12.29.2004

Dr. Politics

http://content.nejm.org/cgi/content/full/351/24/2471
http://www.slate.com/id/2111432/

This is the guy I was talking about the other day. He has a penchant for lending his authority as a surgeon to talk about topical issues. He is good with rhetoric - tone aimed at the layman, even when he is writing for NEJM, and always the personal touch - an individual who died, someone he knew.

These articles are about how Iraq is as dangerous as Vietnam was if you account for advances in medical technology.

The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties. They have saved the lives of an unprecedented 90 percent of the soldiers wounded in battle. And they have done so under extraordinarily difficult conditions and with heroic personal sacrifices.

Funny how doctors work to reduce the lethal wounds rate from 25% to 10% in 30 years - so that 15% of wounded soldiers live when 3 decades ago they would have died - and this works to conserve political capital and manpower so we can fight longer. I suppose doctors face this dilemma often - patient by patient, they fight the forces that push us in perils way - diet, poverty, misinformation, war, without having any impact on the root causes.

I always look for the policy behind Dr. Gawande's work. I think it is here:

Compounding the difficulties, none of these realities have made it appealing to sign up as a military surgeon. Interest in joining the reserves has dropped precipitously. President George W. Bush has flatly declared that there will be no draft. However, the Selective Service, the U.S. agency that maintains draft preparations in case of a national emergency, has recently updated a plan to allow the rapid registration of 3.4 million health care workers 18 to 44 years of age.5 The Department of Defense has indicated that it will rely on improved financial incentives to attract more medical professionals. Whether this strategy can succeed remains unknown. The pay has never been competitive. One now faces a near-certain likelihood of leaving one's family for duty overseas. And without question, the work is dangerous.

- ATLBB

Drought Food

Even my mom knows what to do after a natural disaster. Samoans have drought food - special recipes for food you cook during abnormal times. When all the fruit trees have fallen down and the animals are dying and the seas are empty, when theres been a hurricane, you prepare and bury lots of breadfruit and taro, and when you dig it up it will have pickled, or preserved, and then you can eat it until all the crops grow back. And people have places to hide during a hurricaine - up in the mountains, certain churches, maybe the whole village goes to a school. About every 7 years hurricaines come and destroy villages. FEMA is getting tired of schleping around for the American Samoan islands - maintaining colonies is hard! So they forbid us from rebuilding certain coastal villages. But the samoans in independant Samoa do fine on the coasts because everyone just builds semi permanent houses... always rebuilding and extending them as kids grow up and leave, move back when new kids are born. Or, as hurricaines knock them down.

My mom used to cook drought food - I can't imagine that drought is the correct translation - when she wanted to cook samoan food but no ingredients in Boston - she would make dumplings and pancakes and soups, all from flour, sugar and water.

The word for any kind of canned good, but primarily Corned Beef, is 'peasoupo.' Comes from the aid shipments of pea soup during some crisis or another.

Anyways, I feel bad for the tsunami victims. We have ways of dealing with moderate disaster, but these great waves are different. There are tribes on the andaman and nicobar islands that are ancient, and it is possible that many of them were killed outright.

I didn't know that we lost the vietnam war outright. I think somehow my history books ended at the Paris Peace Accords, and I never learned that the Ho later took over the entirety of the country. Embarrassing lack of knowledge.

The boy is spending new years with me and meeting the family. On the one hand its low key, on the other hand, its a little bit not. I'm expecting to have fun, you know, jacuzzis, free wine, nice clothes, jumping on the bed in the hotel room, hanging out with lolipop and cousin 007...
But I'm never sure what is the most successful way to introduce people. I think... I think the best way is not to get all anxious, but to think about potential problems beforehand, and then go in prepared and confident. Am I making too much of this? I don't know. Anyhow, lots of errands to run between now and later, a database to try and finish, shoes to buy. Beatiful day today, got into work early so I can leave at 5. Rock on.

- ATLMmim

12.28.2004

Pink Pony

Wow. What a week. Things move fast sometimes.

Boy came back from Vietnam for a surprise. Pictures are beautiful there. Saw his travel buddies blog, which is somehow more urgent, presence in Vietnam is more there. I should have surprised the boy instead of the other way round.

I'm on hold with Delta right now, trying to cancel my flight to Cleveland this weekend. I feel so bad for Delta right now... I flew over the infamous snowed in Christmas weekend, and all the passengers were so terrible even though everyone was working so hard and being so goddamned competent and nice about the delays. I watched the weather report just like every other asshole, I knew the airport was going to be a clusterfuck for about 24 hours after the snow stopped falling.

Tsunami is just.. so terrible. I think I will pulse my network, see if everyone can give $5 to Care. I'd like to send it to andaman and nicobar, because they are islands. But its hard to target aid.

Off to the Pink Pony tonight, with Satan Umbrella and the boy and some others.




12.26.2004

Awasalingwego

Last minute, decided to surprise my mom at christmas. Hopped on a plane, hitched a ride to her house and hid under the christmas tree with a bow on my head. The cat thought it was a great game, mom was genuinely surprised.

I'd been all worried about going because my moms nutty sister and her marine husband were in from Okinawa, with the two girls they adopted - one from China and one from Samoa. And my dad wasn't invited, and my mom and her boyfriend have split up but are still living together. Recipe for a christmas to avoid.

But it actually just all turned out great. My dad did show, and he and my forever-absent brother got my sister got a G4 ibook, which I'm wifng from right now, and she cried. It was like seeing tiny tim get new crutches, or however that story pans out. She's perpetually poor, and all her gifts were homemade hot sauce that she made with her hippy boyfriend at hippy school. I wish I'd had the balls to ask her if they were 'magic' during present opening time, but oh well. Gave my brother a guitar and spent the afternoon teaching basic music theory, chords and such. The babies were adorable - both 15 months old girls with pigtails making crazy noises over dinner. Fun.

Anyways, I've been thinking of Christmas as an ancient anglo harvest fest, and I quite like it that way. It takes the pressure off gift giving. Its a time to celebrate whatever you've accumulated over the year. If its not much, someone else will have made something, and you can celebrate with them. Not bad. NPR did a special on 'wassails' - part carolers, part trick-or-treat-ers who demanded beer and wine and figgy pudding from all the lords in the neighborhood at the end of the year. I like.

Not sure what MadTV/Fox thinks Christmas is all about. They did a series of increasingly gross skits last night. There was a skit panning Michael Moore as a hollywood elite liberal who ruins christmas for children. Then 'Woody Allen' saying he liked his women like his Matzoh - yellow and flat. When they moved on to a rap artist, I switched the channel so who knows - maybe it was good. Those people. Make me sick.

Earthquake, Tsunami in south east asia. The boy is in Vietnam, still, wrong coast, but I did worry til I looked at the maps. He still hasn't written, and I wonder if he will. Make me sad if he didn't, but... I wouldn't be shocked. Things have been that topsy turvey.

Offered to be bumped off my flight this AM, and got 400 Delta dollars and an extra day in Boston out of it. Its incredibly dark here, snow, charcoal sky, charcoal trees, charcoal earth. The sunset is the grimmest thing you ever saw... just a little splash of pale gray on the horizon. I could use my delta dollars to come up here a few times over the next year, or I could visit my friend in France, or see her when she gets back to Greece, or hitch along with Cousin 007 when he journeys down South in the spring, or put it towards my Samoa trip. What should I do?

- ATLBB

12.23.2004

Cherry Blossom Girl

Feels like snow. Theres a cold front roiling east across the country, from Indiana weather reports of highways frozen into solid parking lots. Here on campus theres a whiteout, steam running from the buildings and disappearing into a white sky. The air is wet, temperature has been dropping all morning, and if I weren't in Georgia, I would swear its going to snow. My flight to Boston is tomorrow AM and I think the airports going to be hell frozen over.

Since I moved to GA I've been reading in the mornings. Last year it was fiction from the library, then books borrowed from the boy, then the NY Sunday times which I stretch out through the week. Lately its been a book called by a surgeon I used to work with. Its about medical error, medical decision making, which is a little bit iconoclastic. My impression of doctors as a profession comes from sitting invisibly in rooms where they talk together about their contract with society - us and them, shibboleths and all. I was usually permitted to be a fly on the wall; overhearing them in elevators, listening to them vent behind closed doors, handling delicate issues like sexual assault in the wards, noticing their affairs with one another and when they moved into a single apartment downtown, hearing stories about how their children thought 'dad' meant 'telephone'. But the weekly conferences about medical error I was never, ever allowed to attend. They are for clinicians only and are undiscoverable by law.

Theres something strange about the book I've been reading, something unconcious that is unsettling. I was at the authors graduation from residency program, where he gave a 30 minute presentation. His farewell was neither funny nor touching, he was... unsettling. At the time he was the most famous surgeon in a hospital crowded with rich men, entrepreneurs, geniuses, superstars, pioneers. I never tire of telling his star-studded story, which probably gets grander each time: Rhode scholar, triple masters at Oxford in Econ, Philosophy and Politics, worked the first Clinton campaign, then the Clinton health care plan, published first in Slate, then in the New Yorker, then his book Complications was a finalist for the National Book Award. Shortly therafter he published a study on gross surgical errors like leaving instruments in a patients body in the NEJM which made it onto my Yahoo medical news.

Most unusually, he was taken on as an attending almost immediately after graduate to work with some of the nations leaders in public health and quality in healthcare. Anyways, he was our prize possession. At his graduation, he discussed his flirtation with leaving our hospital and going across town to Mass General, which is nothing short of betrayal. And then he spoke about his son's illness, which is his closest approximation of being a patient, I suppose.

Buried in the center of the book he veers away from surgery to talk about pain and nausea, specialties other than his own, in order to explore a non-mechanistic model of the body. Something interesting in there. My favorite essay, I think, is his description of the American Convention of Surgeons and its carnival atmosphere. It is a very strange fair. Reminds me of a cross between star trek and - oh, I don't know.

Having trouble sewing my thoughts together this AM. In the back of my mind I'm laying out all I have to do for my trip, but refusing the urge to hurry. I don't know why I hate haste, but I won't do it. I probably have left too much undone for this trip - gifts, cash on hand, clean the house, cart myself to the airport - should I bring my hairdryer, my running shoes, do I want carryon luggage or no?

Sent the boy a list of questions yesturday, which I will not be able to read a response to until Monday at the earliest. I don't think he can or will answer them, but its nessecary to let him know how volatile things are. My feelings for him are incredibly unstable. I am not the most constant of people - I am prone to doubt - and his affection for me is incomplete, it lapses and whole portions of it sink into stubborn, brave silences. I veer up and down depending on how I slice the situation, which half of my brain I'm using. Theres no uniting my experiences into a cohesive whole - the events are too inconsistent and I don't have enough information. So I've been searching for a core of something, something constant and unchanging, and well, I think I've found it. Its lodged in a teapot. The shape and heft of it, the spirit in which he gave it, indicates permance to me. I'm not sure where to go from there, but its nice to have a sense of center.


12.22.2004

Shantih shantih shantih

Christmas.

Guess I better buy some gifts. Pack some socks. Up in Boston, its a flurry of christmasness. I get all these phone calls from old coworkers and friends and family and - everyones all buying gifts and traveling around and making plans up to the last minute.

I haven't bought a single gift.

Just got my plane ticket. I was going to sit at home and quit smoking and I think that would have been fine. Just me and the cats, maybe drive by my cousin Fionas and see how she and the new baby are doing. Haven't checked in on them since they stood me up for dinner this summer - something about a fight in a parking lot, and they just decided to go home. Oh well.

ATLs a bit quieter. They put up the white wire christmas tree at the Local. I remember last year on Christmas Eve, I had drinks with the boy next to that tree. I was driving him to the airport the next morning. Something quite romantic about it - I had this huge unrequited crush on him, felt like a kid. All thats gone. We joked about Christmas and Jewish Air and all that. Anyways, sat next to that same damn tree last night with umbrella and huggy bear and texas boy, watched them turn into old college buddies. Type of comraderie that I see in english lads who are never going to leave their home town. They've watched each other lose their baby fat, get in touch, grow old and do drugs and quit drugs and meet girls and cheat on them and marry them. Nice. Not me.

Then schmer and her biobro dropped in and we all went over to karaoke at the strip club across the street. Schmers my old friend, but.. we're not that tight. Maybe its my fault, I'm like teflon, I don't stick to life and lifelike things. We sang some songs, drank to christmas themed abuse from the DJ. He told us we were all going to be in AA together so we might as well start clapping now. Huggy bear nailed some iggy pop - real American Idol performance, holding his jacket open like whats his face in titanic for the last stanza. Earned his new nickname, huggy bear did. Umbrella left early because he's got something to live for now that Allycats back. Inspiration to us all.

I smoked too much, we all did, and drank more than I have lately and stayed out late. Woke up so scratchy and tired and red eyed that it was easy to get out of bed. I'm getting hangovers in my old age. Time to start sticking to green tea.

Been thinking about old TS lately. Rebirth, Damyata, sea change. Its the unreal city in me, its the time of year. New years is coming, and thats the real holiday for me. Hard to not think about moving again, searching again for warmer climes.

12.13.2004

Specialty Hospitals

OK, so ... err... yeah.

I was going to look up specialty hospitals and stuff, and blog about hospital economics and income disparity and poor bodies but I got sidetracked because the group that released the report that turned into the news story that I heard today on NPR is from Brandeis, and I've been looking at their grad programs, and then I saw that most of the current students were peace corps vets, so I decided to apply to the peace corps, and then I remembered that I don't have any tangible skills so I decided to apply for MPH programs. Not really, but I checked things out. It was an optimistic Monday morning. I convinced myself that I speak 4 languages.

Later peeps,

BBAtl

Match

I think I'm turning into an old lady. Got a new purple sweater yesturday, and I'm wearing it and a purple striped shirt, purple boots, purple hat, purple socks, purple scarf.

Somethings gotta go. Maybe my jeans, I should be wearing purple pants.

Anyways, non-work topic of the day is specialty hospitals. More later.





12.08.2004

Easing the Spring

So the boy wrote from Vietnam today. Hanoi, I guess. Short message about being solicited for prostitution. I get the impression that boys feel strange about that sort of thing. Apparently the hotel manager inquired about my existence and proximity to the hotel, and now that I think of it, thats the last question I'd ask if I were a pimp. Remind the customer of their significant other? Bad for business.

That the boy is in Vietnam is the biggest news I have, I suppose.

Still working, sort of. At work now, which is better than I did yesterday. I've got to deliver some data and wrap up a project and I'm so not interested in doing the first bit. Then I've got to prepare some hypertext document which I think is potentially destined for publication or something. I wish these were the sort of things that just go away if they never get done.

Been watching movies. AI - Jude Law as robot hooker, which I didn't believe when the plot was described to me, but now I see how it worked in there. Good movie to teach for a hypertext/lit theory class, which I guess is why I had it referred to me. Robot as text/memory, the constrution of childhood, stuff like that. Pick a few scenes, make a few points. Out of sight, another good er... whats his name. Robert, Joe, Chris.. no.. The guy from ER and Solaris and 3 Kings and Oceans 11 and ... I can't remember his name now. Anyways, its a real sweet romance, fiesty female lead. Yay. Will probably rent the Bourne Supremacy tonight, because Matt Daemon reminds me of the boy, and maybe an anti-Bush documentary.

It really bothers me that the boy always has money and vacation time for trips, and I can never put together the two in order to go. And if I become a student I'll never have the money for that kind of thing. And if I make the money, I'll never have the time. I guess what I want is to plan a trip to Samoa next January and bring him along, if he has any interest in that sort of trip.

Now that the boys gone, I can either get more social, or spend all my time alone. I'm not relishing being lonely and getting strange, but I think it might make me focus, pinpoint concentrate, turn inwards and get out what it is I have a month to do. I think he'd like me to check up on a few of his friends who are in rough patches, which I'll do. I cut my hair all off today, now I just have to put excercise into my routine and quit smoking and either pick up the slack at work or get a new job. I'd like to have these things done before the boy gets back, I'm always so distracted when he's here, and I'd like a firm starting point for the new year. Its a short winter we have in Atlanta, mid-December is not to soon to be thinking about spring.

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