After all night and half a day at the hospital, I'm heading home at last. Someone yells out my name before I make it outside, and sticks an envelope in my hand. Inside is an eight-page form bearing the name of one of my patients. A cover letter tells me I have to fill out the entire form, describing in detail the patient's mental condition, since her family is pursuing emergency guardianship in court. The cover letter goes on to state that my patient must be examined by a doctor, a psychologist and a social worker before being declared incompetent to conduct her own affairs.
WTF? The lady in question doesn't need a social worker or a psychologist: she's been comatose from a massive stroke for over a month. (Her aging baby sister, touchingly, spends most days at her bedside, nagging at her to wake up and stop letting her tongue loll out of her mouth.) Someone in the downtown government building has obviously screwed up. Huh. Maybe if I tell them so, they'll let me off the hook for the eight-page form.
Outside the door of the hospital, I blink in pain. It's a bright, breezy twenty degrees, and my eyes burn with fatigue and I realize I no longer care about anything. (I actually stopped caring shortly after sunrise, which was several patients ago. Hopefully the patients didn't notice.) Shivering violently behind the wheel, I fumble with my cell phone and punch the phone number from the cover letter: For questions, please call... Three rings later, a baritone answers on the other end of the line.
Baritone: Swing coconut.
Me (gaping in confusion while sprinting through a yellow light): Is this, um (here I fumble with the forms) the, the County Attorney's Office for Mental Health Issues?
Baritone: Yes.
Me (increasingly baffled): Wow, that's funny. When you answered the phone I thought you said "Swing coconut."
Baritone (very gently): Yes. May I help you?
What? Oh, I get it. It's a mental health department. He thinks I'm crazy. This man who answers his phone with the words, "Swing coconut" thinks I'm crazy.
This strikes me as so hilariously ironic that I begin to giggle helplessly.
Wednesday, January 23, 2008
Sunday, January 13, 2008
welcome, fetus!
My aunt emailed the following:
Just a short message to tell you the exciting news: Dan and Bobbi and going to have another baby! The due date is July 1. We're all crazy with joy. Love, Lil
I sat down to write the usual exclamation in return: Congratulations! That's what people say in this situation, am I right? Congratulations! That's wonderful!
As a three-time fetal incubator, I have heard plenty of Congratulations! myself. But I always wondered grumpily: what the hell are these fools congratulating me for? All I did was have unprotected sex and then go about my business. Meanwhile, somewhere inside of me a sperm and an egg decided to make a zygote of themselves. I can hardly take credit for that.
Congratulations! implies that one has done a good job or emerged victorious from a struggle or won a prize. The winning team that gave their all, the woman who got the big promotion, the student with the A-plus, all deserve congratulations. But do I deserve congratulations for having had sex? Is zygote-making a difficult and praiseworthy accomplishment?
(It would be praiseworthy if I'd done the deed by putting a sperm and an egg together in a sterile dish in my home Fertilo-Lab, then carefully edging them toward eachother with delicate instruments, slowly, slowly, with great patience, until I finally got them to merge. But, y'know, I actually didn't do that.)
I have a dark suspicion that Congratulations! reflects the ancient idea that a woman is a useless husk unless her womb grows some sort of fruit (the male sort, historically). The congratulater assumes that the pregnant woman has achieved something she values greatly: namely, a victory over barrenness. I imagine that when Sarah of the Old Testament finally conceived a child after some ninety years of desperate trying, her handmaidens showered her with congratulations. Whoo-hoo, Sarah, you did it at last! You've finally become worthy of the life God gave you and the roof Abraham has put over your head all these years. You've prayed enough, been patient enough, and stood on your head after coitus enough, to make God bless your ancient, shriveled uterus with a thriving fetus. Congratulations; you've earned it!
Yeah, well. Times have changed.
There's another possible explanation for Congratulations! -- it might be meant to imply moral victory. As in, Congratulations -- you've made the right choice to come over from the dark side! After all these years of thinking your career mattered; after all these years of being too selfish to do your womanly job, congratulations on throwing in your lot with the rest of the mama herd.
(You see, for a while there, all us other mothers were nervous that we'd made the wrong choice. We watched you climb the ladder of success and go out dancing every night and pluck the stars from the sky to adorn your hair, while we were home burping the tots. We chewed our nails and tried not to remember that we had once loved to dance, too. But now you've converted, proving for all time that we made the right choice -- since even women who temporarily claim not to need babies, eventually realize their error and come around. So, congratulations on doing what you should have done years ago -- and now let's make catty comments about all those selfish, perky-breasted females who think they're too damn good to have stretch marks like the rest of us!)
Even more obnoxious than the fatuous congratuations given to the pregnant woman, are the fatuous congratulations given to the expectant father. What is the meaning there? Congratulations, your sperm can swim! Congratulations, you knocked her up like a real stud! Congratulations, you suckered her into doing all the gestating for you -- that oughta keep her home where she belongs. Or is it, Congratulations, you'll finally have a son and heir to carry on the family name and help on the farm!
Furthermore, why should I congratulate my aunt, of all people, on the impending birth of a long-desired second grandchild? Congratulations, you got what you wanted out of your son and daughter-in-law. You must have mounted a successful campaign of hints, complaints, and sighs until you wore them down. Good job!
In the end I wrote back the only thing that I could stomach.
Hey Lil,
If Dan and Bobbi and you are so happy, then I'm happy for ya! I hope the little-one-to-be experiences smooth sailing for the next eighty-plus years.
Somehow that seems like a bit of a downer. I'm pretty sure I was supposed to just say congratulations and pretend that every pregnancy is a fabulous accomplishment which brings nothing but joy forever.
I couldn't do that, though. After all, I'm a mother three times over. And a lousy liar.
Just a short message to tell you the exciting news: Dan and Bobbi and going to have another baby! The due date is July 1. We're all crazy with joy. Love, Lil
I sat down to write the usual exclamation in return: Congratulations! That's what people say in this situation, am I right? Congratulations! That's wonderful!
As a three-time fetal incubator, I have heard plenty of Congratulations! myself. But I always wondered grumpily: what the hell are these fools congratulating me for? All I did was have unprotected sex and then go about my business. Meanwhile, somewhere inside of me a sperm and an egg decided to make a zygote of themselves. I can hardly take credit for that.
Congratulations! implies that one has done a good job or emerged victorious from a struggle or won a prize. The winning team that gave their all, the woman who got the big promotion, the student with the A-plus, all deserve congratulations. But do I deserve congratulations for having had sex? Is zygote-making a difficult and praiseworthy accomplishment?
(It would be praiseworthy if I'd done the deed by putting a sperm and an egg together in a sterile dish in my home Fertilo-Lab, then carefully edging them toward eachother with delicate instruments, slowly, slowly, with great patience, until I finally got them to merge. But, y'know, I actually didn't do that.)
I have a dark suspicion that Congratulations! reflects the ancient idea that a woman is a useless husk unless her womb grows some sort of fruit (the male sort, historically). The congratulater assumes that the pregnant woman has achieved something she values greatly: namely, a victory over barrenness. I imagine that when Sarah of the Old Testament finally conceived a child after some ninety years of desperate trying, her handmaidens showered her with congratulations. Whoo-hoo, Sarah, you did it at last! You've finally become worthy of the life God gave you and the roof Abraham has put over your head all these years. You've prayed enough, been patient enough, and stood on your head after coitus enough, to make God bless your ancient, shriveled uterus with a thriving fetus. Congratulations; you've earned it!
Yeah, well. Times have changed.
There's another possible explanation for Congratulations! -- it might be meant to imply moral victory. As in, Congratulations -- you've made the right choice to come over from the dark side! After all these years of thinking your career mattered; after all these years of being too selfish to do your womanly job, congratulations on throwing in your lot with the rest of the mama herd.
(You see, for a while there, all us other mothers were nervous that we'd made the wrong choice. We watched you climb the ladder of success and go out dancing every night and pluck the stars from the sky to adorn your hair, while we were home burping the tots. We chewed our nails and tried not to remember that we had once loved to dance, too. But now you've converted, proving for all time that we made the right choice -- since even women who temporarily claim not to need babies, eventually realize their error and come around. So, congratulations on doing what you should have done years ago -- and now let's make catty comments about all those selfish, perky-breasted females who think they're too damn good to have stretch marks like the rest of us!)
Even more obnoxious than the fatuous congratuations given to the pregnant woman, are the fatuous congratulations given to the expectant father. What is the meaning there? Congratulations, your sperm can swim! Congratulations, you knocked her up like a real stud! Congratulations, you suckered her into doing all the gestating for you -- that oughta keep her home where she belongs. Or is it, Congratulations, you'll finally have a son and heir to carry on the family name and help on the farm!
Furthermore, why should I congratulate my aunt, of all people, on the impending birth of a long-desired second grandchild? Congratulations, you got what you wanted out of your son and daughter-in-law. You must have mounted a successful campaign of hints, complaints, and sighs until you wore them down. Good job!
In the end I wrote back the only thing that I could stomach.
Hey Lil,
If Dan and Bobbi and you are so happy, then I'm happy for ya! I hope the little-one-to-be experiences smooth sailing for the next eighty-plus years.
Somehow that seems like a bit of a downer. I'm pretty sure I was supposed to just say congratulations and pretend that every pregnancy is a fabulous accomplishment which brings nothing but joy forever.
I couldn't do that, though. After all, I'm a mother three times over. And a lousy liar.
Monday, January 7, 2008
at least do it right
In the news lately: A young woman disappeared while hiking on Blood Mountain, in Georgia, with her dog. A shifty-eyed drifter was arrested practically dripping with her blood. Everyone is shouting for the death penalty.
A few thoughts.
Thought #1: Hey, Blood Mountain! I think I climbed Blood Mountain myself! Isn't it the highest elevation on the Georgia segment of the Appalachian Trail, about four or five days' hike from the southern trailhead at Springer Mountain?
I was right out of college when I struck out on the AT. (That was just before the whole Europe extravaganza I write about in my name is not loulou). Before I left for Springer Mountain, I had to handle a medium-freaked mother who didn't think her girl would be safe hiking alone in the land where Deliverance was filmed. So to make her happy, I found myself a male hiking buddy. He was a grad student named Joe, very manly and stubbly-faced, good at rasslin' bears and fighting off toothless mountain men. He didn't actually exist and my mom knew it, but she pretended that he did, and so did I, and that made us both feel better! So I headed off to Georgia with a big backpack and an imaginary friend and no clue what I was doing.
Now when I read the news of this woman's death, my blood chills. That could have been me getting hacked to death on Blood Mountain, with no help to be had from the vaporously insubstantial Joe. Do you realize how absolutely terrible that would have been? Think of it -- my mother would have spent the rest of eternity shrilling, "I told you so!" -- and I could hardly have argued with her. There's nothing worse than having one's mother be proven right.
Thought #2: Okay, can someone tell me what the hell is up with lethal injection? I hear it's under investigation as cruel and inhumane punishment. Apparently there have been fiascos where people bucked and howled on the table and wouldn't die on cue.
As a doctor, I am totally mystified by this. We put a million people to sleep every day in the OR without any discomfort. Not to mention, a thousand people a day manage to off themselves painlessly by overdosing on narcotics. Does this mean that our prison administrators are less capable than the average needle fiend?
I read a description of the method used. It's baffling. The first medicine given is a sedative, something like Valium. The second is a paralytic, which freezes the muscles so the subject can't kick. (It also means he can't breathe or shout for help.) The third medicine is potassium, which stops the heart.
The paralytic is the problem. It's useless. If the guy is properly sedated, there is no need to paralyze him, since he's feeling nothing and moving nothing anyway. And if the guy ISN'T properly sedated, you're inflicting great torment by locking an awake, conscious person into a state of immobility -- during which time he is asphyxiating slowly (due to being unable to draw breath) but still is fully aware and able to feel physical and mental anguish.
The only possible reason for using a paralytic is to make a painful horrible death look like a peaceful one, by keeping the victim from kicking and screaming and otherwise upsetting his audience. Well, that's just plain silly, IMHO.
I'm now going to spell out my recipe for execution -- just in case any prison system administrator is reading my blog tonight.
1. Start with a massive intravenous dose of a sedative like Versed or propofol. Push it hard and fast. This is not the place to nickel-and-dime the poor SOB by watering down the meds.
2. When the dude's head lolls back, hit him with a monster dose of potassium. Boom, heart stops. What's the problem?
For the record, I'm against the death penalty on most days. (On this topic, my liberally-educated intellect wars with my primitive Sicilian blood, so I waffle a lot.)
But it really, truly, just irks me to see these prison guys botching such an easy job.
A few thoughts.
Thought #1: Hey, Blood Mountain! I think I climbed Blood Mountain myself! Isn't it the highest elevation on the Georgia segment of the Appalachian Trail, about four or five days' hike from the southern trailhead at Springer Mountain?
I was right out of college when I struck out on the AT. (That was just before the whole Europe extravaganza I write about in my name is not loulou). Before I left for Springer Mountain, I had to handle a medium-freaked mother who didn't think her girl would be safe hiking alone in the land where Deliverance was filmed. So to make her happy, I found myself a male hiking buddy. He was a grad student named Joe, very manly and stubbly-faced, good at rasslin' bears and fighting off toothless mountain men. He didn't actually exist and my mom knew it, but she pretended that he did, and so did I, and that made us both feel better! So I headed off to Georgia with a big backpack and an imaginary friend and no clue what I was doing.
Now when I read the news of this woman's death, my blood chills. That could have been me getting hacked to death on Blood Mountain, with no help to be had from the vaporously insubstantial Joe. Do you realize how absolutely terrible that would have been? Think of it -- my mother would have spent the rest of eternity shrilling, "I told you so!" -- and I could hardly have argued with her. There's nothing worse than having one's mother be proven right.
Thought #2: Okay, can someone tell me what the hell is up with lethal injection? I hear it's under investigation as cruel and inhumane punishment. Apparently there have been fiascos where people bucked and howled on the table and wouldn't die on cue.
As a doctor, I am totally mystified by this. We put a million people to sleep every day in the OR without any discomfort. Not to mention, a thousand people a day manage to off themselves painlessly by overdosing on narcotics. Does this mean that our prison administrators are less capable than the average needle fiend?
I read a description of the method used. It's baffling. The first medicine given is a sedative, something like Valium. The second is a paralytic, which freezes the muscles so the subject can't kick. (It also means he can't breathe or shout for help.) The third medicine is potassium, which stops the heart.
The paralytic is the problem. It's useless. If the guy is properly sedated, there is no need to paralyze him, since he's feeling nothing and moving nothing anyway. And if the guy ISN'T properly sedated, you're inflicting great torment by locking an awake, conscious person into a state of immobility -- during which time he is asphyxiating slowly (due to being unable to draw breath) but still is fully aware and able to feel physical and mental anguish.
The only possible reason for using a paralytic is to make a painful horrible death look like a peaceful one, by keeping the victim from kicking and screaming and otherwise upsetting his audience. Well, that's just plain silly, IMHO.
I'm now going to spell out my recipe for execution -- just in case any prison system administrator is reading my blog tonight.
1. Start with a massive intravenous dose of a sedative like Versed or propofol. Push it hard and fast. This is not the place to nickel-and-dime the poor SOB by watering down the meds.
2. When the dude's head lolls back, hit him with a monster dose of potassium. Boom, heart stops. What's the problem?
For the record, I'm against the death penalty on most days. (On this topic, my liberally-educated intellect wars with my primitive Sicilian blood, so I waffle a lot.)
But it really, truly, just irks me to see these prison guys botching such an easy job.
Saturday, January 5, 2008
A great case, solved
Bone marrow biopsy made the diagnosis. It's multiple myeloma: kissing cousin of leukemia, known killer of kidneys, and famed enemy of blood cell precursors in the bone marrow.
For me, this means case closed. I called an Oncology consult and have moved on.
For her, the nightmare is only beginning. Some time later this month, maybe while I'm chasing my kids through the house and laughing, she'll be starting chemotherapy. And some time in the next four or five years, while I'm doing something mundane like complaining about taxes or wiping down my kitchen counter, she's gonna die.
For me, this means case closed. I called an Oncology consult and have moved on.
For her, the nightmare is only beginning. Some time later this month, maybe while I'm chasing my kids through the house and laughing, she'll be starting chemotherapy. And some time in the next four or five years, while I'm doing something mundane like complaining about taxes or wiping down my kitchen counter, she's gonna die.
Thursday, January 3, 2008
a great case 2
The clues so far:
Renal ultrasound shows no sign of kidney obstruction.
Blood tests show that the missing blood cells did not leave her body through any orifice, nor were they destroyed inside her. Instead, she's anemic because her marrow has stopped making new blood cells to replace the ones that die naturally at the end of their four-month lifespan.
My theory of the crime:
Pure red cell aplasia complicated by acute tubular necrosis. Meaning, maybe she has an odd autoimmune bone marrow problem that caused her to stop making red blood cells a few months ago. With no new blood cells to replace the old ones that die off each day, she developed progressive anemia. This stressed out her kidneys, which didn't get enough oxygen and eventually shut down in shock.
Okay, so I've never actually seen kidneys shut down from severe anemia, but theoretically it's possible. And it's the best theory my tiny brain is coming up with.
Plan:
Transfusion (done immediately)
Bone marrow biopsy (done yesterday).
Steroid therapy if pure red cell aplasia is proven.
Dialsysis every other day for now.
Cross my fingers and hope her kidneys wake up.
Renal biopsy if they don't.
Bone marrow biopsy results take days to come back from the Land o' Pathology. I'm on the edge of my seat.
Renal ultrasound shows no sign of kidney obstruction.
Blood tests show that the missing blood cells did not leave her body through any orifice, nor were they destroyed inside her. Instead, she's anemic because her marrow has stopped making new blood cells to replace the ones that die naturally at the end of their four-month lifespan.
My theory of the crime:
Pure red cell aplasia complicated by acute tubular necrosis. Meaning, maybe she has an odd autoimmune bone marrow problem that caused her to stop making red blood cells a few months ago. With no new blood cells to replace the old ones that die off each day, she developed progressive anemia. This stressed out her kidneys, which didn't get enough oxygen and eventually shut down in shock.
Okay, so I've never actually seen kidneys shut down from severe anemia, but theoretically it's possible. And it's the best theory my tiny brain is coming up with.
Plan:
Transfusion (done immediately)
Bone marrow biopsy (done yesterday).
Steroid therapy if pure red cell aplasia is proven.
Dialsysis every other day for now.
Cross my fingers and hope her kidneys wake up.
Renal biopsy if they don't.
Bone marrow biopsy results take days to come back from the Land o' Pathology. I'm on the edge of my seat.
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