Pop should be discharged tomorrow, and a 100% recovery is likely to occur within the week. What a relief, though I still worry. Thanks for your well wishes, folks, in thought or via SMS!
As some of you may know, I love noodles and cake. I eat noodles much more often than I eat cake, so I've been working on this project where I catalog the noodles I eat. Here are the results so far. Further info regarding noodle type and location can be found in my Facebook photo album bucket thing. Whatever.
I'll be adding to this entry as the years go on. Oh, the excitement!
Things to do: 1. complete PLS top sekrit project on revolutionizing indigent patient care 2. prioritize homelife over worklife 3. start thinking about starting my own practice 4. sleep more, work less.
I'm not sure if I've written about this in the past, but here's the breakdown: I live in a nice part of town in the nice part of a city. There's another city across the water that is not so nice. Nice town I'm in has the biggest, nicest hospital in the area. I could walk there if I worked there, it's so close! Poor town is a smaller community hospital serving a poorer population.
The smaller hospital is a better place to work, because the people who choose to work there do so out of a sense of duty or community. Many of the patients we see are uninsured. The city's program for the indigent has grown substantially over the past several years, to the point where getting care for the uninsured has become only slightly tedious.
This is where big changes can take place. It's perfect and in need of new ideas to improve health care, and it's what we, the PLS crew, of Perfect Tommy and the Roll, need to be working on.
But such work goes slowly. How to effect change when there's bills to pay, politics at work, and geograph hurdles? The ideas are sound, and good. But I can't even find time to hang new lamps or work on the house. I need to replace doorknobs. Renovate kitchens and bathrooms. Hang chick0n towel hangers and chik0n calendars.
Progress has been made, though, on the furniture front. And I've stripped the wallpaper down and painted my bedroom, so it's ready to be furnished. Under the wallpaper was a bright teal paint, and the first coat of "Asparagus" made the room look like it was whitewashed with bile. Second coat fixed it, but it seems very... bold. A vegetabley bold.
Work's been somewhat painful. Intra-group politic, battles with administration, a million graphs for a million different measures of quality of care. I try to keep my head down and claim to be a worker bee, but changes need to be made. We're a new group, and in position to start new and remarkable way of doing things. If only, if only, if only!
Some random guy came up to me the other day and explained that I took care of his wife last year, for a terminal cancer, and he appreciated the time I spent with her, that she told him all sorts of stories of how I came in during lunch to smuggle food in for her and watched TV during lunch. I wasn't sure if he had the right guy, but he remembered my name through a common nursery rhyme involving some fellow named Peter and a bunch of his pickles. He also remembered square glasses. Anyway, I was touched. It's not often that people say nice things to me, especially when everything seems to be headed for shit when their loved ones are sick. But it recharges my batteries and reminds me that all the politicking is bullshit, and if I focus on the work and doing a good job, things will be ok.
3. Been thinking about starting my own practice at some point in the future. Be my own boss. Hang my own shingle. See patients in a clinic, do procedures, and offer tasty beverages while patients wait. It'd have a bumpin' implementation of an electronic medical record, which would have to interface with everything else being used in the area, so that it could become the central repository for info. No more of this hunting-down-of-patient-info shit. No more wasted time.
Also, some day, opening a noodle bar. I'd take some time off and travel around the world an learn the methods to make noodles from many cuisines. Then, make and sell noodles! It'd be super sweat, and probably operate at a loss, but hey, it'd be fun.
4. Sleep more, work less. And bring less work home. Because I'm a boring motherfucker when the first thing that comes out of my mouth is a sad story of a sad dood told in a half-million words. Like this:
The patient is a 42-yr-old female with a past medical history significant for some sort of liver disease who presents to the ER unresponsive, status-post code. This history is obtained from the EMS crew who arrived on scene and transported her, as well as family members who are present at bedside.
Pt's son called 911 earlier in the day for his mother's perceived shortness of breath. She refused to come to the hospital, stating that she'd like to wait, and her son will drive her there. Several hours later, her son again called 911 as the patient was unresponsive and having labored breathed.
On EMS arrival, they noted the patient to be unresponsive, and cold to the touch. Her son said, "There's no rush, she's already dead." An AED was connected, and it advised shock. A single shock was delivered at 200 joules as CPR was initiated with an auto-CPR device. Patient was intubated and bag-valve-mask respirations were given.
AED advised a second shock, and a 300 joule shock was administered. Pulseless electrical activity was seen on the cardiac monitor, which slowed to asystole. Atropine and epinephrine rounds were given while CPR continued.
After approximately 15 minutes AED advised another shock, and a final shock of 360 joules was given. Pt's rhythm was sinus bradycardia. Pt was transported to ER for further care.
On my arrival, the patient was intubated and ventilated, blood pressure unmeasurable. Core body temperature measured rectally was 89.2. She had a distended abdomen and palpable liver 3.5 inches south of the costal margin. She was severely anemic, and clotting studies showed distressing abnormalities. Fluid, packed red cells, fresh frozen plasma and platelets were all ordered to be transfused. The ER attending met with the family. "She'll have a better chance of survival if we keep her cold." "I'd say she has a 50/50 chance of making it, and recovery if she makes it through the night." "Dr. P is here and will admit her to the ICU."
Subjectively: this woman was dying. The ER MD was delusional at best, and a lying cocksucker at worst. The family now had the idea that if we did everything we could, the patient would live. I felt that there was nothing we could do except to relieve her suffering as best we could. 0%.
Studies will show that in cases of prolonged cardiopulmonary arrest, the chance of restoring heart function is less than 2%, with her concurrent medical problems, closer to 0%. Chance of recovery to former level of function is still closer to 0%. Every organ system in her body was failing: her brain lost its most primitive reflexes and her eyes were fixed and dilated. Her kidneys shut down and she was making no urine. Her liver had failed and couldn't produce the clotting factors needed to prevent any sort of bleed. Her heart had been fried and was barely moving blood.
I told the family I was sorry. I told them I have only bad news. I told them their mother was dying and that even if I did everying I could to correct all the acute problems, the main problems would be unlikely to be fixed.
She stabilized enough to be transported to the ICU. I let the family stay at bedside through the morning, and was called back when the nurse informed me that her pulse was slowing down into the 20s. I briefed everyone around the patient and asked if there were anything else I could do. We watched her heart stop. Time of death 0445.
People die all the time. I get pissed when some asshole decides to give patients and family the runaround, or when other physicians say things like "nobody dies on my watch." Everybody dies. No one has superpowers, and there are no heroes.
Whatever. Surprise! I write when I'm bitchy. Can't get web host to work for pics, so pics are down. So fuck it. I'll post new garden and flower n rose pics to this later. And maybe a snap of Asparagus paint.
Vegas, the Phoenix and Boozitude. I've been going to Las Vegas for a mix of business, pleasure and that hazy area in between which sometimes involves business for pleasure. You know. You know.
Yes, Las Vegas is one of the last places I would have imagined myself going to, but it was a trip that arose first out of fortunate circumstance: no more boards, no more family drama, and I had a pet-sitting, insulin-injecting friend of who kindly take care of the doods while I was away. There were periods of time I had completely free, so I figgered: hell, why not go on vacation? Why not go someplace by myself, and not to visit the folks? They're stable, and reasonably content; It's time to get my own exploring and traveling done.
So why Vegas? Because initially it was paid for, then it was a cheap flight out and I got to meet my youngest brother who's out there and the Roll, and finally because it was one giant Phoenix convention with Perfect Tommy, the Roll and myself.
I actually somewhat dreaded going. Oh, Vegas is the bastion of manipulation and it's gaudy, and evil, and built on the backs of suckers, etc. Tits, asses, chips and passes: all not my thing. In deciding where I should go: I wanted massive sensory input. Get out of the house and hospital. So I picked Vegas.
And I enjoyed it a lot more than I thought I ever would. The food there is incredible, if your wallet can take the hit. Even if it can't, there's arguably the best Thai restaurant of the country tucked away in a strip mall. You go, game, and observe. The people are fascinating, the technology is fascinating, and it's just... otherworldly. I played poker, well. "You don't have to be good at poker, you just have to be better than one guy at the table."
I played with fervor. I met a trio of players in from Scotland. We worked the Luxor and Mandalay Bay, sitting at tables and marking the suckers for breaking. One by one, rambunctious hotshots would be busted out, and we had a blast. I learned their names, they learned mine, and we had drinks. Cocktail waitress: "Cocktails?" Me: "Sure. Uhmn... what're you gonna have?" Ian: "Something healthy..." Ian's brow furrowed and his face lit up with what he thought would be the best drink invention ever, and he burst out: "VODKA AND ORANGE JUICE." Cocktail waitress: "One screwdriver." Ian's face fell. Me: "It's ok. I'll have one, too. And keep em coming. We need to look hammered."
And so the cycle would continue. At the 1/2 or 2/4 blind tables, each ante is basically one, two or four bucks. Just to play! Pizacake! Bets should be commensurate with the blinds, but suckers would come in a try to bet big, the table being no limit. No limit to bets means no limit to how much money you'll be losing to us.
A break: Outer Space rocks.
Quadrantids were swell, even from here. I dunno why I keep spelling it "Quandratids." Quandaries, I supposes. Lots of them.
Back to business. So we'd take them down, one by one, and make a lot of money which I'd go lose playing craps.
The last night, we hit the tables at Mandalay Bay. It was getting late, and the table consisted of Ian and his crew of two, a nice fellow from Jersey, myself, and two obnoxious fratboys looking to win big. We had them marked, and started to get to work when this beautiful brunette with the most mournful face came to sit at the table. None of us minded shifting over to make room for her.
The fucktards made comments about her. She couldn't hear them well: she had a hearing problem with one of her ears. She was coy. We knew we were in trouble. We got up one by one and went over the ropes to share cigarettes.
Ian: "We're in trouble, boys." Me: "Yeah. This doesn't look good." Ian's pal #1: "But she's GORGEOUS." Ian's pal #2: "It's not that, but she's so well-COMPOSED!" Ian: "Let's play, see how it goes."
We stayed very polite. I mean, we're respectable gentlemen, and we don't go ogling people for kicks. This girl, this quiet, awkward, beautiful girl with long brown hair and some of the bluest eyes I had ever seen, slowly worked the two jocks down to nothing. They started joking about sexual matters, when Ian said "Son, why don't you just take the chip you have left and leave with some dignity. Barring that, go fuck off."
Pit boss saw this, and saw them, and the two troublemakers left, leaving us remaining. None of us wanted to play against this girl. We'd be destroyed. She had already knocked our confidence down to zilch. We talk about calling it a night, when she says:
"Thank you for being so polite and respectful. Good night."
And we all let out a large, collective sigh.
See: I'm not a very social person. I don't go out and actively seek conversation. It tires my brain, and I often find myself thinking about fifty other things I'd rather be doing, like, well, doing nothing at all. But it was different on these trips. The people I met were so damn interesting.
Beautiful women abound. Some working girls, others not. What is the relationship between two people I see at any given time? I played craps with Nate and Nas, with Nas being a spectacularly sharp girl from Orange County. She answered for Nate. She also told him what to do on the craps table. When I called for a marker to play, and had a nice stack of chips before me, her interest turned more to me than him, and this made me feel bad because Nate had probably already had something contractual with Nas. Nevertheless, they won me money with some long rolls.
I came back several times to that table to see if they were still there, and they would be.
Las Vegas is a truly fascinating place. Of course there are so many things about it that are obnoxious. That's part of the point. Each trip was fully comped. The last trip I went out on with PT, the Roll, and my bro included a ridiculous amount of food and service and drinks. All of it paid for by the casino. They sucker you in this way: they make you feel like your shit don't stink. I checked, in the suite they gave me: it does.
But there's something to be said about feeling like you COULD win. With some luck. There's also something to be said about the feeling I get when I play Bacarrat or Roulette at the high-limit areas. Or playing craps with a huge crowd, and a lot of money being thrown down.
The best win at THEHotel? Well, the suite is nice. But the Roll constructed a note for housekeeping to be left in on of the bathrooms. It kindly asked for extra soap. We left a five dollar gratuity. I came back to the hotel after a hard day's walk around the strip to 20+ soaps! JACKPOT! DOUBLE JACKPOT! Bro made off with the body bars, mouthwash, bath powders, shampoos, conditioners, and shoe wax kits.
Anyway, we got a good amount of work done for the next massive Phoenix project. It will involve making the practice of medicine better, with a secret ultimate goal of helping the indigent. Cuz the PLS don't quit, and we're manic, and we aim well. Cut us some slack as we booze it up in Vegas.
If anyone is ever looking to go at any time, let me know. If I can go, we'll go crazy. Crazy VIP services at all the MGM/Mirage hotels/casinos out there are looking to get me back, a) cuz I'm a sucker, and b) because, apparently, I tip well. I feel like tipping everyone here, and I would, if I had a stack of chips with me.
Hair. My usual morning routine consists of hitting the snooze button on the fone, then hitting the snooze button on the main pizacrap alarm clock, then hitting the snooze button again. Then I shower. I towel-dry my hair, and then I put some gunk in it. Fly out the door.
Pre-, post-shower, dried, then styled, but not yet "normalized."
Well, during one of these trips to Vegas, I found myself awake at some point and found a blow dryer in the bathroom. I didn't own a blow dryer, and I don't blow dry my hair. So for novelty's sake, I blow dried my hair. The hair became voluminous. Putting gunk in it made it cool. I mean, real cool.
Now, I don't going around living my life feeling cool. I mean, I put on my clothes, and pants, and a jacket I like, but I really don't find myself thinkin "hey, you look cool." But man, after blow drying my hair and putting pomade in it, I felt cool. I got cool compliments from cool dealers at the table, and other casino patrons.
So when I got back, I went to Target to buy some other stuff and had a look at the hair dryers. The strange thing about technology is that it seems like every gadget out there has a low- medium- and high-tiered brand with related prices. Hair dryers, man, they're all sorta the same, and around the same price. I decided I didn't need the top-tiered ceramic heating element with ionic doodads, and got a pretty basic one with a kick: it has a button to wind the power cord back in! Bumpin.
These days, I blow dry my hair on special occasions. Like for this ljupdate. I don't have time otherwise, though I guess I could wake up a bit earlier during the workdays.
In other news. Orchids growing again. Jap tree brought in from the outside growing and wants to go back out. I got this sweat gardening catalog in the mail the other day, and am planning on ordering up madnuss! Clematis! Lavender! Morning glories! Uhmn. And a whole bunch more stuff. Did you know could just order whole gardens? Like, check a box and POW! They deliver everything you need to will an X by Y plot. Madnuss. More wallpaper stripping in the near future, painting, wall population and furniture! Girls make me nervous, I shouldn't feel intruded upon when I'm welcoming, and I think I need to get my social life in order. I mean, dating life. Emotional life? Whatever. This is nothing new. I need to win $50k bucks in Vegas and some self-esteem. BBIAB.
And that's about it for this update. Apologies for taking such a long time in cranking these things out, but I don't have a lot to say that would be of much interest, and I hesitate to put up more personal stuff here. If you know me, you'd get it. If you don't, and are totally super hot, then let's go to Vegas. Then you'd know me, and then you'd get it.
Local News Things to do list, from several months ago: - Take down wallpaper - Paint - Buy furniture - Epoxy finish garage floor - Renovate bathrooms - Renovate kitchen - Buy outdoor lamps - Grill.
Things to do list, as of yesterday: - Same as above.
+/- was fun n loud, but not louder than my wallpaper.
There's little motivation to get the house in shape. Everything's fine, with most of my belongings on the top floor. I kinda dig not having furniture. Makes cleaning easy. Plenny of space for the doods to vomit.
Switched litter from the clumping kind to Yesterday's News, a bioearthfriendly pellet litter made from old newspaper. I like imagining Link pissing in a corner and waiting for the pellets to unfurl and inform him of the news in Pakistan from a couple years ago: "Everything's fine. No wait. Seriously." To which Roobik would reply, "WHERECOMIXPELLETBITCHEZ/GOTTAPEE."
The pellets aren't folded, compressed newsprint. Cursory examination reveals that they were chopped up, and that there is no discernable copy. Disappointing.
Minitents for the cats! Minisleepingbags in aisle 9!
Metro Work is busy, which is good. Workweeks leave me exhausted. The days off aren't too bad. Already made plans to head to Vegas, making plans for Heavenly and possibly someplace overseas in the coming months. It's kinda strange to find myself having the resources to take vacation, and even stranger having little reason not to. "Fixing up the house" is trumped by most things, apparently. "Buying furniture" loses out to gambling, booze and whores. Which reminds me to say: despite any rumors to the contrary, I am and plan to remain a practicing moralist with occasional scumbag thoughts. Trust succeeds over "mack."
Had a conversation with the Mza a while ago about the state of medicine, and the inherent difficulties of implementing any sort of national policy in the face of ad/diversity. It's too late, I claim, and people are too complacent. Better to start locally and serve as a model for other locales, expand things to a state level. I'm talking about health care, bro, and how fucked up things must be if some places pay out bonuses to incentivize keeping insured patients in the hospital for longer than they have to in an effort to bilk as much money as possible out of paying or insured patients.
It's true, and the fact of the matter is that the uninsured get screwed. Some hospitals get more money from the government to see indigent patients, and some groups will pay their physicians just as much to see them as they do the insured. But as long as there's an inequity in the level of care provided, things'll continue to suck rocks.
How is this supposed to be fixed? Despite what plans I may have or would like to pursue, I've still got to take care of the basics of homelife. Slowly, I suppose, and with an eye towards the long-term. Such solutions might not come about in my lifetime. How aggravating, to have a problem which can't be fixed.
Business CC: Altered mental status. HPI: Mr. H is a 40-odd year male with no significant past medical history who comes to the hospital with altered mental status. He is accompanied by two friends who provided much of this medical history. Mr. H does not speak much English, and what he is able to communicate does not make much sense.
Over the past several weeks his friends have noticed Mr. H entering other people's rooms believing them to be the bathroom. He goes through the motions of washing dishes without any running water, soap, or a sponge. He has been complaining of muscle aches all over, and at times appears to be rather lethargic. He is in the country illegally, has no known medical problems, and has not seen a doctor in a very long time. No specific complaints are voiced, and he believes he's in the his hometown in Mexico.
There is no history of any recent illnesses. Specifically, his friends deny he had any complaints of fevers or chills, nausea or vomiting. No headache. No noticeable change in terms of bowel or bladder habits, including dysuria, polyuria, hematuria, constipation, diarrhea, melena or hematochezia. Questionable history of some weight loss over the past several months, questionable history of decreased PO intake.
There are no other issues otherwise on a complete review of systems.
Past medical/surgical/social history is, similarly, unremarkable except as mentioned above. No alcohol, tobacco or drugs.
VS: Temp 98.0, HR 90, RR 16, BP 117/70. SpO2 97% on RA. Exam reveals a lethargic, confused individual who appears his stated age. He is in no acute distress, but is not oriented to place or time. HEENT: Head is normocephalic and atraumatic. Pupils are slightly sluggish to react to light, but are otherwise equal in size. Extraocular motions are gross intact. Nares patent, posterior oropharynx clear, mucus membranes slightly dry. Tongue is midline. NECK: Supple, shotty cervical nodes, no bruits. CV: Heart is regular rate and rhythm. No murmurs, rubs or gallops. PULM: Clear to ausculation bilaterally. ABDOMEN: Soft, nontender, nondistended, normoactive bowel sounds. No masses. EXTREMITIES: 5/5 motor times 4, no calf tenderness, no edema. 2+ bilateral pedal pulses. NEURO: Cranial nerves II-XII grossly intact. Sluggish pupillary response and confusion as noted above. No problems with heel-shin or rapid alternating hand movements. GU/RECTAL: No bleed, no discharge. Good rectal tone, hemoccult negative. SKIN: Doughy, but no tenting. No rash, trauma visible.
LABS: Pertinent labs include a sodium of 120, glucose of 154. CT head is negative. CBC unremarkable, as is the CXR. U/A, UDS, tox and EtOH are normal.
IMPRESSION: Mr. H is here with altered mental status. Differential is manifold, but he appears to be slightly hypovolemic. Plan is as follows:
1. Hypovolemic hyponatremia: For the time being, slow correction according to protocol to avoid rapid and/or overcorrection leading to CPM. Will instill normal saline at 150cc/hr after a bolus of a liter NS, reexamine for any clinical changes. Will assume chronic hyponatremia for the time being, begin workup for possible underlying causes. 2. Altered mental status: likely secondary to #1. Neuro checks q4 hours. No signs of any focal neurologic deficits. 3. Social: obtain blue phone for translation services. 4. DVT prophylaxis with bilateral SCDs to lower extremities.
Thank you for the opportunity to participate in the care of this patient.
Later... After a transient improvement in mental status with slight clearing of cognition, Mr. H worsened significantly and now has increased and persistent lethargy. A briefly noted, questionable appearance of right-sided facial droop lead to reimaging, with a repeat CT scan being negative. He does not respond to verbal stimuli, but sternal rub elicits movement in all four extremities with no posturing. Furthermore, urologic studies including serum and urine osmolality as well as urine sodium, in addition to other studies, fulfill the criteria for SIADH. While many cases are idiopathic, an investigation in pulmonary and cerebral causes is warranted. CT scan of chest shows some hilar lymphadenopathy, with the largest measurable node still falling within benign ranges.
MRI of the brain, however, reveals patchy, diffuse signal attenuation involving the brain and brainstem with diffusion-weighted imaging. Review of CT scans of the head was performed, and the decision to proceed with lumbar puncture was reached. Two-physician consent was obtained as the patient remains lethargic.
LP was performed. Please review the procedure note. Worth mentioning is an increased opening preasure of 495mm H2O and a slightly hazy appearance of the cerebrospinal fluid. Cell counts show small amounts of red cells, relative lymphopenia, low glucose and slightly elevated protein. The fluid is xanthochromic.
Cryptococcal studies including india ink and Cryptococcal antigens are positive. Treatment with Ambisome and Flucytosine was instituted. Because of the increased morbidity and mortality associated with increased pressure, daily LPs are indicated according to 2000 IDSA protocols for management of Cryptococcal meningitis. Attempts to remove enough fluid to reduce opening pressures by 50% or under 200mm H2O will be made. Pressures will be followed serially.
A bit after that... Despite daily LPs, opening pressures remained high, and without any change in the patient's condition. The workup for Cryptococcus is positive for HIV and an absolute CD4 count of 10. After discussion with infectious disease, HAART will be instituted with close monitoring for immune reconstitution syndrome. I've spoken with the interventional radiologist on call, and will ask him to place a shunt to allow for easy access and draining of CSF.
Too late No change in condition. Patient continues to remain obtunded. CSF pressures are normalizing, but remain slightly elevated. Cultures remain negative save for Cryptococcus. Case manager was able to get a hold of the patient's wife in Mexico, and I spoke with her for an hour over the blue phone, detailing medical care up to this point, current grave prognosis, and code status issues. She wishes for Mr. H to be DNR, with no CPR/chest compressions, shock, intubation or ventilation. By her request, no heroic measures will be pursued. I expressed my sympathies and regret that I have been unable to make any sort of positive change to Mr. H's condition. Our conversation was followed by the case manager and Mr. H's nurse, and Do Not Resuscitate forms have been signed. Current plan of care involves the consultation of palliative care specialists and comfort care measures. Discussion about the patient's HIV status was pursued, and counsel was provided in terms of testing and medical follow-up for his wife.
Editorial I am frustrated that despite the clear and textbook workup for the patient's hyponatremia, SIADH and its cause, I have been unable to effect any change in his condition. I wish he would've gotten better. I hope the case manager is able to arrange for his wife to enter to country and see him before he dies, though this is unlikely. To have come up with so many answers but fail to correct the problem is infuriating. I'm pissed off, and disappointed, and any discussion I have with my colleagues or friends feels hollow. I tried my best, but it wasn't anywhere near good enough. It didn't even get the needle off of zero.
When you know someone's going to die, and you're doing your best to obviate further suffering by having discussions regarding code status, trying to convince family that the best thing to do is to let their loved one die naturally-- this is not a victory. Believing that the best thing for any patient is to let them expire, and getting that DNR form signed: this is not a victory. No one wins. There are no teams. Everyone loses.
All this makes me terribly lonely. I think about how selfish it is of me to feel this way. I can't help it. I come home, feed my cats and give Link his insulin. Sometimes I imagine him saying, "Aw man! Turkey n gibs AGAIN?! Where's the beef FEAST?" and I laugh.
Most times, though, I get angry at an empty house, crawl into bed and try to think of better times.
The Outside The doods came from the outside. They were bar cats who lived in a hippie cat commune with a billion other cats, and they enjoyed dining on buffwings and corn and french fries. Through rigorous training and various deprogramming/reprogramming protocols, I was able to domesticate them to a point-- some of their tendencies could not be mitigated, and so I had to give them patrol duties within our various places of residence.
Once I had left the windows of my ground-floor apartment open during a storm. The screen was either blown out of place, or the cats had torn it down. Either way, they had not gone outside as it was cold and wet and loud. To my relief I found them cowering under my bed that day.
With some effort I was able to get them to hang out on a small cement porch. The bars were fortified with morning glory vines, and there was only one way out to the parking lot, which was blocked by me and a small Smokey Joe grill. They sat calmly on the porch and enjoyed hamburger and fish. I thought they were rather well behaved!
Well, at some point several days ago, one of the ratmotherfuckers got out. I'm recovering. A friend of mine said summin like "hey, I think the door was cracked open, think one of the cats got out?" And I said naw, the door was shut, bitchez are inside enjoying toona. It's iight. Ok.
Fast forward several hours. I gotta go back to sleep. Sup, Link? I thought you loved me, sleeping next to me while I was recovering, but no, now I know your usual daytime habit is to sit yr fatass on my bed and snooze all day. But issok, you still cool. Say, where yr bro? Still on patrol?
Whatev. Went to sleep. Woke up, putzed around. Huh. Conspicuous absence of Roobik. WTF are you? So I looked all over the place. No cat. Link? He's still on the goddamn bed. I checked the garage. I clanged two tins of cat fud together. No Roobik.
At this point I started to worry, cause I don't think that either cat could fend for himself in the wild. I mean, the best either one could do is, like, "Hey bruvva, you got any tooona?" from Link and "GREETINGS COMRADE HAVE YOU ANY TOOONA FULLSTOP" from Roobik, but neither one can talk so they just end up looking stupid while they try to communicate.
I stuck my head out the front door and bellowed out "Rooooooooo... Biiiiiiiiiiiiik." A small rustle from ten feet to the right, and more rustling to the bushes. Then the ratmotherfucker just kinda yawns his way out of the holly bushes, looks at me, says "Добрый день," and walks inside!
ASO.
Sprint Through various negotiations, I should be receiving free, unlimited SMS txt msgs, a bunch of discounts and some other stuff from Sprint for my cell fone. Well, imagine my surprise when I saw that my last bill from them was 90 wingwangs! NINETY. Checking through stuff, I see that I've been getting charged for txt msgs. So I called. The lady verified that I should be getting free, unlimited txt msgs in addition to a bunch of other crap. She said she'd refund the extra charges. Then she looked back to see how long I've been getting charged like this for.
July 2006. That's, like, several hunnerd bones total, man!
Just goes to show you how much I suck at bills and munny. Which is why I went to see a real accountant the other day re: tax stuff and new job. Turns out that instead of forkin over 47% or so in taxes for income/state/Medicare/SSecurity (as I'm self-employed, etc.), I only give 33% this year! WOO! SUKKIT, SAM.
I've been growing flowers n cat. That is Roobik's ass obstructing the right side of Link's face. No, he is not pooping out Link.
Duh I have a difficult time with colloquialisms. Or whatever those phrases are. You know, phrases such as "sticks to the ribs" or "flash in the pan." I think I take them too literally. Either that, or I've got some sort of organic brain process that makes comprehension of such things difficult for me.
In medical school, we learned that some insight could be gained regarding a patient's mental state by asking them to interpret certain phrases. "Tell me what this means to you: 'People in glass houses should not throw stones.'" To which I answer, well, if you live in a glass house, like, that's fragile n stuff, so you can't throw stuff cuz you'll break yr home. Hmn.
I don't watch a lot of TV. I don't listen to the radio very often. I read about things, or catch things in passing. "What's colder than being cold? Ice cool." No. "What's cooler than being ice cold?" No. Or the whole Friends thing: "How you DOOing?" Well, I know that one of the words is stressed, and I know that the character Joey says it. Whatever.
The other day I went to 7-11 to get a Slurpee for my throat. The sign out front says they've got Squishees now, and Donuts. I go to the Slurpee machine, and it says it's Squishee! So I get a Squishee, and pay for it, and go outside, and sukkitdown. There's no candy, no nothing. No tangy chunks, no gummi particles-- no squishy. So I go back inside and ask the lady why there's nothing in the Slurpee, and she just kinda looked at me with the face of a yak chewing cud while her young are suckling on her teat and said something like "mmmooOOOHERe's not supposed to be." So I left. Annoyed that I'd probably paid extra for a Squishee Slurpee when all I got was a regular Slurpee.
More recently, I told this story to a friend of mine. And you know what he said? He said that 7-11 is part of some campaign for some Simpsons movie, and that's why they're advertising Donuts, and Squishees which, by the way, are basically Slurpees in the Simpsons world.
Fucking hell. In other news, pain's almost all gone. Can eat better. Lost 12-15 lbs. Breathing better. Dreaming more. Lots more. Bye.
You'll have to forgive me if this entry is a bit discombobulated. I'm gorked out on painkillers. I want to communicate to you the events of the past 72 hours.
The State of Things Seriously? Though? Who reads this thing to really gain insight into anyone or event? Do you accept it all as truth? Do I trust you to think otherwise? I lie to myself. Whatever. Serious stuff sucks rocks. I've thought about paring things down even further. Prune out the crap. Include other crap. What you read is what I write when the mania is the mostest. I really need to find another outlet. I thought home improvement would be it.
Well, at the very least, I can try to educate and inform. Hello. Here.
How to Paint Walls 1. Pick out paint colors (Saltwater, a nice smashing of Maxfield Parrish vs Roger Dean blues) 2. Answer "wha?" to whether or not you think you'll need primer. Forget to read up on primer 3. Buy insufficient supplies for painting a room 4. Decide that dropcloths are a waste of time, as you're told cleanup is a cinch with latex-based paints 5. Apply too much spackle and joint compound. Sand patches down with the ceiling fan on 6. Seal in the cancerous dust by smoking a cigarette on the deck. Decide it's too hot to smoke. Remember you're quitting anyway. Smoke down the rest of the pack out of anxiety 7. Feather the edges of the walls, just like you've seen and read about from the internet 8. Miss. Miss more. Give up on feathering. Get a smaller brush. Screw the painting to the sticking place, and move on to the roller 9. Roller SWEAT. Roller SEHR GUT. Roller FASTER. Roller sprays out flecks of paint. Roller SUCKS 10. Apply second coat. Remember that you were supposed to learn about primer 11. Try the edger out. Dip whole edger device into paint. Go out to deck for a smoke. Forget extra pack was on 3rd floor. Go back upstairs to get cigarettes. Fuck stairs and smoking. Sit and think about Yes! and Roger Dean 12. Break out the small brushes. Do edges. Do trim. Miss. Decide that the ceiling will be painted one day, so issok to miss just get the motherfuckin edges 13. Paint half a door before realizing semi-gloss on a door looks kinda wack, remember that you were supposed to inquire about primer 14. Clean up. Move furniture into place. Have drinks. Think seriously about hiring painters for everything else.
How to Repair Hardwood Floors 1. Buy crowbar 2. Pry a board out 3. Find no matching wood at Lowes #1 or 2, Home Depot #1 or 2, Random flooring special superstore 4. Put board back into place.
Checklist for Finishing Residency The Phoenix 1er cru burgundy from Jaffelin and Givry Perfect Tommy the Roll Counsel and compulsion Veuve C Mojitos for practice, Mojitos for fun Mint juleps A box for my desk at work.
New job starts 16 July. I'm gettin some minor surgery done to fix bad sinus stuff this coming Friday. Apparently, I broke some things up there when I was a lot younger, and it's been interrupting airflow ever since. A week for recovery, a week to learn about painting techniques, and POW! I'll be workin real good. I am excited.
So yeah, they came down to visit. Super fun, super short. This place is the penis of their trip cross-country, and I'm glad they made the diversion. Anyone else wanna do the same? Free room n board, if you've got the back for it: I've no furniture.
I still think of the girl from DC every once in a while, and mostly feel bad about it. Anyway, that's about that. More important things on the horizon, like people who really like me, and value me for who I am, and can accept my lunacy and OCD and ability to unabashedly write such pablum as this line. Not really. I'm bashèd. "Time is the ultimate anthologist." Vomit. "All bleeding stops." Groan. I'm bashèd. Here, have a couple of songs. I think you'd like them. Say hello again sometime. Peezout.
Tommy's got a baby boy who will grow up to be strong and mighty. Lin's got the superpower of insight and an ultimate forgiveness. I am grateful to know them, and miss them always.
They found the mactop.
They found the Wii.
I quit smoking this coming Friday. What a strange sentence. Hah! Funny double-em. Latez.
My condition has again been upgraded, from critical, to stable, to sweat.
1. the Test It's a two-day test consisting of a billion multiple choice questions and nine clinical case scenarios. These MCQs can have question stems ranging from two words ("What now?") to twenty paragraphs ("So, this dood was eaten cheezburger... Whereupon... Subsequently... The watusi suddenly jumped... What now?"). The CCSs are high-tech in that they're interactive. You order stuff and wait and see what works n stuff. In practice I ordered OB/GYN consults for male patients. The software is advanced enough to tell you to fuck off when you do that sort of thing.
The first day started well. After a couple of hours, though, I was getting slaughtered for time. This was unusual. I took breaks. I ate trail mix, popped some ibuprofen, and tried to feed the nuts from the mix to seagulls. Went home to give insulin to Link and seek advice. He said Don't worry. He said that it's pointless to panic, and that the important thing was to keep yr head up and trust in your preparation. He said that I shouldn't be soliciting advice from cats when it comes to medicine. Roobik nodded his head sagely.
Day two started with a woman crying outside the testing room. She wailed about how things weren't fair, that no, YOU were the one being rude, and asked How could you do this to me? After fifteen minutes of this, she was escorted into the testing room, sniffling.
Not everyone in the room takes the same test. Some are there for their GMATs, some are there for other exams. Some get their scores at the end, upon completion of their test. I've heard people cry and leave the room.
This woman, though, left relatively early. After I had finished my day, I asked the proctors what the deal was. She was there to take some sort of stock broker licensing exam, and she was upset because she wasn't allowed to bring her earplugs in to the testing room.
Fuck that.
2. the Wait Then came the weeks of waiting. I don't know why the powers that be won't give scores immediately after completion of the exam, other than to discourage windmilling rampages of the facilities. I knew that the average time for the release of results was 4-8 weeks, and I knew also that I could check to see if the exam was scored online. I could call the medical school I graduated from to look up the results when they're posted on Wednesdays.
Rationally, I believed that I passed the exam. But I was stricken with a terrible fear of failure. The improbable event of failure would result in very dire consequences. I wouldn't be able to start my new job on time. I wouldn't get paid. I also wouldn't be able to make but a few payments on the house.
It was stupid of me to commit to buying a house at such a juncture. It was also very stupid of me to wait to take the test for so long. Why did I put myself in such a position?
(Because I'm bored)
At any rate, I adopted a terrible mood. I slept very poorly in week three post-test. I hated working. I worried, and worried. Then the fourth Wednesday post-test came up, and I realized I was faced with three possible outcomes: - I passed, all is well - I failed, fucking hell - Results aren't released yet, please check in another week.
Of these, I decided the last would be the worst. At any rate, I called up the medical school's Office of Student Affairs, talked with a very nice fellow (who would've been an asshole if it weren't for the following words) who said: Wow. Uh. You passed. Your score is xxx. Congratulations!
I asked him to double check, to make sure there wasn't another person with my name. Because if I really did pass, I was going to play hookie for, like, ever. Anyway, I passed. I did well. Fuck the boards!
3. Now what? It's a good question. I've celebrated every day since then. I'm celebrating right now. I am very content in my boredom and the mediocrity of how I spend my days. I let myself go out to dinner with an Amazonian woman who was described by members of the office staff as "All leg." Which, by the way, does nothing to encourage me to engage in any sort of relationship with such a person as it makes me think of descriptors such as: "All breast," which, I guess, is about as appealing as "All leg," but then leads to "All thigh," "All white meat," "All dark meat," and "Mechanically processed to include rib meat." In other words, I thought of chik0n.
I think she likes me more than I like her. I don't believe the chik0n aspect enters into this judgement, for me. She is very athletic. I am afraid of pulling my clavicus with her. Her name has to do with Greek tragedy, and makes me mournful for what may come. There is no envisioning of the shape of her calves or her legs or where they meet. There is only sorrow, and the murmurous repetition of the word "poulet."
4. the Near Future! Packing! Moving! Filling of new-housing! More lame joking of Corian countertops originating from the Hermit Kingdom! This whole process remains intimidating. First item moved after closing: bottle of whisky. First order of official homemaking: the recreation of the forest moon of Endor on the deck.
But really, I have few major concerns. Of course, there's the health of my mom n pop, but everything else is comparatively minor. Are brass collar stays worth it? (Yes.) Turkey n gibs or tender beef feast? (The latter.) Should I go out again with leggirl? (If she asks. In which case I'd be motivated by guilt and attempt to transform neuroses into something more productive.)
5. the Very Near Future Will involve the consumption of dinner with my pals B & C @ their frenz birthday something. B is a drummer in 1888, who've recently released their first album. He showed me the ropes of cutthroat billiards.
He's a great guy and a ridiculously great drummer, and his band is wonderful and the kind of music they play makes me go doubleplus good bananas and I'm going to meet the girl of my dreams at one of their shows and she's also gonna go bananas and there will be no questions of honesty or purity because all the girls who go to 1888's shows have bowels which end in a bright white light and there will be no thoughts of chik0ns or farms or tragedy. There will be wondrous prophecies, however, believed by all. The only questions will consist of whether you let your irises fold shut, or look askance as if you're looking for the Pleiades.
And there will be thoughts that would make chik0ns and watusi blush, and she will be cool wit dat.
Tomorrow and Saturday I'll be taking yet another round of the medical boards for licensure. I should do well. I've been reading a book called "Crush!" I think it has been helping. Every day, I've consumed one or two Flintstones Complete chewable vitamins. Any other kind upsets my stomach. Just now, I believe I had a Bam-Bam.
The pass rate for this round is something up and over 96%. I should do well. I've been practicing with an online bank of questions, complete with performance metrics, and I should at the very least pass.
A sample test CD was sent out by the testing service several weeks ago. In the midst of my panic, I tried the questions out and scored up and over 90%. I should do well. I've been eating well (a salad two days ago!) and taking my vitamins. I've been practicing a lot.
Kinda going nuts here. Gotta go see patients this afternoon, then I've got to buy some groceries. The usual test fare: nuts, bars of nuts, random tasty drinks. I'll be packing ibuprofen and allergy meds and will take several pills prior to the test prophylactically. But I should do well.
Whatever happened to mental toughness? I've got to BELIEVE. I am a WINNER. The consequences of me not passing are dire. But, in theory, I should do well. I'm confident. I think. But it's a good time for religion and prayer.
Oh, what the fuck. I'm gonna crush this motherfucking test. Fuck you, motherfucking test, and the horse your father rode in on. Or something. I'm gonna go get some goddamn chik0n fries. I'm goin CRAZY. Who knows what I'll do next? MAYBE NOT EAT MY VITAMINS FOR TODAY.
Shit. Dog. (_!_).
I've been trying to think of things I could remind myself of to build up my confidence. Here's one: when I was filling out all the paperwork for mortgagecrap, there was a box for "Grade." I ask, "what do I put here?" She says, "your grade, you know, for school." "But I'm, like, out of high school?" "Well, how many years did you go to school for?" So I counted and she put down, like, 24 or something. WTF.
Fuck this goddamn test. I'm gonna get a burrito on Saturday, afterward. Then I'm gonna get a six-pack of mack.
a higher-res version here! to be appended: more job stuff, real estate stuff, movie stuff, and pain in the distal insertion of the biceps secondary to overzealous wii play. also: why we should "Think globally, act locally" is a waste of time.
well, a waste of time compared to thinking and acting locally. i mean: tangible benefits and investment for the community. more on this later, especially regarding health care. national health plan? pizacrap. start small, make big. will work.
fixed borked link to orchid vid. i am lost without purpose now that i don't have something regular and scheduled to do. maybe take pics of its decay? need bigger cam mem card.
[1] HD = herrdoktor, but before this (and more significantly) HD = Hilda Doolittle, fellow of the Pound school of Sweat who eventually grew up and out of Imagism in ways that humble and befuddle. Practice? Patience? Penance, for the too little or more of both? How much work does it take to find one's own originality? And how much work to find and polish what might be impossible to recognize? Am trying to write more, and regularly, for serious purposes vs. this LJstuff. Meaning less of this, and more of, well, nothing so far. 8P
[2] A couple of weeks ago I went to see a couple of bands from RVA and here, and was humbled even when they weren't spectacular. Shouldn't I have been spending the past ten years developing or maintaining some skill? What I've done and do now is my job. I wish I could sing, or play guitar, or piano, or trumpet. I wish I had kept up with the violin or writing. And what little creative juice I can sequester is used up on things that can't cohere: that have no real lasting merit.
Take, for example, this business of this LJ. It could be argued that its function as a journal is valuable enough for me. But it isn't: I rarely ever read through past entries, not too much consideration goes into what's presently written, and, above all, it's not the truth, the whole truth, or anything close to nothing but the truth.
[3] Which isn't to say I lie. Rather, it's whatever the result of some cataclysmic, enzymatic reaction leading to a push above and beyond an energy of activation. It is the result of the worst kind of strength. It is riddled with deficits and should never be taken to be complete.
For whom do I write? Of course myself. Maybe you. Mostly for my friends, because it's so hard to keep up with each other, though we may live in the same town. It is humorous to engage in a conversation whose roots are here, and deceptive, to some, to finish them without written resolution.
I suffer from comment-envy, but realize that I don't keep up with my own replies to others' journals. I read them, am late, and feel like I've nothing to contribute.
[4] The job hunt has turned into a feeding frenzy, with stupid negotiations. I suppose it's nice to be vied for, but there's something dirty about the whole process. "Every point in every contract can be negotiated," I was advised. "Compensation" replaces "salary," "signing bonus" turns into "pinball machine," and the word "lifestyle" is thrown around with disheartening frequency.
ATTENTION ALL PLANETS OF THE SOLAR FEDERATION: I'm interested in working with a predominantly uninsured/service population. I don't care about the money, but I would like a pinball machine. Also: I'd rather not work with asshole physicians. I really don't care if 90% of my patients are insured, and therefore, better-paying, and your equivalence of "great lifestyle" with "we have no service patients" is balls. I truly am grateful to not have to worry about future employment, and that whatever you offer in terms of payment will guarantee that I won't have to eat Boyardee out of necessity. But seriously, man, there's a reason why our health care system is fucked up as much as it is.
[5] I've been covering the ICU. It's depressing, and I am finding myself saying that I'm sorry more often than I'd like. I am sorry for your loss. I'm sorry we couldn't do more. I'm sorry that your son's bitch-ass girlfriend didn't bring him to the hospital sooner. Sir? Sir, I'm sorry, but I've gotta suck out some of that pus from your lungs-- I don't mean to cause you pain. Maybe if your bitch-ass girlfriend didn't dick around for the entire day while you were unresponsive on the floor you'd be responding to the antibiotics. And what's the deal with the bruise, brother? She said she opened the door onto you while you were sleeping.
Sorry, I know you're very close to your son-in-law, but you've no legal say in his medical care. Sorry we can't find any next-of-kin. Sorry that we've got to do our "best" and bust some ribs and put you on the vent, even though you're gonna die.
Your heart slows again. This time I imagine it's been you who's been stealing your pulse away. I resent being in this position and having to make such decisions, but it isn't your fault, and when the code's run long enough, I end it with my hand spread out, palm down and angled up, and wish you luck with a wave goodbye.
And to any of you fuckers who cat-call with accusations of melodrama: fuck you. Fuck, also, me, for my misconceptions and delusions of grandeur. In other words, fuck this entry and the ones immediately preceding. I've done and really do try to do my best, but sometimes realize too late that I've lost my bearings. I'm sorry. I really am.
Quality entries from here on: a time-lapse project involving Bonanzo: the Wonder Orchid of Awesome, thoughts of Edward Norton as Ez Pound, Imagism vs Nazism and, if I can find it, something on the Maastricht Treaty and cheese.
[6] PS: G, I swear I'll get to the review this weekend. All I've wanted to do for the past week is sleep and eat cookies. I don't know what to say except: I've been angry, and I wish I didn't make myself so. This doesn't excuse the delay.
The Job So I've been getting some offers, but haven't signed any contracts. It's just a matter of where, how often, and for how much. I hate discussing things like salary and perks. Crocoshit. But then I don't have any obligations like a relationship, kids, a house, a boat, or a restored 1972 MGBGT. I'm looking for a position as a hospitalist, where I'd just be doing inpatient medicine, admitting patients from the ER to the floor or ICU. I like complex medical problems. I think I'll do this for at least a couple of years, and then probably start my own practice or summin. Hang a shingle. Many hospitalist positions entail working X number of days then taking Y days off. Say: a week on, then a week off. This is great, not just because it's like taking a vacation every other week, but because I could be doing other things like service work in the week of downtime. Or, say, a week of pinball.
Where? Probably here. The hospital I work at serves a chronically sick population. It's crazy how half a mile of water could make such a difference in terms of health care, but the other side is hurtin'. Bad. Plus, there's a free clinic it's associated with, and it'd be easy to do service medicine there. I've the respect of the area attendings and hospital staff, and they're the ones who've been rooting for me, speaking with the medical director of the hospital. Plus, the program director has asked me to stick around and work in the office when I can. Sweat.
It's crazy: the hospital can't seem to attract enough hospitalists to fill the position, despite the high compensation it's offering. This is primarily because there are a ton of patients to see, and I guess people don't wanna work that hard. You know: they've got, like, kids, or a wife, or a house, or a life. Me? It's an ideal population to work with, and it's why I abandoned surgery and orthopedics. Plus, it pays well.
I can't wait. Money, power, women: I'll have it all! Pfft. I'm just grateful to be doing what I do, and feel very fortunate to be where I'm at now. I'm also very thankful that I locked my 150k+ in med school loans at a low, low, LOW interest rate. Lower than the rate of inflation! Super sweat!
The Suit New suit! 3-button, vented, lined, sharp n tailored for the modern look. It will win me jobs, it will woo me shallow women. It will also be slimming for TV tomorrow, where I'll have to give a presentation on Falls and the Elderly Population for thirty minutes in front of a live studio audience. WTFOON.
The Life I've said if before, and I'll say it again: medical school is dehumanizing. Maybe that's why I'm single at 31: my emotional growth was stunted for years. Also: I missed out on prime dating years, pursuing academics and a relationship that ended in great unpleasantness. Not this most recent bit: apparently, there was no relationship to speak of. "I can nail my left palm / to the left-hand crosspiece but / I can't do everything myself. / I need a hand to nail the right, a help, a love, a you, a wife." I thought I was cynical but I'm really just a sucker, and I'm demonstrably less cynical than others.
The Leonids As mentioned before: a bust! Developed and scanned some negs last night. Only decent result below. Short shutter time out of frustration over the clouds, one blip of a shooting star not long enough for even a short wish ("MORE TACOS PLZ!"), but nice clouds, and plenty of stars. Bless big glass and wide apertures. Click on pic for a bigger version. Smell my fingers.
No specs None of the preceding stuff meaning that I'm resentful. On the contrary, all positions are understandable and reasonable (even my own?) though I tire of being defensive, even as I recognize my impulsivity. Barring the inherent melodrama of this LJ, there's nothing that keeps me from enjoying this tasty clementine this early AM. But I would like to make things better, or at least whole again. Remember, self: mitigate conflict, internal or otherwise. Maximize comfort. Obviate forgiveness. This is why there are few specifics in this thing, and fewer entries. You won't find the droids you're looking for, here.
The Boot was swell. Great to see G&R again, and great to see G again last night/this morning. And tonight: four game hens! Too bad I gotta work. Anyway, we're gonna hafta duke it out when it comes to Murakami. I admit that maybe I was a tad hyperbolic when it came to my condemnation of Japanese cinema, but really, the preoccupation with the saccharine sucks my will to live. Pictures stolen from C, from the Boot. B and G, I appreciate the matchmaking efforts, but I'm hung up and stuck up and, well, I'm on nights. Nyagh.
Home was good. Tons of eating, the visiting of fambly n friends, and little traffic. Brought the mongrels, and though they didn't dig the car trip, they enjoyed the many stairs of Home-Home.
Finally, night float begins again tonight. Voluntarily picked up these two weeks' worth of evenings to cover for a resident who has taken a leave of absence. At least this means that I won't have to do this ever again! Hooray coming home at 7am and snoozing til the sun sets! Hooray late night snack raids! I cry. I sob. Send txt msgs plz.
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Off to night float. Made food for potluck. Bye G! Bye R! Someone, anyone, entertain me @ work! Burp.
Which isn't to say that I confuse the deep with the shallow, or the broad with the narrow, or muffins for turds. Though muffins, supposedly, aren't merely cupcakes without frosting. I think. But sometimes it's fun to unwind and imagine fantastic improbabilities. My friend the Fef swears that "things happen for a reason," to which I respond: of course! But he is thinking of grander schemes, whereas I compute KICK TO CROTCH -> TINY YELPS.
Believe me when I say that I get it, but don't like it. C, who currently has no nickname and thus is abbreviated as C, makes mention of the confusion of romance for obsession. This makes me think of scents: Poison, Boss, Incanto, Egoiste. Then I feel bad(ly? Now I think of mechanisms, and now movies--) until I try to think of the theme song for the Drakkar Noir commercial. I think of phrases like, "way to blow it," or "you done boned it up, yoh," or "I say old chap, Link here says that you've gone and gotten yourself hurt! Chip chip, ol' pal. Be a good friend and fetch me a tin of toona." And then I think, no, I haven't done anything but represent myself as myself. Which is to say: two fingers' of stupid, a dash of awkward, and a sidelong glance at mania.
Admittedly, this is biased. Maybe I am a jerk/cad/nut/etc. So uncouth. You know what's great about medicine? Patient follow-up. Call them after you've seen them, or stop by their home and see how things are going. Confirm diagnoses, take comfort in appropriate treatment, learn from things that didn't work. I guess the same could be said about post-work preloaded evaluations of car shops: Please rate, from 1 to 5, the level of excellence I have delivered in the following categories. And then we just skip to the "additional comments" section and write in "GREAT," or "WAY TO BLOW IT."
Fred: And one of the things that keeps popping up is this about "subtext." Plays, novels, songs - they all have a "subtext," which I take to mean a hidden message or import of some kind. So subtext we know. But what do you call the message or meaning that's right there on the surface, completely open and obvious? They never talk about that. What do you call what's above the subtext? Ted: The text. Fred: OK, that's right, but they never talk about that.
Whatever. I try to avoid various levels of complications, because it feels manipulative and is a pain to keep track of. Was I supposed to do X? Is it ok to say Y? Etc. Why bother? (Psst, because people think that things happen for a reason, and are always looking for the subtext. Don't defy etiquette. Stick to protocol. Don't be so depraved, lest people take you for a nut.)
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Anyway, enough of all that stuff. It's pointless, and I see no satisfactory lines. So I'm gonna stop talking about it right. Now. The Leonids, overall, were a bust! Damn clouds! Clouds from one end of the horizon to the other! Still, our overall count was maybe 2-5 per person, with a couple of impressive meteors, before we called it quits. I enjoyed spotting the handful of stars I knew including Procyon, which is the Awesome star, because Sirius is such a gloryhound. Hah-hah. Hound. And I had forgotten how loud the waves could be, and how much clouds can transmit light from cities. A clear patch of sky affords a remarkable view of the stars, and reminds me of just how small you and I are, and that all these problems-- all my problems, are so trivial. And similar: remember to do your best, not for King and country, but for everyone else, etc. (This is when I think about how, last week, I covered a colleague's clinic schedule, and helped an old man push his Jeep in the rain, and about that guy who was discharged from my service with my goddamn clothes and my goddamn shoes because he was homeless, and how the motherfucking cosmos owes me. Not really. Scuse me while I pretend to pout.) No pics yet, waiting to finish the roll.
Because I'm supposed to pout? There is no equation for reason. Nonsense happens for no reason, trying to find blame maddens. Except when things are arranged such that I feel like I've done some wrong. Learn what? Why feign?
Link's blood glucose is coming down very slowly. I'm trying to avoid bumping up his doses of insulin, as cats apparently take time to respond. I dunno. Sounds like a load of vet-hooey to me. Regardless, I think he's kinda getting better. Like how some depressed people slowly get better with antidepressants, Link has decided: Hay, you know whut? I think imagonna jump up onto that ledge n snooze today. Wet cat food makes for stinky cat poop.
No, I'm not on any antidepressants or medication, save for some Flonase for allergies.
No, I do not have any significant psych diagnoses according to the DSM-IV, except, maybe, for a touch of hypomania. I keep this under control through dietary supplementation of cake.
I'm still watching a lot of movies. There's an interview with David Gordon Green in the latest Believer. (Thx 2 C&B for the sub.)
And work? Work is work. I still love it, and wonder why some people won't trust me for my motivations while others entrust me with their lives. What an awesome privilege, and how humbling: my concerns are indeed small.
GET OUT AND VOTE Just do it. Also don't forget to write in an amendment to your state's constitution calling for the immediate transport of your state's awesomest women to yours truly.
Kitty Diabetes After months of drinking tuns and peeing tuns and a comment on his weight loss which I attributed to my genius plan of moderate diet and exercise, as well as jokes about kitty diabetes, Link has been officially diagnosed with Feline Diabetes Mellitus. And after forking over wingwangs up the wazoo, I am now in charge of testing his blood glucose with a human glucometer, daily. I must feed him and Roobik special three times daily with low-carb food. Later this week, I'll be picking up some kitty insulin to give Link shots.
The good news is that kitty diabetes is often partially reversible: after a period of receiving exogenous insulin, kitty pancreases can heal and the diabetes can be controlled through diet alone. Cat insulin is the same as human insulin, and I'm thinking of hittin up a drug rep for some free Lantus.
At the vet, Link popped a curious pug puppy in the nose real ninja-like, and the pug went scampering behind his owner's legs. Sucker.
NOW FOR THE MEAT Leonid meteor shower peaks on the night of the 18th. The source of the meteors is the dust from comet Temple-Tuttle, which has a 33-year orbit. This year's predictions are promising, as the earth will be passing through a decent trail left behind in 1932. Additionally, the moon will be close to new, so it'll be dark.
TOTALLY SWEAT!
Here's how to find them: - drive out to the darkest place you can find. One with a clear view of the eastern horizon - look to the east and hold your thumb sideways, parallel with the ground - look up two thumb's worth, then over a bit - in the pic above, the yellow blob is Saturn. To the left of it is the pentagon of Leo's neck. This is where the meteors will appear to originate from - see how close this is to the horizon? Yeah, go to a place with a clear view of the east! Say, Assateague! Ah, nothing but the ocean between you and the stars - as the morning progress, Leo will move up and to the right. Actually, all the stars will appear to rotate around a spot near Ursa Minor - enjoy!
(Ah, this is the view from the eastern shore of VA. If you want an exact view of what you'll be seeing from where you'll be seeing it, send me your location and I'll punch it in. And if you're innerested in taking pics of this, send me a message and I'll fill you in on a quick n e-z way of taking them.)
In other news Old turntable died, so I started calling around the pawn shops n stuff to see if they had any used one. Was looking to get a used Thorens, but no dice! In desperation, I called Guitar Center. They had a used Technics SL1200mk2 without a counterweight for the tonearm for $150! AWRIGHT! Course, when I get there it turns out the tags were switched. But they were switched with one that had a counterweight! AWRIGHT! The ground wire was clipped and the guy sold it to me for $100! AWRIGHT! New headshell and cartridge, check! I got home and found that the thing was BORKED. It wasn't tracking properly and kept skipping, playing a goddamn loop. This, despite the ghetto number of coins I slapped on the head. So I took it apart, found that whoever owned it previously overtensioned the pivot screw of the gimbal. Simple fix! Ground wire extended! Tonearm calibrated! PERFECT PLAYING! YESSSS!
Ah, Guitar Center. Source of a perfectly working turntable for $100 and a Moog Rogue for $300.
And yeah, yeah, high-end belt-driven turntables are superiorwhatever. But this thing is rock solid. AND YOU CAN'T SCRATCH WITH A BELT DRIVE! Just kidding. I mean, about me scratching. Whatever. Stop reading. Go make plans for the Leonids.
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