To Box or Not to Box

There are two types of people in the world:
those who obsessively hoard cardboard boxes for some unknown packing apocalypse and those who mercilessly throw them away.

Obviously, I've been a compulsive box-hoarder since conception.  I mean, duh, right?  You never know when you might need to instantaneously move your entire household under the cover of darkness with only a few hours notice -- and when that day comes, I'll be ready.  No Hefty bag packing job for me!

In contrast, Matt utterly fails to see the utility of saving EVERY BOX that ENTERS OUR HOUSE.  He says things like, "they clutter up the basement," "we can buy boxes someday if we move," and "given the general lack of civil unrest in Durham, North Carolina, the chance that we'll have to pack up and leave immediately under the cover of darkness is very low."   A personal favorite of mine was the following:  "there are spiders living in there."

However, we're at a great impasse, because the one thing Matt hates more than my box pile in the basement is cleaning up the basement.  So, looks like this cardboard box Machu Piccu is going to stay put for awhile.

Curiosities at the Hospital

I am continually fascinated by just how fat Americans are able to become.

Like, people can get so fat, that Medicine had to come up with a word for the extra gut that hangs down and makes a fold over your lower torso--that 'body part' is called a pannus.  I'm pretty sure that word didn't exist 100 years ago, because No One Was That Fat.

I recently discovered that our equipment room on the Urology floor has a bin full of "retracted penis pouches".  Now, I am a doctor, training in Urology, but even I had to read the package insert to figure out what the heck these were.

I'll spare you the gory details, but it's basically a urine collection device that can be used on a man who is so fat, that his fat has actually mounded up and completely obscured his man-parts.  (This problem is so common that someone actually had to invent a device to address it...?!?!?!)

All I'm saying is, if you are So Fat that your fat starts engulfing other parts of your body--such that they cannot be seen or recognized any longer--you need to put down the chicken strips, the french fries dipped in mayonnaise, and your bucket of Mountain Dew and go for a walk.

PS.  Yes, the 'retracted penis pouches' are next to the 'large scrotal supports'.  Let me just say that being a Urologist is a very *interesting* job, and there is really no limit to how large a scrotum can become.

A Threat to All

I don't like jellyfish.  They sting, they are disgusting, and they can make one of my favorite activities (playing in the ocean) a total drag.  Once, one almost ate my sister, so it's kind of personal.  Needless to say, I HATE the lion's mane jellyfish:

Why are you swimming towards it?

According to Wikipedia, these foul behemoths can be up to 120 feet long (longer than a blue whale) and trail over 800 stinging tentacles.  I don't think I'll ever have another night's rest knowing that these gelatinous abominations roam free in our blue oceans.  They hover soundlessly just beyond the breakers.  Their neutrally buoyant tentacles softly probing the shallows for the taste of the coveted flesh of man.  With primordial patience they wait, counting on the inevitable evolutionary mutation that will allow them to leave the confines of the ocean and lay waste to mankind.  There is only one way to meet this threat.

Get On It

Remember when the "Do Not Call" registry came out, and you were able to submit your phone number, such that it would become *illegal* for telemarketers to contact you?

Well, there is now something similar for catalogues.

https://www.catalogchoice.org/

Register at the website (you do have to give them some personal info, but it all seems very official) and then you can specify all of your various catalogue preferences, telling companies which ones to keep sending you, which ones to send less frequently, and which ones to Never Send Again.

Awesome!

Managing Expectations

A lot of being a successful doctor is managing the expectations of your patients.

It is important to say things like:
"after your surgery, you will have pain."
"after your surgery, you will have to get out of bed and work with Physical Therapy."
"after your surgery, you will not be allowed to eat Bojangles Atomic Chicken strips on post-op day 1."

Despite our best efforts at expectation management, patients all too often seem to arrive to the hospital thinking they are about to go on the health-care equivalent of a 7 day cruise.

We hear a lot of things like:
"Can I have another drink?  A Sprite?  No, a Ginger Ale.  Wait, definitely a Ginger Ale, but if it isn't Canada Dry, then actually I want a Diet Coke."
"Do you guys have a long-distance code in here?  I have to call my cousin in Albuquerque.  I haven't talked to that guy in months."
"Would you trim my toenails.  They are nasty."

Given this apparent confusion, all I'm saying is, Do We Really Need TOWEL ANIMALS!?????!?!??!

Sometimes Patients Make You Feel Bad

At the hospital, I meet many new patients every day.  Sometimes, I introduce myself as "J" and other times, I'm "Dr. Llo."  There's not clear rhyme or reason to when I pick which title, but I tend to use "J" with the very young, the very old, people who look like they might be fun to get a drink with were we meeting under different circumstances, and always with patients who are themselves physicians.  In contrast, I make sure to use "Dr. Llo" with patients who are angry, unruly, or have already called me "Nurse" (these patients are usually talking loudly about inane stuff into their cellphones and say things like 'hey, hang on, my nurse just walked in'...um, yeah, I didn't go to 4 years of medical school, pass three national licensing exams, and give up my twenties to be called "nurse"). 

Tonight, a patient came up from the Emergency Department after breaking his tibia falling off of a ladder.  He was a relatively healthy, middle-aged guy who had been painting his house prior to putting it up for sale.

So, after putting in a few orders for pain medicine and a meal tray, I went to the patient's room.  All new arrivals to the service need to be checked out by a doctor following admission, plus I figured a little TLC would smooth over what I'd heard was a long wait in the ED.

As it so happens, this patient did something sort of boldly obnoxious that had not yet happened to me in my almost-10 months of being a doctor.  And he really, really irritated me in doing it.

You see, I walked in and--based on my split-second assessment of his posture, his age, his mood, etc--decided that I would be "Dr. Llo" in my interactions with him, because he just looked a little bit surly. 

"Hi Mr. SoandSo.  My name is Dr. Llo.  I'm one of the night doctors on Orthopedics" [aside:  I'm covering Ortho this month].

"Who are you?"  he asks.

"I'm Dr. Llo.  I'm one of the night doctors on Orthopedics."

"And what is your first name?"

Obviously, I don't love this question since I'd already decided that I wanted him to call me Dr. Llo, but I answered, hoping my ever-so-slightly reluctant tone of voice would clue him in to the fact that I've not invited him to refer to me by my first name--especially since I was referring to him as 'Mr. SoandSo'.  "My first name is J," I told him.

And then we talk...about his long wait in the ED, the 10 feet of his house he has left to paint, the plan for his operative tibial repair.  And the whole time, he's calling me J, in a way that feels simultaneously aggressive and dismissive.  I was so mad...and what kills me is, if he was just a little less threatening to begin with, I probably would have introduced myself as J in the first place!

Friday Feature -- This Will Never Get Old

Anyone who exercises regularly knows that the hardest part of actualizing any given aliquot of exercise is getting yourself off the couch and out the door.  Seriously, if even one neuron in my brain thinks 'exercise,' it's like the couch deploys some sort of flesh magnet and I'm incapable of getting up before watching like four straight episodes of the Millionaire Matchmaker.  And, by then, I'm hungry, making it easy to rationalize that I can't exercise in some sort of horribly malnourished state, at which point I eat a snack, and then rationalize that 'I'm way too full to exercise...If I try to do anything, I'll puke for sure...Best go see what's on TV"...and the whole process starts anew.

Well, having gone through this song-and-dance about 23970572587320598 times before, I demanded that we buy an exercise bike for our basement as soon as we moved into our house last summer.  We got a real gem from Craigslist...and I was able to bargain the guy down on the price!

Basement Exercise Wonderland...?

Now, I'm not saying it's easy to work out in the basement, but I can do it while watching back episodes of Glee on my laptop, which is a pretty good motivator.

 

Being able to work out without leaving home -- that will never get old!

Words Are My Tools

As an attorney, writing is most often the most important task I perform each day.  Since my profession requires so much writing, it is with some embarrassment that I admit that I have only recently read George Orwell's classic 1946 essay on good writing,  Politics and the English Language.

According to Orwell, a scrupulous writer, he will ask himself at least four questions in every sentence he writes:

1. What am I trying to say?
2. What words will express it?
3. What image or idiom will make it clearer?
4. Is this image fresh enough to have an effect?

And he will probably ask himself two more:
[5]. Could I put it more shortly?
[6]. Have I said anything that is avoidably ugly?

Fortunately or unfortunately, my law practice affords me few chances to explore the universe of metaphor.  However, I constantly ask myself questions 1, 2, and 6.  Especially 6.  I may be extremely dorky, but some of the most fun I have at work is writing in as clear and concise language as possible.

Orwell closes his essay with some great rules of thumb:

(i) Never use a metaphor, simile, or other figure of speech which you are used to seeing in print.
(ii) Never us a long word where a short one will do.
(iii) If it is possible to cut a word out, always cut it out.
(iv) Never use the passive where you can use the active.
(v) Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.
(vi) Break any of these rules sooner than say anything outright barbarous.

A Station Wagon

The primary thing that gets me out of bed (slowly and begrudgingly) to head to the office each day is money.  Money is very important because, when we have enough of it, we can trade that money for a station wagon.  J-Llo loves station wagons, and as her dutiful husband, I fully support her.

Not just any station wagon.

The Cadillac CTS-V is rear wheel drive, has a supercharged V8 that produces 566 hp, and comes with a six speed manual transmission.  All that in a STATION WAGON!

In short, it is everything I have ever wanted out of a car.  I would like mine fully blacked out and in my garage right now.

My primal desire for this car overrides all rational arguments against it, such as:

1. The ridiculousness of spending lots of money on a depreciating asset.
2. The $2,600 gas guzzler tax included in the purchase price, as well as fuel costs in general.
3. My repugnance to purchase a vehicle from GM due to their demonstrated commitement to making low quality cars over the last 30 years.
4. My repugnance to purchase a vehicle from GM due to my own radical political beliefs.
5. There is nowhere to legally use even half of the horsepower of that car.

Just imagine 566 roaring horses underfoot with plenty of room in back for dogs and guitars.  Seems like a no-brainier to me.

Bathroom...Progress?

As we round the 4.5 month mark of our hall bath renovation project, Matt and I were finally feeling like we'd made some good progress.  We thought the finish line was in sight.

That is, until we made a list of everything remaining to be done:

-Buy shower curtain and rod
-Install shower curtain
-Hammer-in trim nails and putty over
-Select corner trim
-Install corner trim
-Select baseboards
-Install baseboards
-Patch closet walls
-Buy trim for closet shelf supports
-Reinstall closet shelves
-Paint closet and shelves
-Unclog shower drain
-Clean bathtub
-Patch drywall around light switch
-Tape edges for painting
-Prime/paint white elements
-Touch-up paint gray elements
-Hang fixtures
-Hang storage shelf

Friday Feature -- This Will Never Get Old

Here on DSD, we have previously discussed some of the highlights of dog-ownership.

Indeed, along with highlights, there are also some pitfalls.  For example, Matt and I can only fondly remember our halcyon pre-dog weekend mornings of lazing in bed till almost noon.  Now, our furry alarm clock makes sure we wake up the same time on Saturday and Sunday as any other day of the week... which leads to a favorite game of mine, called "Playing Possum," in which I pretend to be asleep until Matt wakes up and takes him out.  Granted, waking up Matt takes only slightly longer than it took to build the transcontinental railroad, so some patience is required.  (Marriage is not for the faint of heart).

Indeed, early AM wake ups aren't Mitchell's only specialty.  He also has an innate knack for puking in the least opportune places.  Our entire house has hardwood floors.  Seriously, we own about 30 square feet worth of rugs in a 1600 square foot house.  Yet, every time Mitchell has yakked in the last year, he has deposited his gastric bounty on some sort of carpeted surface.  We might as well be buying stock in Resolve carpet cleaner, as much as we go through.

Nonetheless, Mitchell brings us great joy, in terms of his love and affection, loyalty, hilarious antics, etc... BUT, let's focus on what's really important -- his physical appearance.  Mitchell is incredibly handsome, and that handsomeness is especially set-off by his four white paws and white tail tip.  I kid you not when I say that Matt and I mention four-white-paws-and-white-tail-tip almost daily in conversation. 

Four white paws and white tail tip -- that will never get old!

Kicking a Widgets Nest

I really enjoyed checking out Jllo's blog post below involving treating teachers as professionals.  I would highly recommend reading the entire series if you are at all interested in U.S. education policy.  I've always been extremely interested, somewhat secretly, in what can be done to cause real improvement in the educational system in our country in a way that reduces the horrific educational outcomes suffered by those students at the worst schools.  I know... a pretty simple problem I should have been able to figure out while showering or commuting.

Pictured:  a hotbed of critical thinking

The sad truth is that we (as a nation) throw tons of money at capital "E" Education with little to show for it.  According to the Department of Education, we have increased per pupil spending by 360% in inflation adjusted dollars between 1960 and 2007.  I'm not claiming to be an expert, but I doubt that anyone would argue that our ability to educate students has increased by 360% over the last 50 years, and I imagine quite a few folks would agree educational outcomes in this country have decline despite the great influx of cash to the system.

For the 2007-08 school year, Washington, D.C. spent $24,606 per pupil.  I happen to know of an excellent parochial school in northern Virgina that will provide a superb education even to folks like me who are not of their preferred religious persuasion for $15,350 for the 2011-2012 school year (more than double what it cost when I enrolled as a lowly frosh in 1998!  Alas the perils of inflation).  It's even cheaper if you happen to identify with their particular religious affiliation.  They will also dunk on your universe in basketball, no extra charge.

If anyone 1) reads this blog, 2) has made it this far down my post, I will now present my solution to the educational malaise of this country that I thought up entirely by listening to people smarter than me:  educational vouchers for all.  Vouchers of the kind championed by the Milton and Rose Friedman Foundation (they were really smart and average .5 Nobel Prizes in Economics between them.).  The argument goes like this, in brief:

1. It is socially/morally/politically desirable for the public at large to finance the education of the youth of the nation.

2. The primary beneficiaries of a publicly financed education program should be the children, parents, and society at large.

3. In general, parents have the greatest interest in securing a quality education for their children.

4. The current system of government schools severely limits parents choice in the education of their children and places greater powers with administrators and political entities, i.e. school boards and departments of education.

5. The lack of parental choice and competition among schools severely erodes the incentive for current government schools to pursue excellence in education.

6. The burden of poor public schools and no school choice falls disproportionately on families of limited means.  They are stuck sending their children to public schools because they cannot afford to pay twice for the privilege of attending private schools; once in taxes that go to fund the public schools and then again in tuition to the private school.

THEREFORE:

1. Each child, via their parents, should receive a scholarship (voucher) redeemable in the amount of the per pupil spending in the child's local government school system for use towards tuition at any school, including other government run schools, so long as the school meets some minimum requirements.  For example, suppose Durham County spends $9,041 per pupil per year.  Under the voucher system, each Durham student would receive a scholarship in the amount of $9,041 towards the tuition at the school of her and her parent's choice.

2. The minimum requirements to qualify as a school under the program should be a minimal and consist only of bottom-line requirements of literacy and civic education.  The requirements should as unobtrusive as possible and be enforced similar to current health inspections at restaurants.

3. As a consequence of this program all parents will be free to select the best schools for their children.  Schools that provide excellent educations will prosper and thrive as more parents seek to enroll there, and schools that provide substandard educations will wither and close.

4. New private schools, whether non-profit, for-profit, or parochial will be established to serve increased demand.

5. Students from disadvantaged background will have a chance to escape the crippling cycle of poverty and poor education provided by the worst of the public schools.

6. Education standards will rise across America as schools increasingly compete with one another to provide greater educational value at lower cost.

Ta-da!  Problem solved.  Seeing as folks have been advocating this plan for more than 60 years, and yet it is in effect almost nowhere, lots of people are against this plan and for varying reasons, but it seems to make sense.  I'll leave it to our buzzing commentariat (ha ha!) to pick it apart.  But beware, Milton is watching you.

Taking Stock

Ran across the following statement recently and it has stayed on my mind since that first reading:

"We live in a world of infinite possibilities and it creates the illusion that the time to embrace them is also infinite."  (here)

Years ago, a gray-haired attending physician sat me on his knee (metaphorically) and told me, "Jessica, one's college years and early twenties are about opening doors.  You work as hard as you can to open as many doors for yourself as possible.  But, then comes the time for making choices, for narrowing your focus.  The fact is, your late twenties and early thirties are about closing doors."

These statements are sisters, really, all about the finite nature of our time here and the inherent, if unspoken, abandoment of certain opportunties that travels hand-in-hand with our decision to actively pursue the futures we choose for ourselves. 

Every Spring holds the memory of the Winter that came before it, and the Autumn that will come after; every choice holds the ghosts standing behind the doors we closed along the way and the stillborn future we will never know. 

As I make the transition from strictly door-opener to sometimes door-closer, I find myself taking stock.  Indeed, I am quite satisfied by the life I've made thus far, and the people in it; however, that doesn't mean that I don't occasionally take a brief moment to mourn those paths I didn't choose along the way.

How Good Life Is

For those of your who are medically inclined (or economically inclined, perhaps), this NYT article about hemodialysis is food for thought.

Friday Feature -- This Will Never Get Old

Welcome to this week's Friday Feature.

Today, I want to recognize my Android phone as being continually awesome.

As a medical student, I had classmates with smart phones...they were so slick and shiny, so useful for problem-solving on the go, so emblematic of post-modern coolness.

Obviously, I was desperate for one... But, they were expensive.  And I was a medical student -- which is to say, broke.  Well, broke implies having no money, whereas what I actually had was *negative money*, in the form of tons of med school debt.

As such, I couldn't justify adding an additional $100 on my monthly loan bill for a smart phone.  So, I made due with a really dumb phone... no Internet, no texting, a broken antenna, a spotty battery, the whole deal.  All the while, I promised myself that as soon as I got a job (started residency), I'd get a smart phone.

Three years pass, and the day finally comes.

I've had my Droid for 10 months now, and I remain continually in awe of all of its features and the myriad ways it has both simplified and enhanced my daily routine. 

Having a smart phone...That Will Never Get Old.