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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Now Reading

Steve Martin, Born Standing Up

Marilynne Robinson, Home

David Foster Wallace, Infinite Jest

Jerome Groopman, How Doctors Think

Saturday
06Feb2010

The Best Super Bowl Human Interest Story You Haven't Read

As Super Bowl Sunday approaches, we're seeing more and more of the human angle stories about players, fans, and the cities the two contenders come from. Stories about several Haitians playing in the game, about Katrina and the Saints, about Peyton Manning's connections with New Orleans, about Drew Brees's connections with Indiana (he played at Purdue). And many, many stories about the fans.

The best one was published in the New Orleans Times Picayune on February 5. Entitled "Who Dats in Heaven," it is a compilation of remembrances of fans whose loved ones once cheered for the Saints and have not lived to see this glorious day. Since the Saints have been losers for most of their 43 years, there are many, many diehard fans who never got to see the promised land.

Sadly, the story as posted on the internet cuts off the first 5 paragraphs of text. I don't know if this is a ploy to get people to buy the paper or plain incompetence, but it makes the story very difficult to understand online. (NOLA.com, the Picayune's internet presence, has always been poorly managed. Its search engine is horrible. It makes numerous editorial errors like this one, usually does not publish associated photos, and leaves some stories out altogether. Which is why I detest the site, but that's another tale altogether.)

It was hard for me to read the whole article without being deeply moved. I too know Saints fans that never knew what it felt like to watch their team win. In New Orleans, saying the Saints were going to the Super Bowl was always an inside joke -- something like saying "when hell freezes over." As in, "I'll step through the door of your house again the day the Saints go to the Super Bowl."

Now that the Saints are really going, the city is going through a lot of soul searching. Mostly about the meaning of hope, faith, and what happens when you achieve something that was previously thought to be impossible. As Mark Lorando said in an article on the front page of Tuesday's Times Picayune: "Hurricane Katrina? We got that under control. The Saints in the Super Bowl? SOMEBODY CALL A PARAMEDIC!!!"

Below are a few gems from the Who Dat article.

"If you want to know what this win means to New Orleans," wrote someone going by the name Nolascratch on Twitter, "I just visited a cemetery, and more than one grave had today's newspaper on it."

How quirky a town is New Orleans? Quirkly enough that a fan would consider a visit to the cemetery as the first stop after his team wins a trip to the Super Bowl.

"I promised him if they ever went to the big game I would drink a beer with him," wrote jude7654 of her late godfather. "Well, after 40 plus years I will celebrate at St. Louis No. 3 Cemetery. The only problem is he drank Schlitz beer ... anyone know where I could find one?"

Since the online editors mangled the story so badly, I will bend copyright laws and supply the first two paragraphs myself. With them, the online story makes sense.

Who Dats In Heaven

Readers Reflect on Saints Fans Who've Gone to that Big Dome in the Sky

by Doug MacCash

It's a hint of sadness in an otherwise giddy New Orleans Saints season. Lots of longtime fans didn't live long enough to see the boys in black and gold make it to their first Super Bowl.

Last week, we asked our online readers to tell us who among their loved ones they most wished were still here to share the Saints' biggest win ever. The long list of comments was like an electronic second-line parade -- you just can't help but smile through the tears.

The tears part I perfectly understand. Read it yourself, and see if you can't understand it too.

Sunday
17Jan2010

Doctors Without Water

You know all those jokes about Mississippi and indoor plumbing? Well, this past week, they were all true.

The recent cold weather that blanketed the entire country struck Jackson, Mississippi, too. We had roughly 60 consecutive hours below freezing, which is very unusual for the deep South. The result: water mains all over the city, which were very old to start with and not buried deep enough to resist persistent freezing temperatures, froze and burst. More than 130 mains broke, knocking out water pressure over a huge swath of the city. Most relevantly for me, it affected our hospital, as well as two hospitals nearby.

University Hospital, run by the University of Mississippi Medical School, has its own well, and was the only hospital in our area that was unaffected. If, that is, by unaffected you don’t count the flood of patients that showed up there because everyone knew the other hospitals didn’t have water.

As for our hospital, we just did without.

Surely, you say, your hospital must have some kind of water supply. You can’t be completely without water. That would be unthinkable.

Unthinkable, maybe, but also a fact. My office is on the sixth floor, and for three days, when you turned on any faucet or flushed any toilet, nothing happened. There were armies of Port-O-Pottys in the parking lot. (The doctors had a separate temporary trailer that was air conditioned and heated.) All surgeries except emergencies were on hold. Most procedures were on hold, too. The myriad of medical clinics that surround our facility shut down from lack of water.

I had a patient who had heart surgery cancelled twice because of the lack of water. It had never occurred to me that heart surgery is dependent on common tap water, but it is. Doctors and nurses scrub for the surgery using tap water, and tap water is used for the initial cleaning of surgical instruments before final sterilization. The hospital could have cleaned everything with the sterile water it had on hand, but this would have rapidly used up sterile supplies. Eventually two tanker trucks sidled up to the back entrance to supply fresh water for emergencies, and a few of the most critical cases went forward. Non-critical patients often went home, scheduled to return the next week.

By Saturday, low water pressure returned to the sixth floor, but the water was only approved for cleaning. It will be a few days yet before it can be declared potable.

This is the whole infrastructure story come home to roost. For years, engineering experts have been warning Americans about the neglect of our national infrastructure. While we blithely cut taxes and live off credit cards, the bridges, dams, and roads we built 50-100 years ago are crumbling. Eventually, if we do not step up and make the necessary repairs, our neglect will come back to haunt us.

Like maybe now?

The mayor of Jackson says it will cost $300 million to bring the water system in Jackson up to date. In the last 20 years the city has spent about $100 million modernizing. That effort began after a similar freeze in 1989 knocked out the water system for 5 days.

Yes, that’s right. This has happened before. And after the first time no one bothered to take the steps to make sure there was no repeat. Not in 20 years. It’s the kind of thing that makes you wonder why we even bother having a government at all. Must be because we like getting junk mail.

Simply speaking as a citizen, I understand that no municipal water system can be 100% reliable. But it should be close enough that, in almost all cases, the city can supply water to major facilities like hospitals and nursing homes within 48 hours or so. That is not too much to ask of a city that is not in an earthquake, hurricane, or wildfire zone.

By Monday, we expect operations to return to normal at our hospital. I can't complain about the pace of the repairs, which was quicker than I would have predicted. On the other hand, the fast repairs are nothing but patches. Jackson's water system is still as antiquated, and vulnerable to freezing, as it was two weeks ago.

This week’s experience was a lesson, at least for me, in how dependent our critical systems are on infrastructure that we stupidly assume will always work and will never break down, no matter how intently we neglect it.

I don’t think my eyes will ever glaze over when a politician utters the word infrastructure again.

Wednesday
13Jan2010

Grand Rounds

Grand Rounds is up.

It's been almost 2 years since I've participated, and I am glad to be back.

Sunday
10Jan2010

Why Brit Hume Is Like Janet Jackson's Breast

For the last few days, I’ve been browsing the reactions to Brit Hume’s comments on “Fox News Sunday,” when he said Tiger Woods could use a change of religion to extricate himself from his scandals. "He is said to be a Buddhist,” Hume said. “I don't think that faith offers the kind of forgiveness and redemption that is offered by the Christian faith.”

Hume has had a few defenders, and an informal poll by NPR showed that 51% of respondents were not offended by Hume’s remarks. More common reactions include people like Ken Tucker of Entertainment Weekly, who said, “To assert that Christianity is a better faith from which to seek comfort than Buddhism seems a bit naive, to put it kindly.”

Tom Shales, working himself into a particular lather at the Washington Post, derides the comment as one bound to be “one of the most ridiculous of the year,” and then really tells us what he thinks:

It sounded a little like one of those Verizon vs. AT&T commercials -- our brand is better than your brand -- except that Hume was comparing two of the world's great religions, not a couple of greedy communications conglomerates. Further, is it really his job to run around trying to drum up new business?

 

Good God. Oh, excuse me, Mr. Shales — good Generic Spirit. Is it really so remarkable that a religious person would think his own religion better than the competition? Shales implies that a person who believes something shouldn't think his beliefs are more correct any anyone else's. In other words, believe whatever you want, just don't offend us by thinking your beliefs are actually true.

I suppose Shales would never argue that his employer the Post publishes the best newspaper around, for fear of offending New York Times or National Enquirer readers.

People tend to be where they are by choice. They live, when they can, in the neighborhoods and towns they choose; they subscribe to the liberal or conservative political views they think are right. They also choose their religion. It is safe to say that the average Christian thinks Christianity offers more than Buddhism, or else he would become a Buddhist.

So please, spare us the self-righteous shock. I find it irritating that anyone would insist that a religious person pretend he doesn’t believe in the truth of his faith, just to spare the feelings of people who believe differently. There is a difference between putting someone down for his beliefs and simply saying that you do not believe his creed is the correct one. If I believe something is the truth, I am doing neither myself nor anyone else a favor by keeping my mouth shut. If you don’t think what I say is the truth, you have the right to discard it.

Somehow I am reminded of a saying of G.K. Chesterton: “Tolerance is the virtue of a man without convictions.”

There are two things Americans are not supposed to talk about: religion and income. A Hollywood star will write a book detailing every sexual encounter he may have had, but don’t ask the size of the book advance. Even though religious faith informs the opinions of many people as much as or more than anything else, we aren’t supposed to discuss faith, except in the vaguest terms.

Hume said what he said as a private employee working for a private corporation that doesn’t even broadcast on the public airwaves. And he did it on an opinion program. If he can’t say what he said at the time he said it, exactly when do people like Shales and Tucker think he should? In the closet at home, facing away from the door? Should he cover his mouth, too?

Let’s face it, people like Shales think religion is like Janet Jackson’s breast. They know that a certain population wants to see it, and they accept that, but they want fair warning when it is coming so they can clear the women and children out of the room. They don’t object to Hume’s proselytizing so much as they object to it being sprung on them without warning. Religion should be safely relegated to channels and times a good secularist can easily skip.

The offended need to be reminded that there is a difference between freedom of religion and freedom from religion. The first is guaranteed by law in this country. The second is not, and people of reason must accept the idea that people who have a strong religious creed have a right to say so in public.

It’s pretty simple: If you don’t like it, change the channel. People who complain about Hume’s remarks and consider themselves progressives need to take a step back and look at what they are saying. Is it enlightened to tell other people to censor themselves? Do you want to live in a society where no one speaks for fear of offending another, or one where people don’t hold back, at the cost of an occasional ruffled feather?

One last thing. Some people will call me a hypocrite, saying that my telling people not to object to Hume’s statement is itself a form of censorship. That’s not what I said. You can criticize Hume any way you want to — it is only unfair to say he should not say it. It is fair to challenge his assumption, that Christianity is the best path for Tiger Woods. But to argue that he shouldn’t have said it is a special complaint that should be reserved only for public statements that risk public safety. Hume’s remarks did not approach inflammatory speech.

For the record, I happen to agree with Hume. People like Woods are not likely to pull themselves out of their misery without finding a new moral grounding. And Hume is right — the strength of Christianity is the conversion story, the life-altering experience on the road to Damascus that opens new possibilities. I have studied Buddhism, and while I think there is much to be said for it, it is not a faith conducive to dramatic reversals and sudden revelation. Of course, Tiger Woods’s faith is his own business, but it is an accurate characterization of Christianity to say that it strongly emphasizes redemption and inner conversion. I don’t see why Hume shouldn’t have said it, especially if that is what was on his mind.

Thursday
31Dec2009

Late Christmas

When I was a kid, Christmas morning ended with several piles of unwrapped gifts, one pile per kid-owner; a living room cluttered with torn wrapping paper, loose bows, and discarded packaging; and one or two lonely unwrapped presents under the tree. The unwrapped gifts usually belonged to an out-of-town relative or family friend whom we had not encountered in the hurried run-up to Christmas day. Most of these gifts were unexciting tokens — candles, perfumed soap, candy — but nonetheless they fascinated me, and even made me a bit jealous. For the people getting these gifts, Christmas was not over.

There is a special joy in getting a late Christmas gift. And in giving one. This year, because I had to work on Christmas day, we didn’t make the rounds to give away all our gifts before the big day. Two of the orphaned presents under our tree were for children. So this year, for the first time I experienced the pleasure of presenting a child with a late gift. Two kids who thought the entire Christmas harvest was in the barn and that there was nothing left but the accounting. Instead, four days later they got the last thing they expected — one more present — and the gift of seeing Christmas extended unexpectedly.

It’s like being told as a child that you can stay up an extra hour before going to bed. For adults, it’s like waking up at 5 o’clock in the morning, thinking you have to go to work, then remembering that today is your day off. 

There is no pleasure quite like an unexpected pleasure. I have even toyed with the idea of holding out next year, maybe a gift or two, just to extend the fun. I’ve never understood why so many people are so quick to shut the door on Christmas. For me, the best part of Christmas is the days after, when I can relax in the afterglow, free from the frenetic pace of the days leading up to it. I don’t guess it's fair to intentionally keep a gift away from a child for a couple of days to suit my own pleasure, but still, in my mind, Late Christmas is the best Christmas.