Sunday, July 29, 2007
Calm before the storm
I worked Monday through Friday nights (1900 to 0800), and then was off for 24 hours until Sunday morning. Today I'm working a 24 hour shift before reporting for duty in the ICU at 0700. The day has been filled doing little things like adjusting patient-controlled analgesia orders, pulling out epidurals, checking on a patient whose epidural accidentally came out while her blood was anticoagulated (we wanted to make sure she didn't have the potentially devastating complication of an epidural hematoma), and adjusting an overly confused and somnolent patient's medications. (Oxycodone is worth a shot to minimize unwanted side effects.)
Yesterday was a good day. After coming home, I quickly changed and went for my long run in Central Park. Two loops around made as 12 mile run. The first loop was done in 52 minutes (what I felt was a gentle pace), and the second loop, though I felt I pushed harder, took 55 minutes, bringing my total time to 107 minutes including water breaks. I'm not unhappy with this time, though I would like to work toward eight-and-a-half minute miles. And given the warm, humid weather, this was a good chance to practice disciplined hydration. I noticed that chugging six or seven gulps of water every couple of miles makes a big difference.
Because I've worked up a little more gradually to this long run (compared to the half-marathon I did in April), I believe it was a little easier on my body. Sure I was sore afterward, but I didn't feel as much of an old man as I did after increasing my distances very quickly. I'm beginning to appreciate the wisdom of training carefully to avoid injury.
And lastly, a quick update about my black runner's toe. I will spare those with a more delicate constitution a picture. Evidently it is common for runners to develop bruising both under the toenail and at the very tip of the digit. Most often, it is caused by shoes that fit too snugly, though increasing distances too quickly may also contribute. Both of these factors may apply in my case, since I tend to buy shoes that fit well. At one point, I was worried I would lose the toenail on my right second toe since it lifted as easily (and painlessly) as one might lift the hood of a Chevy. However, the brusing seems to have healed a bit over the last few days, and the toenail is reaffirming its grasp on the little fleshy nubbin.
The rest of the day was spent packing, going through paperwork, and in the evening Mauricio brought a movie over: Wes Anderson's Rushmore. I fed him one of my Trader Joe's BBQ Chicken pizzas, leftover salad, broccoli, and pineapple juice. (Mauricio really likes juice, I have discovered.)
My welfare check doesn't cover the iPhone plan
Sorry for yet another post of socio-political musings, but at least I came up with a somewhat interesting title. The thought has crossed, and continues to cross my mind that the richer America has become, the more its citizens expect as a fundamental standard of living.
Perceptions about a "basic" standard of living (is this term redundant?) are affected both by time and space. Air-conditioners, weekly (or daily) fast food, cable television, cellular phones...these are all things that fifty years ago would have been considered amazingly luxurious (if they were even around), but are all things that now, I suspect, can easily be had with a typical welfare check. Even moving from Texas to New York City where the cost of living is much higher, I notice people doing without (no car, no air conditioner, no spacious apartment, no dishwasher, no in-apartment washer and dryer) and not complaining about it. Granted, unless you happen to live on Central Park West, these concessions are out of necessity. But the point remains that just as in this time period, geography factors into basic standard of living, so too within a set geographical domain (the United States), the time period affect the expectations of standard of living.
As a side note, looking historically just a generation or two will show our grandparents doing with less sugar and fewer pairs of pantyhose during World War II in order to focus our nation's resources and attention to where they were needed most. The idea of going without, however, is entirely unknown to Generation X'ers like me. Like it or not, we've been fighting a war for the last four years in Iraq, but our standard of living has changed not one bit. True, this probably reflects a richer country, but it also means that societal economic sacrifice is about as foreign to me as sacrificing a goat at city hall.
But should time and geography affect our perception of whether we are barely getting by or whether we have an abundance? The poor in Africa are just as poor today as they were in 1950. The rich here are far richer. So should the poverty level be an absolute (food, clothing, shelter) or a relative index? I think I could argue effecively either way, but perhaps it should be both. Or one tempered by the other, if that makes sense.
In other words, the thought that a family can afford an SUV, cable television, a couple cellular phones on a family plan, year-round home temperature regulation, monthly movie tickets, and weekly (daily?) restaurant visits, but cannot afford basic health insurance is absurd, especially when viewed from the historical and geographical perspectives I mentioned above. Anyone who can afford all of the above is incredibly wealthy both historically and compared to all people living today. Hence, this situation is not one of wealth versus poverty, but one of wise versus misplaced priorities.
I want you to remember this the next time the discussion of universial health insurance comes up, or the next time you're tempted to complain about the $20 co-pay for your visit to the doctor.
Thank you, Ganden Thurman
Not too long ago, I was read with interest this letter to the editor of the free daily amNew York:
U.S. deserves better health care
Our health care system and the health of the general population of our country are a disgrace--plain and simple. It's high time the government lived up to its constitutional duty to tend to "the welfare of the people" they are supposed to represent. Please grow up and tend to the issues at hand directly rather than blithering about such gross pseudo concepts such as globalization, privatization and capitalism. None of these abstractions has anything to do with our jobs, our country and its potential to become a more perfect union.
Ganden Thurman, Manhattan
Goodness, where to begin?
- I would argue that it is not axiomatic that the United States' health care system is a disgrace. By many measures we have a very effective and cutting edge medical system. (Anyone care to get an elective gallbladder done in Canada or Britain? That's right...you'll have to wait. A long time. That is, unless you have money to go the private route, I'd assume.) Yes, one might argue that the richest nation in the world should provide health insurance or coverage to every citizen. This is not, however, an inalienable right granted by our constitution, and I think its time we stop treating it as such. In other words, discussions about universal health coverage should begin, "Since we've progressed to where we are as a nation, let us consider as a society the advantages and disadvantages of providing universal health insurance to all citizens," not, "Our health care system is a disgrace."
- I might agree with you that the health of the general population is a disgrace. The difference, however, is to whom to assign blame. You clearly blame the government. I, from my humble 6 years in the field of medicine, blame the population. People who make bad choices and then expect the government to fix the problem are dead weight on society. If every American ate appropriately, exercised 30 minutes a day 4 to 5 days per week, stopped smoking, did not abuse drugs, drank alcohol in moderation, and followed his doctor's recommendations, I suspect that the Medicare coffers would burst at the seams. So perhaps that righteous indignation, sir, should be focused not on the government but on our societal sloth and excesses.
- "Welfare of the people." Constitutionally, this includes life, liberty, the pursuit of happiness, universal health insurance, cable television, and fewer dropped calls.
- "It's high time the government [took care of the people] they are supposed to represent." If you're going to write a letter to the editor, please proofread it, or at least ask a friend to edit it. A sixth grader should know that the proper pronoun for "government" is "it," not "they." (Sorry, I'm getting tacky here.)
- This is where it gets fun. The government is instructed to "grow up." Fair enough.
- "...[stop] blithering about such pseudo concepts such as globalization, privatization and capitalism. None of these abstractions has anything to do with our jobs, our country..." This makes me smile every time I read it. There's a story about an economist who visits China during Chairman Mao's regime. There he sees one hundred men digging a pit, while a backhoe sits unused. On asking why they don't simply use the backhoe to dig the pit much more quickly, the Chairman explains that then the men would be out of work. The economist replies, "Oh, well then if its work you're looking for, why not have the men dig with spoons?" The anecdote illustrates the difference between work and productivity, abstractions that have everything to do with our jobs and why our country is even at the place where we can talk about universal health insurance. People that don't grasp the difference between work and productivity, or between income and wealth, are the same people who think raising minimum wage helps poor people, that outsourcing hurts our economy, and that Wal-Mart has made people poorer, not wealthier. These are mindsets that, sadly, I cannot deconstruct in one post. But yes, Ganden Thurman, globalization and capitalism have everything to do with our jobs and our country.
Friday, July 27, 2007
Lone Star vacation
Mauricio came to Texas for a few days. The last time he had been in Texas, he was in a terrible car accident, so this trip was better. I took him to the Mesquite Rodeo.
My second-favorite event at the rodeo: calf-roping. My favorite event was when the little five-year-old girls were released from the chute riding a bucking lamb.
A cute girl who was sitting in front of us.
I took Mauricio to the Sixth Floor Museum which is all about the Kennedy assasination. Afterward we had a drink up in Reunion Tower. Here's a view of Dealy Plaza from the tower. The School Book Depository (which now houses the museum) is the 7-story orange brick building.
I went down to Waco for a day with DO to visit our old roommate Clint, his wife Kristin, and 8-month old Luke. Reese, Jennifer, and daughter Madeline came over for dinner. Here's a picture of Luke and Uncle Jonathan.
And an older picture of Luke. (This is the paradox of photography: the picture is older, but in it Luke is younger.) His hair is very soft and fluffy.
Thursday, July 26, 2007
You don't see this every day
Morningside pics
I'm proud of this shot. I intend to crop it a bit. It looks cool in black and white, the way the light plays off the many surfaces of the ironwork. Maybe I could make it into a greeting card. Probably one that starts off Blank Inside. Or perhaps a Late Birthday, since the iron curly-Q's fading into the distance could signify dejection.
Max SoHa's outdoor seating area. Utilized whenever the temperature is between 40 degrees and 95 degrees.
Wednesday, July 25, 2007
Moving to Morningside
So allow me, please, to sing the praises of Morningside Heights:
- Subway-accessible to work (10 minute ride on the 1 train)
- Park-accessible: The neighborhood is nestled between Riverside Park, Central Park, and Morningside Park.
- Food: Abundant places to buy groceries, from the common Met and corner delis, to the expansive and very reasonable Fairway, to the new and glitzy Westside Market.
- Eating out: Many great choices in this college neighborhood. I'd have to start by mentioning Toast. But there's also the Italian flavored Max SoHa's and Sezz Midi, casual dining as well as fast Asian cuisine, a nearby Cuban restaurant, Dinosaur Barbecue, Greek food, "Central Perk"-style Max's Cafe, even an Ethiopian restaurant and a couple Starbucks to boot. For coffee, however, I'm partial to the Hungarian Coffee Shop iover by the cathedral. (Don't drink the Hungarian coffee; it's terrible. Go with the Viennese coffee.)
- Exercising: The new apartment is only a ten-minute walk from Columbia's campus where I work out.
- Friends: Many of my good friends in the city live nearby, including Ezer & Jan and soon-to-be-born Simone, Justin & Wen, Mauricio, Mavis, Dustin. And Clay is moving with me. William and Katherine used to live a short walk down 122nd.
- Cultural institutions: Morningside Heights has perhaps more than any other plot its size in Manhattan. (That's right, I just made that statistic up.) But within just a square mile or so are Columbia University, Teachers' College, Barnard College, Manhattan School of Music, Union Theological Seminary, Jewish Theological Seminary, Riverside Church, and the Cathedral of St. John the Divine. This is no lightweight neighborhood. Lincoln Center is just another 10-minute subway ride away.
- Bookstores galore. You can find anything from Barnes & Noble to a corner used book shop. One of my favorite is Labyrinth Books which combines the best of all.
- Airport: Many people have a love-hate relationship with many things. However, nearly all New Yorkers simplify the relationship to just hate when it comes to airports. There's the wretched LaGuardia where it's surprising if the security line is shorter than 30 minutes and a shock if your flight leaves on time. There's Newark which costs an arm and a leg to get to. And then there's JFK. I think JFK is somewhere near the Hamptons. I can get to Philadelphia faster than I can get to JFK. But those are the airports we're stuck with, so as long as I have to go to LaGuardia, at least I'll be living near the M60 bus which takes me directly there.
- Church: My church meets at Union Theological Seminary, less than five minutes away. This will make it easier to have people over for lunch afterward.
Wow--I knew I liked the neighborhood, but compiling this list makes me even more excited about living there! The only thing it lacks is a Trader Joe's. I'll follow this post with some pictures I took of the neighborhood.
Tuesday, July 24, 2007
The blur that is ethics
Take that to mean whatever you want. I found this article interesting since I remember hearing a different spin on the story a year or two ago after the hurricane. "Euthanasia" and "homicide" were terms more apt than "abandoned by his government." I don't mean to imply that all ethical issues are gray, but reading the doctor's perspective provided me with another occasion to imagine the sights and sounds of Memorial Medical Center in the aftermath of the post-Katrina flooding. (It was the fact that the city is built below sea level and that the levees could not hold the surge, more so than the actual hurricane, that did so much damage, if I recall correctly.)
In this sweltering hospital with no electricity and no operational pharmacy, patients languish and the staff is stretched thin in terms of both numbers and emotions. At the time, no one knows if help will come in a day, a week, or weeks. (Pre-Katrina, a week would have been inconceivable. However, now's not the time to discuss the politics of it.) Doctors and nurses are doing their best to take care of patients, night and day, that they may know little about. If the staff's suffering is difficult to imagine, how much more so that of the ailing patients.
The facts are that morphine and midazolam hydrochloride were given to some patients. This sounds like a very reasonable regimen for ICU sedation. The doses given, curiously, are absent from the article. In any case, I suppose the question comes down to one of intent: did the physician intend to kill the patients, or to relieve their suffering? The ethical dilemma stems from the paradox that actions based on divergent intentions may appear very similar.
In other words, a dose of morphine and midazolam that is necessary to treat a patient who is hyperventilating, anxious, in pain, or otherwise decompensating may lead to a fatal respiratory depression. Goodness knows that if the congestive heart failure exacerbation patients weren't getting their diurectics and ACE inhibitors (because, as I understand, the pharmacies were shut down), or if the septic patients were not getting their antibiotics, then there is no fine line between easing suffering and hastening death in these patients already on the brink. Rather, they overlap to the degree that there may be no difference, other than that of intent.
As I recall, the Hippocratic Oath does state that the physician shall not "prescribe a deadly drug..." To take this literally would mean that nearly no drug could be prescribed. After all, Tylenol is deadly in large doses. So is water. Coumadin (a common blood thinner) was developed first as rat poison. So what the oath is getting at, I believe, is the intention behind the prescription. Medicines don't treat patients; physicians do.
In this case I cannot make a clear judgement, other than simply to say that from the facts presented, I cannot disprove that the doctor intended only to relieve suffering. And I can also say that I noticed the author used the everyday term "morphine" but included the very technical "midazolam hydrochloride", the latter word being thoroughly unnecessary to all but the pharmacosynthetic chemists out there.
Subway singing
Monday, July 23, 2007
Angel of the night
Well, okay, not that last part, but the rest is true. I show up at 1900 and take over the pagers from the day folks. My job is to see any new (and urgent) consults, to help with any issues that come up on the existing patients, to be a backup anesthesia resident for the regular OR call team, and to hope the pagers stay quiet. With any luck, I'll be able to keep my sleep schedule at nights and catch up on some things during the days.
The evening has already been interesting. I met Dustin at Soundz to celebrate his last day of his old job in the scheduling department of the Manhattan School of Music. (Just because I met him at a bar, I should note, does not mean I drank beer.) Tomorrow he starts in the recording/sound engineering department.
Prior to Soundz, I had picked up some bread pudding from Sarabeth's on 80th and Amsterdam to make good on a bet I'd lost to Dustin. (Sure enough, the still unfinished towers of the Cathedral of St John the Divine are not both shorter than the gabled roof. Why do I make this kind of bet? Why have I not learned? I still owe him a six-pack for a more recent wagered assertion that Baton Rouge is of course fewer than seventy miles from New Orleans. The actual figure is 81 miles, if mapqust.com can be trusted.)
The cathedral in an artist's rendition. I've seen a few variations on the web.
The cathedral more or less how it looks today.
Things haven't been too bad at the hospital. I wrote some patient-controlled analgesia orders for a patient. I also helped a fellow resident set up for and begin a cardiac case--a patient with a recent heart transplant and an aortic balloon pump was being brought back for a ruptured aorta. (I don't see why these things can't wait for morning.) This was pretty cool. He came from the ICU with a spaghetti bowl of IV fluid channels and about ten stopcocks in a row with various pressors and medications flowing in, and his beating heart was covered only by a thin layer of sterile dressing.
Not wanting to get too caught up in all that, I left at a convenient time and made my way back to the tranquility and unfettered internet access of the anesthesia library, my home base for the night.
Out of sequence posts
- every
- bulleted
- list;
every lumbering sentence; every
~~~~~~last~~~~~~~~~~~~ carefully
~~~~~~~~~~~~~~~~~~~~~~penned
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~letter.
For those souls (exist, as they may, only in my imagination) I've devised a new system. I will title my out-of-sequence post beginning with an asterisk*. With this system, the studious and compulsive reader may glance at the titles in the right-hand column and go back and read any with asterisks that he finds of interest. An advantage to this system is that I will not have to periodically write posts such as this one to indicate that I'll be doing some catch-up writing. Enjoy.
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* Because I fear that there may never again be a time again to mention it, I should remark that for the last fourteen years I have been unable to forget my eighth grade English teacher's (Ms Hanshaw's) pithy misquote of Nathan Hale: "My only regret is that I have but one asterisk for my country."
Potter-mania
Running update
- a 4.9 mile "tempo" run in Central Park (8:07-minute miles),
- a five-mile treadmill "hill" run (3-4% grade at 8:34-minute miles),
- a ten-mile "long" run along Riverside Park on Saturday (8:54-minute miles),
- and a six-mile "easy" run on Sunday (8:14 minute miles).
My easy run didn't turn out to be so easy. I found myself trying to keep a good pace and really pushed myself up Cat Hill just pass the Boathouse. Only a handful of runners passed me on the six-mile course which tells me my pace is decent. (One was bare-chested and wearing a heart-rate monitor, so I'm not going to worry about him.)
Runners' World magazine's online training log helps me keep track of my progress. One of the best features is an integrated google-maps feature that lets me plot my route, and the computer tells me the distance I ran. I suspect the ten-mile run was actually farther, given that the running path's multiple twists and turns are not well reflected on the route I traced along the Hudson River. In that case, my time per mile should be even less.
It might be a stretch, but I think a goal coming into focus would be to do the marathon in 3:30 hours, which would be eight-minute miles. I definitely have a lot of work to do between now and October 28. My friend Adam, who also happens to be running the Marine Corps Marathon, has made that his goal. It would be great to be able to run with him.
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* I usually think of Saturday as the last day of the week. I find myself disliking corporate calendars that start the week on Monday since it seems very work-oriented. My online training log, however, places Sunday as day 7. (Seems theologically appropriate for a day of rest, but I'm not sure that's what they had in mind.) Hence, my running week ends on Sunday.
Rainy Monday
It's difficult to go to Trader Joe's without stopping by their nearby wine shop. There I stocked up on four bottles of $3 very drinkable TJ-label wine, a nicer Chianti for my planned "Good-bye Washington Heights" party, and a bottle of Argentinian Malbec, which I'm growing to appreciate.
Before Trader Joe's was a stop by PC Richards, a local electronics store with fairly good prices. I began pricing flat-screen TVs. My justification for buying a new one--rather than buying the old clunky CRT from Brad--is that a wall-mounted TV requires far less space in the new apartment's smaller living room. In addition, as much as I enjoy having people over, it helps to have a good TV for movie-watching. And finally, if we sub-let the "study", the amount I save will quickly pay for a television.
Ordinary 26-inch LCD's were around $800, generous-sized 32-inch ones were approximately $1,000, and the luxurious 37-inch sets were more like $1,200. There was a 42-inch plasma-screen on sale for about $1,300, which is far bigger than I need, but not significantly more than the 37-inch TV's. I plan to do a lot more research to make sure I'm getting a good deal.
A new Trader Joe's shopping bag and an overflowing wine rack are two of the best parts of the morning.
The last highlight of the morning was purchasing a couple more $1 reusable grocery bags from Trader Joe's. About the size and shape of paper bags, these are much sturdier and water-resistant. I'm already in the habit of bringing a fabric grocery bag with me when I go to the grocery store, so I'm sure I'll use these as well. Besides reaffirming and recentering my moral compass, the occasion led to a little introspection on my part on behalf of society. It seems to me that although the population collectively seems moderately to very concerned about the environment, it's striking how little individuals are willing to make sacrifices. Carpooling with one person uses only half the gasoline...but it's inconvenient. And from my memories of the South, it would be absurd to ask people to take a bus. Oh well, at least re-using grocery bags is a start. And for goodness' sake, buy fluorescent light bulbs!
Sunday, July 22, 2007
* Running & Gypsy
A near perfect Saturday:
- Waking up to sunshine streaming in the window; no alarm
- Ten mile run along the Hudson River
- Nap (one hour)
- Lunch. An episode of The Office with audio commentary.
- Nap 2 (thirty minutes)
- Doing this and that around the apartment
- Picking up last-minute tickets for Gypsy with Patty LuPone, a must-see according to roommate Clay. I talked Mauricio into coming. (This was easy: "Hey Mauricio, do you want to go to a musical?" "Sure.")
- Lounging around Midtown waiting for the show.
- Light dinner of feta-cheese-on-puff-pastry pie and hot tea
- Gypsy. The show was okay, but Patty LuPone as the lead role, Rose, was outstanding. She carried the show, and the audience knew it as it gave her an immediate standing ovation and round after round of applause which filled the historic City Center theater.
- Sitting two rows behind Rebecca Romijn. (I didn't recognize her at the time without her blue Mystique costume.)
- Quizzing Mauricio on the nuances of the English language. Of the non-native speakers I've encountered, Mauricio has by far the best vocabulary; indeed his command of the language is better than most native speakers I know. I wasn't even able to stump him with the the word recidivism.
Thursday, July 19, 2007
* Let the weekend begin
Tuesday, July 03, 2007
June revisited
Coming and going
As Dad dropped me off at the airport Sunday afternoon, ominous charcoal clouds filled the expansive Texas sky, and the afternoon took on an eerie greenish hue. Soon I watched Jovian bolts electrifying the flat terrain for miles across the tarmac before fierce torrents rolled against the terminal windows. Instead of appreciating the rich blogging fodder, however, I was merely frustrated that the thunderstorms in Dallas diverted planes and delayed my direct flight--first by 30 minutes, then an hour, then two, and finally four hours. Rather than arrive at LaGuardia at 2030 Sunday evening as planned, I deplaned shortly after midnight and then waited another hour for a ponderous ground crew to unload the bags. The M60 bus doesn't run after 0100, and at that time at night, $30 for a cab to get home quickly seemed like a small price to pay.
Even more than missing sleep, however, I was disappointed because Sunday night was when I'd planned to go and tell William & Katherine bye. I'd missed the going away party, and they were moving out on Monday. At least I'd gotten the going away gift to them in advance, but it still seemed anticlimactic not to bid farewell in person to two of my best friends in the city.
As providence would have it, however, W&K's movers were also ponderously slow in packing up the apartment. I was able to drop by for a few minutes after work and see their place for the last time with its bare hardwood floors, echoing rooms, vacant windows peering out over Amsterdam, and empty kitchen in which so many meals I'd shared had been prepared. We gathered their luggage and the food they'd packed for the short road trip to Canada. And I was reminded that there's something very significant about a final, intentional pause before closing the door of one's home for the very last time. (I'm not sure William paused as long as I would have; he was more concerned about beating the rush hour traffic out of Manhattan.)
The whole experience of helping them carry their bags downstairs, loading the trunk of the rental car parked on the sunny avenue, and giving them a quick hug perhaps didn't have the same eloquence as the last episode of Fraiser (scene 15 in link), but at least it gave me some sense of completion of seeing these two friends off. Waco will be a better city for having them. And this crowded city will be just a little bit emptier.