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Disclaimer

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
Saturday
Feb252006

Buckshot

First Pellet

I have been reading here and there about President Bush's plan to turn over contracts at 6 U.S. ports (including the Port of New Orleans) to a company based in the United Arab Emirates.

As with most public issues, once you get below the superficial discussion on the airwaves, the matter appears less clear cut than the pundits would have us believe.

Yes, two of the 9/11 terrorists hailed from the UAE. And yes, the UAE was the site of some terrorist money-laundering prior to 9/11. But since 9/11 the UAE has been cooperating with U.S. intelligence, if the White House is to be believed. Dubai has also been allowing the U.S. Navy to use its port for its Persian Gulf operations. This is not a small thing, given the current climate in the Middle East.

The ports contract appears to have been a carrot offered to the UAE for its help. In this sense, the contract was a good political move. Building up trust and mutual support with Arab nations is a very important foreign policy goal, especially now.

The problem is that it was a poorly chosen carrot. Of all the contracts the US could have offered the UAE, a ports management contract is certainly one of the dumbest choices, considering America's current security concerns. Why not let Dubai sell hot dogs at Giants' stadium? Or put them in charge of a truck stop on the Jersey Turnpike. Anything but put them in charge of a port.

As a former resident of New Orleans, though, what offends the most is the way President Bush immediately went to the defense of the UAE when the controversy erupted. He as good as told his opponents that they were racist for opposing the contract. The only reason people are attacking the contract, he argued, is because the company is Arab-based.

I wish he exhibited such passion when he talks about the Gulf Coast. Here is a president who feels so strongly about prejudice against an Arab nation that he is willing to go to the mat for them. He has never, ever shown such determination to rebuild the Gulf Coast after Hurricane Katrina.

It is not as if Louisiana or Mississippi have not been loyal supporters. Both states went for Bush in 2000 and 2004, and both went for Bush, Sr. in 1988. And even more maddeningly, the Gulf Coast has almost as great an oil reserve as the UAE has (77 billion barrels vs. 91 billion barrels). We supply 15% of America's crude, which is more than the UAE supplies.

Any respect I ever had for George W is gone, all gone.

Second Pellet

I was dismayed to read that the Commonwealth of Virginia is trying to pass a law making it illegal for doctors to ask their patients about handguns in the home. This proposed law has been written as a response to recommendations by the American Academy of Pediatrics to ask about handguns as part of a routine review of patient safety in the home.

Critics of this policy complain that it is obtrusive and politicizes the doctor-patient relationship. It is tantamount, they say, to doctors discouraging private gun ownership.

Maybe so, but is threatening to revoke a doctor's license the solution? I have asked all kinds of private questions of my patients, such as: Do you have sex with men? Have you ever cheated on your wife? Do you use cocaine? How many abortions have you had? When you laugh do you pee on yourself? Asking about firearms cannot be any more intrusive than any of these questions.

It bothers me that this nonsense comes out of Virginia. I lived in Virginia for 11 years, and have strong feelings about the place. Virginia is the home of George Mason, the father of the Bill of Rights, not to mention George Washington, Thomas Jefferson, James Madison, and James Monroe. The House of Burgesses, founded almost 400 years ago, was the first democratically elected legislative body in the Western Hemisphere. With that pedigree, one would think that the Commonwealth would be more careful than to enact a law that so clearly runs counter to the spirit of the First Amendment.

Kevin, MD has further discussion about this topic here.

Thursday
Feb232006

How I Spent Last Weekend

DSCN1433.JPGThey dogged me interminably. Those niggling bean counters, the ones in charge of the world and of my destiny. All I wanted was a license to practice medicine in Mississippi. They wanted a copy of my diploma, as if such a piece of paper qualifies as proof that I completed medical school, and more importantly, learned something in the process. I thought, naive me, that a valid license in another state, a verification letter from my residency program, a valid DEA certificate, and an active listing with two medical specialty boards would be proof enough. Hardly.

The problem: I left that piece of paper behind when I evacuated for Hurricane Katrina. My diploma was somewhere in what was left of my flooded home.

I tried to order a new copy from my medical school, but that would take 12 weeks. So, after explaining repeatedly that my diploma was lost, and after getting letters every single week for 2 months straight saying that I had to produce it, I gave up and decided that I would try to extricate the thing from my ruined home, come what may.

One fine Saturday morning, my wife and I set out for our old home in Chalmette, LA. We took with us the tools I knew we would need to prove unequivocally that I am a well-educated American Medical Graduate -- a hammer, a shovel, a set of screwdrivers, plumber's boots, and an ax.

The trip through New Orleans has changed significantly since the days right after the storm. The city is now well divided into the quick and the dead, the boundary between recovering communities and struggling ones snaking thought the city like the sharp line of dry gangrene on a withered limb. Those areas that have survived the storm have consolidated into spaces of vivacious activity, while those most heavily hit remain sagging and crushed, almost as they were in August.

Our neighborhood was showing some signs of life. A few of the houses were now gutted of flooded material and stood empty, stripped inside to the bare studs. The FEMA-supplied trailer, ubiquitous in recovering areas of the city, was rare but nonetheless present. This meant a few people were moving back in, and starting to rebuild. There was maybe one trailer on every block -- not many, but a start.

Our street was still blocked by a house that had been swept off its lot on the back street of our subdivision. It sits intact, slab and all, right in the middle of Bradbury Drive. Our new neighbors.

Before we went into our house we paused to look at the maple tree in our front yard. It was under 12 feet of saltwater for 9 days, and stood up to 140 mph winds. Most of its branches were stripped away, but there it stood, breathing green leaves in defiance of the surrounding devastation. The only living tree on our block, it is a symbol of nature's immortality if there ever was one.

Then to work. First, to get some light in the house, we pried the plywood we had used to board up our doors and windows before the storm off the front door and a back window. We moved in. To get the front door to open and close freely, I had to shovel away about 6 inches of swamp mud in our foyer.

Our door had a large hole in it near the lock, a calling card left by the National Guardsmen who broke the door down in the days after the storm. They were looking for dead bodies, and to let us know they found none they kindly left the number 0 spray-painted in hot orange on the front of our house.

My diploma, we knew, was in the utility room. In preparation for the storm, my wife took a number of important items and stored them there, some inside the clothes dryer and some wedged between the washing machine and the wall. She was thinking of wind damage rather than flooding, and the tiny utility room was the most secluded room in our house. Unfortunately, when the water rose the washer and dryer floated up and resettled against the door, wedging it closed. The water rose all the way to the ceiling, soaking it and causing it to collapse, which left a layer of insulation and sheet rock on top of everything. Getting the diploma out would not be easy, which was why I put it off for so long.

The door was immobile, so I went at it with the ax. In a few minutes it was in splinters and I was inside the room. Next, with a shovel I was able to clear away the sodden insulation and sheet rock and took a look around.

Under the washer I spotted a stack of what looked like picture frames. The first one I tried to pick up came apart in my hands. I recognized it as a commendation from the French government to my mother's great uncle for distinguished service in the French Army during World War I. Under that was my residency certificate. Also soaked, and falling to unreadable pieces as I tried to peel it up. And under that, there it was, my medical school diploma. Carefully I was able to separate it  from the muddy floor. I lifted it up, and my wife extended her hands to receive it. She quickly carried it off like an OB nurse whisking off an afterbirth.

In a sweep of the house we recovered a few dishes from the kitchen, and most of our wedding china, which was filthy but remarkably intact. Piece by piece we carried everything outside, and lined the items up on the driveway to dry.

Across the street, our old neighbor, Mr. Jim, was home. The 77 year-old Korean War veteran was slowly stripping moldy sheetrock from his walls and carrying the pieces out to the street. A huge pile of debris stood in front of his house. It looked like his flooded home had retched up its guts, the pile of rubble a mound of vomitus on the sidewalk. He had set up in an RV about a half a mile away and was living out of it, renting a small parking space next to an old shop that had power and, in the American entrepreneurial spirit, had converted its parking lot into a temporary trailer park. His wife sat in the front seat of his pickup, patiently watching us through the windshield. She had lung disease, and he didn't want her coming into the house to breathe the dust and mildew.

There was at least a ton of debris in front of Mr. Jim's house. He had moved every bit of it by himself.

Like the good neighbor he always was, Mr. Jim stopped to talk. He planned to strip out his home and then wait to see how things developed. If there was enough activity in the neighborhood, he would eventually sell or rebuild. Like all of us, he was waiting to see what would happen. None of us want to put money into our houses and then be the only person on a block of abandoned houses. So we all wait in community limbo, to see if a critical mass of citizens returns to make repairs worthwhile.

Mr. Jim had news about Mr. Brian, his 75 year-old next-door neighbor and the inhabitant of the house directly across the street from ours.

As he spoke, I remembered the last time I saw Mr. Brian. It was August 28, the morning before Katrina. We were packing up our car to leave town and Mr. Brian walked across the street to speak to my wife.

"I have never left for a storm before, but I'm leaving now," he had told her then. My wife had asked him if he thought the Mississippi River would overflow. "Oh, no," Mr. Brian had said. "The water is going to come from that way." He then pointed down the street in the direction of the levee facing the 40 Arpent canal, then 17 feet high but today only a nubbin.

Mr. Brian left his home that morning, and died during the evacuation. Mr. Jim said he heard it was pneumonia. The story Mr. Jim heard was that during the evacuation Mr. Bryan got sick with chest congestion and fever and that his family was unable to find him a hospital.

That would be ironic if true: He had lived 4 years across the street from a doctor (me) and then died because he couldn't get appropriate medical care.

As we stood there talking amid the ruins, a tourist bus cruised around the corner. I had heard that visitors to the city were taking tours of the disaster zone, but so far I had not seen it.  I took a certain grim pride in knowing that my neighborhood had made the National Registry of Devastated Places. Maybe we should apply for National Monument status.

The sun was hanging low; time to move on. We collected our now-dried stuff from the driveway. Back at my mother-in-law's house later that day, we had everything spread out in the grass again. In the cool January air, as the daylight failed us, we hosed down all the dishes to get the swamp mud off and then put them away in the garage.

Before I went to sleep that night, I had a vision. I saw my wife and I preparing a dinner at my new house, with FEMA director Michael Brown and Homeland Security Secretary Michael Chertoff the honored guests. We were serving them food on our wedding china, the plates that had soaked in the equivalent of sewer water for nine days. Naturally we hadn't bothered to wash them very well.

My tattered diploma came back to our new home in McComb in the back seat of our car. On Monday I made a photocopy of it, and impishly sent the faded image to the bean counters.

Thursday
Feb162006

TV Head

Maybe I have too much time on my hands, but I worry about how much TV my children watch. My wife and I try to restrict it, but on the occasions when we are both too tired and too busy to fight with them, they have amazed me with their voracious appetite for video input. They could watch from 7 am to 9 at night, every day, without complaint. Sometimes I wonder if they would forgo food for another round of “Thomas the Tank Engine” videos.

In the morning before I go to work, I will observe them sprawled out on the sofa, the steady stream of cool light entering their eyes and massaging the tips of their neurons, stimulating novel neuropathways never heard of when I was a toddler and our one black and white TV was only on a few hours a day. They sit there, almost motionless, and I wonder how that plasma screen is reshaping their little brains . . . .

My mind goes ahead forty years. My daughter is alone in a dark room. Over her eyes is a helmet with a visor that projects video images directly onto her retinas. She has a pair of the latest Virtugloves on her hands, the latest in virtual sensory perception with propriceptive enhancers. In those gloves she manipulates a $3 million pistol-grip joystick (inflation has been a problem in the last 40 years) molded precisely for her hand and no other.

She sees a black field of space. She is in a space ship flying though an endless cyber-cosmos. A small star appears ahead of her, and rapidly grows to become a huge green blob. She eases up on the joystick, searching the surface of a strange planet. Finally she spots what she is hunting for – a narrow crevasse in the surface. She pushes on the stick and glides in.

The inside of this planet is very different from the placid outside. There are electrical currents, like bolts of lightning, traveling everywhere. In a few places she sees these currents tangled up in vast storms. She is careful to avoid them – a single glancing contract and her mission may be over.

She accelerates, knowing she does not have much time, twenty minutes at the most. It took her ten minutes to get this far, so she will have to hurry. She accelerates her ship, rapidly and deftly dodging the currents of electricity that seem to be everywhere. She has never been inside this planet before, but she seems to have a familiarity with every one of those currents, every pathway.

She dives deeper. In the distance she sees what she was looking for, a volcano deep under the crust of this strange world. This volcano is very angry, spewing hot red magma for what seems like hundreds of miles. When the magma meets the electron streams, it throws their controlled flow into chaos, creating more electrical storms.

To get to the volcano, she must fly directly through one of the magma flows. There are only 2 minutes left, no time to hunt for an alternate approach. She thinks she knows enough about the electron streams to dodge them by memory. Through a hot mess of pulsating magma she flies, first darting up then down. She can see nothing; now she is flying on pure muscle memory. The magma clears, and she is right on top of the volcano. Her index finger moves to the trigger, and she delivers a volley of laser bullets into the gullet of the volcano. She waits. Too much ammo could cause surface damage, opening up the volcano rather than closing it.

The magma slows down to a trickle. Three more bullets, no more, no less, she decides. She is exactly right, and the flow stops completely.

Now she reverses her ship, rapidly weaving her way back out to the surface, almost exactly retracing her every move. This is the easy part. The computer has tracked her path exactly, so mostly she just follows its prompts, but on occasion she will make corrections because the virtual terrascape often shifts ever so slightly.

A moment later, she is again hovering over the surface of the green planet. The flight timer reads 18:54, not bad for an emergency procedure.

An overhead fluorescent light comes on. My daughter stands up, and flips her visor up. She blinks at the temporary harshness of the artificial light. The room she is in is empty, except for her chair and equipment. She strips off her gloves. Through a window facing her chair she can see a man lying anesthetized on a surgical table. One side of his skull has been removed, exposing his brain, and a huge robotic arm with a tiny probe on the end is moving away. A second arm supports the cut-away section of skull, and loads up a staple gun to fasten it back into place.

The door opens, and a young woman dressed in white scrubs steps through. “That was brilliant work, doctor,” she said. “You were able to cauterize that intracranial bleed without having to cut through a single major neuro tract.”

“Oh, don’t thank me, Deborah. Thank my dad,” she replies. “He is the one who let me watch all that TV when I was a baby.”

Tuesday
Feb142006

All the Confusion That's Fit to Print

This afternoon, Reuters news service is reporting that Harry Whittington, the man accidentally shot by Vice President Dick Cheney, has now suffered a heart attack. The story states that the attack occurred “when some of the birdshot migrated close to his heart.”

The AP reports it this way, ''Some of the birdshot appears to have moved and lodged into part of his heart in what we would say is a minor heart attack.''

I doubt that there is any malicious intent in these stories, or in the statements coming from the hospital in Corpus Christi that they are based on, but they are erroneous. A “heart attack,” or myocardial infarction, occurs when one of the arteries in the heart suddenly occludes, causing the death of cardiac tissue. This, clearly, is not what is happening.

A buckshot could only cause a myocardial infarction if it severed a coronary artery while passing through the body, which would mean death in minutes, or if it came to rest directly on top of a major coronary artery and occluded it, which is about as likely as a flipped coin landing on its edge and staying there as neither heads nor tails.

What may have happened is that the pellet lodged close to the heart, resulting in local irritation (called pericarditis), and that inflammation has aggravated an underlying heart problem, thus giving the patient symptoms. The problem with this theory is that it is me speculating. It is impossible to know unless someone involved issues a more accurate statement.

Why does it matter? It just makes me wonder: If I can pick up errors in medical reporting as often as I do, how many errors am I missing when I read topics I know nothing about?

Thursday
Feb092006

Two Trillion Ways to Leave Your Lover

IMG_0278.JPGThe White House has unfurled its brand-new $2.77 trillion budget, and I can’t help but feel a little disappointed. This ghastly amount of money is proof, as if we needed it, that we are indeed the richest country in the world. Let me see if I can get all those zeroes right: $2,770,000,000,000. Ten zeroes. Amazing.

But what amazes me most is that, with a budget of that astronomical sum, there is still posturing and moaning in Washington over the cost of the Hurricane Katrina cleanup. $2.7 trillion to spend and Congress is doing the “Let me see what I have in this empty pocket . . . sorry, nothing!” routine. That is, when they bother to stoop to the subject at all.

In his hour-long 2005 State of the Union address, President Bush devoted 151 words to the reconstruction of the Gulf Coast. He used up most of that paltry sum boasting that $85 billion has already been authorized. What he didn’t say was that most of that money is going to projects the government is required by law to pay for. For example: $1 billion will go to repair the I-10 span over Lake Pontchartrain. Great, but that road was federal property to start with. Money to fix your own structures does not constitute hurricane relief.

Also included in that figure is the billions (final figure not arrived at yet) paid to people like me for settlement of insurance claims. The national flood insurance program is funded by the U.S. Treasury, and so the White House adds these payments into its calculation of the “relief” package. This is about as fair as calling Social Security checks welfare. Those of us who had flood insurance paid premiums into the system for years (just as retirees have paid into the S.S. system). We signed the flood insurance contract and paid our money fair and square. The feds may not like it, but that money belongs to insurance policy holders. It is ridiculous for the federal government to call such insurance payments hurricane relief.

During the State of the Union speech, a television reporter remarked that “9/11 is seared on the President consciousness.” Well, Hurricane Katrina is seared into my consciousness. Just this week I talked to a patient and his wife whose 2 year-old son almost drowned in the storm. They were stranded at home because their one car broke down, lost everything they owned in the flood and are now living in a trailer in Mississippi. Both parents work, each driving 3 hours a day from Mississippi to New Orleans to work. These are good people, not the welfare addicts conservatives like to talk about, but they need help getting their lives back in order.

After 9/11, no one asked how much it would cost to put things back together. We spent all the money we needed to and then went to war in Afghanistan to make sure it didn’t happen again. Meanwhile, with Katrina, politicians and pundits started wringing their hands over the cost of recovery within days of the storm. Who is going to war for the Gulf Coast?

Last week, the President said he was opposed to passage of the Baker bill, a homeowner’s assistance program designed to rehabilitate decimated neighborhoods. The White House claims it is too expensive. It will cost about $30 billion. This comes from a government that spends $7.6 billion a day, year round. If Congress trimmed its overall budget by 2% and diverted the proceeds to the Gulf Coast, the Baker bill would be paid for 2 times over.

A month before Katrina hit, Louisiana passed its state budget, which was for $19 billion. The federal government spends more than that in 3 days. Thus, it should be no surprise to anyone that much of the financial heavy lifting has to come from Washington. Like every American citizen, Gulf South residents pay far more in federal taxes than state and local taxes. Not that our local governments are the very image of efficiency. But it is natural for anyone (such as myself) who has honestly paid thousands into the Federal Treasury to expect Uncle Sam to step up in a time of great need. On April 15 I am counted as a citizen, and charged dearly for it. What about the other 364 days?

Many people have expressed concerns about local political corruption. This would be funny if so many lives weren’t at stake. Washington chomps through $7.6 billion of your money a day, borrows $400 billion a year, and employs more people than the entire population of New Orleans and the Mississippi Gulf Coast put together and they are worried about how we spend money. With a $19 billion budget, Louisiana politicians couldn’t steal Washington quantities of money in their wildest dreams.

This is their excuse for doing nothing. The entire public health system in New Orleans is shut down, a system that served 250,000 patients a year, and as of today the feds have not put up a single penny to help revive it. Two medical schools could close, and hundreds of doctors and nurses in training wait in limbo, their education in jeopardy while Washington pauses over concerns about corruption and competency. They do not pause out of concern. They pause out of indifference.

It is not as if Louisiana and Mississippi would never pay America back. Once the economy down here is set back on its feet, it would begin to generate federal tax revenue again. In the long run, New Orleans is capable of creating enough wealth to at least significantly offset the cost of recovery. Louisiana and Mississippi are relatively poor, but they nonetheless offer employment opportunities for hundreds of thousands of Americans and are the source of a rich and interesting culture not found anywhere else on Earth.

America has always had a fondness for the new and a distaste for the old. But there is something unprecedented about throwing an entire city away. Yes, New Orleans is below sea level. Yes, the Gulf Coast is very vulnerable to hurricanes. But Louisiana is home to 40% of America’s salt water marsh. It has more alligators than Florida has and 353 species of birds. It produces the largest seafood catch in America after Alaska. To let all of that go and sink into the ocean given the extreme wealth and technology of this nation is a defeatist attitude I have never associated with America. We have thousands of troops who are dying to bring our political system to the Middle East. At the same time we are prepared to let a region of our homeland crumble and fall away from neglect. God bless America.

The numbers 9 and 6 explain the lack of urgency. 9 and 6 are the number of electoral votes of Louisiana and Mississippi, respectively. Two states that lack the clout of Florida or Pennsylvania in presidential elections and thus can be safely ignored for strategic purposes.

I am tired of hearing that there is no money to be had. $2.77 trillion and no one can find another $50 billion or so to make reconstruction really take off. We have found $240 billion so far to fund a war in Iraq. We are told this money is necessary to bring freedom to the Middle East. Who asks if this money is well spent? Why is it more important to have freedom in Iraq than to find permanent shelter for the 100,000 Americans who are still without a place to live?

I saw a patient last week, a 70 year-old man with diabetes and a history of stroke who is living in a tent in his own front yard without water or electricity. FEMA delivered a trailer a month ago, and it sits in the back yard behind his house unused because no one has bothered to hook it up its electricity. He is on the phone every day pleading with FEMA officials to come by and hook the power up so he can move in. (FEMA insists on doing its own utility hookups.) A FEMA trailer costs $15,000, and it sits in his yard, empty. That is your tax money, folks!

Nothing proves the wasteful indifference of Washington like the Mississippi River Gulf Outlet (MRGO). In 1965, this 76 mile-long shipping channel was dredged through some of the most pristine wetlands in America to give oceangoing vessels a more direct path to the Port of New Orleans. The MRGO costs $22 million a year to keep properly dredged for deepwater vessels, and this dredging process has been hugely destructive. The deep channel is very slow flowing, and thus tides from the Gulf daily carry saltwater inland into fresh water swamps. This process, called saltwater intrusion, has resulted in the complete erosion and loss of 27,000 acres of wetlands and the death of an additional 38,000 acres of bald cypress swamp. Over the 41 years of its operation, the channel itself has gradually eaten away at its own banks, widening from 650 feet at the time of its opening to over 2,000 feet today.

When Katrina hit, MRGO served as a huge funnel, channeling the hurricane’s 25 foot storm surge directly into my community. I lost my home because the MRGO retention levee that was supposed to protect me and the other 68,500 residents of St. Bernard Parish from rising water broke in 20 places.

MRGO was authorized and built by Congress. It was built against the objections of many residents of my old community, and the opposition increased as the years passed and the environmental damage of this channel continued to increase. In fact, in 1958, 7 years before MRGO opened, the St. Bernard Police Jury passed a resolution opposing its construction, arguing that the MRGO would destroy wetlands that serve to buffer St. Bernard from storm surges:

During the times of hurricane conditions the existence of the channel will be an enormous danger to the heavily populated areas of the parish.


But Congress continued to authorize MRGO maintenance despite the real danger it presented to the citizens of St. Bernard Parish. By 2005, MRGO was only being used by 226 ships a year, or less than one ship a day. Still it was kept in operation. Even after Katrina, despite the horrible damage it caused, Congress has still deferred the decision to close MRGO once and for all. The government is reluctant to close it now because no one wants to admit to the magnitude of the mistake that was made. And anyway, no one will lose his job for doing nothing. We only have 9 electoral votes, remember?

A lot of the damage caused by Hurricane Katrina was the fault of federal government neglect. MR GO helped render 68,500 Americans homeless. Outside of New Orleans, no one knows this.

It is not that I think New Orleanians should have no role in their recovery. Obviously we have to take the lead in reconstruction. But the Gulf South is America, and as someone who has lived there, I can testify that it is an America much more valuable than most people realize. It is an America that has suffered from neglect and the ignorance of citizens who have never really seen the place or understood what happened when Katrina hit. The same government that blames us for our problems has never owned up to its contribution to this terrible disaster.

So perhaps you can see why I find a $2.77 trillion budget hard to swallow. I have to pay taxes to support all that spending, even as the government does absolutely nothing to bring my old city back. But, hey, when it comes to the people in New Orleans, the federal government taketh and the federal government taketh away some more.

Two author's notes: First, the above photo was taken on Sept. 30 by me. The house is one block from my own. Second, I apologize for the length of this post, but I had a few things I needed to get off my chest.