The Haversian Canal

Just this morning I was thinking I couldn't imagine an article I would feel comfortable pulling paragraphs from in whole. However, Robert McCrum has written such an article in the Observer, Memoirs of a survivor, first brought to my attention by Shrinkette. These are the final three paragraphs:

There is a sea of horror lapping at the edges of the everyday world, and these messages in bottles are floating in on every tide. These are the messages from the world of pain, messages that describe the suffering of strangers.

From this, I have learned three things. First, that the world's frontline pain is the pain of Aids, cancer, heart disease and stroke (the big killers). Behind the line, there's the pain of despair, loneliness and loss. The aching void in the lives of the bereaved and the afflicted. Second, I now know that we are all, in some sense, in the doctor's waiting room. I used to be indifferent towards, and frightened of, illness. Now I recognise it as part of the human condition. Illness is OK. There's nothing wrong with infirmity. It's part of the way we are. In the famous words of Samuel Beckett's Worstward Ho: 'Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.' Failing better is something every stroke sufferer knows about.

Finally, there's this recognition. Despite the extraordinary progress of medicine, despite all the safeguards we have built into the way we conduct our lives, we are still in the world of our ancestors, when life was characterised by the poets as a sparrow fluttering out of the storm into the brightly lit mead hall, circling through the laughter and the smoke for a moment, before disappearing once more into the dark. Sometimes, when I read these letters, I sense that dark just beyond the window. And I feel grateful to be still alive, in the warmth and the light of summer, out of the storm.

There are other places to learn about these things. My first real exposure was in the Navy, in Columbia, Peru, Mexico, Gauatamala, and other South American countries. The proximity of poverty to death was incontrovertible. My own experience after being operated on has become a small but constant reminder of that: my left shoulder makes sickening clunking sounds and random intervals and the palm of my left hand nearest my pinky finger goes slightly numb if I relax my shoulder too much during the day.

The orthopod at Complications found an interesting article comparing internet users and non-users.

What is the MIT Blog Survey? I took it. What is it? Here's the results of MIT's 2004 blog survey by Fernanda Viegas. The most recent one was administered by Cameron Marlow, also of the MIT Media Lab. If you completed the survey, did you read the consent form? The information page leading to the consent form? Here are Marlow's preliminary results (only available to those who log in to survey).

The real meat is in Viegas' write-up. Rather than quote sections, I recommend you read it. It's short. I'll publish my approach to blogging shortly.

My wife is an occupational therapist, and I haven't found many OT blogs, anyone know of others?

Starting at 50
BoHo chick
Soul Far I Kenya (maybe)

Machines constantly cache the Internet's contents. Published for a second is published for eternity. Even in the event of nuclear war, freak asteroid, tsunami, Los Angeles falling into the ocean, there's a good chance somebody, somewhere, has a cached copy of that tirade about your boss in a RAID level one archive. Ten years ago most people hadn't contemplated the possibility of being named and associated with their every action in an uncontrollable, public, permanant way. Now everyone who knows someone who writes a blog is subject to that possibility. So every blogger has a tremendous power to violate the confidence of their dearest friends and family. Yes, the assumption must be that everything observed is disclosable, however, it would do bloggers well to assume their associates are in their confidence unless an observed action is reasonably the blogger's to report or the matter is otherwise already understood to be part of the public record. Just as everyone has the write to take photographs of anything that happens in public, and the right to publish is equally protected under THE LAW, that only means the blogger can't be sent to jail. Fired? Yes. Divorced? Sure. Castigated and villified beyond all imagination, pursued to the ends of the Earth and left to die in the desert? Absolutely. So that's the privacy aspect of being a public figure.

The responsibility aspect of being a public figure is the assumption that people listen to you. That is, people can reasonably expect public figures to be consistent, and failure to be consistent in statements and actions will cost the public figure some credibility.

Anyone who chooses to enter the public arena is well advised to also assume they will be identified. Think of Ted Kazinsky, or Jessica Cutler (aka Washingtonienne). Anonymity in the public domain is essentially you withholding information from everybody else. Bad odds.

The safest rule is simple: don't publish anything you wouldn't want your family and friends to read on the front page of the New York Times. That doesn't mean you can't publish bad news, or say controversial things, but you better believe in them when you're stone sober. Anybody, including you, may be believe something when angry, sad, or giddy. Tthat's what the "Draft" bin is for on Movable Type.

Everything seems to be on track, or pretty much so. Is a storm brewing? Reading The Social Transformation of American Medicine, by Paul Starr. I wonder how much this single tome has affected the AMA's drop in membership.

Following their Olympic win, London was hit by multiple attacks on their transportation system. This story includes a map. Here's the BBC reporter log.

An excellent idea by the the East Anglican Ambulance Service, brought to us by the BBC:

[people] can store the word "ICE" in their mobile phone address books and put the next of kin's number against it . . . . This is the person to be contacted quickly 'In Case of Emergency' by ambulance and hospital staff."

I filled out the half-inch thick application for the Health Professional Scholarship Program, including numerous supporting documents, interviews, letters of recommendation, transcripts, etc, etc, and took them into the recruiter, who looked them over; gave me a few to-dos. I went home, came back when I had the additional materials, and then the other recruiter needed more. And then his boss needed more and some of the forms had boxes x'd in with pen instead of computer. So I had to drive in again to deliver signed forms with computer-marked x'd boxes. Three trips, an hour's drive each way. I may have a decision this Wednesday.

My wife is applying for licensure. The web listed some things to do to apply for licensure. Listed them as though that was all that was required. She did those then more items were requested. Then her package was reviewed and the inadequacies mailed back. Why did you want her e-mail address if you're not going to use it?! And if you can't get it all done in time to start work, you can pay more for a temporary license. Pretty much everybody gets a temporary. Why not just stay late a couple of days, get caught up, and then the effort of issuing temporaries will be removed from the work load? Her original notarized birth certificate isn't sufficient. If we could make a blown-up copy and get the copy notarized that would be better. Are you kidding me? What, is the clerk myopic and can't afford glasses?

Financial aid: I flew down (primarily for house-hunting) and personally went to the office after they didn't answer my phone calls for a week. The office was closed when it's scheduled to be open. Managed to get in and talk to the counselor on Friday and Monday. Two weeks later, still no financial aid package.

By comparision, the mortgage, job search, day care search, and move are relatively painless. That's the difference between government interference and free markets. See no evil, do no evil. Has anyone got a rusty spoon?

Terrible Nurse Comment • over my med body!. Is this really that horrible a comment to have made? I suppose there is always context to be applied, but if she did know his diagnosis and had developed enough of a relationship with the patient to have a sense that he would prefer humor to pity, then this would be a perfectly reasonable thing to have said, wouldn't it?

So I had my first two experiences with not being a doctor but getting medical questions. First, at about 10 am this morning, my daughter applied a suction cup to the TV and my wife told her to take it off. My three-and-a-half year old pulled on the suction cup and pulled the 100 lb, 23" TV onto her foot after it's center of gravity fell about two feet (TVs are front heavy and it tipped forward as it fell). I was out of the office but got home by 1030 and she was whimpering on the couch. Pressure didn't hurt, mobilizing it didn't hurt. No apparent bruising or swelling. "Does this hurt?" "No, da TV hurt, I sorry... (tears and whimpering)." "You want a ring pop?" "Uh huh, you carry me?" "Hmmm... let's trying walking to the kitchen." As I said that I picked her up and set her gently to the ground. As I slowly loaded her weight onto her feet she still wanted me to carry her but she also took her weight from me and pivoted on the injured foot, without pain. Good enough for me. I told my wife if it started to swell or anything weird happened to call me, and I went back to work.

At work someone asked me about a relative who'd displayed mental changes and is on a bunch of medications. I had no idea what any of them were, but I looked up the prescribing information, applied what I learned from Professor Pontzer in Drug Action and Design, and offered him a little write-up on e-mail of my thoughts, with repeated statements that I'm not a doctor, I could be way off base, and he should talk to relative's doctor, but take the prescribing information to the doctor.

Having interviewed with some of the pharma companies before getting into Tulane I'm pretty much convinced their young, motivated sales reps are brainwashed by headquarters to buy into some morally corrupt ideas about education (sales pitches) without any obligation to make all the relevant facts known to their students (your doctors), indeed, an obligation to withhold disparaging information (that might affect their commision) is strongly advocated (enforced).

So what's the difference between the two situations? In the first, I'm the dad. Every dad has to make these analyses: do I take the kid to the emergency room or not. The answer isn't always yes. Would blue-collar dad have come to the same conclusion? Probably. In the second situation, there probably hasn't been much trained gray matter and time applied to that particular set of drug interactions. Somebody, somewhere, may have nuked it out, but it sure hasn't made into the literature (I checked PubMed). Whether I'm right or wrong, I'm pretty sure all involved will benefit from the doctor receiving the prescribing information and a few key questions from the person who sought me out. Medical advise? Or informed internet research? Where's the cut-off between water-cooler chit-chat at the office and medical advice?

Tim Klimowicz's flash map of casualties is to be commended.

Shrinkette hosts Grand Rounds #42.

I have to admit, I haven't been too concerned about getting the Navy's Health Professional scholarship. The program is routinely overfunded: they have more money than they can spend on the students who volunteer for the program. Nevertheless, with a mortgage hanging over my head (closing on 26 July) I can't just blithely assume it's a done deal so I was glad to get word from a friend who'd heard the results of the most recent selection board, sounds like their endorsement to headquarters was positive. Interestingly, the program offices are in New Orleans, though I haven't figured out where yet. I fully intend to be visiting the office as soon as possible so they can put a face to the name.

Follow-up from yesterday: my daughter's foot is fine.

I was reminded today while listening to NPR, of a new entrant in the pharma industry, NitroMed, which is pushing a patented formulation of two drugs that it calls BiDil. Even Dr Charles L Curry, an investigator in the clinical trials, and a paid member of the NitroMed speakers bureau, thinks the cost, six dollars a day, is high, especially with the two drugs, isosorbide dinitrate and hydralazine, which are available as generics at much lower cost.

My daughter's got a nasty bruise on her foot from dropping the TV on it. It causes her no pain and she's jumping and dancing, but the bruise is big and purple. The furniture repairman came today and did a bang-up job fixing the front edge of the entertainment unit shelf that the TV chewed up as it tipped over and slid off. He cleaned up the edge and then heated a solid laquer until it was soft and he wiped this on, and shaped it, with oil-painting knives. Isn't it absurd that we pay $500 for a TV and then $5000 to put it in a box so we don't have to see it? It's evil, though, the TV, no doubt about that.

The repairman gave me a good idea on another project. Our apartment has radiators that have been disconnected and are covered with lead paint. They don't work. At all. That means they're trash. Toxic trash. They won't clean it up because of the cost, particularly for the government, to clean up the hazmat. So they leave it in our homes and test our kids for lead poisining every six months. So I took all of the radiators in my apartment out and dumped them in an empty room in the basement of the building, as a number of our neighbors have done. Problem is the radiators leave holes in the hardwood floors from the pipes and scabs of old paint where the feet of the radiators sat on the floor. The paint I can sand out and revarnish. The pipes, which are flush with the floor surface, and the nasty margins where the wood meets the pipes, are another story. The solution? Beeswax with a little burnt siena oil paint to match the color of the stained floor. An ideal patch would involve grinding down the pipes and custom fitting pieces of wood to fit in the holes. However, I don't have the tools to grind down 1/8" thick 2" steel pipes in such a way as to keep the surrounding wood cool (grinding steel generates a lot of heat. The metal may turn visibly red). Beeswax is relatively hard and carries a pleasant translucency, much like wood or skin. Having seen some of the bizzare solutions my neigbhors have tried, I think this has worked out the best, short of real wood.

So my wife is studying for her new job in the NICU. Check out Developmental and Therapeutic Interventions in the NICU by Vergara and Bigsby for a good discussion of the pros and cons of letting babies sleep on their backs and bellies. This is particularly germane for us because our daughter slept on her back all the time as an infant and had a very hard time going to sleep as well as staying asleep. We started our son on his back and saw the same trend developing, so we asked around and decided to put him on his belly. He sleeps like a champ, is much more calm, has great head control, and started manipulating objects earlier. Now, all of that may have to do with other factors, but the literature predicts this. Getahun et al reported on maternal and infant risk factors for SIDS here. Neither my wife nor my son have of the identified risk factors. Considering every baby starts sleeping on their belly once they learn to roll over, one has to question the validity of forcing them to be supine. It may have as much, if not more to do with not using soft bedding. The "Back to Sleep" campaign may have done more through simply raising awareness of all preventable risk factors than through actually putting infants on their backs. AAP says put them on their backs, but, our analysis of our circumstances tends to indicate that supine sleeping wasn't the right decision for us.

Aggravated DocSurg hosts Grand Rounds 43.

This was my last day on the job. My assistant gave me a tie clip. He often wears a tie clip; he wore one to his interview. After I hired him I told him I thought was pretty sharp. Today he said advised I wear it out on the town, but not necessarily to physician job interviews: "a little too bling."

Leaving was weird. No fanfare, nothing. Everyone had made their congratulations weeks ago. A couple good-byes during the morning. I took my assistant and my relief out for a long lunch and went home. That was it.

The movers will be here tomorrow morning to start packing. Right now everything is a mess from packing what we're going to take in the cars and all the paper from closing one chapter in life and starting another. I look around and each item seems like a placeholder for the real thing that will only reappear when the movers deliver it to our house in New Orleans.

Thomas H. Benton recently wrote Stacks' Appeal for The Chronicle of Higher Education, which posted the article to Arts & Letters Daily today. He basically laments the loss of the American apetite for books. Apparently he hasn't checked Barnes & Noble's stock trend. Amazon isn't quite so rockstar, but they're much more diverse than Barnes & Noble. As a regular book and library dweller, however, I am inclined to agree that fewer people seem to be as genuinely interested in intellectual books as they used to be. I remember the branch library I used to go to as a kid, where people would go to just read the paper and would find themselves reading Chaucer before their lunch break was over. There was always a line at the check-out counter. Now, I hardly ever see anyone at Nimitz Library, and the longest line at Barnes & Noble is at the coffee counter. If I want to find a quiet aisle I can always go to political science or "literature". Math and Science would be quiet, but it's next to the periodicals. If I stand back and take the long view, I'm not sure, though, that the public's appetite for learning is fading. I suppose graduate school admissions would be a good indicator of national interest in knowledge. I know for one that medical school applications continue to observe a somewhat cyclic behavior and the most recent cycle is on the upswing.

Bye, everybody! Shutting down the internet, see you in NOLA!

We're in Meridian, Mississippi. We left Friday and decided to camp at a KOA campground. I will never again patron any commercial campground. National forests have the best campsites: you're on your own to pick a flat spot. KOA, I'm sure, used bulldozers to create flat spots. Many flats spots in remarkably neat rows, packed one next to another. And they have karoke. Oh, yeah, the Tokyo bad singing craze has migrated to the rednecks, hicks, and hillbillies. The kids didn't go to sleep until after karoke finished at 11 pm and I honestly can't blame my daughter for wanting to sleep in the truck: this place, in many ways, was the scariest thing I can imagine. Sleeping a few feet from giant lumbering campers driving around, who knows who's next to you; fat, tattooed teenagers setting fires across the street (I mean, authentic backwoods path). I've been in shantytowns that were more wholesome. I mean, to hell with any of the nice things that may be associated with camping out in the woods, this was simply disturbing. And then it started raining at 1:15.

I was in the non-waterproof tent and quickly abandoned it to put the rain cover over the sealed North Face tent. Unless North Face takes a major change in direction, I anticipate buying North Face until I die. Not a drop in the tent. Beautiful. My wife finally woke up at 4 and couldn't take it any more so we broke camp (in the rain, mud, and dark), while the kids slept. The two kids and finally the good tent were the last things in the truck. We got to my uncle-in-law's house in Morristown, Tennessee at noon, made lunch and everyone slept while I cleaned and dried the camping gear. We got back on the road at a comfortable time this morning, about 9 am, and arrived in Meridian about 4 pm Central time.Now it's about 9:30 pm and I'm going to go to sleep.

Oh, my aching back, we're here. Two days of unpacking and we're still not done. The closing went well though and we're now homeowners! Finally, the dog can relieve herself without me having to put her on a leash! More later, it's late.

I spent today just like a spent yesterday: unpacking tools, clothes, books, books, books, books, books, computer stuff, books, books, books, books, books, oh, my back. 1400 cubic feet is how much of a tractor trailer it all took. In my application for the move I estimated it would be 11500 pounds, rounding to the nearest hundred. The final weight put my shipment at 11540.

I seem to have that ability: I can eyeball screw sizes and thread pitches. As the conning officer on a ship, giving the rudder orders, I never missed a man overboard, no repeat attempts. This is helpful in the real world, but it's useless, like wasted brain cells, in an academic setting or a desk job. I need to put my five dollars in for the Rudolph Matas Surgical Society.

A low for the New Orleans crowd: the shuttle's tank, with it's haunted foam assembly, is manufactured in New Orleans. Ouch.

They spray some sort of chemical in our streets every night. I think its for mosquitos, but I need to find out. It smells like Raid.

Bought a lawnmower today. My cars are a Honda and a Chevy. I hate to say it, but I went for the Honda-powered lawnmower over the Briggs & Stratton. Honda engines just don't break.

Grand Rounds #44 is up at Pharyngula.

Every box has been opened; only a very few boxes of rather useless books (novels, calculus textbooks, that sort of thing) remain in the house. All the empty boxes have been broken down and baled into a pile on the curb for the movers to come pick up on Monday.

I've been doing some consulting work for a not-for-profit company, basically graphic design with a data bent to it. They're scoping a project for completion in the next six weeks and want to know my availablity. Class starts August fifth. This is painful: poor student has a chance to make money, but has no idea how much time can be committed to making money, which is all the company needs to make the offer. Please, someone gouge my eyes out... AHHHHHH!!!!

The plumbing inspection on the house we just bought said the pipes were clean but the kitchen drain needed to be snaked. Well, it did! The sink backed up already so I just unscrewed the trap and the downstream elbow crumbled like so many potato chips. That elbow did, however, contain a heck of a clog, and the furthest into it I got showed what I think is cured latex paint. It appears the previous owners cleaned their roller trays in the kitchen sink and sent the cured paint down with the liquid stuff. Now the baby's crying, gotta go.