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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.

Katrina Blog Project

And the Envelope Please . . . .

In the spirit of the recent award season, I am unveiling an award of my own, the O.K. Allen Award for Extremely Lazy Thinking. The award is named in honor of Oscar K. Allen, governor of Louisiana from 1932-36. Allen was widely known as a puppet of Senator Huey P. Long, who ran the state from his office in Washington, DC. He was nicknamed “O.K.” because he approved every piece of legislation Long backed, without question or argument. Rumor had it that Allen was in his office one day, signing bills for Long, when a leaf blew in through the window. Allen signed the leaf.

The first recipient of the award is Tim Harford of Slate Magazine, for his egregiously lazy essay “Why New Orleans Won’t Recover.”

His argument starts off with a cheap shot at the band Dire Straits and then makes an assertion that New Orleans is like his stolen CD collection. Huh?

Not taxing a single brain cell, Harford bumbles into his real argument – New Orleans will fail not because it was flooded in a storm but because it was not economically viable before the storm. This could make the foundation of a real argument, if he offered any proof. He weakly proclaims, “Cities have their own trajectories, governed most by the dynamism of their inhabitants and surprisingly little by their physical infrastructure.” I read this and think he is saying a city will survive if its inhabitants have the will to bring it back. Wouldn't’t that be New Orleans? But no. Harford thinks New Orleans will fail because unlike New York, it does not have $1 million apartments. (I’m not kidding; check the article!) By that reasoning, only about a dozen cities in the world can be expected to survive the next decade. Where do you live? You better move to NYC!

Harford breezily dismisses New Orleans as “a charming place for tourists but a desperate clump of poverty and poor schooling.” Oh, slam dunk. So the only two reasons he bothers to offer for New Orleans’ imminent collapse are correctable problems? If poverty and poor schooling are going to render the Crescent City an empty ruin, America has serious problems. New Orleans has never come within a bayou mile of cornering the U.S. market on either, so if New Orleans is going down, apoptosis is coming to a town near you.

In medicine, we have something called a post-mortem. This is an analysis of a dead patient designed to uncover the cause of death, and to help involved individuals learn from the case. But we consider it bad form to carry out an autopsy when the patient is still alive. With a population of 1 million, New Orleans would be the largest ghost town in world history. And none of those million have jobs. Nah.

I think a city that is trying to dig itself out from under a terrible natural disaster deserves better than sloppy journalism. Even if New Orleans is moribund  (which I contest), there is no excuse for such shoddiness. Again borrowing a page from medicine, a doctor is not excused from caring for a patient when the patient is dying. In fact, dying is an important stage of life, and it is a serious breach of professional conduct for any health care professional to abandon a patient just because the end is near.

Rooting against a city that is struggling to survive?  Buddy, here's an O.K. for you.

A second O.K. Allen Award goes to the lazy sportswriters who gave Olympian Zach Lund a free pass for getting kicked out of the Olympic games. This story is over 6 weeks old, so I will recap: Zach Lund is a skeleton athlete who was told to withdraw from the Olympics because he tested positive for Propecia, an anti-baldness medication.

This award has to be shared among the many shallow-witted sportswriters and sportscasters who echoed the same sentiment: What? Kick somebody out of the Games because he is trying to grow hair? It was mostly a joke in the press, or proof of bureaucratic idiocy, all of which was aided and abetted by Lund’s sheepish grin as he packed his bags and walked out of Turin.

The media did get something right. Most recognized that Propecia (generic name: finesteride) is not used as a steroid itself but as a masking agent that prevents real steroids from showing up on screening tests. Then, the O.K. Allen effect kicked in, and there was thinking no more. Har, har, they said, kicked out of the Olympics for being bald. How stupid can the World Anti-Doping Agency (the organization that suspended him) be?

Actually, not that dumb. The Anti-Doping agency added finesteride to its list of banned substances over a year ago, and hardly made a secret of it. The agency publicly publishes its list, and even maintains a 24-hour hotline to answer any questions about banned drugs. If I am an Olympic athlete, training 40 hours a week in an obscure sport that only sees the light of day every 4 years when the Games come around, I would consider it part of my job to make sure I was eligible to compete. If I were Mr. Lund, every pill, lotion, herbal remedy, and poppy seed would be in the trash can in front of my house 2 months before the Olympics. With so much at stake, why would anyone take any risk at all?

Unless, of course, he was not stupid, but using steroids. Only Zach Lund knows the answer to that question, but it is a mistake to just dismiss Lund as a good ol’ American boy with a little hair loss. Steroid use causes hair loss. I can’t help but feel a little incredulous that a doctor would prescribe Propecia to an Olympic athlete with out at least saying, “You understand that this medication is chemically similar to steroids and might show up on a drug screen.” I know I would.

I learned the hard way in my clinical practice how readily patients lie when it comes to drug abuse. I have seen over 10,000 patients in my 4 year career and can count on one hand the number of people who have said to me, “Doc, I drink too much.” Over 90% of my patients say they do not drink at all, which is simply not possible.

When it comes to illegal drugs, the fibs get more and more fabulous. One patient caught red-handed told me he was at a party and somebody must have put something in his drink. (The same guy died 2 months later from a methadone overdose.) Another said he was with some friends who were smoking “something,” and he wondered if crack particles could waft through the air and preferentially deposit in his poor, innocent lung. (A family member called a few days later and told me this man was selling drugs out of his house.)

The reality is that the caught abuser has no reason to tell the truth, and every incentive to lie until his dying day.  

The stereotypical drug abuser is the bum under the bridge, or the crack-addicted prostitute. I have been fooled by many clean-cut, upstanding citizens who just seem too nice to do something so dirty. That is their cover. No one suspects them because, gosh darn it, they are such nice people. In giving them this pass, we grease the path to their destruction.

Steroid abuse is a serious problem in sports, as the latest story about Barry Bonds again illustrates. Lund’s story is proof that the media does not look beneath the surface when it comes to drug use in sports. Such lazy thinking will hurt a lot of people.


When Azaleas Last In the Backyard Bloom'd

DSCN1457.JPGBy disposition, I am a stiff upper lip kind of a guy. My personal philosophy, borrowed in equal parts from the ancient Stoics and Buddhism, is that life is best lived with a certain reasoned detachment. Unhappiness is the difference between expectation and reality. That is, if we expect too much out of life, we suffer because life, with its imperfections, almost always fails to meet our ideal.

Sometimes, though, emotion has a way of touching reason on the sleeve and saying, "Sorry, I'm taking over here." These moments can be subtle or dramatic, but no amount of mental discipline can make them go away completely.

I am having one of those subtle moments now. March is with us, and in the Gulf South March means Spring. People in the North think we have no seasons down here, but this is not true. We may not ice over, but from December to February the trees are bare and the grass is brown. There will be a few frosts a month, and a light jacket is the constant companion of the wise. Shorts and T-shirts migrate to the back of the closet. Not that our winters are harsh by any stretch, but there is a definite change.

In my childhood, I always marked March 1 as the beginning of Spring. There could be a few chilly mornings still pending, but the frost was over. When these first truly warm days came around, I always felt my spirits rise. It was emotion, not reason, that marked the change. Often I would not even notice the grass darkening with green or the fresh shade cast by new leaves until my lighter mood tugged my shirtsleeve and told me so. Even in the days before the term seasonal affective disorder was coined, my heart knew the difference between winter and spring.

Not this year. The azaleas in my yard have been blushing pink for almost two weeks and I have barely noticed. There is no change in my winter mood, as if I have been frozen on the inside this time, and the natural warmth of Spring offers me nothing. I feel that Stoic sadness, the difference in expectation between what I feel and what I think I should feel.

Of course I know why. When your home town is wrecked by a hurricane it tends to rob you of something. Some have compared the damage of a natural disaster like Hurricane Katrina to a rape, but I don't see that. For me, it is more like losing a brother.

A brother is someone who shares your history and upbringing. There is a deep emotional bond, but not necessarily a financial one. When your brother dies, you march on in your life and career, sometimes more successfully than ever before, but to a rhythm that has a lesser meaning. There is a part of your past, a person who can bear witness to what you are and how you got there in a way that no one else can, that is gone.

That is how I feel about New Orleans. I was very lucky; I lost very little financially, but my emotional loss is very close to a loss of identity.

All people who are from New Orleans share in a brotherhood. There are so many things unique to that city, things that only a person who has called the place home would understand. Some people love New Orleans, some hate it. Brothers do not always get along either. But there are so many things shared, so many things that cannot be duplicated elsewhere, that there is no replacing that loss, no matter how hard you try. You cannot replace a brother.

As I walk in my garden, newly mine since last fall, I admire flowers I did not plant and wonder if they will always be mine, or if storm winds will eventually blow me somewhere else. McComb is a delightful place, relentlessly green, peaceful, and full of kind people. It is good enough that I could stay here forever. But I cannot help but remember that I am not from here, and the place I am from has become a wasteland.

I can start over, but there is no replanting a personal history. My main hope for recovering my history is that New Orleans will rise again, and will become something resembling what I remember it to be.

The beauty of a flower, like an azalea in my yard, comes not only from the perfection of the object itself but also from the memories of all the flowers we have seen before. The present and the past meld, and in the moment we experience the past and the present together. This is the value of place. We see the same events and the same faces year in and year out, and each year they acquire new meaning. Perhaps this is why I see little meaning in the flowers in my own yard. They would look more beautiful to me if they were growing in New Orleans.

As time goes on, I expect my present will find ways to resolve itself with my past, so that once again the things I experience will find roots in similar experiences in the past. For now, I can only pray enough of my hometown will be rebuilt that I will one day be able to say, I am from New Orleans, and it will mean something again.


Katrina Photos

I have added a photo gallery to my website. At the moment it only includes pictures I took on September 30, 2005 on my first visit back to by home after Hurricane Katrina hit.

From time to time, I hope to add to it, so please check back.

Tip: I left these pictures in high res, so you can click on them and see them in a separate window, full size. Try it on a few. The details in the pictures really bring out the sense of total destruction that the thumbnails simply don't.


The Kool 100

I picked up the newspaper the other day and read the following:

Patients at risk for abdominal aortic aneurysm (AAA) will soon be eligible for ultrasound screening under the Medicare system. An at-risk patient is defined as a male over 65 who has smoked more than 100 cigarettes in a lifetime, or a woman with a family history of aneurysms . . .
A triple-A! I read on in horror, scarcely able to contain myself as I learned that the AAA kills 15,000 people a year in the United States. It is a silent killer, a ticking time-bomb. The aorta, the story explained, is the largest artery in the human body. In the abdomen, under the pressures and stresses of a lifetime, it may bulge outward, forming a pulsating egg that grows and grows until it finally and catastrophically bursts. I could be gardening, doing the laundry, cutting grass, or watching TV, when BAM, my aorta bursts, and, as Homer says, darkness is swirling before my eyes.


I had never heard of the AAA before, but the more I thought about it the more certain I was that I had one. I had to have that test. Even as I sat and read, the paper resting against by protuberant belly, I could see the newsprint bob up and down as my throbbing Triple-A ballooned.  There was not a moment to lose.

I made an appointment with my doctor the next day. The nurse showed me to the examination room, and I waited anxiously to make to plead my case for this lifesaving ultrasound.

A few minutes passed, and Dr. Hebert came in. He read my chart and my request. "So you are afraid you may have an aneurysm?" he asked.

How could I explain it to him? I have a AAA until proven otherwise, my mind screamed, but I said, calmly, "Doc, I don't know. But I have had these stomach pains, and I am worried . . ."

"I would be happy to order the test, Mr. Kent, but you know the Medicare rules. You read the article. I read it too because you left it under my windshield wiper in the hospital parking lot yesterday. You don't meet the criteria."

"I am 66 years old . . ."

"But you don't smoke. Oddly enough, this is the one time in life when there is a material advantage to smoking. Of course, if you want to pay for it yourself, you could get it for a few hundred dollars."

"Can't do it, Dr. Hebert." I was crushed, having blown all my money on lottery tickets. After choking back a sob, I finally said, "I'll figure something out."

I stumbled out of the office in a fog. At home, I fixed myself a cup of coffee, and lay on the sofa thinking. As I stared at my stomach, I swore I could see it pulsating, that evil AAA ripening like an August watermelon. How many minutes did I have left? Then I got an idea.

Without a word to my wife, I got into my car and drove over to the convenience store. Running up to the counter, I said to the clerk, "I need 100 cigarettes."

He made a funny face. "You mean you want a carton?"

"Whatever it takes to make 100 cigarettes. See, I gotta make criteria."

We figured it out. Twenty-five cigs a pack, so I needed 4 packs. I couldn't believe how much a pack cost! Each pack had a warning that said, "SMOKING IS HAZARDOUS TO YOUR HEALTH." But the Surgeon General certainly would approve under these extraordinary circumstances. These 100 smokes would save my life.

I took the cigarettes home, emptied the packs out and laid all 100 out on my kitchen table. My wife then walked in and asked what I was doing, though not as polite as all that.

"I am saving my life by qualifying for an ultrasound," I said.

"Not in my house!" she hollered, and I obligingly picked up all the cigarettes and went out to the yard.

Tobacco, of course, is the most addictive substance known to man. If I was to smoke 100 of them, I knew I had to make it as unpleasant an experience as possible to minimize my chance of getting hooked. To achieve this, I intended to smoke all 100 cigarettes in a one-hour period.

I lined them up side-by-side, and then picked up 5 and lit them. I stuck all 5 in my mouth. They were pointing in all directions, and with my fat head in the middle I looked something like a bagpipe. I inhaled. Presently I felt very dizzy, my heart beating faster and faster. I spat them out and lit up five more.

By the time I had gone through thirty I began to feel a horrific burning in my stomach. Along with it there was a buzzing sound in my ears. The bagpipe was revving up. As the stomach burning converted into intense nausea, I fell to my knees. I vomited over and over again, and then rolled over on my side, the whole world a haze.

My wife was standing over me. "What kind of fool are you," she said, and tried to pick me up by the collar. "It's bad enough that you are making yourself sick. You also set the lawn on fire."

She turned on the garden hose and snuffed out the blaze on the grass. Sick as I was, I made sure to gather the remaining cigarettes to my bosom so they would not get wet.

"I only have 55 to go," I murmured, and fumbled to find my matchbook. There was no going back now.

"Why don't you smoke them one at a time, instead of making yourself sick like a moron?" she said.

"I don't want to get addicted," I said, my heart palpitating. "If I make myself sick doing this, I won't want to smoke again." I grabbed 5 more cigarettes and stuffed them between my lips. The tips waggled up and down, and with my trembling fingers it was almost impossible to light them all with a single match.

I took a few more puffs, choked, and all 5 butts landed in the grass. I threw up again, and my wife doused the fallen cigarettes with another burst of water from her hose. When I vomited yet again, she hit me in the face with the water. I was on my hands and knees staring at the ground in near-defeat. A string of mucus ran from my nose down to the ground.

"Oh, you won't get addicted. If you ever pull this again I'll pound your head in with a frying pan."

How I did it, I will never know, but somehow I got through with all 100 cigarettes before everything went black.

The next thing I remember is waking up on the sofa. My wife had dragged me in somehow, and I found myself with a cold cloth on my forehead and a glass of water at arm's reach on the end table. After a few minutes, my wife came in. "Oh, you're awake," she said, and then launched into a tirade that I choose to block from my memory.

The next day I was in the doctor's office. I still looked rather wan, and Dr. Hebert was observing me suspiciously. "You smell like smoke," he said.

"I want that ultrasound test," I said. "I have smoked 100 cigarettes in my lifetime, so I qualify. If you don't believe it, you can ask my wife."

"Oh, I believe you," Dr. Hebert said. "I have already talked to your wife."

"Good. When can we get the test?"

"January 2007. Medicare is not starting the program for another 10 months, John. You will have to wait until then."

I thought I was going to faint. Deep in my abdomen I could feel that aorta, stretching, tearing, on the verge of explosion! Could I afford to wait another 10 months? I guess I had no choice. "Book it," I groaned, "on January 1st. At 12:01 am, if possible."

As I got up to leave, another thought passed through my mind.

"Doc, I just smoked 100 cigarettes yesterday. Think they would pay for a chest X-ray? I swear, I have been feeling a tumor in my chest ever since I woke up this morning."


The Smoking Gun

So I guess now we have it, the proof that President Bush was warned prior to Hurricane Katrina that New Orleans was at risk for levee breaks. Exhibit A: a video tape that shows Bush being briefed on the hurricane 48 hours prior to landfall. On the tape, National Hurricane Center Chief Max Mayfield clearly tells the President and his advisors that the strength of the New Orleans levees was a major concern. They knew, but did nothing about it.

The liberal press has taken up the standard. Bravely they accuse the White House of dishonesty, indifference, incompetence, and even outright lying.

I wish they would just shut up. The people of New Orleans have known since September 2 that the government let them down on all levels, and in every conceivable way. This news story tells us nothing new. It is nothing more than an attempt by Republican opponents to get cheap publicity over a great tragedy.

There is something awful about people who seek to profit from the suffering and humiliation of others. These critics don’t care about New Orleans any more than Bush did. They simply see this videotape as a great gotcha moment, and they will exploit it for all it is worth. Even as they speak, one can see in their eyes that they are forgetting the very people these mistakes have hurt and their criticism is intended to benefit. The human suffering in the aftermath of Katrina is not a political football, and it is shameful that so many people want to treat this situation as some kind of a game.

If opponents of President Bush really want to help the people of the Gulf Coast, they should be working to help rebuild instead of jockeying to make Republicans look bad. Bush’s critics have a lot to say about what went wrong, but when it comes to recovery plans they are absolutely silent. The people of the Gulf Coast don’t care if the President looks bad or not. We want our houses rebuilt.

If they are not going to help us with that, we would prefer that they just go away and leave us alone.

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