Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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    Saturday, October 23, 2004
     
    Requiem

    My friend from Down Under writes a wonderful remembrance of his late father-in-law. Read it.

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    Christmas Present

    Santa, I want an Atomic coffee machine.

    Gimme.

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    Wednesday, October 20, 2004
     
    Links

    A field guide to medical specialists - from the Head Nurse. What can I say? She's got us nailed.

    Noooooo! Dave, what will we do without you?

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    ... In Which Dr. Alice Decompensates

    So I came home late last night from an emergency school board meeting. (Health tip: never sit on a school board. There. You've just added ten years to your lifespan.) It was raining heavily - here in Los Angeles, we've been hit with the first storm of the season much earlier than usual. I entered the house through the basement door - make that the door to the brand-new, just finished basement - and stepped onto soaking wet carpet.

    Yep. It's leaking.

    My beloved Batcave is leaking.

    The problem was solved fairly quickly. Along the side of the house, next to the driveway, are several bricked-in planters. Into one of these planters empties a rain spout. During the construction the guide at the base of the spout, which was supposed to direct the rainwater onto the driveway, was removed, with the result that about a gallon of rainwater per minute was pouring into a small, boxed-in planter.

    So there I was, running around in the rain shoving cookie tins frantically under the spout, trying to bail out the planter with my hands, a Pyrex measuring cup, or whatever came to hand. Not to mention dragging out every towel I had from the linen closet and throwing them on the rug in a futile attempt to sop up the water.

    The rain has stopped, at least for now, and I put in a frantic call to my contractor who promptly answered and promised to go assess the leak (we haven't made it to the final inspection yet, thank God, which at least guarantees he's motivated to help solve the problem). But it wasn't the best night I've ever had.

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    Tuesday, October 19, 2004
     
    Conversations with an Endocrinologist About Food

    Dr. Alice and Dr. V. are chatting in Dr. V's office. Dr. V is trying to finish her phone calls and get out of the office (it's her half day) and has just finished speaking to a patient who needs surgery to resect a thyroid nodule.

    Dr. V (mumbling to herself as she writes a consult): Please... evaluate... for surgical resection... cold nodule consistent... with...colloid.

    Dr. Alice (apropos of nothing): Did you know mayonnaise is a colloid?

    Dr. V (blinks, then recovers): Well, that makes sense, actually, it would be. (pauses) Thanks for sharing.

    Medical Assistant (who has entered room just in time to hear a stray phrase): Did you all just mention mayonnaise?

    Dr. Alice (trying to rescue conversation): Well, a colloid is droplets of liquid suspended in something. In mayonnaise the liquid is suspended in fat. Egg yolk. In the thyroid it's suspended in protein.

    Medical Assistant (eyeing doctors, backs slowly out of room): Oh, okay.

    Dr. V (calls after the MA): Don't worry, doctors are just weird!

    Dr. Alice: Especially us!

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    Hello 1918

    Among the tidbits of information furnished us at the monthly staff meeting last night: we aren't getting any Flumist vaccine, either.

    Damn it.

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    Monday, October 18, 2004
     
    Catchup

    I haven't had many medical postings lately due to being very busy; I switched call groups at the beginning of the month and am now working with the hospitalist group (which means, when I'm on call, I have to go in and admit patients). Most of my Friday nights are spent in various emergency rooms now. This past weekend, in a fit of insanity, I worked both Friday and Saturday nights. Let's just say Sunday was a day on which very little was accomplished.

    Drama abounds here at The Firm. Last Friday, a patient belonging to one of my partners (whom I had just admitted to the hospital two weeks previously) died at home half an hour after coming in for a visit. He was in his nineties and had severe chronic illnesses, but it was still a shock. He was a courtly Hispanic gentleman with a marvelous accent and was still as sharp mentally as he ever was. As he left the office in his wheelchair that last time I'd held the door for him and was rewarded with a warm "Gracias, doctora!" It's hard to believe that somebody so alive could die such a short time later.

    Then there was the 75-year-old patient I admitted with acute leukemia not long ago. I sat with him in the emergency room as he stared at me and asked, "How long do I have?" There's no way to answer that kind of question, even if you give them the facts and tell them what to expect over the next few days. How to give hope and a realistic assessment at the same time is something I have still to learn.

    As we head into the flu season I am bracing myself for many busy nights to come. I'm taking my vitamins in the hope I won't come down with it myself.

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    Saturday, October 16, 2004
     
    Get Ready for the Flu

    It's pretty clear that our group will not be getting a supply of flu vaccine this year, thanks to the Chiron vaccine problem. We're already getting anxious calls about flu vaccine -- hell, my mother called me up asking if we had any. Do you know how it feels to turn down your mother for a flu shot? Not good. Trust me on this.

    I think we'll be offering a lot of prophylactic meds this year, like Tamiflu, since nothing else is available. There is another vaccine available - Flumist, which is administered nasally - but since it is a live attenuated vaccine, it is not approved for use in anyone over 49 years of age or who is immunosuppressed.

    The shortage has spawned one good joke that I heard: before the third debate, Bush and Kerry flipped a coin. The winner got a flu shot.

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    Friday, October 15, 2004
     
    How Much Would YOU Pay...

    ... to get your name carved on a tombstone at the Haunted Mansion?

    (According to the article, more than $16,000.)

    If you're a Disneyland fan, try going here, here and here.

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    Wednesday, October 13, 2004
     
    Great Idea

    Lileks for Senate!

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    Tuesday, October 12, 2004
     
    Go Here at Once

    Magnetic poetry is now online. My favorite is the sexual innuendo kit.

    (via Wifely Steps)

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    Monday, October 11, 2004
     
    Sarcasm and Medicine

    Got the following emails - the first from V. (she actually had a patient tell her this) and the reply from our friend the Infectious Disease expert:

    Hey Scientists!!
    I've just learned of a new test. You spit in a glass of water, first thing in the morning. Don't brush your teeth first. Come back a bit later & if you have germs in your stomach, you will see that the water's become cloudy & there are wormy things floating on the top of the water. Gee, what a great test!! It might just put those ID & GI guys right out of business.


    Followed by:

    I've been performing this test for years--and charging for it.
    Another thing I tell my patients that are concerned about eating sushi (and all the germs that could go along with it), is that if they take a hot bath afterwards, they'll cook the raw fish. Most people find that very comforting.


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    Wednesday, October 06, 2004
     
    Unbelievable

    Read this, from the New York Times:

    WEST COLUMBIA, S.C., Sept. 29 - Katherine Bibeau came here in March, to a red-brick doctor's office tucked between a furniture store and a steel factory, looking to slow her physical decline from multiple sclerosis.

    Ms. Bibeau, a 53-year-old laboratory technician from Minnesota, met Dr. James Shortt, who practices alternative medicine. He is, according to a sign on the front of the building, a "longevity physician."

    "Hydrogen peroxide would be very good to kill whatever's in there," Dr. Shortt had told Ms. Bibeau over the phone in February, according to a transcript of his taped recording of the call, "because, right now, we don't know what it is."

    On March 9, Dr. Shortt administered the hydrogen peroxide, intravenously. Over the next five days, Ms. Bibeau bled to death.

    Intravenous hydrogen peroxide. Stupid, stupid, stupid. Why would anyone do such a thing? It's guaranteed to destroy your red blood cells and anything else it comes in contact with - it's a powerful oxidant.

    These guys give "alternative medicine" a bad name.
    (via Code the WebSocket)

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    HOWL

    Blogger, what are you doing to me??

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    A Brief Review of the Vice-Presidential Debate

    Cheney: This is what we've done. This is what we're gonna do.
    Edwards: I'm Kerry's bitch.

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    Tuesday, October 05, 2004
     
    Apocalypse Now

    VISA has come out with a Thomas Kinkade credit card. Can the end of the world be far behind?

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    Monday, October 04, 2004
     
    I Dare You Not To Laugh

    Ladies and gentlemen, our next president.

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    Sunday, October 03, 2004
     
    Housekeeping Announcement

    At long last I have updated and reorganized my links. Sorry for the delay. Take a look at the left column; they're all good.

    Also, check out these Rules for Residents submitted by the Head Nurse (as in neurology). They reinforce what my dad told me before beginning residency: "Nurses can be your best friend or your worst enemy. Respect them."

    And here is a new blog which may interest you if you're an Angeleno: the 4th Floor Blog is an anonymous blog written by somebody in L.A. City Hall. It seems to have quite a bit of information on what's going on. I especially liked their name for former Chief of Police, now mayoral candidate Bernard Parks: "Bitter Bernie."

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    Friday, October 01, 2004
     
    Link O' the Week

    Have you heard of a web comic called Sluggy Freelance? If not, go there ASAP. It's a scream. Chock full of parodies of Star Trek, Alien, the Harry Potter books and much, much more. Also features a cute, homicidal rabbit named Bun-Bun. What more could you ask?

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    Amazon List of the Day

    This is hysterical: Books for People You Don't Like

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    Wednesday, September 29, 2004
     
    Fashion to Die For

    In the parade of patients I get the occasional goth-dressing type in the office. They're generally very pleasant, articulate people. One showed up yesterday, dressed all in black, jet jewelry, heavy eye liner, all par for the course. What threw me was her purse: it was shaped like a coffin. Looked exactly like the one in the link.

    Then there's the more annoying fashionista type - the retired woman who comes in dressed to the nines, dripping with jewelry, always talks about her next trip abroad and never ceases to complain about her copay going up. (Not to mention the cost of meds.) Grr.

    Then there's me. I am pretty damned hopeless at this sort of thing - I will never win the award for Best Dressed Doctor. I tend to go with what's comfortable (when I was a resident, it took a stern edict from the residency director to get me to stop wearing scrubs). This morning, for example, I got scolded by my secretary. I have a dinner meeting tonight and came in wearing my new ensemble. My secretary wandered into my office, noted the outfit with approval, fingered my earrings:

    "Now show me your shoes."

    I knew I was about to ruin my good impression. Reluctantly, I extended a foot. I was wearing my flat clunkers - not even my prettier flats, as one of them was lost and nowhere to be found this morning.

    "AAAH! I'm going to kill you! You need pumps with that outfit!"

    "I know, but I hate them."

    "Just little ones! They don't have to be high!"

    Ten minutes later she came marching in with a catalog and slapped it down in front of me, to emphasize her point:

    "You need these in navy, black, brown and beige."

    I cringed. We're going to be debating this one for a while.

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