Charity's visit

My younger sister Charity and her friend Sarah came to visit in January for a spur of the moment weekend trip. It had been several years since Charity had been here, so it was fun to show her the city. They came at the tail end of my ten days of running a NYC hostel. Company on consecutive and overlapping days included my cousin Andrew, a friend of Scott's from UVA also named Andrew who was doing a week of research at a library in Harlem, a friend of a friend of Clay's, and lastly, Charity & Sarah.

The following photos are courtesy of Sarah.

The view of Manhattan here is absolutely thrilling. This is why I always try to get a left window seat when I'm flying into LaGuardia. The flight path more or less traces the East River going northward. The United Nations building can clearly be seen along the river, and in the middle of Central Park is the Reservoir, which Ezer and I ran around a couple times last week.

Sarah's artful eye caught this bright railing. (In the strictly figurative sense.) I walk past this every day and had never noticed how interesting the yellow paint is. I like how she made a short focal length so that the background of my subway stop is blurred.

On Saturday evening we walked around Times Square, Ninth Avenue, Rockefeller Center, and then up to Serendipity which we eventually bailed on, eating instead at an inexpensive-yet-good Asian diner. Here Sarah caught some condensation in the cold night air in front of Radio City Music Hall. A yellow cab happened to be driving by.

Charity, me, roommate Clay, and Andrew W. One of Andrew's funniest comments was made after we spent thirty minutes speed-walking around Times Square trying to get rush tickets to a show. We were too late, having left my apartment spontaneously after someone tossed out the idea around 7:00 PM after we'd been sitting around the dining room table talking. Andrew said, "I wished I hadn't talked about my research so much."

Charity and Sarah. I'm not sure where. Charity needs to work on her scarf tying a bit.

Charity and me at the Magnolia Bakery. I can't tell if she's holding a cupcake or a little roach with a cotton swab on its head. Probably a cupcake.

And my favorite picture: me and little sis' on the subway.

A Little Pizzazz

The art of capturing the audience with the title and subtitle

I've never heard formal teaching on this topic, but I've noticed how newspapers and magazines often make use of both a title and a subtitle. As a result, I've developed an intuitive sense of how most writers use these features. It seems that a title is used to catch the eye. (In the case of this entry: "A Little Pizzazz.") Anything to spark the reader's interest. Commonly, the subtitle goes on to clarify, especially when the title scintillates to the degree of obscuring what the article is really about. An example of title/subtitle from a recent issue of The Economist:

Taming Leviathan: These are both the best of times and the worst of times for the American-Jewish lobby.

The article is accompanied by a dapper illustration of a sea monster tossing about rowboats filled with men in dark suits. This fits the paradigm nicely: the subtitle should not bore the reader, but rather encourage her* to read on.

Perhaps better to have no subtitle, however, when the subtitle in mind is about as sexy as oatmeal. Case in point, from the same issue of The Economist:

What price carbon?: Britain and the EU have learnt from some green-policy mistakes, but not from others.

Tantalize, this subtitle does not. It reeks of balance and fairness. It bores in its stated attempt to see both sides of the issue. And whereas the title should at least provide a little spice for the eyes, the question form serves only to confuse the reader. Thumbs down.

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* Usually I'd revert to classic English rules and use "him" when referring to a person whose gender is unknown. "The doctor said to his patient..."; "The pilot made his announcement..."; "The principal asked the student to step into his office." However, I thought I'd mix it up sometimes and try "her" on for size. "The nurse picked up her uniform from the cleaners."; "The flight attendant enjoys her job." Feedback in this area would be appreciated.

The PACU Pager

In the world of anesthesiology, the pager generally functions in non-patient management roles. I might return pages to hear people say things like, "Hi Jonathan, this is Nina in the Education Department. We just need you to sign your contract for next year," or "Jonathan, this is your team captain for tonight. Do you have any dinner preferences?" Typically I receive one or two pages per day.

Not so carrying the Post-Anesthesia Care Unit (PACU) pager, as this week has shown. The mornings typically start a bit more slowly--as is evidenced by my writing this post. (I've already worked on the crossword.) By ten o'clock, however, the pages really pick up, and it's possible to go non-stop until the evening team captain takes over at four o'clock, or five o'clock on Thursdays.

This week seems especially busy, as several surgical floors and ICUs have censuses nearly at capacity. Then, the PACU becomes more of a step-down unit. Yesterday's special experiences included

• The angry, paranoid Dominican women with a deep venous thrombosis (DVT) and pulmonary embolus (PE), who's already had a fasciotomy for compartment syndrome in her leg and an IVC filter placed to try to prevent future PEs. She's been camped out in the PACU for days. The day before her breathing rate and work of breathing had increased, though she maintained her oxygenation. Her fluid intake was two liters greater than her output for the day, her lungs sounded "wet", her CVP was elevated, and her chest x-ray was consistent with fluid overload. Even though she didn't have a history of congestive heart failure, I gave her a small dose of Lasix, which prompted increased urine output and eased her breathing. I clearly documented all this, yet I still got the impression that the surgery resident thought I was nuts for giving Lasix and not more fluid. (?) Fluid management in the PACU seems to always be a point of contention between surgeons and anesthesiologists.
• The same angry, paranoid Domincan woman once again, yesterday, began her difficult breathing. In discussing it with my attending, we considered she was having repeat PEs even though she was anticoagulated. In addition, perhaps her paranoia could be related to her withdrawal from her ordinary 5 daily beers. I talked to the ICU fellow and requested that she be transferred there. The ICU is a much more appropriate place for her than the PACU, especially since I can potentially be covering 40 patients at once. Of course, the ICU resisted accepting this patient until her troponin level became elevated, evidence of heart strain and damage (perhaps secondary to her pulmonary emboli).
• Another Spanish-speaking woman with atypical post-op chest pain (after a shoulder arthroscopy). Being a nurse, she insisted that the EKG I got wasn't a good once since they forgot to put a lead on. (My paper copy showed all the leads. Still trying to figure that one out.)
• A woman with a history of post-op hypotension with chest pain. Given that it was nearly five o'clock, we got an EKG, labs, and called the primary team to admit
• A woman with a history of chronic pain killer use who demanded intravenous Demerol (a medicine better at producing heroin-like euphoria than actually helping with pain).
• An Asian man with asymptomatic bradycardia down to 30. Once again, get an EKG, contact the primary team and recommend admission and cardiology consultation.
• A young woman with a history of Wolff-Parkinson White ablation with tachycardia, flushing, and chest pain after a slow infusion of Vancomycin (an antibiotic which, if given too quickly, causes "Red Man Syndrome" of hypotension, tachycardia, and flushing). Fortunately everything resolved, but we still got a cardiology consult in the PACU. It came out later that she'd had this same reaction before with Vancomycin. It might have been helpful to tell us that before!
• A middle-aged British woman with persistent hypotension on a phenylephrine infusion despite what appeared to be adequate fluid resucitation.
• Doing various blood draws and starting IVs when the nurses can't do it. Sometimes I get the sense they don't try very hard.

Part of what makes the experience memorable is not just the patients, but the way the nurses contact us. There are three main PACU areas on two different floors. I will try to sweep through and ask if anyone needs sign-outs as long as I'm in the area, but without fail, several times a day I'm paged back to an area I just left for a sign-out. I feel better that other residents have this same experience.

For some curious reason, the pager is programmed to give me two pages for every one page sent. When the arrests/stat-intubation resident handed off his pager to me (which I carried from 1600--1700), I got four pages for every one page sent. (Both pagers receive PACU calls as well as stat-intubation calls). At one point during the hour two nurses must have paged me at once from the ambulatory PACU, meaning my pagers rang 8 times within a minute.

All that to say, it's been a different perspective on anesthesia care. I like the mornings. The afternoons go fast, and they aren't so bad as long as I'm doing PACU things rather than ICU management or nursing tasks. But it will be nice getting back to my ordinary relationship with my pager in another week or so. "Sure Nina, I'll be by to sign the paperwork," and "How about Indian food tonight?"

Security at LAX

Returning from LAX to JFK a couple weeks ago after Nicolle's nonwedding, I was attempting to go through security when, after glancing at my boarding pass, a security member redirected me from one set of escalators to another.

Waiting in the much longer line, I realized that the shorter security line was for first and business class passengers, whereas the much longer line held us economy folks. After a ten-minute wait, the bourgeois line snaked us past another female agent who, after confirming that a passerby was about to miss his flight, might, at her discretion, redirect the tardy passenger into the first-class area. Although I generally wouldn't consider myself a populist, this incident may have converted me. It seems grossly unfair for two reasons.

Primarily, the designation of first class versus economy class is one of the airline, not the airport. Although the lines to check in at the airline's counter are shorter for Admiral's Club and sundry chihuahua-and-Gucci-toting and fur-trimmed passengers, I say they've earned it by paying several times as much for their ticket. Of course they get to lounge in plush pre-flight accomodations rather than sit on a vinyl chair near crying toddlers at the gate waiting area. Sure, they recline in generous leather chairs (with built-in electric massage) and sip mimosas on board before Boarding Group 5 gets to cram our luggage into the overhead bins and fight for the rare paper pillow and thin blanket. But fair's fair. They've paid to be treated like royalty.

But the airport itself should be an egalitarian institution. Security standards mean everybody has to remove shoes. First class passengers are all familiar with quart-sized plastic bags and 3 ounce rule . The Starbucks near Gate 38 doesn't have a shorter line for first class passengers. There's no special taxi queue at LaGuardia for the few returning from the summer home in the Alps. Airports are paid by airlines for use of the gates and renting space. So why would airport security offer shorter security lines to first class passengers?

The second reason is that even if the airport is slave to the airlines' coffers, the airlines should still make an attempt to maintain the dignity of economy passengers by not flaunting first class privileges. The Admiral's Lounge is discreetly tucked away. The curtain is demurely closed between cabins before the filets mignon are rolled out. I applaud all of this. Maintaining two security lines, however, serves only to increase the ire of passengers with already frazzled nerves* and grow resentment toward the first class passengers.

Settling into my seat on LAX's tarmac with my knees snug against the backrest of the chair ahead of me and wondering if my neighbor would hog the narrow armrest, I did realize, with no uncertain air of moral superiority, that economy class passengers have a much smaller ecologic footprint than first class fliers. That seemed to help.

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* Just to clarify, I did not have frazzled nerves. I arrived at the airport well in advance, and in fact was able to hop on an earlier flight back to JFK. Punctuality is a virtue..

This is good to know

I knew that ever since beginning to read a British news source which I will not name here, I've become increasingly confused about placing my periods and commas with relationship to the quotation marks. It used to seem black and white (The comma always goes inside), but more and more these days, logic tells me to place it outside.

For clarification, see this article, apparently written by a teacher of grammar. Grammartips.com has to be reputable! Apparently the British and Americans differ with respect to the placement. The American convention has interesting historical roots, but you'll have to read the article to find out more!