William Bennett's faux pas

I couldn't help but comment on this article.

It seems like an incredibly stupid thing to say, and I noticed how the bold type under the headline seemed to quote him in the most provocative way possible, as if this were something to be entertained. It's not nearly as provocative--but still stupid--when you read the context here:

"If you wanted to reduce crime, you could -- if that were your sole purpose -- you could abort every black baby in this country and your crime rate would go down.

"That would be an impossibly ridiculous and morally reprehensible thing to do, but your crime rate would go down," he said.

The exact same statment could be made about whites or hispanics, because all races commit crimes. Giving Bennett the benefit of the doubt, however, I think his premise may have been that, statistically, black people on a whole commit/are convicted of more crimes per capita than other races. This is a statement of fact which could be proved or disproved. I can't imagine what good he was trying to accomplish by speaking as he did in such inflammatory terms.

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Addendum 10-4-2005

After a few comments back and forth with those who disagreed with me, I find myself appreciating their perspective a bit more. (At this point, I wouldn't have written the original post in such definitive terms, but I'll leave it there since those were my thoughts at that the time. Admittedly my context was somewhat limited too, and I didn't take the time to pursue it further.)

A few sage words from a friend. It's good to have friends who agree with you, and perhaps even better to have friends who disagree.

I think it's ok to speak out loud, or in print, a particular conclusion, as evil as it sounds, given the right context and critique. And while Bennett's comments were abbreviated, I thought he did a decent enough job given the medium he was working with. I am disappointed in everyone else, supposedly bright legislators and media folks, and their inability/unwillingness to actually think through what was said.

"Thank you for your application..."

That's how all too many medical school rejection letters begin. Typically, they'll praise the applicant's accomplishments and express regret that they simply can't interview everyone they'd like. I suppose it's a little more gentle than, "Sorry, you just didn't make the cut," but still the tone can seem a bit insincere.

My brother, with his solid GPA and MCAT scores, has the opposite problem. He's received flirtatious e-mail from schools to which he had no intent to apply. He recently showed me a response he crafted to a certain school in southern California, in which he attempted to mimic the classic "med school rejection letter" tone. What's funny is that he actually sent the following!

Dear Dr. Q,

Thank you for contacting me regarding the ______ School of Medicine. I am, indeed, intrigued by the possibility of living in Southern California, and in fact, I had already considered applying to your medical school. Unfortunately, however, due to limited temporal and financial resources, I will be unable to apply to [this university].

Best wishes in recruiting a distinguished and diverse class.

Sincerely,
D

Notre Dame football

Okay, so I'm not the biggest sports fan in the world, but I thought this story was particularly touching.

Back at the computer...

A week's vacation leaves me feeling a bit behind on some things....though I did have a great trip to Philadelphia! Highlights of the trip include...

• Hanging out with Luke & Marianne--eating Cheesesteak at Keswick Tavern and going to Christ the King Presbyterian Church of Conshohocken
• A quick trip to Princeton: reading on the beautiful campus and having a cigar with my friend Mark
• Lunch with Mike & Rachel at their picture-perfect apartment near Westminster.
• Spending some quality-time with Uncle Paul and Aunt Betty. I helped Uncle Paul trim a couple large branches from the oak tree in the backyard. Even though being 20' up on a rickety ladder made me nervous, I felt less nervous than when Uncle Paul was up on the ladder! Many hours were spent at their home, doing everything from visiting to napping on the porch, to picking apples from the tree in the backyard.

The mild temperature in Pennsylvania was a welcome change from the nearly 100 degree heat of this Texas city where I live! On the trip I was able to finish my Flannery O'Conner book A Good Man is Hard to Find, and I did quite a bit additional reading too.

I hate this part of the job

After lunch today it was hard to stay focused on clinic work. My mind was elsewhere, trying to make packing lists and looking forward to my trip to Philadelphia tomorrow.

And then came one of the last patients of the day. A charming 88 year-old woman and her daughter showed up in clinic; the mother, previously healthy, was referred for a cough and shortness of breath--new and progressing over the last two months. Her CT scan was consistent with idiopathic pulmonary fibrosis, and given the rapid progression of symptoms and radiographic findings, her prognosis is poor. This is a disease that doctors cannot successfully treat; in a minority of patients, symptoms are abated for a matter of months to a year. But this lady already had advanced disease...she likely won't live to see her 89th birthday.

This is the sort of lady you would love to sit down and chat with. Her white hair was bobbed and curled, and she wore a bright green linen pant-suit. Her bright blue eyes complemented her winsome smile.

And she smiled still after receiving the news, though it seemed forced, and her eyes were troubled. Turning to her daughter, she remarked, "I've been healthy all these years--how can it be that this silly cough means I'm going to die?"

No tears were shed in clinic today, but even as I write this I have a pit in my stomach, and a renewed appreciation for that necessary--yet blurred--line between giving compassionate care to patients and taking their burdens upon my shoulders; that is, becoming so wrapped up in my patients' lives that it impairs my decision-making as a physician. And yet I dread and fear the day that I can come home from work and forget about the patient to whom I gave bad news, the patient whom I supported in her suffering.

Old people...you gotta love them!

No disrespect intended here...I just have really enjoyed my interactions with the local AARP members coming into clinic. They seem much more alert and with-it than the average Medicare patient coming in the E.R. I can even joke with several of them.

One gentleman, easly three times my age, told me that we physicians are looking younger and younger now-a-days. He asked me how old I was, and I replied, "Let's put it this way, I'll get to start voting next year!" His robust laughter affirmed me.

Another 85 year-old patient had answered no to almost all of my questions: "Are you having a cough? Any trouble sleeping? Any shortness of breath?" As I tried to figure out exactly why he'd been referred to pulmonary clinic, I said, "Sounds like you're a pretty healthy young man!" He was flattered.

Maybe tomorrow I'll try out the line, "So this year, you're 82 years young!"

P.S. Let it be known to all that Tyson is my roommate David.

My favorite day

Well, Thursday is one of my favorite days. It's not the flashiest day of the week, certainly not a Friday or Saturday. Nor is the Day of Rest, or the Wednesday fulcrum of the week, or laborious Monday. I'd say it's most like Tuesday--they're both good, solid, roll-up-your sleeves sorts of days. I'd say it's among the mellowest days of the week. Anyway, that said, I was pleased for my birthday last week to fall on a Thursday--September 8.

And this Thursday was almost as good. In clinic this afternoon, I watched the dark clouds roll across the sky and the rain drops began to bead on the windows. A downpour greeted me as I left the parking garage (which, thankfully, is accessible by an enclosed walkway), and the rush hour traffic--slowed even more by the rain--prompted me to take an alternate route home which took me by a gigantic used book store. It's hard to pass this used book store and not stop...today was no exception.

The rain pounded the metal ceiling as I bowsed for five, ten, thirty minutes. An hour and a half after entering the store, I emerged carrying several new treasures, obtained at 20% off the marked price:

1. A CD of the Academy of St Martin in the Fields playing Beethoven's Fifth and Eighth Symphonies
2. A book of Stephen King's "delightfully titillating and creepy" short stories as described and recommended by a friend here.
3. An interesting vocabulary book.
4. A book of a collection of medical photographs from the nineteenth century. A cursory skim in the bookstore belied the appalling graphics found in this book. This is the sort of book a child would naughtily puruse with guilty and horrified fascination. At least I can keep it as I do have an established interest in medicine. My favorite is the black and white photo of the orbital abscess which causes the eye and lids to protrude out and down. We should all take a minute and be thankful for the advances in medical science over the last hundred years
5. A Philadelphia guidebook, purchased in preparation for my trip next week to the "Windy City."

By this point, the rain had let up, and so I rolled down the car's windows on this warm, humid evening. The noise of the traffic competed with Beethoven's signature rhythm as I rolled down the expressway home. I especially enjoyed seeing the sunlight, poking through a still cloud-covered sky, glinting off the gold cross at the apex of the newly finished steeple of the hundred-year-old church downtown. (How many prepositions in that sentence?)

Another evening at Vespers

I've written before about how much I enjoy attending Vespers at my church. Last week I finished clinic at 5:15 and made it there just in time. Of course, it was, as always, a beautiful respite in the midst of a busy week. However, it was that much better because who should sit down beside me but Sinclair Ferguson! I learned that he's much quicker than I at finding the correct page in the hymnal; he must have had a light lunch, too, because I thought I heard his stomach growl at one point. The reality is still sinking in that even Dr Ferguson has to interrupt the transcendence of his day with something as mundane as eating.

And then, at the end of the service, he was asked to pray. This has always amazed me and continues to: that Dr Ferguson can produce the most beautiful, meditative, elegant, and heartfelt prayers on a whim. They seem to simply flow out of his heart. Part of me wishes I could have a copy of this prayer for further meditation. However, I realize too that perhaps it's better left as is...a little jewel of the moment. And I, a little brother in the faith, can learn from this example, not by studying his prayers, but by meditating on that which he meditates.

My brother's new job

My brother David is teaching this year in a nearby city. His subjects include math, physical science, chemistry, logic, and religion.

During the first week of class, he attempted to teach the theoretical nature of points and lines. He stressed that a point takes up no real space, and that two line segments of different lengths actually have the same number of points: an infinite number, since you can always put another point between any two points. At this point, one of the brighter kids, sitting in the back of the class, raised his hand. His question stumped my brother: "Teacher, if a point takes up no space, how can an infinite collection of them form a line, which has length?"

A fresh breath of anesthesia

So the last week has been a good change of pace--I'm on outpatient pulmonary medicine in September, but since clinic doesn't start until 9:00, I've been able to spend time daily with the anesthesiologists from 7:00-9:00, starting cases, intubating, and starting i.v.'s.

One thing I appreciate about anesthesiology is how laid back the anesthesiologists are. They love their job, and their feathers almost never become ruffled. One day last week, the anesthesiologist handed me the syringe of Ancef (an antibiotic) to inject into the patient's i.v. line. I proceeded to inject half of it before he calmly said, "Now this patient is penicillin-allergic, so let's hold off on the rest of that and just watch the blood pressure a bit." (Sometimes patients allergic to pencillin react to the "cousin" cephalosporins, and one complication is a critical drop in blood pressure.)

In another case with a different doctor, I was holding the oxygen mask over the patient's nose and mouth waiting for induction. Suddenly I noticed the beeps of the monitor getting lower in pitch, indicating a drop in oxygen saturation. Sure enough, within seconds I saw it drop from 92% to 88%. Quickly, I looked for the patient's finger to see if the monitor had fallen off. It was obscured under a blanket. Another second later--85%. I turned to the anesthesiologist as the oxygen saturation was dipping close to the 70's, but before I could say anything, he gently suggested, "Why don't you go ahead and ventilate the patient?" He'd pushed the induction drugs without my noticing, and there was the patient: apneic, and rapidly desaturating!

Fortunately, both patients did fine. The first one did not react to the Ancef, and the second patient rapidly re-saturated when I began ventilating her. Lessons learned.

Call me "Doctor..."

Well, I'm back in the swing of things after a long Labor Day weekend. Being on an outpatient rotation this month, I was able to actually take the three day weekend off! Several fun activities included a one-year old's birthday party, going back to PCPC, Sunday brunch with friends, a trip home, and playing with my nephew at a nearby park.

My pulmonary clinic experience is a fairly passive learning environment. I shadow from 9:00 to 4:30, which makes the time go slowly; then again, these are established patient that would be difficult to sort through for the first time.

Today, a well-respected doctor from my medical school came into clinic with his wife, who was the patient. He looked puzzled when he saw me, until I reminded him of how he was my attending for a while. In the midst of the patient encounter when an unrelated concern arose, the pulmonologist turned to me and said, "Well, what do you think we should do next in working up this issue?" Here I was, giving diagnostic recommendations to the pulmonologist (who was rather out-of-practice on some general medicine issues) in front of my old attending! I suggested an ultrasound and held my breadth, waiting for the other physician to correct me! Fortunately, I'd guessed right for once!

At the end of the encounter, I said farewell and "nice to see you." "Nice to see you too, Jonathan," came the reply.

Hazards of the job

Scientists rescued from isle

from the Associated Press, Augst 18, 2005

"OSLO, Norway -- Three unarmed Polish researchers stranded on a remote arctic island were rescued by helicopters as polar bears were closing in on them, officials said Wednesday.

"The hairsbreadth escape took place on an island in Norway's Svalbard archipelago, about 650 mile from the North Pole.

"'It was the worse imaginable situation. They were cold and wet, had no equipment or weapons, and were surrounded by hungry polar bears,' said Peter Braaten of the Svalbard governor's office..."

I've provided a couple photographs for illustrative purposes. Some people confuse these furry creatures with Panda bears. -Jonathan

New Orleans

On call at the hospital yesterday, we were supposed to get an influx of patients from New Orleans. Only a few ever came. Later, we heard the reason why: snipers were shooting at the ambulances carrying patients, so they had to turn back to the waterless, powerless hospitals running low on food and supplies.

This amazes and disgusts me. Here's CNN's perspective.

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