25 December 2011

The True Meaning of Christmas

Well said, Linus.

From Calamities of Nature. For each of you that click through the link before the end of the year, the artist will donate $1 to Doctors without Borders.

24 December 2011

A song for christmas



The snowflake thingy makes it even cooler.

20 December 2011

17 December 2011

The Field Where I Died

The wife is watching an X-Files marathon while we make christmas cookies. This was one of my favorite bits from that series:



The text is from an old Victorian poem by Robert Browning:

“  At times I almost dream
I too have spent a life the sages’ way,
And tread once more familiar paths. Perchance
I perished in an arrogant self-reliance
Ages ago; and in that act a prayer
For one more chance went up so earnest, so
Instinct with better light let in by death,
That life was blotted out — not so completely
But scattered wrecks enough of it remain,
Dim memories, as now, when once more seems
The goal in sight again.”
Paracelsus, Robert Browning

14 December 2011

One Year

It's been a year since diagnosis. Sort of a weird anniversary to celebrate, but a milestone, hopefully the first of many. I don't have a lot of introspective thoughts here, so I'll leave all you ladies with the admonition to feel yourself up:


Wonder Woman


Catwoman

via @copyranter

12 December 2011

Feeling Old-Timey



From the Coen brothers' brilliant but underrated "O Brother Where Art Thou?"

Full of Win

MODERN MEDICINE. on Twitpic


Via Gruntdoc, from @bungeechump on twitter. Based on some of his selected favorites, he's well worth following.

11 December 2011

On a roll

More Flogging Molly:



Don't like it? Feel free to start your own crummy blog. (please don't)

10 December 2011

Saturday Night

Rock on:



Flogging Molly, "Don't Shut 'em Down"

09 December 2011

Nerd Rock Kings

TMBG, of course:



Though I would also accept Tim Minchin as an alternative.

How Doctors Die

No CPR
A must-read piece from Ken Murray:
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
Worth the full read.

And so true. I've joked about getting the above tattoo when my times comes. (I would quibble that the modern CPR success rate is better than infinitesimal, especially with hypothermia, but it still ain't great.)

It may have to do with the time I spent on the onc ward as a med student, or it may be because my mother in law is a cancer counselor, but I have the dubious distinction in our shop for being the doc most likely to make a palliative care consult and/or make a patient "comfort care only" prior to admission.

Personally, I think it's because I am lazy, and like any other person I take the path of least resistance. Which isn't to say that I don't want to do the work of keeping someone alive -- not at all. It's that I find it so traumatic and horrible to subject a dying person to that sort of abuse that I'd rather face the family and have the "We need to talk" moment. It's not less work, but it's less awful.

I wish more ER docs took the time to do the same. I know what I want when my number is up, and I don't want a week in the ICU on triple pressors.

08 December 2011

This is not my daughter or my dog

But it could be:



I have a little girl just a few months older than this child, and two Bernese Mountain Dogs. We have scenes like this all the time, but I have never managed to capture one quite so well. I do offer you this old pic of son #2 who decided to nap on our late, lamented Berner #1:



The Oldest Profession

Seriously NSFW anti-prostitution ad, and one that comes closer to any I have ever seen to convey to men a visceral sense of how awful it must be to be a woman in the sex trade:


Campaign against the prostitution english version from Black Moon prod on Vimeo.

I should say, as a point of order, that I'm not anti-sex. I'm sure there are out there many Julia-Roberts-eque hookers "with a heart of gold" -- call girls who are beautiful, sex-positive and in control of their bodies and their lives, able to choose their clients and making money and happy and good for them. They're not who this is about.

I see hookers all the time in my ER, and have for a long time. I see them up close and personal. They're not sexy. They're sad and miserable. They have abscesses from IV drug injections. They have missing teeth from meth use. They have sagging breasts and stretch marks on their bellies from the babies they had in their teens. They have psychological scars from the abuse they suffered at the hands of family members.

They don't usually think of themselves as hookers, and few of them fit the "streetwalker" image. They would be offended if they heard themselves described as prostitutes. But they are desperate and addicted and sometimes homeless and they have sex with men for money and drugs and shelter and protection. They don't think of it as turning tricks, typically, they just think of it as surviving.

I don't have any data, but I suspect that women (and some men) like this probably account for a huge majority of people in the sex trade. Add to that the illegal immigrants who are actually coerced into the profession and the more traditional streetwalking ladies of the evening and I am sure this is a large majority of the trade.

I don't know whether ads like the above do anything to help. I guess they increase awareness, so that's good. I actually don't think prostitution should be a crime. But I wish that the circumstances that led to prostitution could be eradicated.

07 December 2011

Beyond the Mandate -- Why ObamaCare Matters

There was an op-ed in the LA Times written by one Ms Ward, a woman with breast cancer. It's well worth reading, and I'll quote some of it here, but the whole thing is worth the read:

I want to apologize to President Obama. But first, some background. 
I found out three weeks ago I have cancer. I'm 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. ... With the recession, both of our businesses took a huge hit — my husband's income was cut in half, and the foundations that had supported my small nonprofit were going through their own tough times. We had to start using a home equity line of credit to pay for our health insurance premiums (which by that point cost as much as our monthly mortgage). When the bank capped our home equity line, we were forced to cash in my husband's IRA. The time finally came when we had to make a choice between paying our mortgage or paying for health insurance. We chose to keep our house. We made a nerve-racking gamble, and we lost. 
... If you are fortunate enough to still be employed and have insurance through your employers, you may feel insulated from the sufferings of people like me right now. But things can change abruptly. If you still have a good job with insurance, that doesn't mean that you're better than me, more deserving than me or smarter than me. It just means that you are luckier. And access to healthcare shouldn't depend on luck. 
Fortunately for me, I've been saved by the federal government's Pre-existing Condition Insurance Plan, something I had never heard of before needing it. It's part of President Obama's healthcare plan, one of the things that has already kicked in, and it guarantees access to insurance for U.S. citizens with preexisting conditions who have been uninsured for at least six months. The application was short, the premiums are affordable, and I have found the people who work in the administration office to be quite compassionate (nothing like the people I have dealt with over the years at other insurance companies.) It's not perfect, of course, and it still leaves many people in need out in the cold. But it's a start, and for me it's been a lifesaver — perhaps literally.

It hits home, for obvious reasons, but it's also important for another reason. So much of the battle over ObamaCare has focused on the Greatest Threat to Liberty Since Slavery, the individual mandate. It's utter, cynical, opportunistic bullshit, of course, since for years and years the mandate was the conservative counterproposal to further-reaching liberal plans. But after the PPACA passed, it was the only legal line of attack conservatives could find, and so here we sit, wondering what the most powerful man in America, Justice Anthony Kennedy, will do.

Will he strike down the entire law? Will he sever the mandate and leave the rest of the law? I have no clue. (I am assuming that the rest of the court will vote in their partisan blocs. Surprise me, guys!) But whenever this comes up in the media or in discussion, the flash point, the focus of the debate is the evil or awesome individual mandate.


What gets forgotten, though, is how much more is in the law than the mandate. While most of the attention during the drafting of the law rightly went to the plight of the uninsured and the near-universality of the coverage, much and more of the law was devoted to root-and-stem health insurance reform.

Reforms that help women like Ms Ward. Without the high-risk pool the PPACA established, she would be without any relief. State high-risk pools are unsubsidized and the premiums are unaffordable. The only reason this program is feasible is because it is temporary -- a bridge to 2014 when the insurance exchanges go into place, along with other critical insurance regulations.

Why does this matter? Because people like Ms Ward are in the individual market, and insurers individually underwrite each applicant -- and refuse those who are bad risks. Come 2014, every individual policy will have to go through each state's health insurance exchange, and they must conform to a number of new requirements. They cannot refuse any applicant. And they may no longer charge different premiums for patients with varying health histories, a feature called "Community Rating."

This is, it must be understood, how large insurers currently work. If you go work for Boeing, they don't ask you before you are hired whether your wife has breast cancer. All employees get charged the same, and the premiums for the entire pool adjust to cover the aggregate cost. All the PPACA does here is bring the same rules that the group market already works under to the individual market. And that's huge for so many people.

This is just one bit of the law that really matters to people, and that really will make the difference in the lives of so many Americans. And there is so much more. The requirement that insurers must spend 80% of premiums on actual healthcare. The prohibition on insurance "takebacks," or recissions. The expansion of coverage for kids. The requirement that premium increases must be reasonable and justified. Increased funding for primary care and community health clinics. And on and on.

So the next time you are inclined to go off on a spittle-flecked rant over the individual mandate (and I've emitted a few of my own), just pause and take a moment to remember that there is a lot more in this law than the mandate. I'm not going to persuade anybody who's already formed an opinion that the mandate really is good policy, but maybe I can remind them that a nuanced view of the law might be in order. It's not black and white. Regardless of the fate of the mandate, we should all be hoping that Justice Kennedy lets the rest of the law stand.

06 December 2011

TimeScapes

What a beautiful world we live in.

02 December 2011

Holiday decorating tip

It's that time of year when folks venture up ladders and out onto their roofs, putting up christmas lights and other holiday decorations. My own house is lit up such that it is probably not visible from space, but could serve as a beacon for passing aircraft. (Energy-efficient LEDs, of course.)


Anyhoo, it turns out that if you're not really accustomed to working on a ladder or walking on a roof, and if conditions are cold, wet and icy, or if the roof is mossy, the chances of suffering an acute and traumatic case of gravity are pretty decent.

Be careful out there.

01 December 2011

Always been a sucker for models

But this one takes the cake:


I wish I had many millions of dollars to make something like this.