse and not from some hostile relative. It seems more private. More personal. More about Hazel and less about people and their games. For the next little while I will be telling you little stories from the road. The road to Jonesboro and the road of Hazel's life.

Do-Do Bird

2006-05-21T16:21:00.000-07:00

I have cats. Because of this I am obliged to avoid yard ornaments such as bird feeders and bird baths. These fall in the general category of bird traps as far as I'm concerned. Last weekend I was sitting out on the back porch when a bird crash landed into the bag of tortilla chips I was noshing on. It looked at least as surprised as me only somewhat saltier. My jumping up and down yelping and waving my arms failed to communicate to the bird that it should fly away immediately so My Beloved grabbed it and tossed it toward the bushes. This may well have been the bird's maiden voyage since it didn't take the opportunity to fly off and instead landed like a stone amongst the tomato plants. Smidgen aka the Holy Terror chased it into the hostas from where she had to be extracted by the haunches and shaken until she dropped the bird. Dropped it directly into the clutches of Princess who grasped it firmly in her mouth and made off for the cover of the nearest flower bed. Both of us lunging awkwardly after her followed closely by Dogzilla who was anxious to find out why he was barking seemed to bring Princess to her senses and she dropped the bird. Either that or she had observed the strategic opportunity to pass the bird off to Killer who sped in from the side and intercepted it. Killer was much more determined and had to be tackled and the bird pried loose by force. Finally safe in the alley the bird sat closely observed by each and everyone of us. It's parents came and inspected it closely and aside from being shocked and not too bright he seemed okay. Later I watched them boost him up into the tree. Last Friday morning the idiot bird came back for a visit. Maybe he wanted to say thanks but I suspect he's just a dim bulb even for a bird. He allowed me to snap a picture of him before he shat all over the mums and flew off making several intermediate stops on various plants to gain altitude and was gone.

Take Me to Your Leader

2006-05-18T11:30:00.000-07:00

As I feared the ability to think and solve problems is rapidly disappearing from the hospital landscape. Over the years I have witnessed my modest but well-established community hospital turn into a vast impersonal center of techno-medicine. I suspect that soon there will be a mono-rail connecting it to the Mother Ship at the University. I am a grown girl and I am not a Luddite. That said I am a staunch believer in the Art of Medicine as a humanist endeavor. My recent stunned blog silence was in part triggered by some mind numbing experiences at My Hospital. Here is one of them.

I had learned a few nights earlier that a dear, bright and independent elderly lady had fallen at home and broken her knee. Not that long ago she had had her hip replaced and would need the services of this same orthopedic surgeon. The emergency room doctor had spoken with the surgeon and was calling me to see if I would accept My Dear Little Lady onto my service and place a consult to the surgeon. The surgeons prefer this type of set up since a lot of older folks have other medical problems that need special management in the peri-operative period and this type thing is outside the surgical comfort zone. Of course the surgeon could accept the patient on his service and place a consult to me but then he gets the bothersome discharge planning and dictating and so on to do rather than me.

Now would be a could time to explain the concept of a "service." My service consists of all those souls currently lodged in the hospital and assigned to me as my primary responsibility for medical and bureaucratic management. We don't say "my patients" or "your patients" because most doctors are part of a group and any member of the group may be responsible for the hospital patients of all the other members of the group at any given time. Claiming the patient as "mine" for some physicians is quite uncomfortable since it implies a relationship with the patient that either doesn't exist or is not desired. In big academic settings where most doctors work for the University a "service" may be an entire medical specialty such as renal or infectious disease. This is the height of status and of anonymity.

Back to the story. My Dear Little Lady had had her knee fixed on the day prior and I was rooting around the nurses' station looking for her chart. I found it at the bottom of a pile at the elbow of a woman I didn't know. "Could I use My Dear Little Lady's chart?" I asked. "Who are you with?" was her reply. I felt exactly like I had felt one time when registering at a hotel near London and was asked for my name by the desk clerk. "Miss or Mrs?" she asked me. After an awkward silence I replied "Are those my only options?" So anyway I gave Unknown Woman a withering look and identified myself by name hoping she might put it together with my name on the chart. Alas no such dawning realization took place and I was forced to ask her just what her business was with My Dear Little Lady. She identified herself as the representative of Dr. So-and-so. She herself apparently had no actual name rank or serial number. I don't have the pleasure of knowing Dr. So-and-so and had to ask in follow up who the hell he was and what his schtick was all about. Meanwhile I forcibly removed My Dear Little Lady's chart from the pile and opened it. It rapidly became clear that Dr. So-and-so was some internal medicine doctor who was equally unknown to My Dear Little Lady and who had been invited by the surgeon to come and manage My Dear Little and remarkably healthy Lady's non-existent medical problems. I proceeded to explain that the services of the esteemed Dr. So-and-so would not be needed and with a pleasant smile and a flourish of my pen I disinvited Dr. So-and-so and his lackey. I find that these things are best handled with a smile and a flourish but it would have been most satisfying is Unknown Woman had disappeared with a pop at that point.

After evaluating My Dear Little Lady, saying nothing about the little tussle at the desk, I returned to the chart and found that the surgeon had written a consult to Dr. So-and-so as part of his pre-printed post-operative orders. The pre-printed orders are supposed to reduce medical errors but they have an untoward side-effect of causing physicians' brains to shut off as apparently had happened to the orthopedic surgeon. I'm quite sure he knows nothing of this oversight and couldn't care less if he did. I felt no need to chide him over it as it would have been a waste of breath on my part. He and I are largely along on the same wild ride of standardization and efficiency currently dis-serving My Hospital.

Later that morning I paused as I crossed the main lobby on my way out because I thought perhaps a concert was being performed nearby. To my mounting horror I realized that what I was hearing was a xylophone and harp version of "Desperado" being piped in apparently over a new Muzak system. I suspect this is meant to conceal the subliminal messages that are coming next.

Good News

2006-05-17T20:29:00.000-07:00

I found this happy news website and want to share it with you.

Blog Silence

2006-05-15T13:45:00.000-07:00

I've been mute. Inarticulate. Rendered speachless by life. You get the picture. I have at least been putting up some new photos if you've noticed and have visited "Bookcrossings" a little bit. Please don't abandon this little patch of cyberspace. I feel some thought congealing and promise to try and share them with you soon.

Our Lady of Everything

2006-04-10T12:51:00.000-07:00

I avoid accepting gifts from patients as much as possible, but I admired a patient's bracelet and was promptly given an identical one as a gift. Fortunately it is not of great monetary value and I actually like it in a perverse way. It should be clear by now that although I was raised in a seriously Catholic home I am a dismal failure as a Catholic and don't even identify myself as such. Nevertheless I have retained my childhood affection for all things Catholic. I just love the little prayer cards, candles, statues and what not. I have surrendered to this and accept it more or less uncritically as a cultural expression rather than a religious one.
The bracelet was purchased from a religious order called the Missionary Oblates of Mary Immaculate. Unfortunately they are probably out it the world teaching people not to use contraception and according to my patient if they get your name they will solicit you mercilessly for money and ask to be named in your will, but I digress. My bracelet has 12 little pictures on it which are described in the catalogue as "Christian images." I don't mean to quibble but I think they are more appropriately referred to as "Catholic images" since I don't think the average Methodist would recognize a one of them. I myself could name about half of them. After digging through my old "The Lives of the Saints for Children" and a bit of internet surfing I can name all but one. The bracelet features St. Theresa, Padre Pio, The Divine Mercy (this looks like some kind of rainbow princess), St. Anthony, St. Francis, Our Lady of Lourdes, The Immaculate Heart of Mary, and then comes somebody, maybe St. Anne, but I'm not too sure. She's the mostly gold colored one below the 10 on my watch. She is followed by Our Lady of Fatima, Our Lady of the Snows, Our Lady of Guadalupe and finally Our Lady of Perpetual Help. Prior to this I hadn't realized Our Lady of Perpetual Help was real. I thought Garrison Keillor invented her for Lake Wobegone. Anyway if anybody can tell me who the mystery saint is I'd appreciate it.

New Shoes

2006-03-29T12:50:00.000-08:00

I am a physician all day every day. I can tell because I just bought new shoes. I found these nice sensible shoes the other day that fit into my new healthy-me kick. I think I like them because they reminded me of my school shoes from fifth grade. They were brown Mary Janes by Famolare. Famolare you might remember was a big deal in the 70's. They had wavy crepe souls and were famous for really high platform wedge sandal's. So anyway I happily wore my new shoes on Saturday and discovered that when I walk I make a noise exactly like the heart sounds of someone in congestive heart failure. Apparently I have narrow heels. Perhaps the last remaining bit of me which can truthfully be referred to as thin. At any rate it seems that my medical training has completely saturated every last aspect of my life. I can't even run away from it because then I sound like congestive heart failure with tachycardia.

My Home Gym

2006-03-27T13:32:00.000-08:00

Who needs a gym membership when you own a decrepit old house? Some houses are money pits. Mine is an athletic center. I've been in a "disgusted with dirt" mood lately. Maybe because it is finally spring and the species is genetically programmed to clean out the cave in the spring? It's not really very spring like so maybe it is my primitive attempt to banish winter by putting it out with the trash. All I know is I've been pitching and sorting like a mad woman. Occasionally I veer dangerously into bitching and snorting but who cares when you are alone in the basement?
Eight bags of trash and two huge stacks of flattened boxes later I have moved everything in the basement at least twice. Except the washer and dryer which I only moved once. Okay, I'm kidding about the washer and dryer. On the way to the garage with the trash I noticed the yard needed tidied and so did the alley beside the house. Two more bags of trash later I had to stop myself from starting on the neighbor's yard. Clearly I'm obsessed. It was a great work-out though and cheap, too.

Freaky Talk

2006-03-23T06:15:00.000-08:00

Last Friday the New York Times had a travel piece based on regional dialects in North America. The writer drew his inspiration from a recently published Atlas of North American English. A $600 book with over a hundred maps and who knows how many sound recordings. Fridays they write about weekend getaways from New York City so the guy didn't get very far. He made his way from New York City going from diner to diner sampling the local accent, pie and coffee until the grand finale of his trip in, you guessed it, Pittsburgh.

I honestly didn't notice the accent when I first got here. I think because I was in school with a bunch of people who were also not from here. Every once in a while I'd hear "n'at" which I've since adopted as a useful modification to my normal speech. So much easier than all those syllables in "and all that". The thing I remember most about the English language upon arriving in Pittsburgh was the fact that everybody spoke it. Having spent a lot of years in the Bay Area I was accustomed to communicating with people in possession of a whole range of English skill levels from nonexistent to seriously broken to merely accented. I'm not proud to say that I rarely communicated in their languages. I did get good at pronouncing Chinese names though.

Growing up in Iowa I probably got one of those "nothing" accents everybody thinks they've got. Really though Iowa doesn't sound like much. We don't have the Minnesota intonation or the drawl you start to detect as you approach the Missouri border. Iowans sit around sounding like a bunch of newscasters forecasting the weather to one another while here in Pittsburgh we can talk about nothing in particular and sound quite colorful doing it. Witness Rob Rogers' "Brewed on Grant" cartoon in Wednesday's Post Gazette. The scene is a diner and the dialogue goes like this:

Guy: What do you think of (Mayor) O'Connor's new "Redd Up" plan?
Waitress: Great idea... But I hope he doesn't use Pittsburghese for all his initiatives.
Guy: At least he didn't call it "Needs Fixed".
Waitress: His crackdown on violence could be called "Sick'N Tard of Guns 'N'At".
Guy: His plan to attract people downtown could be called "Meechins Dahntahn".
Guy: The "T" expansion could be called "Ovadair 'N'Back".
Waitress: I'm just hoping the "Dooder Jobs" plan is a success.
Guy: What's that?
Waitress: That's where they all just "Do Their Jobs".

Lazy Lazy Girl

2006-03-18T07:43:00.000-08:00

I am a lazy blogger I am. Actually I'm not. But, I prefer to think of myself as a lazy blogger than as someone who's life is so consumed by work that I cannot even steal a moment of online amusement for myself. So in the interest of giving you something to look at I'm providing for you a link to Wymsey Co. The best description I can give is that this is the on-line equivalent of Lake Wobegone for the English. Amusing. Indeed.

Operation Eden

2006-03-11T14:14:00.000-08:00

It is rainy outside and the weather in my head is rather foul as well. Instead of sharing my stormy weather with you I would like to direct your attention to something I like: Operation Eden. I'm not saying it is a cheery place, but the guy takes some really amazing photographs and deserves more attention for it.

Smidgen and the Cold, Dark Night

2006-03-06T12:38:00.000-08:00

Smidgen really has grown into her name. Which is to say she hasn't gotten all that much bigger. Wednesday last week I was holding down the fort at home all by myself so of course it was sleeting outside and the wind was howling. I decided to retreat to the warmth and security of the bedroom a little early but before I did so I needed to grab the mail. If I don't bring the mail in daily the postman takes it upon himself to declare us out of town and hold delivery of our mail. Being as it was nasty out I opened the rarely used front door just wide enough to get my arm through, blindly grabbed the mail and locked the door back up. I trundled upstairs without looking at the mail and promptly fell asleep with my reading light still on.

At 3AM I woke with a start with the fully formed thought in my head: "Smidgen is outside." Had My Beloved been home I would have promptly woke him up and sent him to look for her. Heavy things, sharp things, middle of the night things, smelly things and strange noises fall in the general category of "his job." But as I was home alone I started the search on my own. I forced myself to search the house first: under the beds, in the closets and cupboards, in the basement, and behind the furnace. All the while the film loop of her slipping out the front door onto the stoop under my extended arm played in my head. Killer and Princess followed behind me looking first at one another and then at me. "Now that you mention it. I haven't seen her either" was what they seemed to be saying. Finally I got bundled up and retrieved the flash light from the trunk of my car and went searching.

I started in the front. This is unfamiliar terrain for the animals since we don't come in and out this way. There is also virtually no where to hide. I crawled around on the icy sidewalk looking under all the parked cars and under some raggedy shrubs. I shined my light down the narrow passages between the houses. I decided she would not have gone far down the street. It was unappealing to a small scared cat. Probably she had followed one of these passages into the alley at the center of our block. Just to be systematic I went back around my house and started at the very end of the alley checking the big pine tree and the big pile of crap in the neighbor's yard on the way.

It was very CSI walking slowly down the alley shining my flashlight here and there. Except for the fact that all the while I was softly calling the cat's name. Thankfully she had enough sense to meow when she heard me calling but she wouldn't come to me. I had to follow her pitiful little voice until I found her 2 houses down behind the neighbor's cellar steps. She was too cold to move but let me scoop her up off of the cement and allowed herself to be carried home. She now spends the night sleeping directly on top of me.

Ah Yikes, Med School!

2006-03-01T10:22:00.000-08:00

I honestly don't remember how I found this blog. Well, rant really. To the best of my recollection I stumbled upon it on the single occasion I followed links to the next blog and the next blog and the one after that. I have started checking it now and then mostly out of morbid curiosity. It reminds me of some of the creepier moments (and creepier people) in med school. It vividly brings to mind that intern I worked with on my inpatient medicine rotation at the VA. He spent the entire month mournfully muttering under his breath: "I should have taken that toll booth job." The writer does show some flashes of insight but alas he is young and does not appear to have enough so called real world experience to realize that what he is experiencing isn't about medicine but about life in general. None of that is his fault of course. This is how we make doctors. So on my days when I'm tired and way too old I will have to stop and be thankful for how much energy I'm able to conserve by virtue of maturity.

Dead Drawer

2006-02-24T15:14:00.000-08:00

One of the old metal desks I inherited when I took over this practice sits in the hall outside of my exam rooms. I don't notice it often. There's a large plant on it. Sometime pharmaceutical reps leave ephemera on it. The large drawer, the one that files fit in, is my dead drawer. It is where I put the charts of those people who have ceased to breathe. There's a certain protocol I follow when adding a new resident to the dead drawer. First I write "deceased" and the date discretely on the cover of the chart. Then I write a medical abbreviation for the cause of death. The chart remains in "purgatory" on my desk until I have spoken with the next of kin and/or sent a note of condolence. Once I've accomplished this I file the chart alphabetically in the dead drawer.

The drawer has seen a lot of action this week. Three deaths since Monday. The first a shocker, the second expected and the third not really a surprise. I will not tell you the stories of these souls. They lived and died and that is all you need to know. I find it interesting and peculiar that their charts and the often hieroglyphic notes they contain can bring them back to my mind as if they still breathed. It is as if I'm looking at a photograph of the person. All that data some of it quite intimate is like a composite sketch and when I see it I recognize the half forgotten face. Usually I get a series of recollections. Unfortunately the first memory is of their dying; one half millimeter slice of time in the long process of departure. Next is the first time I met them or the first time I managed to connect with them. It floods back so fast it's as if I have the memory equivalent of a split screen. It is either morbid or silly or neither that I sometimes visit the other denizens of the dead drawer when I have the occasion to introduce a neighbor. I scan the names and the chart covers. Did I print deceased neatly? In all caps? Did I write in my leisurely script in which all the letters of each word are present, discernible and artfully depicted? Or is it the busy scrawl in which only the two d's can be identified? Did I let someone else write it?

At the beginning of this year I had to prune the dead drawer and move the longer gone souls to make room for the more recently departed. I will miss them: the ones that are now in a box in the basement and inaccessible for all but the most occasional reminiscences. I confess however that I allowed one chart to stay behind in the dead drawer a little longer. I did it because I knew that I would be placing her husband's chart next to it in the drawer soon enough and I wanted her to be there waiting for him when I did.

Four

2006-02-15T10:46:00.000-08:00

Four Jobs I've Had:
Corn Detasseler: This was a great job to get. You only had to be 14 because it was farm work and it paid twice minimum wage at the time. Basically you rode a school bus out to some field somewhere at 5AM and walked the rows of corn pulling the tassels off of the female plants so they wouldn't self-fertilize. At the end of the day we would emerge from the fields muddy and covered with spider webs. Once in a while they'd bring in this piece of machinery. Basically a tractor with big arms from which baskets hung. We'd climb into the baskets and roll through the field grabbing the tassels. It was actually worse than walking. When I slept at night I would dream about rows and rows of corn sliding past me.

Handwriting Decipherer: That wasn't the actual job title. I was a graduate assistant. But what I did was squint at the quill scratchings of a French 18th century noble woman and try to figure out what she had written. She was not a good speller. Someone else had the job of transcribing the bulk of her writing and just left me the tough bits. I had recourse to some period dictionaries and the microfiche of the original documents. Once or twice a year someone, never me, went to the Rare Books Library at Yale to look at the actual documents and tried to figure out the ones I couldn't get. Not being a good speller and having peculiar handwriting I felt a kinship with her. I have justified my lack of effort at improvement by saying I am potentially creating employment for future graduate students.

HIV Test counselor: This was San Francisco, 1989. A different world.

Bus "boy" at the IHOP. My sister got me the job. She was waitressing there. I got to wear a little bow tie. I'm pretty sure I was underage.

Four Movies I Can Watch Over and Over:

Stuart Little
Monsters, Inc
Lilo and Stitch
Cinderella

While I was a resident I did back to back in-patient teaching service months June and July. While working the in-patient teaching service we got two days off in the entire month. By the second month I was in pretty bad shape. To make matters worse the new residents start in July so there were all these clueless newbies to watch over. Every single day for the entire month of July I came home and put in my tape of Stuart Little. I rarely made it all the way through. I have used the other movies similarly.

Four Places I Have Lived:

Des Moines, Iowa
The Midwest was a lot more remote when I was a kid.
Aix-en-Provence
Total culture AND climate shock for an 18 year old Iowa girl.
Berkeley, California
Some people leave their hearts in San Francisco but mine is in Berkeley.
Pittsburgh, Pennsylvania
Been here for over 10 years now.

Four TV Shows I Like to Watch:

American Idol: It has an effect on my brain similar to Stuart Little.

Golf: Great back ground sound for a nap on the couch. Reminds me of Saturdays at my grandparents.

Lawrence Welk: Turn off the sound. The color and movement is beautiful. Color TV was so new that they really put some time and effort into it.

Medium: I like Patricia Arquette.

Four Places I've Been on Vacation:

Vacation? What's a vacation? Must have been those long car rides we took when I was a kid. In that case it would be:

Disneyland, Rocky Mountain National Park, Philadelphia, St Louis.

Four Favorite Dishes:

Pasta Fagiole, Tortellini in Brodo, Butter Bean Casserole, and Kraft Macaroni and Cheese.

Four Websites I Visit Daily(or almost):

Caleb Walker; my sister's blog: Life on the Other Side; My Daily Yoga; Art Underfoot (I'm ever hopeful)

Four Places I'd Rather Be Right Now:

Home in bed.
New York City
Paris
Anywhere with my sister.

Four People to Tag (meaning people who should do this, too):

Well, obviously Art Underfoot, Life on the Other Side, AC, and Ohmygod, I don't know anybody else!

My New Toy

2006-02-14T15:37:00.000-08:00

Thanks to Caleb Walker I have a new internet toy. I mean tool. It's PBWiki.

See?
They say it's as easy as making a peanut butter sandwich. Personally I don't use as many of the funky keys on the keyboard when I make a peanut butter sandwich as when I use PBwiki. Like all new things I'm expecting it to revolutionized my world. Or at least clear some of this crap off the surface of my desk. I will also finally have some place to post my buprenorphine talks. It's not much to look at right now. But if you want to know where I like to buy my shoes you should check it out. This is where you can go if you want to see what their about in general. If you want one of your own. Click here. (Oops.)

What a Pain

2006-02-13T11:30:00.000-08:00

The first person who says this'll make me a more compassionate physician gets popped in the nose. I don't care how much it hurts me. I remember laying on a gurney in the ER having painful exam after painful exam while they tried to determine if my appendix needed to come out when the attending surgeon of all people had the nerve to say just that. It's a good thing his neck was not in reach. For starters it was not what I would call a teachable moment. I also found it very presumptuous of him to assume first of all that I wasn't already sufficiently compassionate and second that I hadn't perhaps already had enough experience with pain in my life to have learned my lesson if indeed I needed one.

Fast forward several years and you find me, you guessed it, treating all kinds of people with all kinds of pain. I have my ups and downs with it. Some days I don't want to deal with it anymore. It just seems like too much. Trying to piece together a diagnostic work-up spread out over many years and several hospitals. Trying to get a coherent story out of a person who has become accustomed to being mistrusted and is often in significant unrelieved pain while trying to tell the story. Trying to filter through the various emotional overlays of grief, resentment, humiliation and fear that have accumulated over the years. I feel like giving up. Then I have a fraction of a second to think and I realize my patient doesn't have that luxury or for that matter any other doctor to whom to turn. So I hang up a Frieda Kahlo calendar in the hall and soldier on.

Now in December for no apparent I suddenly remembered this book I'd read in med school called The Gift of Pain by Paul Brand. I loaned it to someone years ago and never got it back. I decided it was time to reread it and got myself a new copy. Before I could get around to reading it my hands started to hurt. I was stunned. At first I tried to believe I had developed hand pain because I just inherited about 100 patients with hand pain from a surgeon who retired. But really, I'm just not that suggestible. Nevertheless my hands hurt and they continue to hurt. It hurts to hold a book. It hurts to take a cap off a pen. It hurts to pull the covers up in bed. It hurts to drive. It hurts to open a door. It hurts to palpate somebody's belly. It hurts to take a blood pressure. It hurts to pick up a chart. It hurts to lift a pan of food off the stove. Long story short, I've been driven to seek medical attention from someone other than myself and I appear to have either arthritis or carpal tunnel syndrome. I take acetomenophen. I take ibuprophen. I nearly burn myself with the heating pad. I sit immobile like a sick cat. I grump at innocent bystanders. I have pain. I am a pain.

I'm glad I've taken pain seriously all these years. I just wish the karmic pay off was coming sooner.

Good News Bad New

2006-02-10T06:24:00.000-08:00

I had truly hoped that we'd have at least a week of "New at 11: The Steelers won the Superbowl!" But, unfortunately we went straight back to the arsons, shootings, and hit and runs. The two weeks leading up to the Superbowl proved that we don't actually need to know all of that stuff in order to conduct our daily lives. The entire evening news would be about the Steelers with an occasional "Oh, by the way all the coal mines in West Virginia have been closed because they are unsafe. But, the Steelers are still going to the Superbowl!" I've decided the television stations need to make two evening news programs. One for good new and one for bad news. Can't you just see it? News teams fanning out over the city looking for boys helping old ladies across the street and firemen getting cats out of trees? They could cover kindergarten graduations and tree plantings. Wouldn't that be great? I'm sure there are viewers out there ready to tune in and advertising dollars out there to pay for it.

A Super Dish in a Bowl

2006-02-04T13:05:00.000-08:00

"What the hell are these beige lumps?"
That was my reaction the first time I encountered Butter Beans ala My Beloved. His traditional family recipe involves opening a can of them, heating them on the stove and plopping them on your plate. He was needless to say disappointed when I didn't care for them. Recently I discovered a recipe that makes those dreary beige lumps quite tasty. It is a big hit at home. And, it is good for you. So, here is my ever so slightly tweaked recipe from the Vegan Society:

1 large onion, chopped
garlic to taste
2 large carrots, sliced
2 good size leeks, sliced
100g mushrooms, sliced
1 large can of tomatoes
1 large can of beige lumps, drained
1 TBS tomato paste
"dried mixed herbs"
salt and pepper

saute the onion, garlic, carrot and leek until onions are translucent and carrots are softening. Add mushrooms and cook a little longer. Add everything else. I usually use thyme and basil. Put it all in an ovenproof dish and bake for 30 minutes at 375F.

Eat until all gone.

Still More Aphorisms

2006-01-31T14:05:00.000-08:00

Where there's a will there's a way.
The proof is in the pudding.
There's no time like the present.
The truth is stranger than fiction.

I can't believe I say this stuff but I do.

Dogzilla-burgher

2006-01-30T13:02:00.000-08:00

Dogzilla will not be trimming his facial hair until after the Superbowl.

Here We Go

2006-01-29T14:07:00.000-08:00

I guess it was '95 when the Steelers went to the Superbowl the last time. I had only lived in Pittsburgh a short time and was fresh from my organic-girl, quaker days in Berkeley. The whole thing basically went right by me. I lifted my nose from a medical textbook once in while and wondered what all the screaming was about but that's about it. One of my slightly more atuned Menonite friends noticed enough to complain indignantly that night after night for two straight weeks the lead story on the evening news was guess what: The Steelers are still going to the Superbowl. Shades of Francisco Franco is still dead. Now that I'm older and a good bit more weary I take pleasure in the reassuring glee of the nightly news. I am glad for the reprieve. The lead story will soon enough be about shootings, hit-and-runs, arsons, missing and abandonned children. And, this being Pittsburgh the occassional porch collapse.

Meat & Potatoes vs. Wine & Cheese

2006-01-23T14:19:00.000-08:00

Despite my best efforts I have been following the Steelers this year. There are plenty of fan websites and whatnot where you can read the stats and download the fight songs including a couple of polkas. There's even a blog I stumbled across. But, what I want to know is why don't we have cheerleaders? The Colts had cheerleaders. The Broncos had them, too.

Now the Steelers couldn't have just any cheerleaders. Pretty girls are a dime a dozen after all and when you've got the Steelers to watch, who needs eye candy? Ours would need to know how to fix halushka, keep the crowd loud and if the defense lets the ball through get out on the field and stop it... Here's my vision:

Dada, dada..... Introducing the Pittsburgh Pierogies!!!!!!!!!!! Here comes a crew of women d'un age uncertain and weighing at least one standard Pittsburgh unit (ie: about 180 pounds). Except that is, for the really, really skinny one. A few would make reasonable contestants in the newest reality TV show called: "Get That Woman Some Teeth!" Forget the silly little costumes. The Perogies wear army boots with cutoffs and that traditional Pittsburgh favorite: a tank top. They celebrate touchdowns with synchronized arm flab routines. Anybody fumbles and they're gettin' a whoopin'. You got hurt? She's putting a bandage on it and shoving you back out there with a hardy "Quit yer cryin'."

Look out Seattle!

More Aphorisms

2006-01-18T13:51:00.000-08:00

Slow and steady wins the race.
Be careful what you wish for.
An ounce of prevention is worth a pound of cure.
The road to hell is paved with good intentions.

That last one bites me on the hiney almost daily.

Read This

2006-01-17T08:16:00.000-08:00

Not THIS. Read this: "Yeah, I said it" by Wanda Sykes. It is super funny. She uses a lot of naughty words though so if you have sensative eyes you should read something else. If you are a republican you can read it but don't come whining to me.

Indianapolis

2006-01-16T13:56:00.000-08:00

With the dramatic Steelers win yesterday I was reminded of my recent visit to Indianapolis. (I can't believe I follow football but it's hard not to notice when My Beloved is running around the house shouting "Yeah!".) We passed through Indianapolis New Year's Eve and stopped for dinner. When we saw the sign advertising burritos "as big as your head" we just had to stop. Fortunately La Bamba offers a scaled down version of which My Beloved and I (and Dogzilla) ate two. While we sat in the car we noticed an interesting fact. Don's Guns across the street had a sign out offering guns for rent. I hope not too many Colts fans know about this.

How to Keep Going

2006-01-10T19:30:00.000-08:00

A while back I had a free moment and read part of a New Yorker (October 31, 2005) and ran across something that made me pull out a pen and circle it. It was this:

"You have to assume good faith, even on the part of people with whom you disagree... If you don't assume good faith, it makes matters personal, and it makes it harder to reach a good result and, in my experience, it normally isn't even true. People do act in good faith. The best clue to what a person thinks is what he says."

This was a statement made by Supreme Court Justice Stephen Breyer as quoted by Jeffrey Toobin in his article "Breyer's Big Idea."

Medically Induced Coma

2006-01-09T13:52:00.000-08:00

Between the surviving miner in West Virginia and Sharon it seems like every other story on the news is about somebody in a medically induced coma. This term is entering the vernacular so to say and soon I expect to have a patient say to me: "Doc, ya know I've been under a lotta stress lately an I wonder if you could put me in one-a those medic-ly induced coma thing-ys just until stuff settles down."

Well, I haven't posted for about a week now because I've been in my own kind of medically induced coma thingy. Mine doesn't involve any interesting sedative unfortunately. Mine is more of a side effect. The instant I walked in here from my Christmas vacation I felt like I needed a vacation. I realized of course that it's not a vacation I need, but a new life. All day I am completely absorbed in an avalanche of other peoples' problems. Each problem needs 100% of my top quality attention, not that kind of attention I give to one thing while I'm doing two others. The problems don't always require high-end brain power but my whole self has to be there focused and listening. Throw in a few interruptions of the "before you get started" kind. (Guess what. Once I've closed the door to the exam room, I've started.) Throw in an earnest and talented medical student who deserves feedback and a quality learning experience. (Me, again.) Throw in a patient population of frail elderly folks who would blow away in a stiff wind. Then, throw in a complete absence of physicians in this community willing to treat pain. Set all that against a back drop of extreme social injustice, obscene bureaucracy and no net under my tight rope and you've got one little old Me in my own medically induced blog coma.

Grandma Would Be Proud

2006-01-02T14:23:00.000-08:00

As a kid I spent a lot of time at the kitchen table with my grandma going through old photos. Every time we sat and looked at them she would get upset with herself for not having written anything on the back of them when she first got them developed. We spent hours and hours trying to figure out who was who, when the picture was taken and where. I got so that I could tell her brothers apart better when they were in their 30's than in the present day. Ever since I took my first camera to summer camp she was after me to label my photos and for the most part I have done so. Labeled them and put them in albums. Now that the whole photo thing is digital I am trying to keep up my good habits. My Beloved and I just returned yesterday in the wee hours from a trip "home" and I have the pictures essentially ready to view. Click on this if you would like to look at my "albums." Happy New Year.

The Annual Christmas Tragedy

2005-12-25T09:30:00.000-08:00

It happens every year.

Before:

After.
Merry Christmas.

It is His Birthday After All

2005-12-23T07:46:00.000-08:00

This year's look in "holiday" wrap chez moi.

Aphorisms I've Uttered Today

2005-12-22T08:10:00.000-08:00

There's little education in the second kick of the mule.
Luck favors the prepared.

Introducing Art Underfoot

2005-12-21T10:52:00.000-08:00

I would like to introduce you, faithful reader, to my friend KR. KR is new to the blogosphere and I think her blog will have the feel somewhat of this photo which I took at her establishment. Check it out.

Winter Light

2005-12-20T08:26:00.000-08:00

One recent wintery morning I slept in and this is the photographic record of that momentous event. For more click here.

Where's my hat?

2005-12-20T07:57:00.000-08:00

Some days I'm like a schizophrenic who's lost his aluminum foil hat. All that evil crappola out there in the world get super pointy all of a sudden and goes straight to my heart. Usually the badness out there just makes me want to work harder at fixing the bits I can get my hands on. Maybe it's because I don't feel too good. Maybe it's hormonal. Maybe it's the short and cold days of winter. But the last little while I just haven't found a constructive response to it all. This is painful for a natural born problem solver like me. I just can't figure out what to do with that criminal we call a president. I can't figure out how to make my dream of being a parent happen. I can't figure out how not to work myself into the ground and end up like my predecessor who retired too late and found he had nothing left of himself. I can't figure out how to help those shelterless Pakistanis who are slowly freezing to death in the rubble of their homes. I can't figure out how to get my colleagues to care about addiction and do something about it. Right now all I can do is throw bits of Milkbone for the dog to chase (Why should he be deprived? None of this is his fault after all.) and cry a little into my knitting. Once I find my hat maybe I'll organize some knitters for afghans for Afghans.

Lunch at Broadway and Bleeker St.

2005-12-16T10:29:00.000-08:00

Lunch
Originally uploaded by still just me.

Clearly I need to get out more.

Escarole is Good for You

2005-12-15T12:24:00.000-08:00

I'm slowly teaching My Beloved a few new dishes. He likes to cook but his repertoire is what you might call limited. As of last night I believe he has finally mastered my version of Pasta Fajole. First you chop up and saute a whole bunch of garlic in olive oil. For us it's an entire head since My Beloved smokes and can't taste anything but for you that might be a couple of cloves. Add cooked white beans. About a can of them if you are wondering where the "cooked" comes from. Salt and pepper to taste. Add what you are sure is way too much basil. Simmer a little but not too long or the beans'll go to mush. Now pour in a large can of peeled whole tomatoes which you have ripped into bits. While that simmers nicely start a large enough pot of water on the stove for about a pound of rigatone or penne. Next it is time to clean the escarole. Clean it. Dry it and tear it into shreds. Compost the really tough white parts. They taste fine but have the mouth feel of shoe leather. Once the tomato sauce is still just a little too watery load in all the escarole and squash it with the lid. In not more than ten minutes that stuff is shrunk down to nothing. Hopefully you've cooked and drained the noodles by now and can toss them inna bigga bowl, top with Parmesan if you aren't a vegan, and serve it up.

Nessie the Reindeer

2005-12-13T15:20:00.000-08:00

Nessie the Reindeer
Originally uploaded by still just me.

A new arrival.

The Strand

2005-12-10T08:44:00.000-08:00

While I was in New York City for 5 minutes last week I poked my head into The Strand for the first time ever. I was dazzled. Amazed. Euphoric even. I strolled around the first floor only and had to leave before I got delirious and embarrassed myself. I can't remember the last time that I've seen so many books that I've never heard of before. I'm not the most well-read nerd on the planet but the blinders placed on me by the best seller pabulum served up at the ubiquitous Barnes and Noble and Amazon.com fell off in that moment. The place was abustle with apron wearing bookinistas and bookinistos. It took me back (doesn't everything take me back somewhere?) to my happy if hungry days at Stacey's Book Store in San Francisco. We wore similar burgundy aprons with name tags we made with a labeler. We were not required to put our actual names on the tags. I was Zelda for a long long time. The kids at the Strand were busily looking things up on computers and tracking down just the book for just the person. Once upon a time I was as fast and efficient with a microfiche reader as they are with a mouse. But I date myself. I plan to use the Strand's website for all my purchases from now on. The only nerdy quibble I have with the place is their ultimate New York pretension of selling books by the foot for the purposes of DECORATION. It's enough to make nerds everywhere turn over in their graves or their book laden beds.

Courtesy of KR

2005-12-10T08:37:00.000-08:00

We've been getting lots of compliments on the appearance of the waiting room these last few weeks thanks to KR. We like to keep things fresh out there since so many people spend so much time sitting there waiting for their session with Dr. C. Click here to see the current soothing and homey decor.

Princess Hijacks the Blog

2005-12-10T08:02:00.000-08:00

I don't know what those stupid humans see in that damn dog. Stinking, poop-eating, whore for attention that he is. He is just way overboard with the wiggling and the jumping. And don't get me started on the yapping, Lord. Then there's the kitten! They think she's so cute. Retarded little midget tromps around the house with all the grace of two humans in a cat suit. It's beyond embarrassing. Poor Killer is so misunderstood. He is the epitome of discretion and dignity. There is no other cat that even comes close to his skills as a stalker and hunter. Those humans had better straighten up and fly right. And turn the space heater back on in the kitchen because between Killer and I we've got all the dirt on them. Oh boy the things I could tell you. So the space heater and some Iams Catfish Formula canned food pronto or I'm letting the cat out of the bag. Hahahahahahahahaha.

If Only I Didn't Have Toes

2005-12-06T14:14:00.000-08:00

I saw these shoes in a magazine and decided I would check out the real article while I was in the Big City. I was crushed to find that they DON'T MAKE THEM IN MY SIZE. I have had these gigantic feet since I was about 13 or 14. I used to have no choice but to wear shoes which did not fit. I didn't count wearing shoes just like Sister Leona Mary's as an actual option. I do admit that things have gotten somewhat better but I still shop for shoes by walking up to the first clerk I see and asking to see what they have in an 11. There is no real point to looking for shoes I like and asking if the gods saw fit to create them in my size. This is the sure path to damnation or meltdown. The exceedingly helpful man whose lunch I interrupted at United Nude (see the link above) gave me the card of the store's previous owner who has gone on to a higher or at least a larger calling. Unfortunately his new endeavor "Elleven Up" doesn't have a web site but you can rest assured I will go there one day. Not this trip, but surely on another visit. I am not the jealous sort so if you have the opportunity to get there before I do it is located at 12 W 57th Street in suite 1005. In the meantime I will hold tight to my fantasy of finding a drag queen having a garage sale.

City Winter

2005-12-06T13:49:00.000-08:00

Thankfully the snowfall that had been predicted to coincide with my visit to New York City amounted to nothing but I've always disliked "back east" winters. This includes Pittsburgh for those of you who have gotten the silly notion that Pittsburgh is in the Midwest. Maybe the defining criteria for whether a place is in the East or the Midwest should come down to this difference in the winters. New York winter, the prototypical "back east winter,"is in my experience sloppy and wet. There may be frozen lumps of snow piled at the curb but basically what you've got is slush. In the Midwest, the real Midwest, there are giant mounds of snow to climb over in order to cross the street, too. But in the Midwest you don't climb over the giant mound of snow in order to land in a vast puddle of slop of indeterminate depth. You climb over the giant mound of snow and skillfully cross a vast patch of ice. If you lack this skill or fail to acquire it you must promptly move to Florida. If you have some rudimentary capability you might be able to get by with some assistive devices such as cleats. When it is a puddle of slop you must contend with your only strategies are long jumping, pole vaulting or getting rich enough to use a car service. I did find one item that makes winter anywhere a little more bearable and that is the wonderful "wonderwarmer". These are nifty little thingies that become nicely toasty when you snap a little capsule inside them. After they've cooled off their magical properties can be restored by boiling them for "just five minutes." I plan to use mine on the walk home. With a small modification these could probably be slipped into your earmuffs or hat as well.

A Minor Interruption in the Time-Space Continuum

2005-12-06T13:17:00.000-08:00

Late last week I was invited to come up to New York City for a meeting. It concerned an issue about which I care deeply so I undertook to make it happen. Being away for the day on short notice involves rescheduling a full day of patients, spending many hours at the office on both Saturday and Sunday doing things like actually seeing the patients whose appointments had been cancelled and getting all the reports and results reviewed and properly followed-up.

Monday night I slept in a guest apartment rather than a hotel. Oddly enough I believe the apartment is in the building in which I would have lived had I done my residency up here. Isn't it interesting how time and space seem to spiral rather than go in a nice straight line?

I attended this morning's meeting with interest and found it stimulating and discouraging in turns. Not to reduce the whole thing to a mere social occassions but I was very pleased to see the French Psychiatrist who had come to my aid earlier this year on the occassion of my allergic reaction. He was accompanied by another French colleague who I had not met previously. Between them they are two Very French Fellows. Now the VFFs had me beat on travel of course not only because they came from Paris, (isn't that where all the VFFs live?) but because they had arrived the night before and were departing later today. Being a confirmed "noticer of things" I couldn't help but spot the carry-on of one of the VFFs. I hesitate to call it a carry-on since it was more an objet d'art. It was essentially an outsized black leather doctor's bag. Very outsized. A black leather doctor's bag on steroids. I expect it is quite inconvenient to carry around but I suppose when you are a VFF you must suffer these things. I found it so intriguing that I am convinced if you open it and step inside you disappear in something like a cross between Mary Poppin's bag and the enchanted wardrobe of C.S. Lewis. It must take you into a world were that unique substance that gives life to VFFs is mined by dwarves. I am only speculating but I expect this is an entirely seperate place from where Very French Females get their elixir.

Smidgen's Wishes

2005-12-04T11:39:00.000-08:00

I may have to change the name of this blog to "Take Two and Don't Call Me" because I'm almost too busy to breathe. One little person in my life has the capacity to bring me to a screeching halt in the here and now though and that is Smidgen. You may remember her from this summer when she arrived at our house a flea bitten handful of fur. She's not a baby anymore but she is still just a little kitty. She is very very talkative. When she enters a room she announces herself with a little trill of M and R sounds. When she is being ignored and prefers not to be she chatters like a mad bird. When she is being transported against her will away from a tempting plant or other trouble she sounds like a very small fire engine. She is also very articulate non-verbally. She will lick you raw when she is content. And, she will push her box of kitten food over to you and bump your toes with it if she needs to make a point.

She is the most intensely here and now when I am trying to knit. She understands that she is not allowed to play with my knitting. She learned this through repeated lessons involving chasing, running, yelling and being jiggled until the forbidden ball of yarn dropped from her jaws. Nevertheless she loves to sit on my lap and gaze longingly at my project. The flicking arrangement of needles in my hands, the long wiggly piece of yarn that disappears tantalizingly into my knitting bag, the delectable ball of yarn that makes sudden and delightful appearances are equally fascinating to her. She stares long and hard until she is entranced into a dreaming pile of furry feet and ears.

She has made peace with the other resident animals. She and Dogzilla engage in playful run and chase games and when they wear themselves out she tries to bathe him. Princess deigns to recognize that Smidgen is useful as a Class A Food Mooch and happily shares the kitten food Smidgen wrings out of her hapless people. Killer, while lethal to rodents and birds, is essentially a pacifist and allows Smidgen to run hog over him. He prefers to observe from a distance like the fur-bearing anthropologist I've always suspected him of being. So Smidgen is a happy little thing but if she could wish for anything at all I believe it would be some knitting of her own and someone smaller than her to boss around.

If you're feeling old

2005-11-21T11:19:00.000-08:00

If you've just turned 40 and you are feeling a little old go play bingo in a nursing home. Everybody bingos twice and the came isn't over until the cards are full.

Fear of Knitting

2005-11-09T09:18:00.000-08:00

Here I am in Dallas. Again. For the first time since 9/11/01 I brought my knitting on a plane. I've always been afraid of having it "seized." I was mildly anxious the time since I'd made no advance preparation as to what to do with it if they wouldn't let me through security. I just gambled that the very fine, very blunt bamboo needles 1) wouldn't be seen or recognized on the scanner, and 2) wouldn't appear threatening if examined. It helps that there is the very diminutive embryo of a sock hanging off of them. Maybe we are on our way back to civilization.

Snapshots

2005-11-06T10:54:00.000-08:00

I'm here at my desk on Sunday trying to get caught up before I leave town again. And, oh yeah, write the talk I'm to give on Saturday. So obviously I'm taking a break at the moment in order to provide a couple of links for you faithful reader. I managed to take some cool photos on my recent safari to Arkansas what with being up and out at all hours. So first here are the photos of the way down there. These are mostly of Cairo, Illinois and of the confluence of the Ohio and Mississippi Rivers at the freakin' crack of dawn. Next there are some pictures of the monastery where My Beloved spent some of his high school years because his parents didn't have a clue what to do with him. Western Arkansas is really beautiful. Maybe it was just me who didn't know this but did you know they have mountains there? Finally there are just two shots of nice spots in Arkansas that My Beloved showed me.

Goodbyes

2005-11-05T09:06:00.000-08:00

After the little pause that accompanied my re-entry to the Burgh I'm going to try to tell you a story about what happened at the wake.

My Beloved and I spent virtually all of our time sitting with his Grandmother at the nursing home. She enjoys company and Dogzilla has a lot of fans there. The day of the wake we sat with her all morning and then returned to wait for My Beloved's sisters to come and get Grandma. My Beloved had dearly wanted to drive her there and be with her when she first saw her daughter's body but he had been denied this privilege by his aunt who will hence forth be referred to as Lady Tremane. My Beloved had earned Lady Tremane's disfavor when he objected to Grandma being put in the nursing home a year ago. He and numerous other people thought this was unnecessary. He and I believed then and believe now that this was purely a move to obtain control of Grandma's modest annuity.

My Beloved adores his grandmother. When she was ill last year he spent weeks in Jonesboro, hours a day at her bedside and was generally a burr in the sock of those who wanted to do their sneaky deeds unobserved and unquestioned. Lady Tremane and her Fools are so afraid of My Beloved's ability to do what he sees fit with total disregard for their plans that they are driven to some pretty bazaar behaviors. One day last year he and grandma sat at the Home looking at multiple generations of family pictures and drew up a family tree. This was interpreted as My Beloved making grandma sign papers and caused an uproar. Later when she was settled at the Home and he was packing to return to the Burgh one of the Country Cousins physically assaulted him because he tried to leave Grandma's old house with a duffel bag containing his filthy clothes and a box of photos. I can only assume they thought he was making off with the Confederate gold Grandma had hidden in the attic all these years. Keep in mind these are the same people who provided a live re-enactment of the War Between the States at our wedding 3 years ago. Apparently last week they managed to work themselves up into such a state that they imagined My Beloved would kidnap his grandmother and head for the border if he was allowed to drive her to the wake. This is the only explanation I can think of for the presence of the perplexed Jonesboro police officer at the nursing home when the girls came to get Grandma.

Well, we were pretty sickened by this but there wasn't much to do about it. We dropped Dogzilla off at a friend's house and went to the wake for the last few minutes of the private viewing. Before hand we stopped for a strategy session. Over a quick coffee (they have two coffee shops in Jonesboro) we shook off our nausea and got reoriented to the fact that this was about his mother not about Lady Tremane and her hi-jinks. With a little prompting My Beloved was able to conjure up his fondest memories of his mother and with these images in his head we went to face the Fools. As we pulled up to the funeral home we realized there was more than one service going on and shared a bleak joke about his mother's being the one with the cop stationed in front of it. There was no cop but it gave us a laugh anyway. On the steps outside were some married-in members of the clan. One went out of his way to make us feel welcome but the other high tailed it into the funeral home. Apparently he needed to alert the Fools inside and sit next to his wife just in case my beloved uttered a swear word and had to be challenged to a duel. We were there no more than 10 minutes.

My Beloved's mother is dead. Her wishes and dreams as well as her suffering are over. It is not what I wish upon those people but rather what will inevitably happen. One day hopefully a long time from now their mothers will one by one die. They will stand next to the casket vacantly accepting condolences and they will feel that chill wind that picks up at your back and strengthens slowly as each of your elders leave this world and they will feel remorse if only for an instant for their cruelty to my Beloved upon the death of his mother.

5 Minutes

2005-10-28T15:08:00.000-07:00

After being put off for two days My Beloved was finally permitted to see his mother for a few minutes. Apparently she had not wanted him to know of her death until after the fact. We are honestly puzzled by this but since My Beloved is the family scapegoat we can only assume he is guilty of some misdeed of which he knows nothing. He was forbidden to speak while he was in the room and was sternly prohibited from touching her either. A few hours later she died but remarkably they didn't try to blame this on him. This morning we had to tell his 90 year old grandmother that she had out-lived her only child. "Oh me," she said.

13 hours

2005-10-27T07:13:00.000-07:00

I feel a little like Dorothy in Oz. Tuesday, I was in the middle of the usual controlled chaos of another work day when there was a sudden and dramatic shift in priorities. By 9pm Tuesday the car had been to the shop, some urgent banking had been done. Cat-sitters had been arranged. Hotel reservations made, we crossed the state line into West Virginia on Highway 70. My Beloved's mother lays dying in Jonesboro. It was a fluke we found out about it at all as various family members had conspired to hide this fact from My Beloved. This is a family that seems to use day-time soap operas as their moral compass. We saw the dawn in Cairo where barges and their tugs emerged sleepy-headed from the foggy confluence of the Ohio and the Mississippi as if from their bedcovers. Cairo is well on it's way to becoming an archeological site. Never have I seen a town so vacant and decayed. We crossed into Missouri and left the interstate at Hayti. From there to the Arkansas line the cotton harvest was complete and the rectangular bales sat like small trailers the color of new cement parked at the end of the fields. Tufts of cotton lined the shoulder of the road. For some reason across the St. Francis river in Arkansas the cotton is still in the fields. Early Wednesday morning we checked into the Holiday Inn which had granted special permission for Dogzilla to stay as a guest as long as he was more dog than zilla. He loves the Holiday Inn for the sole reason that it is not moving. I love the Holiday Inn because Dogzilla will finally stay off my lap. It's not so much that he minds car trips but he will not have anything to do with My Beloved's lap, the back seat, or any number of doggy-bed options. He is attached to me as if with suction cups increasing the pull of gravity over my lap in the way only an anxious animal or child can do. So here is Jonesboro a featureless but thriving town. Thriving like mold in a closed refrigerator with the power off. We are waiting for the five minutes My Beloved has been granted to say goodbye to his mother. In a little while we'll have lunch with his grandmother, her mother, who is ignorant of her daughter's immanent demise by order of the family cabal.

Thanks

2005-10-21T15:40:00.000-07:00

Last weekend I attended the inauguration of the State Medical Society’s new president. While I sat and listened to her thank and acknowledge all the people who had helped her in her career I started to imagine what my speech would sound like if I were standing up there in my 70’s being inaugurated. It didn’t take long for me to realize that I needn’t wait that long to thank people. It’s funny the ways in which people influence you without you realizing it. For example my grandmother was one of the hardest working people I’ve ever known. I believe I owe to her the fact that I derive such satisfaction from hard work. It was she who gave me my conviction that hard work is more easily done with a smile on one’s face than with a frown. I thought I was born with it, but I got it from her. Mercifully my mom didn’t form my personality too much. She did give me my love of reading, my ability to break down overwhelming problems into manageable bits, and a knack for weighing the pros and cons in difficult decisions. She also taught me the very useful skill of memorization. Memorization was not a common didactic technique when I was in school but mom taught me how to memorize my catechism and it has served me well; the memorizing, not the catechism. I believe I get my empathy for the weak and vulnerable and my sense of outrage at injustice from my dad. He was forever bringing home injured animals and continues giving too much of himself to people he feels have greater need than himself. Sometimes I wish they’d raised me to be heartless and money grubbing. Oh well.

Bring on the Goodies

2005-10-20T13:31:00.000-07:00

It hit me the other day while I was waiting in line at the grocery store and I saw the Halloween candy: it’s time for the annual food onslaught to begin. First it’s individually wrapped chocolate bars. Then it’s pumpkin flavored cookies, cakes and pies. Soon after that the holiday collections of salted nuts will begin to arrive. As Christmas bears down on us the homemade baked goods and commercial gift baskets will start to appear. The homemade stuff is my favorite, especially the Italian pastries. I feel a little guilty for liking the stuff but I do. After Christmas it still doesn’t let up. New Year’s is ushered in with stuffed cabbage, nut rolls and kielbasa. The chocolate doesn’t let up until the end of February.

House of Delicates

2005-10-18T09:22:00.000-07:00

This past weekend My Beloved and I took a little road trip to Hershey for the Pennsylvania Medical Society House of Delegates. My Beloved enjoyed long soaks in the tub, cable TV, and a home-repair free weekend. It was a nice drive since the leaves are turning and this time of year the Turnpike is relatively construction free. The House of Delegates is kind of fun. The doctors willing to put time into this kind of thing are generally very idealistic and optimistic people if benightedly Republican. Before the meeting they mail each delegate this H-UGE packet of reports and resolutions to read. When we arrive we are given a gigantic three-ring binder to put it in. Such a binder I have never seen before. It has handles on it so when you close it you can carry it around like a briefcase. Every morning you start at 7 AM if not earlier by meeting with your caucus. In this closed door session you decide as a group what you will support and why and who will go to which meeting to argue for it. I suppose this is what the Junior UN is like. On the second day we approved a change to the by-laws and instantaneously went from Davis Rules of Order to Sturgis Standard Code of Parliamentary Procedure. This caused some distress because nobody knew what archaic verbiage to use. There were very few women in attendance. The only upside to this is that there was never a line for any of the bathrooms. It also appears that my haircut is the standard middle aged female physician hairstyle. There will be more about my adventures in parliamentary procedure shortly.

The Garden in Fall

2005-10-07T12:46:00.000-07:00

1968

2005-10-02T11:39:00.000-07:00

On this date in 1968 students gathered in Mexico City to demonstrate for greater freedom. 500 were killed by police.

Camp Dad

2005-09-28T10:45:00.000-07:00

My house is a mess. Absolutely everything is covered with dust. Some of the dust is plaster dust. Some of it is wood dust. A little of it I suspect is coal dust. This is the result of a marathon visit from dad. Dad retired earlier this month and is relishing his new found freedom. I am very pleased that his first adventure as a retiree was a trip in his new van back to see me. He brought every tool known to dad-kind. He used every one of them, too. He and My Beloved fixed the furnace, installed a garbage disposal, and hooked up the ice maker. Then they really got down to business. They used something with a name that sounded like "Sawzaw" to cut out a section of the main sewer pipe from the upstairs bathroom. This pipe had a big crack in it that My Beloved had temporarily fixed with some metal glue. Now there is a section of PVC pipe in there with the old iron stuff. Next Dad had to build a box around it since it is right there in the front hall and all. The Boys also reopened a doorway from the hall to the dining room. This doorway existed at some point in the past and had gotten walled over. The doorway had to be drywalled and required a lot of horrible "mudding. " The mudding is horrible because it requires lots of sanding and plaster dust is nasty I've discovered. They also stripped and sanded the floor and woodwork in the hallway. Hence, more dust. Needless to say (needless if you looked at the pictures anyway) a good deal remains to be done. The floors need polyurethaned, the woodwork needs paint. Let's not even start about the foyer. There is about a million years of sweeping and dusting and mopping and wiping up to do.
Now through all of this the boys got along pretty much okay. You've got to know that my dad is one of those loner types. Something Clint Eastwood as The Man with No Name meets Johnny Cash. And, that My Beloved has what he thinks is an extremely mild case of Attention Deficit Hyperactivity Disorder. At one point he wore on dad's nerves so bad that dad would only grunt at him for about a day and a half. Dad asked me later "has he got that same thing your sister's got?" Yep.

Dates to Remember

2005-09-14T11:09:00.000-07:00

When I was in high school history class Sister Jean made us memorize only one date. That date was December 7, 1941. I remember asking my grandmother what she was doing when she learned of the attack on Pearl Harbor. As I recall she said she and grandpa were at home getting ready to drive out to Aunt Jenny's house for the afternoon. Sundays were usually spent cooking, smoking and playing cards. This was when everyone was first married and in first homes but hadn't had the first kids yet. The Ivanovich baby boom didn't start until 1943 when grandma, her sister and her sister-in-law all gave birth within a 6 week period. That particular Sunday was spent the same way except with the radio on and the knowledge that none of the men in the room would be present in 3 months time.

In Junior High we studied presidents and we had an assignment to ask our parents what they were doing when they learned Kennedy had been assassinated. On November 22, 1963 my mother had a 18 month old baby at home. My sister, not me. Mom was watching her soap opera on TV. Probably Another World which I remember her watching when I came along. She called dad at Minneapolis-Moline Farm Supply where he worked. They tuned in a transistor radio and listened to the story there but dad had to keep unloading trucks.

There were some days I thought would be important as I was growing up. I remember thinking that when the last colony in Africa became an independent nation it was a memorable occasion. I also thought when Egypt and Israel signed a peace treaty it was worth noting. I was a geeky kid. As it turns out the massacre in Jonestown is the only thing that gets periodically revisited. I was sitting on the couch doing my homework in front of the TV when I heard about that. I was home alone. It is the first time I ever remember them warning viewers about disturbing footage and recommending that children leave the room. I was probably 12 and I remember looking around the room and thinking "If I leave the room how will I know when it's over?"

Now the Big Obvious Date to Remember from my adult life is September 11th 2001. If I ever have children or maybe great nieces and nephews I fully expect to be asked where I was and what I was doing on that day. So for the record on September 11, 2001 I was scheduled to spend the morning with Dr. B. Any interaction with Dr. B. was what we used to call "high yield" so I was looking forward to it. My mornings started then much as they do now. Wake up. Brush teeth. Pee. Apply clothing. Go to the hospital. This particular morning I allowed enough time to stop by the resident's lounge to pick up a pop-tart; the resident's staff of life. As usual the TV in the lounge was on and playing to an empty room. On the screen was the image of the first tower ablaze. They announced that it had been hit by a plane. An Internal Medicine resident I didn't know came in and asked me what had happened. I repeated what I'd heard and proceeded to my meeting.

We spent the morning sequestered in Dr. B's office looking at slides and learning all kinds of useful stuff I've since completely forgotten. At one point his phone rang and he took the call. He said "no" and the "yes" a few times followed by "everything is okay" and got off the phone. We picked up where we had left off in the bland "I heard nothing" way that doctors tend to use when something is none of our concern. In the late morning we took a break and stepped out of Dr. B's darkened office into a completely different world. Someone had moved a television set into the conference room and one of the attendings was sitting very close to it listening with the volume low. A few others were standing around. I saw the first tower collapse. I don't actually know if it collapsed at that moment but for me it did. I stood there stunned but the part of my brain that never stops quickly thought through the time elapsed between the first crash and the first collapse and estimated how many people could be evacuated from those buildings in that time if evacuation had been initiated promptly and carried out in an orderly fashion. I pessimistically reduced the number some assuming neither of those things had happened. When my non-emergency response brain came back on line I called My Beloved. We had heard a plane had crashed near Pittsburgh but at the travel agency where he worked they hadn't heard anything yet. One of us called over to the ER. If the local trauma centers were overwhelmed with casualties all the medical cases in the city would end up at our hospital and they would need help over there. They reported the trauma centers where not on divert. We could only assume no one had survived the crash.

I don't know what the mechanism is by which a person learns to walk away from a tragedy and move on but we all learn it. Without admitting defeat or despairing over loss we seem to recognize that there is still life in us and we go to the living. We returned to our lessons because we must learn to be the best possible doctor for the still living. A few minutes after we resumed my semi-contraband cell phone rang. It was a 515 area code phone number which I didn't recognize. I excused myself to answer it saying usually no one calls from back home unless it was an emergency. It was my dad. He sounded shook up. I immediately imagined him hurt or in danger but he was only calling to see if I was okay. The news had made it sound like the other plane had crashed in the city of Pittsburgh itself. Of course to him this could only mean it had landed directly on his daughter. Being a parent must be really hard because it took a while to reassure him. The earlier call it turns out had been from Dr. B's son.

Normally at noon the residents feed as if from a trough and consume a lecture at the same time but on this day at lunch a few people sat pushing food around on their plates. Others ate mechanically their eyes fixed on the table a few inches in front of their plates. Lecture was cancelled. The TV in the corner by the ceiling was on. Once we were done eating conversation slowly started up. One of the international residents was dismayed because everyone was assuming this was the work of foreign terrorists. I remember explaining to her why we thought this was the case. Our home-grown terrorists tend to be in the West and Middle West. They also tend to attack symbols of the federal government. Finally most American homicidal maniacs are too paranoid to work with the number of people needed to pull off an attack of this size. She thought about her experience in this country and decided these statements rang true. In the end I felt a strange relief that none of my grandparents had lived to see this. At least they had lived out their lives able to believe that the sacrifices they had made would keep us safe at home.

Cusco-Pittsburgh

2005-09-09T09:53:00.000-07:00

Down in Cusco there is a bar called Norton Rat's. I had heard of it once from a friend who'd traveled there. He described it as a friendly and interesting place with lots of motorcycle stuff. Maybe a year later I met a guy who is currently known as My Beloved. Back when he was still just a guy we covered the life story stuff and I learned he had not only quite an adventurous past but a vast network of friends the world over. In October 2001 when he was not yet My Beloved but more than Just a Guy, something along the lines of a Perennial Favorite, he took me on my first trip to South America to meet his old friend and travel partner Jeff. My Beloved and Jeff had taken off from college in Tucson in the 80's and rode motorcycles all the way down to Cusco. I will not try to tell you the story of their trip since I was not there but suffice it to say that Jeff stayed on in Cusco and opened the above mentioned motorcycle bar. You can't really see it on the website but all around the bar is a series of pictures of two guys on bikes. These are of course Jeff and My Beloved. One of the friends traveling with us commented in the way that mostly only children tend to do "Oooh. That's you? My you were handsome!" He would know.

Needless to say we had a spectacular time in Peru and even though there are lots and lots of place I have not yet been I would go back there in a flash if I had the chance. Lacking that, the next best thing is a visit from Jeff who still has family up in Cleveland. Labor Day weekend provided an opportunity for Jeff to air out his Up North Norton and come down to Pittsburgh for a visit. Jeff has a charming daughter who goes to school in Cleveland and is not only a seasoned motorcycle rider but fortunately a very patient girl since she came along for the visit and as it turns out Norton's are finicky. High maintenance even. On the way down there was a problem. Something to do with vibrating and oil leaking. While it seems I heard everything and even saw the problematic bits none of it found anything to hang onto in my brain so the mechanical details are gone now. All I know is that we had a nice Monday hanging out in the back yard and garage while Jeff fiddled with the bike. Later Jeff and his daughter roared off in success and our little group of former travel companions sat a while longer pretending the stones of our garage were an Inca wall.

Pittsburgh Tourists

2005-09-07T08:27:00.000-07:00

Don't let it get around but Pittsburgh is a really cool town. Our recent visit from Out-of-towners included a physician from Croatia and a New Yorker. Now we may be cool but honestly it is a little bit of a challenge to compete with NYC as a tourist destination. But, My Beloved who is a natural born travel guide, and I were up for the task.

Out of the millions of things we could do we planned out an itinerary that started in the Strip District. The Strip gets it's name from the narrow bit of land it occupies between a limestone cliff and the Allegheny river. This neighborhood is a warehouse district where produce, fresh meats, and fish of all sorts can be bought for cheap. The prices are guaranteed to wow the Big City Folks. You can pretty much get anything here that you could get in New York it's just that there's only one or two places to get it instead of a hundred. Also in the Strip District is St. Patrick's Church. In the middle of the warehouses is this tiny church set behind walls which enclose a beautiful and tranquil garden. The church is one of the only I know of around here which is open 24 hours a day. I also know of no other church that consists largely of a flight of stairs. You open the door and in front of you is a flight of stairs which you are meant to climb on your knees. Right at the top is the altar.

We also visited the Warhol Museum. I spent most of the visit sitting in the lobby talking to my patients on the phone. Just one of those occupational hazards. I did have time to visit the gift store though. My guest and I both bought package tape imprinted with a series of Warhol likenesses of Jesus. This will make easy work of Christmas wrapping this year. Too bad for you dear reader. You cannot get the tape on line. I recommend the switch plates however.

Finally we had a good "Hunky" lunch at a place in McKee's Rocks which I call the pierogie palace but which is actually called Pierogies Plus. Need a starch fix? This is the place for you. If you are going to each the stuff you might as well eat the best. You can order them on-line....