My Thoughtful Spot

*this* is what they're talking about in the state senate?

As I was catching up on some news items during a bit of downtime, I ran across this article, which reports the state Senate has passed a bill that bans the sale of mylar balloons in the entire state of California. It goes on to discuss that hundreds of power outages are caused by mylar balloons and kites every year, which increases the workload and expense of the power company. And it causes power outages to manufacturing plants and hospitals. Which sounds like a crock -- not all 400 outages were to those types of establishments, I'm sure. And, last time I checked, all hospitals are required to have generator power.

That is what we're paying all those rediculous fees to the power company for. So they can fix a blown transformer when it gets attacked by a freaking mylar balloon. And this is worth not one, but two votes in front of the state Senate. (They voted before and it was not passed. I wonder how much money changed hands to get those extra five votes needed for it to pass.) We are paying these morons in Sacramento to ban balloons when there are so many other problems in this state: crime, pollution, illegal immigration, wildfires, and, to top it all off, an unbalanced budget. And they waste time on balloons.

I'm willing to concede that mylar balloons may not be the best for the environment, but that isn't the reason they are being banned. Despite my conservative politics, I do believe that we have a responsibility to take care of the earth and not pollute. So until I hear how mylar balloons impact the environment negatively, we should be able to have them.

And what about the offending kites? I'm willing to bet money that of the 400 outages from balloons and kites at least half are caused by kites. Are they going to outlaw kites next?

It seems pretty simple to me: balloons make people happy. Not enough people are happy. So for every single power outage there is, there are probably hundreds of people who have been made happy, if even for a moment, from a mylar balloon. They should just deal with it.

9 days left

But it might as well be nine years. I know that doesn't make sense, and I don't think I can really describe what all this is like. Trust me, though... 9 days seems really far away right now. My last day off was 10 days ago and my next one is... well... in nine days. Plus the last ten days hasn't exactly been a walk in the park. It could be worse. It could always be worse, but I've had to deal with some pretty heavy things that have been weighing on me.

1. There are three kids in the ICU. They have all been abused to the point that their functional lives are over. In fact, it would probably be a blessing if they died.
2. A lady I operated on last week had a massive stroke and died.
3. A guy who was admitted as a trauma several weeks ago died. The family wanted us to withdraw care. Actually, they wanted me to withdraw care. It was the right thing to do, but that doesn't make it any easier.
4. For the last two weeks, our team has been down by at least two people on any given day. Which means that we're busier than we usually are.
5. I'm so busy and have taken so much call (just finished my 124 hour week) that I can't exercise. I could really use some endorphins right about now. I can see how doctors get addicted to alcohol or drugs.

People keep asking me if I'm excited. Of course I'm excited. There is just too much on my shoulders to go leaping down the halls at the moment. Get back to me on June 6th.

musically speaking: may 29, 2008

Fear
And panic in the air
I want to be free
From desolation and despair
And I feel
Like everything I sow
Is being swept away
Well I refuse to let you go

I can't get it right
Get it right
Since I met you

Loneliness be over
When will this loneliness be over?

Life
Will flash before my eyes
So scattered and lost
I want to touch the other side
And no one
Thinks they are to blame
Why can't we see
When we bleed we bleed the same?

-- "Map of the Problematique" by Muse
One of the things that makes this song so sweet is the very unusual drum line. Worth a listen.

the sign

The mood in the operating room can vary widely, as I'm sure you can imagine. It largely depends on the kind of case that is being done and the time of day. Also not to be underestimated is the personality of the attending surgeon. If s/he is the kind of surgeon who likes to crack a few jokes and play music, everyone is a little freer to have fun. We still a good job; we just have a better time doing it.

I did a hernia repair today with a "fun" attending. Part of preparing the patient for surgery is to shave appropriate areas. Which meant that I had to do one-sided manscaping. Well, that looked pretty funny, so my attending came over and told me to even it out because he'd probably go home and try to do it himself and end up cutting himself. I argued that I should get a tip; Brazilian bikini services begin at $60 in salons. I think I did a pretty good job that even my aestetician would be proud of.

As we were doing the hernia repair, the circulating nurse kept complaining. One bitch after another. They weren't about anything major, but about things like the music, why were we taking so long, etc., etc., etc. I finally looked up and her and said, "Are you ok? You seem to be complaining a lot today."

"You obviously haven't seen the sign yet."

"Sign?"

At which point, she pulled a scrap of paper out of her breast pocket where she had the sign in case she needed to show it:

a hypothetical

[scene] A cool night in any beach town. Four friends are driving home from a day at the beach where they enjoyed food, drinks, and a few other mood enhancing substances. Pete is sitting in the back seat with his hand hanging out the open window so he can enjoy a few last minutes of ocean air. His 18 year old friend Jennifer is driving... rather recklessly.

Pete: Hey, Jen! You'd better slow the f**k down!

Josh (also in back seat): Yeah, dude -- you're gonna flip the car! to Pete: I knew we shouldn't have let her drive after drinking, the weed, and the ecstacy.

Jennifer: F**k you guys, I'm fine! I am totally in control of the car. Watch!

At this point, Jennifer starts swerving the car across the three lane road, which she was free to do because there were no other cars out at the time.

Pete (screaming): Stop, you crazy b*tch! You're gonna flip the f**king car and kill us!

Jennifer: [lauging]

As the car speeds down the road, increasing in velocity, Jennifer overestimates how much room she has on the right side and clips the curb with her right front wheel. Sure enough, the car flips... three times or so. Pete's hand had a very bad bit of road rash on the back of his hand all the way up to the middle of his forearm. It will need surgical debridement and skin grafting.

The occupants of the car slowly emerge from the wreck and sit on the middle island waiting for the police. The dude sitting in the front passenger seat takes off running down the road for some unkown reason. Pete and Jennifer get taken to the hospital, where they are screened for injuries and there are none... save for Pete's hand.

But Pete decides to leave against the advice of his doctors. And Jennifer gets her license revoked.

This is an example of something I might see in the trauma bay. Sure there are worse, but this is pretty typical.

musically speaking: may 26, 2008

It's looking like a limb torn off
Or altogether just taken apart
We're reeling through an endless fall
We are the ever-living ghost of what once was

But no one is ever gonna love you more than I do
No one's gonna love you more than I do

And anything to make you smile
It is my better side of you to admire
But they should never take so long
Just to be over then back to another one

But no one is ever gonna love you more than I do
No one's gonna love you more than I do

But someone,
They could have warned you
When the things start splitting at the seams and now
The whole thing's tumbling down,
Things start splitting at the seams and now
If things start splitting at the seams and now,
It's tumbling down
Hard.

-- "No One's Gonna Love You" by Band of Horses

speeding up america's game

Most people who know me know that I'm a Red Sox fan. I'm sort of an odd fan in that I can't actually watch most, or even half of the games. It's really a function of what I'm trying to accomplish in my life and that I don't necessarily have three hours a day to spend watching tv. Also, I'm on the west coast. Most of the games that are played by the Sox start around 4pm Pacific time, when I'm still in the thick of things at work or I'm at the gym.

In my less gracious moments, I have a lot of jealousy for people who do get to watch or listen to the games on a nearly daily basis. I love baseball and not seeing it on a regular basis makes me feel like I'm missing the whole season. But then I try to remind myself that we all don't live the same lives and I have made certain choices to do things with mine. This is just one of the many unforseen consequences of that seemingly simple decision. But I try to stay on top of things when I have a chance. I'll surf on over to a Red Sox news site, or Dawn will keep me updated by email.

Apparently, in last night's game at Oakland, hitting coach Dave Magadan was ejected over the enforcement of new rules that have been introduced to try to speed up the game. JD Drew's bat broke and the bat boy did not have his replacement bat at the ready (it wasn't) and, unaware the rules were being enforced, argued and got ejected.

The other rules include limiting how far a batter steps outside of the batter's box, how much time a pitcher can take between pitches, and how long a reliever takes getting from the bullpen to the pitching mound.

As a loyal baseball fan, these rules insult my intelligence. Baseball cannot be turned into a fast game -- it cannot be turned into an "action" sport like basketball or hockey. If it is forced into a certain time frame, you'll get pitching and fielding errors and sloppy baseball. Instead of gaining a few fans with short attention spans, the loyal fans will get ticked off and watch less often. Ugly baseball is frustrating to watch. Everyone knows that some games are just longer; it's part of the strategy. Strategy is key in baseball. Red Sox/Yankees games, for example, are usually around four hours long. But do we really care? No. Each and every one of those games sell out. Every. Time. Why? Because it's one of the greatest, if not the greatest sports rivalry in sports history. And we want to see that drama unfold before our eyes, no matter how long it takes.

good day, II

Last week, I did a laparoscopic cholecystectomy, which we have affectionately rename lap chole (kol-ee). It's very bread and butter general surgery and something that I will be doing a lot of when I start my new job.

Lap choles come in a variety of forms. The "chip shot" ones are great. These are usually younger patients who come to a surgeon when they have pain in their right upper abdomen an hour or so after eating and then it resolves spontaneously. They've got gallstones that occasionally cause problems, but they don't have symptoms of blockage or infection. Internally that translates into very favorable conditions. No scarring from repeated untreated infections or years and years of symtpoms.

Then there are the actuely infected ones that are about easy to medium. The infection causes edema and internal scarring which is usually soft enough that you can just pull it away from the gallbladder and the areas you need to dissect.

The hard ones: multiple untreated infections, old people who have had years of symptoms without infection, a stone escaping the gallbladder and blocking the pancreas and causing pancreatitis, diabetics, and men. I don't know what it is about men and gallbladders that make them harder, but some of my hardest cases have been in men. A male having gallbladder disease is much less frequent than in females, so they have a much higher percentage of difficulty. Diabetics are harder because the diabetes causes a neuropathy that can dull their ability to feel the pain associated with gallbladder disease. That usually translates into years of untreated disease.

Back to last Friday. It seemed like this was going to be an easy-medium one: acutely inflamed in a youngish female. There were dense adhesions that really wanted to stay where they were. The gallbladder seemed to be sucked right into the liver. Plus she had had so many years of symptoms that the stones had completely eroded away the posterior wall of the gallbladder -- the part that is touching the liver. The gallbladder itself was very long and dissecting out the key areas was very hard.

The attending who helped me admitted that it was one of the more difficult ones he's done in a very long time that didn't convert to an open chole. That I could be impressed with myself for completing it, even with all my swearing and whining about how hard it was. And that any day you can complete a gallbladder like that without opening is a good day.

let's be realisitic here

I managed to have a pretty good workout yesterday, considering that I was post-call and everything. The plan was 10 minute warm up, strength training for legs, chest, and abs, and cardio for at least 30 minutes.

I warmed up on the rower, which is something I almost never do. Should remember that one and add it to my repetoire more often. Then I came to a realization: it's silly of me to expect that I should be able to run 5, even 4 miles on days when I do strength training for my legs. Especially with me running almost every day. So on legs days, I'll have an easier cardio workout with either the elliptical or an easy jog on the track outside.

It was sprinkling as I ran around the roof; a real treat here in Southern California.

One last thing that I'm almost ashamed about being so excited about... as I was going into the gym, I saw a trainer that I see a lot on the floor. We always exchange a "Hi, howya doin'." He said that I was looking good recently and that he could tell that my work was paying off. That's a paraphrase, because I was so giddy immediately after that I completely forgot his precise words. Oh, SNAP. :-)

permit #838

As my residency draws to a close, I'm realizing leaving is not as simple as turning in my badge and saying "See ya!" Last week, the chiefs were handed a packet of papers called the "Separation Packet." Apparently several different people at the main medical center need to sign off that I haven't left any loose ends like library fines or unsigned/undictated medical records. Which is odd, because every July I ended up taking care of some former chief's delinquent dictations and they were able to separate just fine.

One of the forms pertained to the VA. I have very mixed feelings about the VA. I love the vets. Here is a population of Americans who, of their own free will or not, defended our country and freedoms at some point in their lives. Often, it was in service to America that they became sick; post-traumatic stress disorder, alcoholism, paralysis, lung cancer... These brave men and women deserve respect and quality, timely care.

I despise the bureaucracy at the VA that prevents the vets from getting that care. A culture exists, not just at the VA, but at any government office, that the less work you can do in a day, the better. Lunch breaks get longer and longer, paperwork gets filled out for the sake of being complete, a phone call to ask a simple question results in six transfers to some other unmanned desck, and corners get cut. That may be tolerable at the DMV, but when people's lives are concerned, step up to the plate and do. your. job.

Back to the form -- the "Employee Clearance Form." I needed to go to various departments to make sure all my stuff was taken care of. The list was thirteen offices long. Thirteen.

1. Supervisor
2. Police (car decal)
3. Employee Health (I can't imagine why they wouldn't sign the form)
4. Uniform (never been there; didn't know where it was. Just got scrubs from the scrub machine.)
5. Canteen a.k.a. cafeteria
6. Library
7. Medical Records
8. Supply/Property Management (huh?)
9. Human Resources/Employee Relations (again, huh?)
10. Rideshare (they wanna know if I carpooled??)
11. Bills, Indebtedness & Travel Advances (because being a resident requires extensive travel)
12. Human Resources/remit badge
13. Resource management

As I was driving over there at 11am or so, I realized I wouldn't arrive until 11:30. Many people would soon be taking their lunch break or already on said lunch break. Add that to the fact that I didn't know where most of these offices were (and they were listed wrong on the form), and I was positive I would be there until 3:30 getting all these signatures. (3:30 VA time is 5:00 rest of the world time = time to go home.)

But luck was on my side and I managed to get all thirteen signatures in just over an hour. Yes, I have lapped the entire campus about three times and, yes, I was sweating bullets, but I was done. And I got lots of well wishes and said goodbye to many co-workers as we passed in the halls.

On one of my laps, my quest reminded me of one of the Twelve Tasks of Asterix, which is an old feature-length cartoon we watched as kids. It was originally in French, then dubbed in English. The general idea is that Asterix and Obelix are two members of a village in Gaul and are able to emerge victorious in battles against the legions of Ceasar by using a magic potion that gives superhuman strength. Ceasar meets with the village leader and a deal is hammered out; if the Gauls, represented by Asterix and Obelix, cannot complete twelve tasks appointed by Ceasar, he will seize their land and property. If the Gauls do complete the task, Ceasar will not only leave them alone, but relinquish rule of Rome to them.

One of the tasks was in Rome, in a governmental building, to get a simple form... Permit #838. Get the form and that task is completed. I found a video of this scene; the quality is a bit bad, but then again, so is my original copy. I don't even know if it's on DVD. If you have ever had to get anything done at a governmental office, then you know all too well this little clip is true.

My favorite part is when they go to the chief adminstrator's office and he's being pushed on a swing by his hot secretary...