iCramer.com

Email. Ugh.

2011-01-03T20:06:00.001-08:00

I like email, sort of like I like getting real mail from the rusty box across the street in the driving rain.

Too much crap. And some irrational fear that by throwing it away, It will somehow become important and unrecoverable.

Gmail makes that nice by letting me never throw anything away... which doesn't help a lick.

The other thing that's become a problem is all the newsletters and such that I signed up for, of my own volition...don't read them, think I aught to, so they sit there and pile up. 236 unread Medscape newsletters at last count today.

Trashed em. Hope none of my patients die from my ignorance of those very important breaking news flashes now scattered throughout the interwebs.

At least I feel better.

Just a bunch of lights

2010-12-27T22:04:00.000-08:00

There's something a bit depressing for me about Christmas lights after Christmas. It's over. The anticipation and the magic has been released into the ether.

Sooner or later, people will turn them off and take them down. Or leave them up until they become a joke in their own right.

If they're on tomorrow, am I overdoing it? If they're taken down, am I turning the page too soon? How many rainforest square inches do I denude to power another night's twinkle lights? How many square inches of landfill do I occupy with old energy-hog lights? How many people's nights are brightened well into January if I choose to spread the glow of netlights on bushes? How many paychecks are padded by my ER trip after tripping off the roof?

Such a weighty decision.

Clang!

2010-12-21T19:54:00.001-08:00

A day or so ago, I was perfoming an IUD insertion. Had to do a pap first. Nervous patient, nervous PA. I just don't do many.

I did the pap first, finished, and told her I was stepping away to change to sterile gloves. I turned. A loud metallic noise ensued. I turned back. She had managed to expel the speculum noisily onto the floor.

A meek "Sorry!"

A confident, "No worries! We'll just get another."

Think of a duck with an open beak. How the hell did that thing come out?

Refreshing

2010-10-02T23:42:00.000-07:00

Oftentimes, conferences and seminars are most good for the opportunity to catch up with old friends. I truly regret having chosen to sit through several sessions of conventions rather than sitting with some buds, at a bar, shooting the breeze.

Last week, I was at a conference and didn't regret staying in my seat. Only one hour was dull as a butter knife, and only one other hour had me nodding off, and that was due to the lunch-induced afternoon drowsiness.

This one was good because it produced at least three separate instances where a person, a truly brilliant person who was obviously much more intelligent and well-versed than myself (and I encounter these people more frequently now that I don't think that I am the smartest person in the world), was able to speak in an eloquent and engaging fashion about something about which he or she were an eminent expert...and make it so interesting to me. I'm talking engaging like maybe only a handful of teachers have been in my past experience.

That's rare. And like a glass of cold lemonade.

Why I rarely open email from my Dad

2010-09-30T13:07:00.001-07:00

maybe it's because the most interesting subject line is usually something like this:

Fwd: Fw: Unstoppable Virus

While it could be a wonderful treatise on hanta virus, it could also be some computer virus that he picked up on all of his tea party emails. Why should I chance it?

Just a little different

2010-09-29T08:12:00.000-07:00

I've become very comfortable with Panezanellie's Breadstick Shoppe in my time here is Sublimity. It's the type of place you want to go to, and the type of place that wants you to come back. Good people and good food, and well, good feelings while you're there.

The owner is a really nice man who had a restaurant up the canyon years ago and was very successful. He sold it and sold his recipes (with a 15 year non-compete), and went to work as a carpenter for something new to do. Fifteen years later, he decided to get back into it, and I'm glad he did.

Now he's got some form of cancer. It may be throat, it may be esophagus, it may be thyroid. I don't know. Because I didn't ask him, he didn't tell me, and I'm not his doctor. but we all know he's sick and being treated, which sucks twice.

He was in the shop today, working away, smiling, and looking really good. I told him so, and offered support to him as we exchanged pleasantries. My fingers are certainly crossed.

The gruff old men sitting around drinking coffee noticed too:

"Is John in today?"
"Yeah, he looks good."
"I thought so. The rolls taste a little different today."

Yes they do. A little better today.

Pediatrics is great fun

2010-08-17T20:47:00.000-07:00

There's a clinic in Salem from which I needed to request records today. It's called

Children's
Health
Associates
Of
Salem

I love people with a sense of humor.

It's a Miracle!

2010-08-16T21:58:00.000-07:00

I actually wrote this sentence into a chart today.

"Mechanism of crash involves little dog in car needing restrained, poor wheel alignment causing car to veer to right, and a faulty recall-worthy steering column lockbar that unexpectedly malfunctioned, causing the car to become an unguidable missile hurtling its unrestrained occupants head-on into a parked car at approximately 35 mph, whereby, and with unfortunate circumstance, the airbag did not deploy. Luckily, the driver esacaped relatively unscathed and unbruised."

Somewhere, the angels were shining down from heaven. I guess.

Questions you should ask

2010-08-15T22:25:00.001-07:00

Over the last couple of weeks, I have thought on more than one occasion about the questions that I would ask departed loved ones if they were with us today.

Perhaps it is because I've been meeting a lot of new patients who happen to be old and declining. I'm not sure. I just know that if my granddad were here today, I'd ask him a lot of stuff about how it was when he was my age and raising his kids.

I never asked him that. I didn't have kids when he died. I didn't know to ask him that then, when tomorrow seemed like just another day that he'd be alive and available to chat with.

This isn't so much a lament that I didn't ask him more questions, or that somehow, I wasted those years with him. On the contrary, I think I gleaned a great deal from him. But there were things that I didn't know that I did not know. The unknown unknowns, to quote Donald Rumsfeld (and I don't think I ever have done that before!).

The Smokin' Pit BBQ

2010-08-10T08:00:00.000-07:00

So, my boys were safely delivered to the curb in Burns where their grandparents promised to pick them up for the relay to Winnemucca, where they will enjoy 14 days of fun and sun. It's so great there, they should call it Winne-mecca. Apparently, Winnemucca is currently suffering from the least amount of unemployment of any county in Nevada. This may be a spurious honor, but you take what you can get.

But I digress.

BBQ.

When I got to Burns, I found the listing for Smokin' Pit BBQ, on D street. I started to salivate. Burns isn't that big, but my google maps feature on my phone was having a tough time connecting...something about data roaming charges (which don't matter a whit to me...I'll pay the bill, but let me see the location of the BBQ, you damn Sprint faeries in my phone!).

So, I ask the guy pumping my gas. Cause it's Oregon, and I'm not really savvy enough to do it myself.

I wasn't able to try the Smokin' Pit. Cause it's only open on Thursdays at noon. And I wasn't there on Thursday.

So, right off the bat, the Smokin' Pit BBQ gets some points in favor. It does so because a place that can exist and thrive while being open only once a week must be pretty damn good, or people wouldn't support it.

There are places in Texas, almost mythical good, that are open only a few times per week, and that are so wondrous, you need to get there in the early morning in order to have a shot at getting the brisket. It is commonly all gone before noon. The best BBQ in the world gets eaten for breakfast.

So Burns may have that.

Plus, the guy pumping gas talked about a horseradish-based sauce that was so good, his eyes rolled back in his head, he shuddered, and I thought a wet spot might show up on his pants.

So, some day, I'll have to make it back to Burns on a Thursday and bring an extra pair of shorts.

The weekend wasn't a total waste, though. There's a newer BBQ Joint in Sisters, called Slick's Cue Co. It's owned by a guy whose on the board of directors for a national BBQ organization, and that doesn't mean a damn thing to me, because I was once a president of a state professional organization, but that didn't mean I was super awesome as a professional. The BBQ will speak for itself.

I ordered the sampler platter. 4 meats, three sides. Bonus points given for real plain white bread on the side, and sliced dill pickles available at the bar. Demerits given for having brewed iced tea, but sweetening it all, giving the customer no say. WTF? (Frankly, my attitude was poor after that revelation. It almost destroyed the review before having a bite.) I was neutral on the observation that this place did not have cornbread. I like it, but I like a lot of stuff. Doesn't mean you have to have it.

the four meats:
Pulled pork...could take it or leave it on its own. Nothing special.
Smoked turkey...succulent, but my dining companion did mention that it was exceptionally salty. A turn-off for some, but I soldiered past that.
Brisket...good flavor, smoky.
Black Ends (of the brisket)...Only meat to be pre-sauced. Excellent.

All four meats were distinctly different in flavor, and there was only one sauce to choose from. It was good, and complimented all three unsauced meats. Unfortunately, the pulled pork NEEDED the sauce and did not stand well on its own. The sauce appeared to be an imported brand from Texas. I don't know how I feel about that, but I think it is a slight negative, as if I think some effort to make a sauce from scratch would have been nice. However, I liked the sauce and would buy it at the grocery store if reasonably priced.

The sides...potato salad, coleslaw, baked beans. I'm more of a smoky beans guy that a sweet beans guy, and these were sweet beans, but they were good and I'd have them again and again. Big chunks of pineapple in them, along with bacon, and the beans were clearly good pintos, with a lighter sauce that settled out a bit.

The coleslaw was slightly sweet, also not my favorite, but got props because it wasn't heavy on mayo or sauce, and was primarily the solid vegetable particles of cabbage. I'd have it again.

The potato salad was unusual. Apparently of red potatoes, and without a heavy mayo or mustard presence. I liked it, but cannot really tell you why.

The place... lots of attention to decor and ambiance, really kinda touristy, but well, I was on the main drag in Sisters, Oregon. I think the owner was just complying with local codes. It was so kitschy that I thought it must be a chain restaurant, but the newspaper reviews and articles on the door convinced me otherwise.

Would I go again? Sure. Would I recommend it? Yes, because my sampler platter, enough for both me and the woman, was $21. We would not have gotten to try all the items in two entrees for any less. And it was served on the aluminum pizza pan.

But, I'd rather go back to Burns first.

Holding hands

2010-08-09T10:00:00.000-07:00

When I was driving back to work one day, I saw two kids holding hands, and it got me to thinking.

They were young-ish. not young like children who hold hands with anybody who wants to, but young like possibly the first in their circle of friends to do so confidently down the street on a perfectly good summer afternoon.

They weren't old and seasoned pros, and they didn't have the syrupy closeness of the couple together against the world at the tender age of 16. They didn't have the slow sashay of those enjoying the moment, but rather a purposefulness to their walk that said they were going somewhere.

To where? I wondered. Are they really so comfortable as a tween to state to the world in broad daylight that they are linked? In love? In that wonderfully absurd promise-ring stage? Are they instead putting on a brave face, in order to gain a perceived level of maturity that they need to thrive in their world?

Is he holding onto his newest possession? Is she clinging to her self-image? Is he nervous as he dreams of more than holding hands? Are they old souls who realize their match in this world is striding alongside?

I don't know, but it's a wonder I don't wreck the truck on days when I get to thinking.

Steve Carrell would be proud

2010-08-08T19:00:00.000-07:00

37 year old PA..."So, you don't hear so well?"

85 year old new patient..."That's what she said."

37 year old PA..."Attaboy!"

Weekend Destination: Burns, Oregon.

2010-08-07T08:00:00.000-07:00

Luckily, I was still able to obtain a hotel reservation at this late date. I'll publish any good barbecue leads when I return.

It seems that Burns is a good place to drop off my boys so that their grandparents (my father and step-mother) an take them off our hands, back to Nevada for a couple of weeks. That should be fun, but we will see.

I'm still contemplating how to or if to mend the relationship that I have with my father. I clearly want my children to know him, and perhaps to be disappointed by him. No, really I don't want that, but I fear it is inevitable. And that's really the crux. I want them to have a good time, but not just play an Xbox for 2 weeks. They'd have a great time if they got to do that, but its' not really the point, and I don't want to project my attitudes onto them. They can make their own decisions.

Yet another beer quote...

2010-08-06T11:54:00.000-07:00

"So, you put down that you drink 2 beers a day...."

"Yeah, a little more when I'm happy, and a little more when I'm pissed."

"What do you average in a week?"

(following some demonstrably agile mental math)..."About 2 12-packs. A case, I guess."

"Oh."

"But I don't drink any pop!"

Because clearly that would be unhealthy. Plus, how could you afford it on top of the necessities?

What brings you in?

2010-08-05T09:00:00.000-07:00

I've noticed that wives tend to make their husbands come in to see me when they are concerned about them.

Husbands tend to make their wives come in when they're worried about themselves.

Just sayin.

headaches

2010-08-04T11:48:00.001-07:00

Some patients have headaches, others are headaches.

Some are headaches because you get to see them so often. Others because they see you so rarely.

I got one after my afternoon visit with a patient yesterday. She came in ostensibly due to weeks of diarrhea. But really she's been shitting her pants because her life sucks. I of course only hear one side of a story, so I have to decide just how big a prick the husband is, and just how close to killing herself she is, and just what I can really do for her anyway.

Most days, I feel just so impotent to help others. But yet I try. And it gives me a headache.

Yes, I'm back.

2010-08-01T22:15:00.000-07:00

I realized back in June that I am no longer tethered to a computer, except by choice. Also that it finally quit raining, and I spend more time outside then.

But I miss it, and will be musing more frequently.

WTF

2010-08-01T22:07:00.000-07:00

I saw a kid named Jay-Z for a 12 month well child check on Friday. No, not really named Jay-Z, but a name exactly like it, in terms of structure.

I don't know what these parents were thinking, but probably about the same thing they were thinking when they decided to allow/perform some practice tattooing of "Eat Me Bitch" on their nether regions before the onset of pregnancy. Sexy.

Anyway, I mention this because of course, the name itself is ridiculous, but also because they have no clue what they've done. To wit:

Dr: "So, her name is pronounced Jay Zee?"

Parent: "No, it's Jay-zzzzz."

Dr: "Oh. So there's a hyphen there."

Parent: "No, there's no hyphen. That's a dash. (Duh!)"

I shit you not. I would not have been able to resist "So, are you sure it's not a minus?"

Some random thoughts

2010-07-11T18:56:00.000-07:00

I have been away, at least in my mind, for a while. I'll see if I come back. In the meantime, some things that have struck my fancy recently.

From a colleague: "Nobody ever died of BV!"

From a patient: "Yes, I drink a 12-pack a day. But it's light beer."

And, from my drive aound town today: "I have nothing against little furry dogs. Except when they're in the lap of the drivers I pass by."

Alanis Morissette is in seat 3C

2010-06-22T16:40:00.001-07:00

As I lurched forward in my seat in response to the brakes as we approached the crossing, I couldn't help thinking how ironic it would be if my Amtrak bus were hit by a train.

Big Dreams, small world

2010-06-06T21:43:00.000-07:00

My son was born ten years ago this weekend. Some days I thought I'd kill him first, but he made it to 10.

It's amazing how many things have happened in that time, but yet, we still live about 15 miles from where he was born.

I remember him toddling the full length of the high school as we walked from my office to the gym. It took 10 minutes, but it was pretty cool to watch.

Now he runs everywhere in our house, colliding with walls and his brother.

Turning 10 is bittersweet too. We're probably over halfway through our time together. I certainly hope he moves out when he's an adult, but I've grown attached to him for now.

Busy Busy Busy

2010-05-23T18:38:00.000-07:00

So, not much posting for the past little bit. Had a lot of patients at work, and got a bit behind. Also had a sore behind and went to see the chiropractor.

But, the big news was that I was back in Montana, visiting my mom in the hospital, where she was recovering from a triple bypass. At age 57. Had six blockages, but three were more important than the others.

She's got some bills coming her way. She's got no insurance. She doesn't qualify for medicaid, and is too young for medicare.

We are filling out applications for financial assistance from the hospitals, and it looks very promising to work out.

But I just don't understand how so many people like my mother, without the proverbial pot to piss in, wouldn't vote for universal healthcare.

I firmly believe that if she had coverage of some sort, she would have made an effort to keep her blood sugar from averaging 339. A single person who makes so little money that she doesn't owe money for income tax doesn't have the resources to afford basic health care. But that person is eligible for three facilities and two air flights of health care, surpassing $100,000 in charges. And so many people who could find themselves in her shoes are swayed by the rhetoric of richer, more comfortable people, railing against the evils of socialism and tyranny, voting against helping others.

What a crock. It's tyranny, all right. It's tyranny of the privileged, the wealthy.

Ancestry

2010-05-11T15:00:00.000-07:00

I learn quite a bit when I get to experience the Sepia-toned stories that are tole whenever we gather for family reasons. Generally, they seem to be for funerals and illnesses these days, so the memories from the old-timers really help to lighten the mood.

I heard some good stories, some of them for the fifth time, but one that I found incredible was about an old aunt named Mae.

Mae was born on the same day that her sister, her grandmother, and her mother died of influenza in 1918. She came early, and the doctor told another aunt to let her go too. The other aunt thought differently, and put her in a small grape box, fed her every hour, and kept her toasty in the warming oven of her wood-burning kitchen stove.

Mae lived past the age of 80. Strong work.

BBQ Update

2010-05-10T16:00:00.000-07:00

Traveling through the hinterlands of North America is no excuse to deny myself the pleasure of barbecued meats. So, while in Missoula, I ate like Missoulians...at the Dinosaur Cafe.

The Dinosaur Cafe is located inside another establishment. You have to enter Charley B's, a landmark bar in downtown Missoula. The bar stretches down the west wall, seemingly for a hundred yards. Above the bar and along the other wall is a stretch of black and white photos, all older than the current customers, all featuring some authentic patron from yesteryear. The faces are diverse. I saw some smiles, some stares, some jokesters, and some serious folk. Even a black man thrown in for good measure. There may have been a woman, and there may have been a full set of teeth, but I didn't see 'em.

Anyway, you walk past the bar, like you're heading for the bathroom. Then you see it. A window to the kitchen. A line of folks. And a chalkboard announcing the fare of the day.

The Dinosaur Cafe specializes in Louisianan cuisine. Gumbo, Jambalaya, and Gumbolaya were prominent features, but the day's special was boneless barbecue ribs, with slaw and bread, for only $7.

It was good food. It was a good value. It was a great venue, for you get your food and sit at the bar...on either side of the bar.

What it was not, was particularly authentic barbecue. "But so what?" I say.

What I would fix:
The bread was Po Boy french bread. White wonder bread would have been a touch more authentic.
The slaw needed more vinegar tones for my taste. However, it was not runny or mayonnaise-y.

Would I go again? Yes. And that's really the bottom line.

Defender of Mankind

2010-05-09T05:17:00.000-07:00

Apparently, that's one of the many meanings of "Alex," which could put a little pressure on a guy if he were to tend to take things to heart. It's not my name, but I've thought a lot about my children this week. They've played baseball, they've gone to school, they've raced pinewood derby cars. I've missed some of that, but was thinking of them nonetheless.

I'm not much of a philosopher, which has made defining my philosophy perhaps a little harder in life. I believe in certain things, and in other I have skepticism. There may be flaws in my thinking, but its probably sound, for the most part.

Evolutionarily, species care for their young. It is innate and helps to ensure the survival of the genetic material. We care for our children because it is natural. We love them because they are lovable, which makes us quite invested in their survival and thriving. Routinely, decisions are made in favor of the young, the unaccomplished, the non-contributing...at least in part because there is a natural drive to preserve the young and their potential, even in the balance against proven, positive quantities that have reached adulthood.

We protect the vulnerable. At least some of us do. Others protect the vulnerable to whom they have great attachment. This is where we seem to diverge with the natural world. The vulnerable, sick, and older animals become the food for others. They contribute to the well-being of the world by returning their energy to it in some other form.

I've read of many cultures in earlier times, where elders were left to die when their usefulness to the group was exhausted. Actually, I've read of cultures where the elders realized their expiration and left to die of their own accord, because it was their final duty to the group.

There's a certain cold nobility in that, but that's not who we are. We care for the vulnerable, young and old, and the only real question is of timing. When do we cease to be the vulnerable, and assume the mantle of caring? When do we revert to vulnerability?

It helps to have companionship, to rely on others, for the yoke of vulnerability can be a swiftly changing burden, and the otherwise strong may assume it intermittently as they progress through life.

But, anyway, the point I'm getting to is that I'm firmly entrenched in my moment of strength, where it is my position to defend those who are vulnerable. Clearly, parents care for their children until their children become strong. For most, finishing high school and entering the world of adults marks that transition, but those parents currently housing their 30 year old children must be wondering when that moment will come.

At some point, the parent becomes vulnerable and the child? Well, the child often assumes responsibility. Sometimes, they are a bit slow to arrive at the task. How come? Perhaps it is a matter of awareness, or of selfishness, or of denial.

Sometimes it is more a matter of subtlety. Vulnerable people often don't need care in a given period of time. It might be that the balance of strength in my family tipped toward me when I was 18. Perhaps it was when I was 22, or 26. It certainly wasn't as late as 37, but that's when it became obvious. That's when my mother's triple bypass on May 4 (Ironically my grandfather's birthday) eliminated all subtlety and trumpeted that it was my turn at bat.

We all have a bit of Alex in us, but perhaps we need to pay attention to find it.

Exhibit # 3,546 that I must be old and fat...

2010-05-06T06:00:00.000-07:00

...I injure my knee while umpiring a 3rd-4th grade baseball game.

A tidbit of knowledge

2010-05-05T12:00:00.000-07:00

Lazy Eye.

Picture it in your mind.

The kind of person you see, where one eye doesn't quite follow the focus point, drifting off to the side. Lots of people have strabismus. My sister had it, and got an operation on the muscles that maneuver her eyeball.

Strabismus is what most all of us think of and picture when someone says they have "lazy eye."

And we'd be wrong.

I was, last week. I was examining a kid with suspected pinkeye (but that wasn't what I was seeing) and his mom mentioned that he had lazy eye, and that he was nearly blind in that eye.

Seeing no strabismus, I sort of poo-pooed her statement, but did end up sending the boy to the optometrist in town affiliated with an opthalmologist (and who happened to be the kid's regular eye doctor).

Later on, I found out the kid had amblyopia. Amblyopia is the real LAZY EYE. The eye itself, not the muscles that move it, is lazy. It sees like crap. His was about 20/100 with correction.

No strabismus, but he did have lazy eye.

Favorite Patient of April

2010-05-04T08:00:00.000-07:00

Has to be the old farmer who called me up a couple days after I invesitgated his urinary troubles and let me know that I might have found some... pot... in his UA. I told him I wasn't testing for that, and so he said, "Oh. Well, forget I said that, then."

Man in Blue

2010-05-02T21:38:00.000-07:00

The local youth baseball league costs a bit of money to play. It costs a bit more if you, as a parent, do not volunteer a measure of time to help the league be successful. I like this. Pay a fee, get some back after you work.

So, I am an umpire. Not necessarily a good one. But an earnest one.

I was heckled by only one person during the first game. A second grader playing catcher. Named Cramer. If he would have drawn a line in the dirt, I'd have run him.

It never gets old.

2010-04-28T21:31:00.001-07:00

I have this recurring dream.

I'm on Jeopardy, kicking the greatest contestant ever's ass all over the place (I'm referring to Cliff Clavin, not that Ken Jennings douche).

Actually, time out, I have to go off on a mini-rant. The day Jeopardy caved in and let people stay on the show more than five consecutive days was the day that they gave in to the Man and I lost all respect for them. I haven't really watched since. There was something elegant about a show that rewarded the load of crap knowledge floating around in my head with cold, hard cash, yet knew were to draw the line. Win five times, you get to retire a champion. No one takes that away from you. Very few people get to retire on top. Or choose when to do it,like Barry Sanders did. But that's another story. Very few on top. And now that that fricking Jennings dude won like a billion dollars (rigged I think), no one will ever be a "Retired Jeopardy Champion" because it will all be about the dollar amounts. Shit. It would have been possible to be a five-time champion and go home with only five dollars! That would have been incredible!

OK, enough of that. Back to the dream.

Kickin ass, takin names. Clavin's my bitch. Besides, I know he's going to fuck up the Final Jeopardy question anyway. "Who are three people who've never been in my kitchen?" Exactly! Forget Cliff. Categories like "80'sRock Music" and "The 2007 Seattle Mariners" and "Internal Derangement of the Knee" have me well positioned to tell Alex Trebek where he can stick his elitist attitude. He got smart by hearing shitloads of trivia every day for thirty years, and should remember that he's only one step away from Wink Martindale in the great scheme of things.

I get the last Daily Double of the game, in a category that I rock. No one touches me in "Patients Say the Darndest Things."

"I'll wager $17500, Alex."

"Ohhhhh. Making it a true Daily Double! Good luck to you." (Luck? I don't need luck.)

"This declaration, earnestly spoken, prompts an immediate "Sure you do, sport!" reflexively."

I pause, for the drama and to make Clavin think he's got a chance, before mouthing "What is 'I've got a high pain tolerance, doc.' ?"

"Right you are! A true daily double!"

I never finish the dream. I wake myself up giggling. That never gets old.

Why do I tell you this? Because today, the dumbass blurted out "I have a high pain tolerance!" right before he actually passed out in the chair as I gave him an injection. "Sure you do, sport!"

It. Never. Gets. Old.

Being the best

2010-04-27T21:17:00.000-07:00

Being the best is an awfully fine goal, in theory.

I'd like to be the best, but being the best takes something more than "like." It may take relentless pursuit. Love or lust, not like. It may also take some natural attributes that don't really have one iota of responsibility to effort.

Today, I was reminded of how refreshing it is to meet someone who has their head on straight, despite being the best. Because, let's face it, life's better and easier for the best, and sometimes, they can be dicks about it.

Today, I met a kid preparing for the district track meet. I walked in the room to see an attractive person, with a nice smile, a confident manner, and a sensible agenda. (let's also stipulate that our encounters with people are mere snapshots in time, and it's quite possible to meet a real asshole and not have a clue, and vis-a-vis, meet mother Teresa on a bad day and get the wrong vibe)

So, I could be wrong, but my initial impression was favorable. We chatted quickly and I asked whether she anticipated placing at districts. She smiled, and said yes, and that truthfully, she would be placing at state. having already won six times in her previous state meets. And that she was going to run on scholarship at a nearby institution.

She could have accomplished this statement in innumerable ways, from bald arrogance to feigned humility. It may seem awfully presumptuous, but it wasn't. She said it without pretense, and as if it were simply fact, and not terribly noteworthy.

She could have spoke as if it were less than important, something to embarrass her, but she did not.

In those few simple words, she acknowledged that she was the best, but that she was not better than anyone. She acknowledged that her expectations did not lessen another's perceptions of success, and that should her version of history, in fact not become our common history, she would not be surprised or disappointed, but merely would gain that knowledge.

She was refreshingly the best. So rare to encounter.

A day in my mind

2010-04-25T08:37:00.000-07:00

My docs left town on Friday morning for a conference and relaxation in Vancouver. I was left to my own devices, running the show. I am slow. I write a lot about each patient (Thank you / f**k you, Dr. Park). I thought maybe it would be instructive to see what I think in my head as I get through the day. I have used profanity in my writing before, but I am warning readers now that I'm just going to let it all hang out in this post. You'll see why I was having a harder time working with children and impressionable adolescents. I have a potty mouth. Not proud, but loud.

These are all unspoken thoughts, had while working in the clinic on Friday.

"Well well. Large and in charge. I'm kind of a big deal."

"Hmmm. Are you blacking out and falling due to your heart, your brain, or your drinking?"

"Fuck. Should I really be writing your mom a prescription for xanax, phenergan, and percocet? Could there be a better note from before to guide me? Fuck!"

"Maybe its jungle rot. Trench foot. Stupid toe. I don't know, but you don't want medicine anyway. I cannot believe I'm scraping your toe jam and looking at it under the microscope. And there isn't any sign of fungus. Shit! That was my fallback."

"So, your mom woke you up today. Good for her. Your eye is worse. I can't figure it out, but the fact that your mom now tells me you are essentially already blind in that eye either reassures me or scares me to death. Which is it? Oh yeah, scared to death. I'm calling for backup."

"Well, I haven't cured this goddam ear infection. Off to ENT you go. Shit."

"There is no way. No way that your IUD strings are causing your partner and you that much pain. There is also no way. No way that the expensive lube you got from 'romantic evenings dot com' is better than astroglide from the drug store. And finally, there is no way. No way that I'm going to worry too much about this since you still have sex 3-4 times per week anyway."

"Hmm. You might have a growth plate fracture. I don't really care about your club volleyball team right now."

"I cannot believe I'm filling this viagra. You have sex every night. Or so you say."

"Hmmm. That's a bigger gun you're wearing today. You must be feeling better."

"Finally! That's easy. It's a wart. I'll freeze it. Trust me, little guy, this will feel cold but will help. (...nu-uh. It hurts, you jerk!)"

"Yes! Two in a row. That's thrush. I am ruling out leukoplakia because your three-month-old does not chew tobacco."

"I'm glad you appear to have your depression in control since you spend time working on scaffolds 10 stories up."

"Fuck. Your lungs sound fine, but your house burned down. I don't have a pill for that. I don't know how to make that any better. And you're a good kid, and you don't deserve it. No one does. Shit."

"Goddam, that's a lot of charts to finish."

"Me kind of a big deal? Not so much. The patients are kind of a big deal."

On finding an MA

2010-04-24T11:00:00.000-07:00

Medical offices used to employ doctors and nurses. Then, nurses started to be replaced by medical assistants. Doctors started to be replaced by nurse practitioners and PAs.

Not really replaced, but roles changed, and frankly, I may have the details wrong, but my point is, things evolved.

So, where now we employ MAs to do what used to be done by RNs, we do it because it's cheaper. Nursing is a great profession to earn some money in, but you won't make that $25 an hour working in our rural family practice clinic. Nope, you've gotta go to the hospital, the surgery center, the nursing home, somewhere else to make the good nursing money.

We employ MAs. I have one. Make that had one. And then had another. But so far, they haven't been quite what we are looking for, so I have none right now.

Why? Likely because you get what you pay for.

We want a person with MA qualifications, but we want one with exceptional talents. We want one who could easily go to nursing school and make an exceptional nurse, but one who doesn't want to go to nursing school, one who is satisfied with being an exceptional MA who doesn't get paid exceptionally.

That's a difficult position to fill. We want someone with talent and skill, but without ambition for advancement. I understand that isn't unique to medicine, but it still makes things challenging.

We interviewed a great person recently. I think she's what we are looking for. But she's been paid better in the past, and will want more to work for us than we will pay. She's likely worth what she wants, but that's not how it will play out.

Another candidate is less desirable, but perhaps affordable. But, because there is a great candidate, the ladies aren't going to be thrilled should we hire the less desirable candidate.

And, to boot, should the clinic pony up what the good candidate wants, the MAs who have been here and do wonderful work will be pissed off, and making less. That would poison the whole system too.

It's really a no-win unless the good candidate says yes to less money, and then I'll wonder why. Maybe she's not as good as I think? I'll overanalyze it.

Random drinking quotes

2010-04-22T13:30:00.000-07:00

"Everyone keeps saying I have an alcohol problem. I don't have an alcohol problem. I have a Xanax problem. I haven't had a drink in over a week."

"I don't drink any more. The last time I drank was 4 months ago. I had rum-and-coke. 20 of them. I felt sick after that."

"I drink occasionally. Once per day."

"I'm not an alcoholic. My mom is. She's drunk all the time. I just drink a lot."

"I drink on occasion. Three times a week, probably. How many? Oh, as many as it is before I pass out."

Cerumen

2010-04-20T09:30:00.000-07:00

I cannot hear. This is nothing new. Ask my wife.

Some examples from this week...

"Meredith Bates called about your patient." = "Marian Estates called about your patient."

"The (4th grade) presentation on The Book of Mormon was really funny." = "The (4th grade) presentation on global warming was really funny."

Occupations

2010-04-18T21:28:00.000-07:00

Life really takes all sorts. I enjoy hearing how people came to be what they are. Some faithful readers may recall my run-in with a pole dancer a couple of years ago. She pre-judged me a whole lot faster than I pre-judged her.

Anyway, this week, I met a female oil rigger. An unusual career for a woman. So I asked, "How did you find your way to this job?"

And she replied, "Well, My second ex husband, he got a DUI, so I was driving him to work. A while later, they needed a helper, and well...I was there everyday and on time anyway, so I got the job."

I'm glad I asked. The truth is so much cooler than my imagination.

What's in your wallet?

2010-04-08T21:06:00.000-07:00

I had a patient the other day who was concerned about an antidepressant medication affecting her libido. She's in her 40's and going strong. This was a real sticking point, so I just asked...

"So, what kind of frequency are we talking about here? How often are you doing it?"

"Every day. Sometimes more than once. For the last two years."

"Really? I'm sure there must have been a couple of days, you know, when you were a little under the weather, or had been sqabbling just a little, when you just weren't interested...?"

"Uhhhhhhh....nope."

I, having a reputation among the office for being a talker, was not speechless.

"Well, congratulations!"

Where everybody knows your name

2010-04-07T21:46:00.000-07:00

I really want to be a regular somewhere. I strive to have my own stool somewhere. But I want to be Norm, not Cliff.

Those of you who know me might say "Then stop moving so damn much!" It is hard to be a regular when you're always the new guy.

Sublimity is one of those places I might have a chance.

Today, I walked into Panezzanellie's after driving the boy to school. We listen to song 6-5 on the radio, "Somebody Told Me" by the Killers, because he's learning it right now. Last month was "Dead or Alive" by Jon Bon Jovi. "Crazy Train" by Ozzy before that. We'll see what's next.

Anyway, I walk in and hear "Hi Doc! How're you this morning?" from the owner. I know, I'm not a doctor, but I'm not really impersonating one in the coffee shop, and if he wanted to read my name tag, he's see that "Physician Assistant" line too.

I LIKE THAT. The only thing better would be "Nice Pig, Doc." Actually, the other day, I got a "Nice truck, Doc" and that was frickin awesome too.

Anyway, I order up my sweet roll and fill my cup with organic mind-body-soul free trade coffee, which tastes just fine, and the old man next to me says "You new in town?"

I say "Yes I am."

He says "You buy the Johnson place?"

I say "Nope."

We get to talking and it turns out he's the Vet in town. Been doing it since he graduated in 1966.

Just this week, he pinned an epiphyseal fracture of the femur in a 3-year-old cat. No shit. A cat.

We chatted for a while longer, and in the course of conversation, he mentioned that he had seen me at church the other night (Easter Vigil, one of the two times a year that I beat the children and make them come with me to make their mother happier, and maybe open the gates to heaven some day), and that's probably what opened the door to the conversation in the first place.

He didn't have a quick grasp on what PAs were, but understood the moment I equated them to NPs on a professional plane, and we went forward from there.

Long talk in a short time, but I felt like a pig in shit.

The way I see it, I'm just that much closer to a seat at the table of old crotchety men grumbling about the weather and health care reform over a cup of coffee each morning at a diner in your neighborhood.

It's good to have goals.

Snapshots

2010-04-04T21:48:00.000-07:00

Most of the time, life plays out like a movie. Continuous action, rolling film, the longest tracking shots in existence aren't those like the club entrance in Goodfellas, but are rather my real days, from alarm clock in the am to lights out in the pm.

But, sometimes, life is snapshots. Easter is one of those times.

Back before there were kids, before there as a PA in the family, before she was Mom and I was Dad, we lived alone, but happily. I had friends from work, she had friends from work, and some of those people were friends of us both.

One of her work friends invited us to share Easter with her family. So we did. But not the actual Easter dinner, because Mom likes to make that meal, and didn't want to give it up. It was the best of both worlds for me, because I got a great meal at home, and then got to go over to the other house and have more food (turkey, not ham) and lots of desserts. And, the opportunity to lose some money at the poker table.

We've been to Easter afternoon at Ted and Vicki's many times since 1999. Not every year, because Coos Bay was a bit too far from Lake O to be practical. But we've been to enough to compile a few shapshots.

I see these people once a year. The biker, the broker, the shifty, the straight, the uncle, the grama, the sisters, the stoners, the preppy, the grumpy.

The young ones have grown up. The preppy's hair grew out. Some passed away. Some added children, some got married, some became separated.

But all those things happened outside the snapshots. Inside the snapshots, we are always welcomed as if we are family too. That feels good. Easter feels good. I'm so thankful for these people in our lives.

Plus, I won $5 playing poker this year. Only 8 years to go to break even.

April 2 is no joke

2010-04-02T20:45:00.000-07:00

April fools day used to be kinda fun. Like back when I was a kid. Back when Granddad made every day fun and foolish.

But that was before I got a phone call one April 2. It was a day late to be a joke, and it wasn't one.

He went quick, and I'm glad for that. But I didn't get to say goodbye, or to get right with it.

April fools has seemed lame ever since.

Tiger

2010-03-29T20:58:00.000-07:00

I suppose that if you're anxious because your girlfriend still texts her exes, and you look on her phone, and read them, and tell her, and she says "I'm sorry that you feel threatened by that," and you think it must be your personal failing, so she decides to just delete her texts, but you demonstrate your anxiety by looking at the phone account online, and she gets perturbed that you don't trust her fidelity, when "I wish you were next to me" at 3 am clearly has an innocent meaning, that I could give you some pill for that.

But I don't think it will do the trick.

A law of nature

2010-03-16T13:30:00.000-07:00

I was in the homestretch of the Shamrock Run, having enjoyed all the bright and cheery costumes of people running around me.

I was pleased with myself, having run the entire race. I was planning to continue my plodding pace through the finish line, in part because I had set my goal of finishing, and finishing upright, and hadn't really considered the race portion of the event. People, old and young, big and small were kicking up the pace, racing to the finish line. As a result, I was being passed like a counterfeit $20.

I didn't think much of it until a guy in a bear costume passed me. That pissed me off, because he was wearing this super heavy and hot bear suit! and still passing me like I was standing still.

But then I remembered...you cannot outrun a bear. Instead, you're supposed to play dead. So I didn't feel so bad then.

No one is too cool to be schooled

2010-03-15T17:16:00.000-07:00

I finished reading Bowerman and the Men of Oregon this week, not because I have caught the running bug (which feels like a nasty virus, by the way), but because as a product of the University of Oregon, with many hours spent in the Bowerman Building, and with a few hours out on the track, once escorting the 2nd place finisher in the Prefontaine Classic Hammer Throw to his appointment with a urinal and post-win testing, I have a bit of a personal interest, plus somewhere along the way, they slipped me the kool-aid.

I nearly worked for Nike, having parlayed a great first interview into a potential-job restructuring, and promptly lost out on the newer, better job to another applicant (that really hurt). And, I toiled for three years in the hometown of Nike's (and Oregon's, and America's) icon, Steve Prefontaine.

So I wanted to read the book, but never wanted to shell out the cash. Then I discovered the Public Library lets you take home books to read, for free! So I checked it out.

Two things to say about it...

1.) Kenny Moore does a good job of making written recaps of footraces that took place 40 years ago seem fresh and exciting.

2.) Steve Prefontaine, no matter how iconic, was still a human being, and deserved to be ribbed by friends. My favorite anecdote...

After his 4th place finish at the 1972 Olympics (which were a crucible for athletes in light of the terrorist action), Pre mellowed a little, and some were wondering if he would regain the fire that he had had for so many years. Apparently, they were treating him with kid gloves for a while, waiting it out. he was out running with a friend and teammate, and happily mentioned that "They're naming a street for me back home!" The friend, without breaking stride, shot back "What're they going to name it? Fourth street?" and kept going. No more kid gloves.

Resistance is futile...

2010-03-14T17:08:00.000-07:00

I became the Borg today, with a time of 35:54 by wristwatch. The best thing about a first race is that it's a PR.

A measured response

2010-03-10T14:57:00.000-08:00

People instinctively know that it's no fun being treated like shit. Yet we do it to others, even if we aren't true assholes.

As parents, as teachers, as professionals, we try to impart lessons and information, and we see that taking the time and effort to do so in constructive, caring ways yeilds better results than does being an asshole.

When an asshole teaches you a lesson, you tend to remember the asshole instead of the lesson.

That's not to say there isn't a time for harsh, quick, curt teaching. If your kid walks out into the street, time does not permit loquacious discourse. Safety demands it. Safety makes demands on a deadline.

However, I've noticed that people tend to invent their own deadlines and substitute the harsh tones and curt messages when on deadline, and also when situations may have grave outcomes.

Operating rooms are good examples of this. I had the pleasure of learning how to run a laparoscopic camera in the presence of a man who was pleasant the vast majority of the time but who was a real dick in the OR. Sadly, his OR behavior was very common, and it was excused because of the gravity of that environment and his role in it.

I write this because I am trying to become a better parent, coworker, and boss. There are times when an error in my clinic, by myself, or by another staff member, may have grave consequences. Harm may come to those who seek our help.

But in those times, in fact especially in those times, when the importance of the lesson is clear, when the point to be made is salient, when the matter at hand must be ingrained...the message must be delivered well, and not by an asshole. Dickish delivery obscures the information for those who need it most.

And we cannot forget this.

Single parents have it hard

2010-03-09T14:50:00.000-08:00

My wife's out of town, being a VIP in the Chicagoland area for about 10 days. I've got to hold down the fort by myself.

It's really not so bad, and we aren't going to starve or go without showers. But, it's a bit more like the no-frills, pay for your bags, rent-a-pillow experience of today's air travel than the good old days when you could get a pillow for free, if you happened to be one of the first ones on the plane, in order to grab one. You just don't sleep as well.

Yep, my wife is the provider of the icing on the cake. And, does make better cake too.

It really highlights how much she does...and I know deep inside how much she does, but it is pretty easy to take the status quo for granted...good old boring everyday life. Until it's not the same and you realize how much you really appreciate what's missing.

The trick is showing the appreciation in times when it's not such a stark contrast.

being on call

2010-03-08T14:47:00.000-08:00

I began taking weekend call. It's pretty low-key, and so far, the sound of the phone ringing hasn't given me Pavlovian nightmares or flashbacks to my time wearing a pager at Legacy Emmanuel.

I swear, when I'm in the hospital, which isn't often, and a pager goes off, I flinch. And I honestly liked going to the traumas, but the thought of missing one or sleeping through it, or seeing Seth Izenberg was just too much to bear. I flinch.

It's been a little different doing basic telephone triage and really always having the safety net of "...well, if you think it's getting worse, you should go up to the ER and they can take a look."

Dedication

2010-03-07T21:52:00.000-08:00

My son who attends second grade woke up at 1 am on Saturday night and vomited. He mostly hit the area rug, which wasn't so bad for cleaning.

He then immediately stripped down to take a shower, because that's just what we do at our house after vomiting. Even if you aren't hit by any chunks.

Then, he proceeded to ask me if he could still go to school on Monday, roughly 30 hours from that moment. Apparently, he takes his current perfect attendance streak seriously. Just what we do at our house, I guess.

Grave diseases

2010-03-01T22:17:00.000-08:00

Every time I've driven past the vet clinic in Stayton on my way to work, with its readerboard advertising important immunizations, I say a little thank-you that I only have to deal with cancer and diabetes and hypertension...and not heartworms. I would just have an awfully hard time breaking that news to someone.

To sit on top...

2010-02-28T16:39:00.000-08:00

I just finished an article on Paul Krugman, one of the foremost economists of his generation, a Nobel Prizewinner.

I couldn't help but find myself thinking how cool it would have been to have been a person so in tune with his specialty as to have been one of the greatest.

I don't necessarily mean to have been the smartest person in the world, any more than I mean to have been the fastest runner, the best mountain climber, or the best poker player.

I just wonder, not without a degree of envy, what it must be like to be one of a handful of exceptional people, and to know it at the time.

It might just be intoxicating.

What is the worst movie that I love anyway?

2010-02-26T17:00:00.000-08:00

This is an interesting question. As I watch NBC's "coverage" of the Olympics, while prime time is wasted by Mary Carillo's exploits the the loggers of British Columbia, interspersed with "live" (at some point in time, it was live) footage of figure skaters arriving at the arena, I saw an ad for the remake of "Clash of the Titans." It's as yet unrated, but Liam Neeson is in it. I have no real desire to see it.

The old Clash of the Titans was pretty bad, but I liked it. Maybe because I was like 8 years old or something when it came out. Flash Gordon was bad but good too. The Beastmaster, Road House, most other movies that TBS knows to play in a continuous loop, all bad but good.

But,maybe because I've been watching the Olympics, filled with self hate over my inability to look away in principle from the spectacle presented by the Peacock, my favorite best bad movie is...

Hot Dog...the Movie!

That's right, a movie that had to tell us it was a movie. A movie with a climactic sports scene that would make a great Olympic sport...the Chinese Downhill.

This movie is awful, but I own it. I had a crappy copy taped off HBO as a kid, bought it on VHS from the Wal-Mart dustbin at some point in college, and upgraded to DVD sometime after my kids were born, even though I don't think I've even watched it since.

I don't need to watch it. I know the words. There's even a great song, written by Prince, and performed by Mitch Ryder, (When You Were Mine) that you cannot get a copy of in the free world, because this movie wasn't good enough to actually have a published soundtrack, and Prince and Cyndi Lauper did the song better, evidently.

Anyway, I would love to see all these pretty, spandex-wearing, ruggedly nordic types, and Johnny Weir, strap on a pair and launch off the rim of the mountain to win a gold medal at the bottom. It would be so much better than my other idea, which is to just take a vacation to anywhere in Canada,hole up in a hotel room, and watch 5 or 6 channels of live coverage. Maybe those dumb bunnies in Washington could fix the health care mess soon, so that they could then work on something else that Canada does better...Olympic coverage.

Seriously though, go watch it.

"Bonners Ferry Flash."
"Wheaties."
"Sunny side up, Sunny side down..."
"What the f**k is the Chinese Downhill?"
"...get on up there! I got $20 on you!"
"I remember when this used to be a sport!"
"...not on zis side, but right in zee middle!"
...and so many more.

Bonus... Send me your personal faves for best bad movie. maybe we can host a festival. That would be awesome.

Anticipation

2010-02-25T21:22:00.000-08:00

Lots of things out there are good and bad. Pizza is good, but eat too much, and it can be bad.

Anticipation is one of those things. I was a reasonable ballplayer as a kid because I had good anticipation. It was how I compensated for my familial foot speed and childhood dwarfism. Team motto..."We were small, but we were slow." ...name the movie, win a prize.

Anyway, anticipation.

Anticipation heightens expectations. I've had some good Christmases, but frankly, I don't know that I've ever had a Christmas live up to the expectations of the days before Christmas.

Likewise, I've had some bad things happen, but they're never quite as bad as anticipated...

I'm kinda sick today. Was worse yesterday, and boy does it suck to be sick on your admin day. But the worst day was Tuesday, when I knew I was getting sick. The anticipation of being sick was really much worse than the illness turned out to be. The immunizations that make some kids shriek, hyperventilate, and scream generally aren't that bad, and over fairly quickly.

I guess that's why, in retrospect, the things that happen without any warning, without anticipation, can be so painful and crushing.

You cannot anticipate a young person's cancer. You cannot being anticipate being maimed in a car accident. You cannot anticipate losing to a one legged man in a butt kicking contest.

Because if you did, it would be even worse. eek.

See one, do one, teach one.

2010-02-22T21:33:00.000-08:00

This is the mantra of my education. It's an institutionalized form of "from the frying pan, into the fire."

There are certainly some strengths to it, in that one had better be paying attention during the "see one" phase, knowing that only one more instance will present itself for "do one." One also must be hopeful that the example was a good one, because teaching is just around the corner too.

Today I placed an IUD in a patient. It was my first, and my "see one" happened about a year ago. Being the junior male provider alongside a husband and wife family practice/OB team leaves me with perhaps fewer opportunities for such activity than others in the building.

My patient knew it was my first time too. She asked up front. I said, "No, I've not done this before, but I have observed it. Would you still like me to do it?"

She said, "Yeah, I guess so," and away we went.

I performed a pap first. This IUD placement was triggered by her desire to not become pregnant as she recovered from her cesarean section several weeks ago.

You pick a speculum. There are two main types, and they come in three lengths. You have to guess which one is the best, and you must pick wisely, because it's poor form to have to excuse yourself from your first effort n order to pick another model. Number one, if you've picked too small, the patient doesn't appreciate your modest compliment about her size as you then jab a second stainless steel appliance into her hoohah, and second, if you overestimated her vault, you've managed to uncomfortably stretch her with said large stainless steel before settling on the more appropriate size, and her appreciation has already been lost.

So, Graves or Peterson, short, medium, or long. Then, don't actually lube it up, because there's this perception, perhaps not backed by science, but rather backed by fear and anecdote, that you will corrupt the pap should you use something designed to ease her pain. And, so goes the thinking, repeating a pap because you sucked the first time sort of ruins the goodwill that you attempted to earn with the lube.

In our office, you're either a broom guy (five revolutions) or a brush and spatula gal (one to three revs). Me, they've assumed I'm a broom guy. So I am.

Brooming the cervical os (hole) completed, I look ahead to the insertion of the Mirena IUD. Sterile gloves on. (I had gloves on for the pap, but not sterile, because we just don't need them. I apply copious amounts of iodine to the cervix in order to sterilize the os.

I then grasp a tool called a tenaculum. fancy word for toothed grabbing tool that resembles pincer jaws. grasp the cervix at the 12 o'clock position. I don't achieve reasonable purchase on my first attempt, so I pinch it again. The tenaculum draws blood (normally). You (I) can only imagine how this feels.

Purchase obtained, I remove the Mirena from its sterile wrapper. It's spendy, so one waits until the last moment to commit, and I suppose that once the tenaculum is clicked into place, you've committed.

One more thing before insertion...sounding. You can twist the picture in your mind and imagine that you are leaning off the bow of a Mississippi riverboat, measuring the water depth in order to proceed upstream (Mark Twain, anyone?), but in reality, you are measuring the depth of the uterus in order to avoid poking a hole into it with your efforts. You use another stainless instrument, a round rod called, a "sound." Not a "sounder." They play soccer.

Sounding accomplished, the Mirena can be set to be deployed in a suitable range. I make sure the strings are unwound and not tangled. I hold the cervix in place and slide the Mirena inserter into the uterus, up to the sliding collar that I have set to the proper depth based on my sounding effort.

A simple slide of the handle deploys the T-shaped device. Another simple slide removes the inserter, leaving behind the device and a trailing tail of 18 inch long strings, made of a synthetic monofilament line (I have no idea what pound test, and I never plan to test it).

A quick trim of the strings and I'm ready to remove the tenaculum. With a flip and a click, it is clear, and I can then turn my attention to controlling the bleeding that I have caused.

Several large cotton swabs and some judicious application of silver nitrate later,the bleeding has stopped. Bleeding that I caused. On purpose. Once finished, I can remove the speculum that I had so wisely chosen correctly at the beginning of the process.

Pleasantries aside, the procedure is complete, and I can excuse myself from the room so that the patient can re-robe and experience a degree of cramping, pain, and spotting over the next several hours.

This is sure a long ways from taping an ankle. Something, I might add, that I was not permitted to do after watching only once.

Just a quick thought from the world of primary care:

2010-02-09T20:30:00.000-08:00

I sure hope that old ladies bat their eyelashes and flirt with me as much when I'm their age as they do now.

reaching an understanding

2010-02-06T22:30:00.000-08:00

I'm taking a parenting class for the next few weeks. It wasn't court mandated. Just Sayin.

Anyway, me and the boy played a game like the newlywed game, where we answered questions as we thought the other would, and this is what I learned....

My boy's favorite subject in school is math, and if he had $50 to spend, it would be on video games. We were in perfect agreement on this. I patted myself on the back for "knowing my son."

My least favorite chore is doing the laundry, and if I had $50 bucks, I'd spend it on student loans. So said my boy.

I said "cleaning the toilets" and "clothes?" without much conviction. Then I thought, "He doesn't know me very well. We should talk more."

But then I realized, he does know me. He knows the me that I project, just as I know the boy that he projects.

I think we're all more or less good at observing others and getting from them what they are putting out.

I just think we're not so good at knowing what we're putting out.

One small step for man...

2010-02-01T21:19:00.000-08:00

OK, so maybe it wasn't that dramatic, but well, I exercised today. And it did hurt. But only a little.

The student at our clinic, bless her heart, still gets all sparkly-eyed about things like running and elevating one's heart rate and stuff.

So I have been goaded by my inner demons into preparing for the St. Patrick's Day run here in PDX. I don't know why. I don't like running. I don't like beer. The whole point of the St. Patrick's Day run is to go run a bit so that the beer you drink in celebration doesn't have a moral, or even a nutritional cost.

But I'm doing it. Besides, if my knee swells, I'll have a good excuse to get it checked out.

I had the greatest conversation today

2010-01-29T22:05:00.000-08:00

One of my patients today came in wearing his white checkered New York Yankee hat, size 7 1/2 (I could tell by looking at the big gold foil New Era hat sticker still on the perfectly flattened brim), cocked to the side and tipped just a smidge. His big earrings caught the light in a dollar-store way. He has a problem or two (which I absolutely nailed, by the way) and we chatted for quite some time. I found out about his work, his hobbies, his life, within the context of trying to help him with the issues he brought in.

What's so cool is how he helped me with the issues I brought in, even though that wasn't the premise of our appointment, and even though I still got to bill his insurance for my therapy.

He was articulate. Not in a higher-education way, but in the way of a person who had concerns and wanted to convey them. He was open. He was willing to share, and we had a two-way conversation. I left it floating on air, so happy with how it went because it was so unlike my previous interaction with "guys like that." Or more to the point, it was so different than my expectation of a sullen and difficult interaction with "guys who look like that."

And it wasn't that he was different. It was that I realized that my invented truth was wrong.
This is not my original thought. I was just lucky enough to read a great blog post (feel free to click on it: I Just Remembered Chris Matthews Was White) : that articulated my personal shortcoming.

It's not that this kid was different. It is that I was wrong about what I had constructed as true.

Now you might say, "Gee Erin, you're pretty happy to have learned that you're a dumbass."

To which I'd respond, "Yeah, because now I'm a little less of a dumbass!"

My new business card could read:

Mr. Dumbass, PA-C

"I'll Try to Help You"

One of those days...

2010-01-28T21:17:00.000-08:00

You ever had one of those days? One of those where good things happened, and pieces just fell into place without even trying, or even thinking to try?

Well, today wasn't one of those days. But yesterday was.

It was my admin day. So I decided to actually do some admin. Four hours in the office catching up on stuff, and serendipitously being present (yes, by just merely having showed up) when the sibling of a demented patient from the day before happened to come in hoping to get some help!

I was stoked! I'm a little HIPAA shy, due to some lovely proceedings with a lawyer up in P-town where a young and naive student tried to help a patient. Lesson learned. It's hard to drop a dime and call someone to help a patient who obstinately refuses that a problem exists, ...and well, she still managed to drive to the hospital and then to the clinic and then to the hospital and then home, all without forgetting where she lived.

But when the concerned party comes to you, you can speak in generalities, let them connect the dots, and really help the person. Tough old bird, though. Still tends to the homestead and the stock, and does ok. But really should not be driving. Not when even the name of the town has been lost to the ether.

And then, to top it off... Marion County (she didn't know that one, either) didn't need Juror #307 this morning, and was kind enough to say so the night before. SWEET!

Do I have the Passion?

2010-01-26T20:51:00.000-08:00

I don't know.

I left athletic training, at least in part, because I didn't have a passion for the work any longer. I was bored, I was complacent, and frankly, I was dangerous. My skills were such that I could do almost anything, and well, but I wasn't sharp, and I wasn't getting sharper. I was becoming a diminishing asset to my athletes.

Today, I had an encounter that stirred the pot, upsetting my newfound pool of placid family practice medicine. I saw a kid who wanted clearance to resume wrestling. He was sent to me by his athletic trainer and his coach. I think his coach probably holds all the power in the situation, for it is a small town, where the athletic trainer who toils for a PT clinic by day doles out his skills by evening, likely at less than fair market value, to a small high school where many things are as they have been since the days of double-knit athletic coaching shorts.

Letting him return to the mat was easy, for he really did not have a condition for which my new found stamp of disapproval would be appropriately inked. is back was hurting, but likely a soft tissue injury that will heal with some rest and guarded progressive return to activity. Perhaps the athletic trainer on site can enforce this idea, and exert his expertise in managing the injury. But, perhaps he really has nothing to do with it and I have just signed Willy Wonka's golden ticket back into a dual match this Thursday, where the athlete will do as he pleases and end up in pain on Friday morning.

I cannot tell.

But even that is not what consternates me. No, it is the history told by the medical chart in front of me. That of a physically gifted boy who has raised the interest of a regional institute of higher learning, dangling some scouting offer of scholarship or otherwise, to come and play football in the coming seasons. That of a boy who has received four (4) concussions in the previous18 months. that of a boy whose care has been ostensibly managed by his primary care physician, but who in actuality has been mismanaged by parents, coaches, and dreams.

There is no state-of-the-art concussion management protocol at the boy's high school. There is no adequate daily medical care available for the boy. There is only that which has always been...the glory and exploitation of a town's young people for the gratification, amusement, entertainment, and pleasure of its citizens.

And I know this. And I could work to change this. But I don't know if I have the passion to take it on. It's a dark day for me.

Focus

2010-01-20T19:58:00.000-08:00

I completed my student loan consolidation application today. It was a bit depressing. I am filled with a tiny but growing sense of dread at the prospect of the coming months.

Back, way back, in the latter part of the twentieth century (OK, really, just 13 years ago), I was getting calls left and right from tons of companies wanting to be the one that I picked to consolidate my loans. They were like horny high school boys vying to dance with the pretty girl at homecoming. I felt pretty. I selected one and enjoy an interest rate of 3.65 percent on that loan, representing seven years of schooling and two degrees, totaling (originally) just shy of $22,ooo.

Fast forward to 2009-2010, where we are in the midst of a recession with interest rates at an all time low, where credit is really cheap (for those who can get it....I know, another story). How it is that the best a person can do on consolidation now is a weighted average of their total (should be about 7.5% for me) is beyond me. Even more concerning...private banks are pretty much out of the game now. The federal government is the only consolidator of loans that I could locate. My current old lender said "thanks, but no." Sallie mae, who services the loans, said "we don't do consolidations. But we'll let you pay four of them to us simultaneously!"

Now, for much of my adult life while not in school, paying attention to the arcane world of higher education finance has not been on my radar. Perhaps the government cleaned up some bad juju that was artificially lowering the consolidation rates back in the day. Or perhaps its totally bogus but just the way it is.

Either way, I have essentially taken on two mortgages in the last year. Nothing like a little motivation to be a good PA.

Yes We Can...

2010-01-18T20:46:00.000-08:00

sell a table saw to a guy wearing a "Palin/Limbaugh 2012" sweatshirt. Why? Because his American cash spends just the same as mine. Why else? Because his cash came from selling his patented homemade blocks/toys at Portland Saturday Market, and probably came from some left-leaning microbrew-drinking brother of mine.

What a country.

BTW, for those of you keeping score at home, that's one table saw gone, one to move, and one to keep. Then I gonna look for a good band saw or three. That'll keep her on her toes.

Enabled

2010-01-17T18:49:00.001-08:00

So my spending moratorium lasted a little over twenty-four hours, and I was locked in a giant fairgrounds hall for a cub scout event for part of that time.

I did what any addict would do, and got my spouse (whom I affectionately call the enabler) to get me some money from the ATM.

Then, I jumped in the truck and went to check out a really nice table saw. I ended up buying it, loading it into the back, and driving home, where I faced a ration of ridicule usually reserved for truly special occasions.

Maybe I got that grief because it was the third table saw I've purchased since January 1. Yes. I said third table saw.

Maybe she has a point. I'll go put one or two up on Craigslist tonight.

Great Service!

2010-01-15T08:13:00.000-08:00

I must say, T-Mobile offers great service. Too bad T-Mobile is not my cell carrier. I have no real complaints about my cell carrier, but last night I got a phone call from T-Mobile that set into motion my newest self-improvement activity...

I have been toying with the idea of trying to go for an extended period of time without buying anything. See, I'm a spender. My sponsor says the first step toward recovery is to admit it, so there you go. (I'm a lot of other things, but there's only so many hours for recovery groups in the week, so I'll start with spending.)

I had a friend who I think went a whole month without buying anything, and I have always thought that was cool. So, I've been thinking of trying it. And now, I will.

You see, someone out there obtained my address, my phone number, and my credit/debit card number, and decided to re-charge a throwaway cellphone with my money. I only found out about it because T-Mobile called my phone to verify the transaction, at random.

Of course, I had no idea what the hell was going on. So by dumb luck, I was able to cancel my card and start (what turns out to be a very involved process) fraud alerts for my info.

Thus, my debit card is useless this morning. Day 1 of my extended period of not buying things. I feel so empowered.

Bloodletting

2010-01-14T19:43:00.000-08:00

We didn't learn bloodletting in PA school. While it was a very common practice in medicine, even into the late 1800's, it didn't make the cut. We didn't have a long time to learn everything, so some things ended up on the "to do" list, in the hopes of being learned later.

As an aside, apparently, the earliest physicians got the idea of therapeutic removal of blood by observing that menstruating females tended to improve when compared to their pre-menstrual selves. Out, out damn spot!

I saw a patient this week who just might benefit from some bloodletting. Eighty-something years old, with diabetes, hypertension, some memory issues, the whole nine yards. My leeches were on back order at Medco, so I had to spend some time getting a history.

Turns out, this patient has 3 siblings with hemochromatosis. Yes. Hemochromatosis. A long and fancy word, with etymological roots in the Greek or Latin (I don't know which) for blood color problem.

It is a genetic problem, and there is a huge possibility that my patient would have it like the siblings. Simply put, it is a condition in which the body collects/keeps/holds too much iron. Kinda the opposite of anemia.

The normal machinery for getting rid of iron isn't working, and the excess has to go somewhere. It ends up in places like the liver and other organs, where it can play havoc for quite some time unnoticed. Its symptoms can mimic other conditions, so it can be easily missed.

I can test for it, and will do so, because the patient brought the MayoClinic.com printout that told me all about it. The patient really wants the test. I ordered it.

But here's the kicker...what am I gonna do if it comes back negative? Am I gonna get out the genetic testing manual and order even better, spendier tests? The patient is like 83 years old! How far into the wild will we chase the goose?

Heck, what will I do if it comes back positive? The treatment is...bloodletting. Get rid of some iron the old fashioned (like the crusades) way. Will I do it? The patient got other problems that may not cotton to me installing a tap on her plumbing.

Never a dull day.

She's a Gamer

2010-01-12T18:53:00.000-08:00

I've seen my share of practice players, and of gamers. There's something quite annoying about those people, unlike me, who had the talent to coast through practice and then flip a switch for games and be successful, and more importantly to a seventeen-year-old, be better than me. Annoying as hell.

Anyway, today, I met a gamer. She shuffled in, sans walker, after having seen her last week. She was in some pain, and by that I mean "SOME pain." We discussed her options, and she kindly shot down my suggestions of more medicine, of physical therapy, of ice and heat. She had it in her mind that a cortisone shot would be nice. If I would accommodate.

Only one problem...I hadn't given one in the SI joint before. I hadn't given one to a woman who had survived broken humerus and femur, leukemia, and 89 years on the earth. I wasn't yet a gamer. In fact, I hadn't really even practiced.

So, off I trudged to the good doctor, whose eyes perked up at the thought of a joint injection. Back we went, and out the door the patient's daughter went, not fond of needles.

I sat her down, marked my spot, numbed her up,and entered the joint quite easily. (It is kinda big) I was surprised, because my efforts at lumbar punctures had been feeble at best during my rotations. (But the SI is really much bigger) In I was, and I squirted the steroid into the back of the nicest little old woman I'd seen that day.

And like that, it was over, and she had immediate relief. That was cool. Because I made it happen. With assistance, of course.

Then I had the bonus smile of hearing the patient say "I don't have much tolerance for pain," and her daughter saying "And I just was saying out there that you had a high pain tolerance!" which just solidifies my point about pain tolerance being the most accurately described personal attribute that I have ever run across. Not.

And then, the kicker... "So, is there a limit to how many of these I can get?"

Lady, since its playoff season, I think we should make that a game-time decision, if you know what I mean.

"An American Issue"

2010-01-11T20:13:00.001-08:00

I have a patient who is gay. He told me so. Because I have yet so few patients of my own, it is possible that he is the only gay patient that I have.

But it is also possible that I have other gay patients, ones who have not been comfortable in sharing that information with me. That prospect makes me sad, for I try very hard to help each person who comes to me, and to be a genuine advocate for each of them as they try to navigate the world of health care. Some may not trust me sufficiently to share who they are.

I did not consciously, knowingly, have any gay friends growing up, and I'm certain that I have on more than one occasion referenced homosexual people in ignorant and hurtful ways, whether just by saying "that's gay!" or "don't be a fag!" or some other juvenile nonsense. I cannot say when I was able to understand that the difference between me and the person next to me is inconsequential when compared to the similarities, but I do understand that as I write today. I have for some time, and it is that understanding that has compelled me to attempt to live in a harmonious way with those around me, and to try to impart the importance of respect for others to my children as they grow. Some might call that a Christian idea, but I do not attach that far. Rather, I think of it as a human idea.

I've never felt threatened by a gay person or by homosexual culture in general. I've felt curious, as I really feel that I have no understanding of what it means to be different from the majority in a meaningful way. Perhaps because of that, I have never quite understood the need for some people to "defend marriage" from those who have historically been under the thumb of another.

Ted Olson is the former Solicitor General of the United States. He is a Republican. He is a heterosexual male. He is a conservative.

He also is the lead counsel in the federal lawsuit to overturn Prop 8, the California voter initiative led by "conservatives" to revoke the right to marry for thousands of citizens of this country who are so much more the same as you or me than they are different.

Please read his explanation for his decision to be a part of the case. He's much more eloquent than me.

http://www.newsweek.com/id/229957

You might say, "Erin, why do you care? This doesn't affect you."

To which I would respond, "It certainly does affect me. I do not wish to be a member of a 'community' that shuns even one of its members.

Saturday Ichiro Wisdom

2010-01-09T19:54:00.001-08:00

It is the process, not the results, that makes the person.

Dream Analyzer

2010-01-08T21:42:00.000-08:00

One of my many hats.

If you are having a dream in which you are traveling through hell, encountering Satan, randomly contacting long passed individuals from yor memory, and you actually really truly feel the fires of hades...what does that mean?

It just might mean that your waterbed heater has malfunctioned during the night, and you've burned your arm and shoulder in your sleep. And maybe you're a little crazy too.

I don't make this stuff up.

Read the fine print

2010-01-07T20:51:00.001-08:00

When negotiating contracts, it's really important to read the fine print, and lets be honest, do any of us read the fine print? I know when I download software, I click right through it.

From an article on espn.com I read today...

"Since the firearms language was strengthened in the 2005 collective bargaining agreement, NBA players are subject to discipline if they bring guns to the arena, practice facility or an offsite promotional appearance. That gave Stern the option of taking action now instead of waiting until the completion of the criminal case, as he usually does."

Darn Firearms clauses. Poor Gilbert Arenas stands to lose about $150,000 per game because he didn't read the firearms clause. WTF? Is this real? How can a professional sports league need firearms clauses? Doesn't that lawyertalk boilerplate violate their second amendment rights?

Admin Days

2010-01-07T16:30:00.000-08:00

I get one "admin day" each week. Apparently that's code for "day off." Sweet.

Every time I make an appearance on an admin day, like to do admin stuff, people look shocked and say "What're you doing here today?" To which I answer, "Taking care of a few things." Apparently, that's code for "Dropped the boys off at school, and I'm too lame to have anything good planned for today."

The Variety of Family Practice

2010-01-06T18:00:00.000-08:00

My docs were out of town for a couple of days. I called them a couple of times, once to ask about dosages on an antibiotic, and once to ask about the cooking time on the potato casserole. More importantly, I didn't need to call my busybody fairy godmother PA.

The breadth of characters who walk through the door is awesome. The day flies by. Just today, I saw:

1. A middle aged woman for an annual exam.
2. A teenager who cannot sleep (Might be the Unabomber)
3. A man with a sinus infection
4. A baby with a fever
5. A woman with an abscess on her buttocks
6. A child with an upset stomach
7. A woman with a sore throat
8. A man with De Quervain's Tenosynovitis
9. An infant with a rash
10. A teenager pissed at her mother
11. A woman with PCOS
12. A man with chest pain
13. A woman with a cough
14. A child with a UTI
15. A man with depression
16. A woman with back pain

And not one cancellation or no-show, which I was starting to take personally.

I was listening one day in school...

2010-01-05T21:02:00.001-08:00

So, this abdominal pain started in November?

And you had your gallbladder out last...November?

And your appendectomy in 1980 was in...November?

And you had a miscarriage the year before that in...November?

Damn. If I were you, I'd try to figure out why your body hates November. Because all your lab tests and scans are negative today.

And don't buy any lottery tickets this coming November...it doesn't look promising.

Overheard in the clinic...

2010-01-04T19:13:00.000-08:00

I don't often hear this, but it sure felt good:

"I'm really glad you're my doctor." (I know, I'm not a doctor, but my stethoscope was in my ears and I was listening to an arrhythmia, so I figured I could let the correction slide, just this once.)

And I never hear this:

"Are you related to the Cramers of Troy, Montana?" (Lady, I am the Cramers of Troy, Montana. I literally do not know of any others besides me. So, "yes.")

It truly is a small world, filled with bits of joy. Sometimes, you just get to accidentally hear them through the filter of a Littman Cardiology III.

Today is just a waypoint

2010-01-03T19:13:00.001-08:00

Aside from a now-deleted and unappreciated long advertisement for Christianity in the form of a parable left as a "comment" on my last post, by a still-unknown source,not much happened with my query...yet. So I'll kick off the sharing with my own thoughts.

My accomplishment of 2009:

In a deadline squeaker, "owning" the roof over our heads. We foolishly listened to a mortgage professional and found ourselves knee deep in a home without a clear path to ownership. As time went on and another professional worked to extricate us, the market continued to decline, other homes were put up for sale, and the potential for student loan repayment evaporated as it became crystal clear that migrant farm workers just do not drive out to Sublimity to go to the doctor.

That gnawing little voice inside my head? It got louder by the day. So loud my tinnitus,present since my earliest recollection, was lost in the background. But, I woke up on December 30th with a fresh ringing, as the sound of reason had been eradicated once and for all, hopefully not to appear as my nightmare of 2010.

My dream for 2010:

I want my clinic to break even in 2010 due to the extra patients that I bring to the door and help with their troubles.

I want my boys to thrive and earn the responsibility that I unfairly burden them with at such young ages.

I want my bride to see carnations bloom in the spring as two pine trees take root and become perennial Christmas trees worthy of a Griswoldesque lawn display in December.

Nothing much, really.

Because I want to know...

2010-01-02T22:25:00.000-08:00

I'm interested in you, the reader. You read my rants, my drivel, my glimmers of hope and perhaps even an occasional flash of brilliance. I suspect we share much in common, so it's your turn.

As we look forward to 2010, what are you most proud of having done in 2009? And what are you looking forward to attempting in 2010?

New Year's baby

2010-01-01T10:53:00.000-08:00

We'll she's not my baby, and really came into the world a few days ago, but my new year's baby was a little yellow when first I met her yesterday.

While yellow's a nice color, a buildup of baby bilirubin turns them a bit yellow. Nothing that a bunch of sunlight (oh wait...this is Oregon in January. What sunlight?) and pooping desn't cure.

Yellow's not so bad itself, but it's the buildup of that bilirubin that puts their brain at risk...

And so I get to worry about a little one this weekend. But not too much. I kinda like it.

Changing names!

2009-12-30T21:33:00.000-08:00

This blog will begin living at http://www.icramer.com/ in the next few days. Until the switch, the original rotatingthruschool.blogspot.com will work. Following the switch, it is my understanding that you will be redirected from old to new, but no guarantees, so please switch over.

Maybe I don't need to switch, but school is finished, and I used the blog to keep my sanity during that time. Now, I'll be using it to keep my sanity as I plow forward in my new career, with my same ol' sidekicks. Stick with me!

How important is perfection?

2009-12-29T19:12:00.000-08:00

How important is trying your best?

This weekend, the Indianapolis Colts had an opportunity to extend their unbeaten streak to fifteen games this year as they attempt to finish this season with a Super Bowl championship.

They lost the game, and they may have done so because they consciously decided to rest their first string for the last 20 minutes of the 60 minute game.

Their reasons were sound. Winning a Super Bowl involves being both healthy and good. They certainly are good, and want to stay healthy. Football is an inherently dangerous activity, and the more plays one spends on the sidelines,the more likely one is well rested and uninjured at the end of the day.

Not that I agree with them. And not that I give a damn about the Colts. I like Peyton Manning's commercials. I will stipulate that he plays football very well, but I have no stake in his success. It neither pleasures nor galls me when he plays the game. But he's a damn funny pitchman for a growing variety of products.

Apparently, several thousand Colts fans weren't very pleased with the team's decision to finish the game with their reserves. They booed like crazy.

There was also a great deal of dissent among the talking heads of ESPN. Several ex-coaches were heated in their criticism, and generally speaking, it boiled down to a variation of rumination on perfection, ie- "because they had a chance at perfection, they had the obligation to strive for it!"

It's hard to win every game you play. Only one team, the 1972 Miami Dolphins, have accomplished it. If you believe what you read, those guys throw themselves a little party every year after the last unbeaten NFL team falls, for they still hold that solitary distinction, and they take great pride in it.

Ok, good for them. But still not my issue with the Colts. Why? Because I believe that all those people screeching on TV would have been just fine with the Colts and their strategy if they had entered the game at 13-1. To them, it was all about the opportunity for a perfect season.

Whereas for me, it was all about the weekly workmanlike desire to see consistent effort put forth toward the task at hand.

Perfection is cool, but what I want, and what I expect from professionals, is a good faith attempt and effort to win the game, week in and week out.

I don't watch exhibition games in the NFL. Why? Because they aren't true contests, as teams play starters for a while or not at all, other players are fighting for their professional lives,etc. Coaches try stuff out to see if it works. It is an experimental atmosphere. Players can still get hurt, so there's disincentive all around.

The Colts turned the game on Sunday into an exhibition game. They didn't play to win. They chose to be safe. To me, it's not about perfection but about the honor of the effort. It may pay off to have protected their assets, and if they win the Super Bowl, I get the point,and think that this strategy may have played a meaningful part.

But it's not what I expect from people doing their jobs. I expect their best effort. I spend a lot of time trying to instill values into my boys. My older boy has a lot of talent for things in life that he doesn't need to use in order to get by on what is asked of him at school, home, etc. he give effort adequate to complete tasks. Not his best effort, but adequate effort.

In response to this very discussion, he mentioned that I told him it was more important to have fun than to win or lose in sports. Kinda pinned me down after my "I expect them to try to win every time" comment. It was hard to explain my splitting hairs between a game and a profession (when they are the same thing in this case).

Now my head hurts.

look for some revamping to this blog in the new year.

Migraines

2009-12-21T19:32:00.000-08:00

"The migraine gene? Isolated? Well, no one's really mapped it, but you can smell it on them. Family history is......genetics."

-Neurologist at lunch today. Brilliant.

First do no harm

2009-12-10T18:34:00.000-08:00

Karen and I went to our first Christmas party for medical staff this weekend. Decent party, no mishaps, but one good story...

This is a small town. The kind of town where Moonlight Graham could have been the doctor.

There have been several Moonlight Grahams in Stayton and Sublimity. Beloved old guys who served the people throughout their lives. Some guys are lucky and die quick. It's hard on the ones who love them to wake up with a giant hole in their lives, but thank the gods that those wonderful people don't have to suffer for long on their way out of this world. It just wouldn't be fair.

Dying slow is for the unlucky ones. It's hard on everyone.

Getting Alzheimer's might be in the middle, and perhaps just sometimes, a happy medium. Last year on rotation in Astoria this time of year, I got to encounter a pleasant old woman in the later stages of the disease who would visit with me so nicely in the hospital room, and later,as I was rounding on other patients, I would hear "GO BEAVERS!" yelled with gusto every few minutes or so.

But anyway, a story about Moonlight Graham. Doc Graham was a family practitioner in Stayton for 40 years or so. He lived a little ways out of Sublimity, like 2 or 3 miles from the true center of town, in the country but still "in Sublimity."

He got Alzheimers and had to retire. He was still a visible member of the community, and people looked out for him. The hostess of our party, the head of the radiology department of the hospital, knew Doc Graham for years.

She was driving around Stayton one day and saw him walking. Knowing that he was demented and probably lost, she stopped and picked him up. She drove him home and dropped him off.

A few weeks later, she saw him walking again, and did the same.

A third time, she saw him walking around. He hadn't really recognized her the first couple times, but had been polite and traveled home with her. This time, he refused. He said "Lady, I'm not getting in that goddamn car with you." He was very adamant, and despite her best repeated attempts, he would not get into the car.

She gave up and drove home, and then got on the phone with Doc Graham's niece, who took care of things for him.

"Sheila, I saw Doc walking down by the Dairy Queen and I tried to give him a ride home, but he wouldn't get in the car. I'm worried about him."

"You say he was walking by the Dairy Queen?"

"Yes."

"When you say 'home,' where do you mean?"

"Well, his home. You know, out on Berry Lane."

"Val, we moved him into town and sold the old place six months ago. He lives in the Mountainview Care Center (next door to the Dairy Queen)."

Apparently, Doc Graham didn't know who the woman in the car was, but he knew that getting in would buy him a good six-mile walk back from the stranger's house on Berry Lane to his room in the building next to the Dairy Queen, and goddammit, he wasn't getting in again!

I hope nobody shoots their eye out.

2009-12-09T21:25:00.000-08:00

Kinda slow day in the clinic on Tuesday. But the best patient of the month, by far.

I love when parents come in with their kids, and you can tell they aren't bad people, don't let their kids smoke crack, and make sure the fires get put out before bedtime.

It doesn't really matter though, because a pack of seventh grade boys can undo all that good work in seconds.

This week has been pretty darn cold for this part of the country. Daytime highs have been in the upper 20's, and Sunday didn't climb out of the teens. Add in clear skies and the Willamette Valley was a bit nipply.

Nipply enough to freeze our hot water pipes on Monday night. i swear, if it had been really cold out, I would have taken precautions, but in the teens isn't all that cold where I come from, so it didn't occur to me.

Anyway, back to it... 9:00 AM acute appointment. Luckily, I had the space in the schedule. (Yes, some days are still really slow as I build a practice.) 4th grade boy, 9 years old, Named "Alex." (No, not my kid.) Took a dare from middle schoolers.

Alex was accompanied by his parents, both of them. He had a bit of a wound on the tongue and on the nose. He was embarrassed, but quite a sport overall.

His parents were flabbergasted, but my kind of folks. They made fun of him for the entire visit. Just like I would have done to my Alex.

I told him he should get an A on his science experiment.

Here's the best part: Apparently, none of his teachers or school staff thought to try warm water on the pole. They called 911 instead, and let the paramedics free him. The local media, who evidently have a police scanner like 75% of the people in my hometown (cheap entertainment), responded to the school with a big camera too. This kid's predicament will live on....

Where you gonna put a tree that big, Griswold?

2009-12-06T20:59:00.000-08:00

Put up lights. Didn't fall off the roof. Didn't staple a glove to the wall. Didn't pull down a gutter. Didn't overload the circuits.

Went and got a tree. It's a little full. Didn't dig it out of the ground. Didn't need to trim it. No squirrel yet.

Pictures to follow.

"He was one of my students."

2009-12-05T15:00:00.000-08:00

Bullshit.

"I taught a class."

Bullshit.

She was a guest lecturer for three or four days, discussing pregnancy, and doing a whiz-bang job so common to medical professionals who like to play "teacher."

Guest lecturers were a common feature of PA school. Notice I wrote feature rather than asset or detriment. Some days they were winners, some days they were losers, and some days in PDX, it rained.

I am married to a teacher. I taught a bit myself. (enough to know that teaching is haaaaard.) My "classes" had discussions and lectures and tests and readings and lots of work for the teacher. Not four days of historical (read: not up to date) regurgitation about pregnancy from a PA who does not do OB.

I guess I wouldn't be so pissed about it if she weren't acting like a mother hen trying to save me from evil doctors who will take advantage of me and make a few days of the year clinical hell while they're out on vacation. Because they won't.

Her 30 years of experience does count for something and earns her a level of professional respect that my 90 days does not, but things have changed in 30 years too, and I didn't just fall off the turnip truck returning from my first rodeo where I was born yesterday green as cabbage fresh off the boat wet behind the ears .

There is a concept of which I am often reminded. Each of us has a ceiling, a limit to what we can be based on our potential, our skill, our aptitude, our guile, etc.

I think it is wonderful when a person reaches their ceiling. Some even break through the ceilings that have been imagined for them. It is a waste when one doesn't even approach a ceiling, choosing (or being forced) to dwell near the floor.

My point is not that this woman lives in a basement apartment. I make no judgement about what floor she's on. Maybe she's Charlie effin' Bucket and has to burp to avoid the fan in that Willy Wonka Movie.

But I get wicked mad when someone who doesn't even know me tries to project their ceiling on me. Get off! I can do shit that you cannot imagine! I just don't feel the need to show you. It's not worth the effort because I perceive that you won't understand anyway.

Obamacare

2009-12-04T19:12:00.000-08:00

I cared for a man today that has an expanding skin eruption most likely due to his stress over the prospect that he will lose his health insurance and go bankrupt under the proposed health care legislation currently in the Senate. He has literally worried himself sick. And he still has half of the bill left to read online.

I guess that's a good thing, as it will keep him too busy to watch Fox News and read Sarah Palin's book.

I got paid for suggesting less worry, more hydrocortisone cream.

Little known fact

2009-12-03T16:09:00.000-08:00

A 37-year-old man can eat 74% of a Costco apple pie. Just not in one day any more.

In my craw

2009-12-02T20:50:00.000-08:00

Ok, so something's been bothering me for a while. A couple of weeks ago, I got the pleasure of attending an Oregon Duck football game, and watched them spank the Arizona State team led by everyone's All-American dickhead, Dennis Erickson.

I had a great time, and was blessed by the generosity of a Medford city councilman, hooked up by a goofy parks-n-rec guy, and accompanied by a good friend who was politically downsized from his job just the day before. About 58,000 other people were there too.

I've been to only one other Duck game, back in the mid-90's, when UCLA kicked the crap out of them. I attended many other games at Autzen Stadium, back when the Eugene high schools played home games there on Friday nights. I was an athletic trainer for a Springfield school (Springfield being the cousin Eddie to Eugene's Clark). 2000 spectators for a high school game on a rainy fall night in the Willamette valley looks nothing like 58,000 screaming crazies in a remodeled stadium on a crisp night. It was awesome.

But that's not what bothered me.

As we arrived at the stadium, me and my bud walked through numerous examples of largess otherwise know as tailgating. People were tailgating with vehicles that likely cost more than my house. It was stupid crazy.

We also passed by numerous homeless (or at least down-on-their-luck) people who were out in the night air at the stadium too. Perhaps they were fans, too. But I don't think so. They were fans of the cans. I noticed that as frat boy after coed after trophy wife after booster filed toward the gate, they would drop their last empty can (or bottle) into big plastic bags manned by homeless people. Enterprising homeless people. Five cents a can. It made standing outside the stadium, in the ridiculing gaze of people who afforded their RVs, their down coats, as the y passed by with their passes to the entertainment beyond the gates (and mine were $50 each but free to me) worth it to them.

(and I will not go into what I think about the state of the union when such a statement as written above is true...)

But that's not what bothered me.

What bothered me was walking into the grocery store the next day and seeing a sign that announced that Oregon Statutes limit the redemption of cans and bottles by any one person at any one location to 144 per day. That's $7.20. Less than one hour of minimum wage work in Oregon. Just another way to keep a boot on their necks, I guess.

time flies

2009-11-29T21:05:00.000-08:00

I know its been a while. Things have been crushing. I'll write more soon.

The good old days

2009-11-12T22:04:00.000-08:00

I loved high school. Not enough to do it again, but I had a really good time.

Or so I say. I think really that I had a goo time enough of the time to just not remember all the bad or boring and neutral times. I remember things like riding around in a bathtub in the back of a pickup driven by my cousin for a scavenger hunt. I remember waking up at 8:20 and making it to school by the 8:30 bell because the town was just that small. I remember all the great times I had in PE (because I wasn't picked last). And the hits just keep coming back to me....

A lot of my nostalgic longing for my youth was dispelled by my six week rotation there last fall. It wrapped up in the early part of November and on I plowed to the Korean Crucible in Astoria, where I learned that taking your time writing a patient history by hand could be your only link to sanity.

But I say all that to tell you this:

I love apple pie. It is my favorite pie. I hardly ever eat it anymore. I'm much more likely to choose cherry or peach or berry or pumpkin or rhubarb or "not apple" pie than I am to choose apple.

This is so because a little old lady who made my favorite apple pie ceased to make pies in 1998, and passed away in 2006. She made good pie and the various substitutes that I tried in the ensuing years just didn't measure up. You can try feeble imitations for only so long before you either devote your life to a soul-baring journey to find suitable pie, or give up the search for satisfaction.

There are some good pies out there. There are some not so good pies out there. Everyone likes a pie, so I cannot claim there are outright bad pies, only bad apples. Speaking for good pies, the Costco apple pie is pretty tasty, and very cost efficient from a volume to taste standpoint. But it's not like that old lady's pie.

I've decided (although it wasn't really a conscious decision, more of an evolution) that I won't seek the best apple pie. I'd rather remember the old lady's pie as the best there was, and ever will be. I feel special for having been able to taste it. If I actually journeyed to waypoints about the globe, and found the holy grail of apple pies, that would be a wonderful thing, but it would also be tragic, for another thing from the good old days would lose its luster. Another thing from the soft focus of my life's archive would be wiped away like old Polaroids lost to the water from a leaky roof onto the attic storage.

I choose to stop while ahead. Some see a quitter, some see a winner. Your perspective may differ.

But what do you do when you stumble onto the grail without even trying?

There's a little place in Sublimity called Panezzanellie's. It's a hole in the wall. Run by a family. Dad cooks, but he used to be a carpenter. He did that after he sold a restaurant and the rights to his recipes...for 16 years. That was 17 years ago, so he's back to cooking.

He makes decent pizza with a crust that is a touch too sweet for my topmost approval, but it is good. He makes good salads too. Excellent sweet rolls in the morning. And he makes desserts. The menu doesn't list them, because they change daily, by whatever whim that lights his fire in the morning. You just get to find out what's ready when you walk in the door.

Today there was pie. First time there has been when I've been in for a bite. It was apple pie. With a slice already gone, showing off the layers and layers of apples, stacked like well fit bricks in a mason's proud handiwork. It looked vaguely familiar, like an acquaintance you see after 20 years,familiar in core but blurry around the edges. maybe an extra 20 pounds, different clothing, grayer hair.

So pie I had. It may have been the grail. I ate it in bittersweet silence, for I found that I couldn't really remember how the old lady's pie tasted, but only that it was good and that it fed my soul.

I know this: That pie was good. As much as a slice of pie can change a day, that pie did. Was it the grail? It may have been better pie than the old lady's, and it may have been the best pie I have ever had. But I cannot judge it against the ghost pie of my past. If it were the grail, each bite would hurt as it obliterated the memory of pie past.

This isn't really about pie. It's about all that we hold dear and lose as we grow old. But, if you want the pie, good luck. Sublimity is about 12 miles east of Salem. Panezzanellies is open Tuesday thru Saturday. You never know what's on a given day's menu. And he's closing down for a couple a moths from mid-December to mid-February.

Why? Because you can do that sort of thing when people will write for 20 minutes about your pie. He knows I'll come back in the spring.

New practice record!

2009-11-09T14:00:00.000-08:00

I had a new patient on Friday, a 65 year old male. He is a smoker, and just might outlive us all, but you never can tell.

He's been smoking since the age of 5. F-I-V-E. No typo.

Started when older brother stole cigs from mom, and he demanded a cut or he'd tell on his brother. Pack a day by 7th grade.

Good business instincts. Think of what this guy could have done if he'd hooked up with Donald Trump, or Goldman Sachs, or the Mob.

We are dealing with a lot of shit here

2009-11-08T21:42:00.000-08:00

"Mom, my rat tail is driving me mad. I can't go to sleep until it gets combed."

"Then comb it."

...and maybe candlesticks would make a nice wedding gift. I'm just saying.

practicing within context

2009-11-08T15:00:00.000-08:00

A couple of days ago, I had back to back infants with concerned moms. One was looking pretty good, but I gave her antibiotics because mom was paying attention and her ears didn't look great. The other one wit clear ears didn't get anything from me, even though he'd been miserable and feverish for a week and mom was at the end of her rope.

I reassured mom that she was doing the right things, and then beat myself up over it later,when I made the mistake of comparing the two cases.

Friday, the miserable kid was back for a well child checkup. Not miserable any more.

Sometimes I get lucky and listen to my head instead of my heart.

But I don't forget that the heart is important too.

Hardwoods

2009-11-07T21:09:00.001-08:00

I gave a guy viagra today.

He is having sex three times a night.

But he says it's taking a while to warm up and it gets soft too easily.

So you can see why a professional would give him viagra.

The new paradigm

2009-11-04T22:48:00.001-08:00

I went to a lecture/dinner sponsored by a drug company last night. Drug companies have a love/hate relationship with medical providers. Many of the providers that I trained with over the past couple of years were very much anti-drug sales. They didn't want to listen to a pitch, or hear a spin. A few places were anti-samples. They had good reasons and I can see that point of view. Others were tolerant or welcoming of drug reps and their information/goodies.

On January 1, 2009, the rules for drug rep visits changed. In the old days (think Harrison Ford in The Fugitive, fighting the bad doctors who liked fishing trips paid for by bad research for cardio drugs), the companies would pay for trips, and shower doctors with goodies. It got leaner and leaner, until they could no longer even give us cheap plastic pens with the drug names on them. As a result, Christmas 2008 was a great time to get a drug pen, or even a whole box of them, as reps ditched their swag prior to the deadline.

The funky thing is, they can still pay for lunches and dinners for us while we listen to them. My office has a free lunch scheduled for every remaining Monday and Friday this month.

Those rues were enacted in part due to valid research that shows a bias by providers toward products that are promoted with free crap, even if it was just a shitty pen. Apparently, I'm not swayed by Olive Garden, Red Robin, Chinese, Mexican, et cetera.

So, I'm sitting there and I realize that the real lesson of the evening was an economic one:

When I was a powerless student, I had to pay (good money) to sit and listen to mediocre lectures with shitty powerpoint presentations.

Now that I write the prescriptions, I get paid (with good food) to sit and listen to mediocre lectures with shitty powerpoint presentations.

Hmmm. I guess I'll bring my own pen.

A day with Pat Sajak

2009-10-31T23:23:00.000-07:00

I cannot believe that, of the two day this weekend, this is the one with only twenty-four hours.

We started early, with the final soccer games of the season. The older Joker has been lucky to be able to play with his cast. Rather than the HS-mandated 1/2 inch of high-density closed cell foam for protection of the other players, we've been using some really big-cell bubble wrap, and it has worked much better.

He had two assists today (well, three if you count the own-goal, but I do not, because he plays with a bunch of dandelion-pickers who don't anticipate for shit, and he was trying to do something wonderful on a corner kick defense, and it just didn't work out.) and it was just glorious to see.

His brother, scheduled to saddle up as Jack Frost for evening doorknocking, had been grousing on an almost daily basis that he wanted to play a game in the rain, and thankfully! he got his wish today. He did some patented WhooHoos! while running in the drizzle. After-game cupcakes were enjoyed by all.

I needed a nap after that. I had stayed up late carving and scraping and carving and scraping and drilling and cutting.

So, off we went to learn whether our neighborhood was a good candy neighborhood or one of those sorry ass neighborhoods where people turn off the porch light when they see you coming, or pass out toothbrushes instead of candy. You know, the kind where you get home and dump out three pounds of dum dums, smarties, laffy taffy, and tootsie rolls and not one single blow pop or starburst in the bunch. (honestly, I like tootsie rolls but blow pops rock)

Our neighborhood kinda blows. Some good scores, lots of dark and vacant homes, and some middling pickups. I asked a teenager making the rounds with his younger sister where the good houses were, and he quickly replied "The swamp over by Dairy Queen." he was right, as I found out later.

Karen stayed home while I walked around with the boys. She got a few, but not many kids at the door.

Some things I overheard throughout the evening:

"My mom's good at birthday cakes and Halloween costumes. That's it."...the Joker, to a random parent who complimented him on his costume. Apparently, she doesn't do shit for 361 days of the year.

"C'mon, Dad! That house has promise!"...Jack Frost.

"Those are the best costumes I've seen tonight!"...several homeowners...perhaps sincerely.

"Thank you!"...Jack and the Joker, every time.

"Who are you? Pat Sajak?"...random homeowner to Jack Frost.

"I'm tired."...Joker.

"I'm thirsty."...Joker.

"I hurt."...Joker.

"Just let me take my shoes off for a moment."...Joker.

"I think I have enough candy. I'll just stay home and watch the rest of the Duck game."...Joker

"Dad, what's a p-e-d-d-l-e-r?" ..."Why?"..."It says 'NO PEDDLERS?"..."Oh. Maybe that's why the old man is peering through the curtains wondering why you rang his doorbell twice and then knocked. C'mon Pat Sajak, you're not getting candy here."...dad.

"That's my ex-grandparents house."...teenager from before.

"Nolan!"...multiple little girls to Pat Sajak as we walked around the neighborhood.

"I'll go. Are you ready?"...Pat Sajak, when asked about hitting the swamp.

"See that girl? That's Geniveve. She's brave. Follow her up to the house."...some Mom, at a particularly spooky house that was going to get skipped by Pat Sajak otherwise.

"I'm having fun."...Pat Sajak.

"Hey, you're Jack Frost!Good costume!"...random homeowner to Pat Sajak.

"Thanks!"...Pat Sajak, to every person who complimented him on his costume.

"I wonder when this will end. I mean, I don't want it to end. But I suppose it will end when I take a shower."...Pat Sajak.

"Hey, nice park. We should come back here and play sometime."...Pat Sajak.

"Oooh. That's chilly."...random woman patting Pat Sajak's frosty hair, one of four people on the night to know who he was, although he didn't figure out that she was one of those people.

"So many people, so many compliments."...Pat Sajak, getting a little smug.

"That was awfully brave."...Pat Sajak, critiquing his own performance following Geniveve to the candy trough at the spooky house.

"Hey Alex! Look!.........Smarties!"...Pat Sajak.

It was fun.

Doppler

2009-10-29T21:40:00.000-07:00

I was solo in the clinic again today. No big problem. A couple handfuls of patients, but one in particular seemed like it could go either way.

A young pregnant woman, near term, called in because she hadn't felt her baby move in several hours, and that was highly unusual.

I had her come in. I was worried and the knot in my stomach inched tighter as I worked through two other patients before she arrivd.

My assistant works methodically, so it took a while for her to get through with her duties, while I waited just outside, watching the seconds tick away, wondering what we'd find out when I put my hands on her tummy, when I placed the small gel-covered probe against her skin and hoped, with held breath, that I would find that rapid thump that meant things were as they should be.

I went in, and the smiles were awkward. We all knew why we were there, and what was coming, and what would make or break the day for us all.

I find heart tones easily. It's not hard, but I'm not perfect. I've struggled to find them before, but today, there would be no mistakes. If I did not find them, it would be because they weren't there.

And so I washed. I do that with everyone. It's routine, and I need routine, especially in times like these. What would I say?

Gel was applied. Buttons were pushed. Belly was touched.

And heart tones were heard. More than 120 of them.

Thankfully.

Signs, signs, everywhere signs...

2009-10-25T22:20:00.000-07:00

I've never had my name on the sign at work before. Or, maybe I should say "I've never had my name on the sign at work that wasn't written with a sharpie in the dim twilight while crouching low to avoid the security camera while someone stands watch for the patrolling officers."

Times, they are a changing.

Oops, I said that out loud.

2009-10-23T21:53:00.001-07:00

Should I do a urine GC/Chlamydia?

I'm not so big on the urine GC Chlamydia.

Well, should I just save that for her annual that she's scheduling with you?

Why is it again you're wanting the STD screening?

Well, she doesn't have any symptoms,but you go having unprotected sex with your internet boyfriend and then find out he's got more women in his chatroom, you think twice and decide to get tested.

(after laughter subsides and composure is regained)

Oh. OK.

For the troops

2009-10-19T21:59:00.000-07:00

I have been remiss about keeping up with my peeps. Sorry.

Since my last real effort, my boy broke an arm, we went cub scout camping, I've rewired two old light fixtures into switches and outlets, repaired the drywall and touched up the texture prior to painting, went to a Trailblazers game for nearly free, celebrated a younger boy's birthday, saw a soccer game, and went to the Bauman Farms Pumpkin Patch.

Also I worked. I cough here, the flu there (yes, H1N1). A finger in the butt here, a speculum in the vag there. Another day, another dollar.

But I've been saving this one:

My cub scout's first camping trip fulfilled one of my bucket list items. I never was in scouts as a kid, but it seemed like the cool thing to do, and I always wanted to. Now, I am an accomplished tent dad.

We went down to Springfield and slept in a field for the 17th annual fall Rendezvous / Jambo. Short for Jamboree, which is evidently too old-school geeky, and must be truncated as if a word from a Lionel Ritchie song is hip for today's youth.

It was part traditional scouting, with BB guns, climbing walls, the Marines, knots, and archery (albeit with a cool 3-D Tyrannosaurus Rex target for the arrows) and part old school mountain man granola stuff (with some hippie-types that can start a fire with just a couple of sticks). I don't think the guys from the Corps and the guys from the Oregon Country Fair hang out together very often, but it all came together at the Rende/Jambo.

And it is here that this episode takes place. I try not to be mean, but sometimes, it cannot be helped.

There was a real live blacksmith at the event, demonstrating his blacksmith skills and knowledge. Actually, there were two, but one was a real dick, not even trying to be friendly and answer what I thought were good and thoughtful questions that I had about his specialty, even though he was there as an exhibitor. It was his job. Dick.

So anyway, one blacksmith, and one knob. The blacksmith was busy hammerin away, working some small pieces of metal, as can be seen in the photo. He had some samples of other work that he had banged out, and some were pretty cool. The ones he was working on at this time seemed, instead, very simple.

I listened, because sometimes I do that instead of running my mouth, and learned that he was fashioning a cool little tool that would enable a person to open a can of soda pop (or perhaps a frosty malted beverage) more easily. As you can see, it looks like a little l-shaped pry bar that can increase a person's leverage about the pop tab by a considerable amount, and will allow them to push or pull about the angle to open the can. At some point, he stated that he was hustling along, needing to turn out forty of these tools.

Hmmm, I thought. That's really something.

I waited and watched, as the smith hammered away, periodically placing the small implement back into his fire and then shaping it carefully over his anvil. A true demonstration of frontier craftsmanship, and a testament to what helped make this country great. he could have just beat a bunch of allen wrenches flat on the short end, but that wasn't really the point, and even I could realize that.

I decided a question was in order.

So, what population are you making these tools for? (yes, I did ask it just that geeky way.)

"Huh?"

I mean, are they for people with arthritis, or something?

"No, no no no. They're for our good fighting men and women, serving their country in Iraq."

You don't say.

"Yep, they can even file down the ends and use them as screwdrivers on their M16s or something. But I'm not doin' that. They can do that themselves if they want to."

Hmmm. But, can't they just open their pop cans with their fingers? (since feeble arthritic hands shouldn't be attached to the arms of our fighting finest)

"Hell no! They're in the middle of a danger zone, where every man, woman, and child might threaten their lives, and they have to remain on constant alert!"

Are you fucking kidding me? These little doohickeys you're making still require hands to operate, you numbskull! They can't keep both eyes on Charlie and both hands on the weapon and open a goddamn can of pop, even with your little allen wrench dumbass! Have you been sniffing too many coal fumes? For the troops, my ass. Sell some war bonds instead.

I just couldn't believe the marines manning the climbing wall weren't all clustered around the blacksmith, placing orders for extra pop openers. They've got self discipline I guess.

And one last thing...you can tell the scoutmaster by the one without hair on his hands, from lighting the propane camp stoves. I am not him.

It took nine years

2009-10-11T22:18:00.000-07:00

A boy finally broke a bone. Mild radius fracture, near the base, no angulation. Did it at soccer practice on Thusday.

In the picture above, you can see the green cast encasing his right forearm, extending past the elbow.

This story pretty much exists as a testament to why you don't treat you own family.

He fell at practice, at about 6 PM. I was working late, and drove over to the field because Karen had called me about it. He was really upset, and in a lot of pain. Apparently, he thinks enough of his dad that he requested my consult. Cool.

I looked it over, had him move it a bunch, palpated all the bony landmarks and in between, and felt that he had likely sprained the interosseous soft tissues between the radius and ulna in the proximity of the wrist. He had no snuffbox pain, he was able t flex and extend, able to make a fist (albeit weakly), and allowed me to really manipulate the wrist, forearm, and elbow.

His biggest complaint was some pain with compression of the styloids, and pain with pronation/supination. No swelling, heat, or discoloration to speak of.

So we waited. He was in pain and kinda helpless that evening. The Big camping trip was the next day (and blog-worthy in its own right). He awoke in less pain. He could move it a bit more. Good news. However,he continued to be the biggest dead weight imaginable. It is his right arm. He is left-handed. The refrigerator is a left-handed opening fridge. He asked for help opening it.

Anyway, he continued to baby it and I continued to tell Karen it was fine. We went to Salem, and I was thinking I was going to have to splint it for the scout outing. I put a wrist brace that we had handy on it. He wore it for about two hours, but it was uncomfortable.

I got tired of the questions about the wrist from my wife. So I decided to call and throw my weight around, getting my colleague doctor to order up an x ray, stat! I'd show her! Question my judgement? What was she thinking?

That was a great idea, except for that part where the bone was clearly broken. So, I had to switch gears and sound all knowledgeable as I showed the x-ray to her and described the break. But even that was humbling, since it was pretty easy for everyone in the room to see the bone.

So, Alex got a cast. He got a long arm cast, above the elbow, to prevent pronation/supination. Which is what he should have gotten. But it's not what I would have put on him. I would have put on a short arm, because I could have padded it for soccer. I could pad the big one, but I don't like the risk to the upper arm.

I had even wrapped the cast padding for a short cast and the doc came in and decided a long one was a no-brainer. And I tried to talk him out of it, just like a hundred parents have tried to talk me out of things for their child.

What have I become? Well, I did it just like the other parents, because my short term desire to make my kid happy is clouding my better long-term judgement. He's waited two years for me to finish school so he could play soccer again. We move, and get him signed up, and the YMCA has its head up its ass, and he doesn't have a real coach for two weeks, and they didn't print enough shirts, so he goes without for three weeks, and the team really sucks, losing each time, but he is living it, an they are playing better, and he scored a goal last week, and even though so much of it is crazy, he loves to play and he's happy to play, and I want him to get to play.

So I hoped it wasn't broken, and I hoped it would feel better in the morning, and I hoped he wouldn't need a cast, and I hoped it would be a short-arm.

And that is why you shouldn't treat your kid. Because he deserves more than just my hope.

This is important. Watch it.

2009-10-07T23:30:00.001-07:00

http://www.msnbc.msn.com/id/3036677/vp/33217642#33217642