Updates, Bags, and Social Networks

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Blog Updates:
I’m happy to report all is well. The blog software is updated, making room for all the “current” plug-ins, themes, etc. and most importantly, the security fixes applied so that I don’t get h4x0r5 hijacking the site to something hideous and embarrassing like an online yarn shop. I’d never live that one down. Regarding the slick black theme: yes, it’s understated, and surprisingly, yes, it’s pretty much done. I downloaded it of course, because I can’t create much of anything, but I can always edit and tweak. (which I need to do because I want my links underlined and my blogroll subcategorized) However, I really like the minimal, clean look. Maybe in a month or two I’ll think to add a graphic here and there, but the day you see a flash ad at the top (for yarn and fabric!) is the day you know for sure I’ve been abducted. Thanks Vijay and TinyShrink MD (heh) for the shout outs.

Bags:
As I wrote on Twitter the other day, I have a serious thing for bags. I am, in fact, completely indistinguishable from a woman shopping for purses with the level of scrutiny that I investigate pockets, seams, zippers and compartments. However, the presence of my Y chromosome does mean that I must depart somewhat from my inner female in that looks and it matching anything else I have are nearly irrelevant. I don’t care if the bag looks like a freak accident that escaped the Coach genetic testing labs–I care about function,form, and feel, ONLY and in that order.

So my brother was here last week, and I saw a bag he had that I don’t recall his having this last Christmas. I asked what it was, and he said “Weren’t you the one that told me about this?” Disgustedly, I gave a look like, “You fool! Do you think I’d forget something like this?!?” as I pawed The Precious.

Here is the object of my desire. It’s different from my brother’s, but our gear needs are different. Yes I know the orange isn’t the most aesthetically pleasing color, but just look at that removable DSLR camera bag attachment. Yes, I know the whole “snake” theme is a bit odd, but that’s some sexy stuff. YeSSSSS!

Obviously, I’m not getting this anytime soon, but my current eBags laptop backback is not doing too well (in fact, it’s nearly unrecognizable from the online pictures). It’s also surprisingly heavy all by itself–something I found recently as I emptied it to have it be managed by Claudia when I was last in the hospital. “Honey, I need this because, like, you know, the next time I might be in the the hospital–what? yes, I know the doctor said all would be fine, but you never know…ok!–I’m just saying, the next time, if I have this, it won’t be as heavy for you when you have to manage it,” just isn’t very convincing. I’ll work on it.

Social Networking:
In my previous life, I was a senior-level IT person/consultant. It should come as no surprise, then, that when faced with a “SIGN UP NOW” email from a relative, friend, or annoying co-worker–it matters not–in order to see their pictures or whatever online with some proprietary service, I normally would hit “delete” without a second thought (and might even be annoyed that thanks to them, they at least have my email address). Why on earth would I want to give away my information to a business that I have nothing to do with who, upon trying to make ends meet, will be like so many others and whore their user data to the highest bidder, maybe even sinking so low as to start putting up yarn ads. (If you got that reference, you’ve read this all the way through and I thank you from the bottom of my ad-less heart)

Maybe it’s the sweltering Texas summer heat, maybe it’s having some burnable time on my hands, but I seem to be trying out new services sites like it’s going out of style. Normally meticulously recorded in SplashID on my Blackberry (encrypted of course), I have yet to keep up with all the usernames/sites I’m registering. It’s like I have Daddy’s credit card and going on a registration/shopping spree and don’t care about amounts or receipts, wadding them up and throwing them on the floor as I search the next target. There’s a ton of redundancy and overlap in these things, and I think I’ve reached the limit of what I’m willing to try. I think with each useful service, there is a “best of breed” product; that’s the one I’ll sign up with.

And what it is with the lack of vowels in these names? Flickr. Stumblr. Feedlr. Tumblr. Mastrbatr. I gotta pull back before some 21-year-old CIO in the Bay Area tweets to his other entrepreneur buddies and with all their collective information figures out the exact position of all the constellations at the time of my birth. On their iPhones.

(Medical stuff–personal and news/commentary–coming in a jiffy, I promise!)

Blog updates

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Tonight I plan to upgrade this site to WordPress 2.5.x. I’ll also be applying a new theme, though I’m not 100% sure which one it will be. I can say, however, that it will NOT be a completed task anytime soon. I’m not a web designer and I don’t want to waste time making things purty. I care more about functionality and such and will be adding a few new plugins as well. So, if there are a few glitches y’all notice over the next 24-48h or so, please PLEASE let me know. Letting me know what you think of the new semi-temporary look and feel as well would make me verrry happy.

I may yet continue as a Mexican medical student at another school, so I haven’t given up the domain yet, but it’s time for some serious housecleaning around here. If your blog is not on my sidebar and we’ve commented/emailed in the past, let me know–it’s just on oversight on my part. OK, time for me to start scrubbin’!

Pendejos at Pemex

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I just saw what is perhaps the stupidest thing I’ve read in a long time. Apparently, many people from SoCal are driving to Tijuana to fill up their vehicles because of the cheaper, Mexican-government-subsidized Pemex (Petróleos Mexicanos) gasoline. Since the government controls the gasoline, Mexicans do not feel the week-to-week spikes driven by speculators and doomsayers (that also conveniently coincide with things like Memorial Day weekend) and enjoy a more stable price that’s based on longer-term, “reality-based” data.

The problem is that although it’s cheaper, Pemex gas sucks. It’s dirty and is, in my experience, at least a third less efficient than American gasoline (measured by mileage on what a fillup gets me on either side). It deposits more gunk in the engine, requiring more oil changes (which comes from, you know, OIL) and filter swaps (plastic = OIL) to make things run comparably. Additives like STP gas treatment to help boost fuel efficiency by raising the volatility of the gasoline in the combustion chamber (organic liquid = OIL) are often added by locals at fill-up at additional cost, negating savings. Since it’s less refined, the combustion of Pemex gas is also horrible for the environment, as any traveler who’s experienced the pollution in Mexico’s large cities can attest.

Away from the pump, you’re going to spend upwards of $2-3 each way crossing the border in tolls, and then you’ll have the random-ass inspection coming in on the Mexican side, combined with the all-too-familiar US Customs agent with a hard-on for being the one to catch an al-Qaeda operative coming in as a roofer (who, by the way, is in my trunk as we speak). I guess these people’s time isn’t worth anything.

I think the only way this could POSSIBLY make a difference is if one was filling up a very large tank or several portable tanks to make the crossing/time factor worthwhile, even with the 33% lowering in efficiency if one is saving at least 33% on the cost of the gas. Perhaps for some, like those that drive around town all day looking for that one filling station that has the gas at $3.87 instead of everyone else’s $3.89, it’s all about the satisfaction of proving …. something.

As pump attendants [in Mexico, you don't pump your own gas by law] struggled to keep up with dozens of vehicles lining up for fuel, U.S. and Mexican drivers traded insults. A few even brawled as they waited for hours in searing heat this week in the rough border city of Tijuana.

“I am not budging until I get to the pump. I don’t care what anyone says, I’ve been waiting for two hours,” said Jaime Rosales from Southern California, at a gas station where buses, trucks and cars all vied to get to the pumps.

Talk about asking for an ass-kicking. The article talks about border town violence like it’s everywhere–it’s not. But don’t think for one second you just might be pissing off the wrong person. In Mexico, the American is the foreigner, and too many cross over and think just because the USA is a few miles away that “someone has their back.” Um, no. I hope the gas was worth it for them, because the time it took for the average vehicle owner to go, wait, brawl, wait, fill up, wait and come back, I actually got something done without wasting any gas.

High Definition

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One of the things I love to do in my free time is photography and video. I don’t claim to have any special talent for either, but given enough time and footage, I can make something pretty cool video-wise. For our IRS “stimulus check,” (which, thanks to my working last year for those months I earned one) we did our patriotic duty to help piss in the ocean invigorate the economy and bought a high-def camcorder. Given our financial situation, this was a rather extravagant purchase (and I bought it for way cheap as a refurb, so I think I did pretty well) but our 5-year-old camcorder was ailing so badly, I’d rarely break it out; consequently, I missed filming many moments of our little one.

Here’s the funny part: there is no HDTV in any of our family members to be found. Oh sure, the computer monitor can serve that purpose, but who wants to watch a movie on a 20″ monitor? After the firesale we had in Mexico to move back, the only TV we have is this bargain basement 21″ Magnavox which does a shitty job of showing standard definition without problems much less HD. So why bother with HD at all? Simple: futureproofing. I have yet to see my daughter’s 2nd birthday last month in its full HD video glory, but it’s on digital tape (HDV format) whenever that time comes…

…which leads me to another quandary: this whole process has underscored how much I need to upgrade my computer system. Handling HD video is seriously CPU/GPU intensive. The raw video (1920×1080) doesn’t even fit on the computer screen. The disk space requirements are enormous as well: going from HDV->Apple Intermediate Codec will cost almost 75gigs/hr of hard drive space. Ouch. Now I need a RAID array as well, because I sure as hell ain’t going to trust a single drive to be slammed with that much I/O, project after project, and survive for long.

But what a cool camera. In truth, I can record in HD and export in downsampled SD DV like any other tape-based consumer camcorder. The difference is that 1) I have the original footage in HDV format on tape for future re-import, and 2) the image quality is STILL a product of a superior CMOS image sensor and all the functionality the camera provides leveraged to make a much better video product. I’m still learning everything, and I’m scared that the more I learn, the more I discover things like “if I had this kit to use a 35mm lens adapter, imagine what depth of field control I could have!”

I am not a filmmaker, and I have no plans to change careers to become a cinematographer or movie editor. I think I am drawn to this new (and inevitably expensive) hobby because it channels the dormant parts of myself that are creative, that do yearn to create something brand new, or at the very least, transform the ordinary into something special. Just as a picture can be worth a thousand words, a visual story can be worth a thousand pictures.

This should be fun.

Hospitalia: Bowel Run

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So at long last, this series continues. We left off with a negative EGD and an extremely low Hgb/HCT that was dropping even within these 48 hours. Well, what’s an eager GI doc to do if an EGD is negative? Of course: the colonoscopy. Aside from the unpleasant idea of having a metal snake going against traffic, I was pretty calm, knowing enough from recent experiences that I wouldn’t know any better.

Even though I’ve never had one, I know a few who have, and I knew that a “bowel prep” was involved. This is a nice term that means being forced to take some substance(s) that make you go to the bathroom so much that nothing is left. Literally. As long as you haven’t eaten recently, the upper GI is empty after a few hours unless you have a problem (eg, stricture), so this prep is unique to the lower GI where visualization would obviously be a problem without it.

I already spoke of the less-than-optimal bedside manner of my GI doc, but he outdid himself this day. The sadistic asshole ordered–and I shit thee not:

• 4 doculace (Colace): This is a mild laxative/stool softener. Harmless enough, but why 4?
• 1 bottle (~10oz) magnesium citrate: This is some nasty stuff. It’s fizzy salt water with a metallic-limestone aftertaste. Alone, this would make most people regret they drank it. Cramps and disomfort are par for the course here.
• 10mg x 3 lactulose: OK, here’s where Dr. Fecophilia has just jumped the shark. This order alone would have at least resulted in some violent events. The problem with lactulose is that gas/cramping is massive. Oh, and I was supposed to have already had mag citrate above. When my dad was in end-stage liver failure before his transplant they’d use this stuff for hepatic encephalopathy; it’s a different mechanism for why but the end result GI-wise is the same. I saw what ONE would do to him; I don’t want to imagine 3. Ah, but the best is yet to come…
• 1 gallon Golytely: Perhaps the most ridiculously inappopriately-named product in medicine, one does not “go lightly” at all. No, one does not go gentle–one rages, rages against the power of the ‘lyte. This stuff also has a relative called “NuLitely,” probably because one says, “Nooo! Nooo!” after knowing what it is. It’s not enough you are drinking a laxative in the first place; you are essentially chasing it with a gallon of water. Oh, and you can’t nurse this stuff over hours since the water would be gradually absorbed in the small intestine, enter circulation, and would eventually be peed out instead. No, this stuff has to be imbibed as if one were a pledge at a frat party, slamming one small glass after the other without mercy. This is often used all by itself for surgical bowel preps. What I did to this sadistic bastard to make him use this in concert with the others in his terrible arse-anal is beyond me.

To make this long story short, I refused the Doculace and the lactulose. I had been on a combination of clear liquids and NPO for over 48 hours; this was overkill on a normal day, much less when lime Jell-O was the closest thing to solid food I’d had. The next morning in the GI lab, the doctor came by and asked why I “refused his orders.” I said I thought it was overkill and that I promised I was adequately prepped on what I took. He then lectured me patronizingly on the need to follow directions but stopped short of cancelling the study (as if I’d let that happen w/o a fight).

The actual in-room experience was even more pleasant this time than the EGD: no foul throat spray, no mouthpiece/bridle (to keep from biting the scope) being fitted, just lying on my side when all of a sudden I was sleepy, then I was in the recovery area. That propofol is some dreamy stuff.

[Un]fortunately, the colonoscopy was negative, no signs of bleeding, polyps, erosions, or anything suspicious. Now what?!

Well, that’s for the next post.

Like last time, here are some more tidbits to share:

• I wanted to know all the values of my bloodwork, so I asked to see my chart rather than nickel-and-diming the nurses for individual values (which is all they’d be willing to do). I had to sign a release form authorizing myself to view my chart. My signature had to be witnessed that it was indeed me signing it. For me. And I had to fill in exactly what I would “allow” myself to access (labs only, h/p, etc.) Does this not strike anyone as the height of the absurd? I’d understand if I had to sign something putting a request in writing to appease the hypermeticulous records people, but an authorization?
• Said chart review had to take place with a chaperone. I can understand this–not everyone has a “big picture” view of this document’s importance, and some malcontent nutzoid could have bad intentions. I had 30 minutes with which I could view what I wanted (or what I “allowed” myself earlier, heh), and while I knew someone from cubicle-land would be there, I didn’t expect the Eye of Mordor watching me, just standing there, making sure I didn’t harm The Precious. Never a word, always watching. I would have liked to have browsed more at leisure, but I think it was the whole point was to be made to feel like a voyeur to your own data.
• Nurse: “So they tell me you’re studying to be a doctor.” Me: “Yes, that’s true.” Nurse: “So what’s your major?”
• What’s with medical staff of all varieties barging into the room while knocking?! If you’re going to invade my room space, as is the right of you to do since this is a hospital and not a hotel, don’t make it seem like you’re “respecting” my privacy when you’re fully in the room, door wide open to the hall on the second knock as I’m walking from the bathroom with my gown open. Knock, wait a second or so (at least don’t open the door fully to the hallway), or don’t bother.
• If techs want to wear white coats and stethoscopes (which, as in respiratory techs can be totally part of the job), receptionists want to wear scrubs when they see no patients, and doctors can wear whatever they want, please don’t blame the poor patient not knowing who is who. I made the mistake of thinking my new, un-introduced nurse was a radiology tech and you think I called her mother a slut. (“Did you hear what he said?!”) Hospitals need to impose some basic standards to avoid confusion, and common sense dictates that unless you work in a peds clinic, My Little Pony scrubs will not foster respect or that one is in good hands by any adult patient still conscious.

Next installment: the even longer metal snakes these GI docs have waiting in black suitcases, [un]informed consent, and the past that comes back to haunt you.

Ping

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Just a ping (“One ping please, Vasili?”) to let everyone know that I’m clawing my way back into the blogosphere. I just fired up my newsreader and counted the thousands of posts since I last ran it over a month ago. SHOCKING! Most friends had 20-30 posts, and not a small few had quite a few more than that. I am so ashamed.

So, given the above, I’m sorry to admit to my peeps that even though I’d like to, I almost certainly won’t get to read all of your posts. If your magnum opus was much before last week or so, chances are I won’t see it unless you tell me.

As for me, well, I’m doing better in some ways and worse in others, all to be shared soon. I know, you’ve heard that before, but this time, I’m motivated by something coming up in my ongoing personal medical drama in a couple of weeks for which I’d like the site to be current. That aside, I genuinely am motivated to write again for its own sake. I think I had to step away for a bit (part voluntary, part forced) to appreciate what I have here, namely, the friends and associations I’ve made online and the support I’ve received publicly and privately.

Lastly, after having been egged on somewhat by Dr. A. and Vijay, I am trying to get over myself to start audio and/or video blogging. I’m 100% ready to go, except every time I record something, and especially for video, I see it, I shy away and trash it instead of posting it. So why the conflict? Well, put simply, “blogging” in this way is SOOOOO much easier. A long post that is edited, re-edited, etc. can be simply dictated/filmed naturally. Sometimes typing is a chore, and I can’t seem to shut off the “edit” filter with the written word; since we’re not talking Hollywood special effects here, I just don’t feel the need to over-edit for A/V media. So if this seems even remotely interesting to you, please leave me a comment telling me what you think so I can stop second-guessing myself and put it out there once and for all. If tomatoes get thrown my way, I’ll just make a marinara.

P.S. You can also follow me on Twitter (when it’s up–don’t get me started on that…), since of course it’s far easier to update goings-on there.

Grand Rounds 4:33

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Sorry for the late posting, but my friend Ramona Bates at Suture for a Living is hosting this week’s Grand Rounds, and in true “better late than never”-fashion, I ask that you go check it out for the best of the medical blogosphere this week. Dr. Bates is a plastic surgeon from Arkansas, and this week’s edition features some really nice local and state pictures. Check it out!

(and I’m doing better but was offline for too long–the nerve of various places and family members not to have WiFi!! Can you imagine?! Updates soon once I get re-situated)

One step forward, two steps back

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So the reason I haven’t blogged much of any substance lately is because healthwise, I seem to be regressing from late post-op complications. At first, I was taking good strides forward and hit a setback here and there, which is to be expected. Now, 5 weeks post-op, I’m facing some issues that I thought were well over weeks ago, so much so that I’m seeking medical attention in a few hours. It sucks not being able to continue/finish a wonderful story that I so energetically started, of all things because the story hasn’t even ended! Maybe that’s a pre-requisite to starting a damn personal story in the first place…

Anyway, just wanted to drop a quick note…I’ll see what the doctors say, and hopefully I’ll be back sooner than later. Until then, please don’t lose faith in me and put down the fork–I’m not done yet.

SurgeXperiences No. 20

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In honor of Dr. Sid Schwab’s masterful edition of the surgery blog carnival, SurgeXperiences, I offer this humble introduction:

Dr. Schwab shows a natural attraction
To verse in utmost compaction.
 He’s written a book
 So go take a look
At our Limerick Laureate in action!

This is the first time I participate, so I’m especially honored to be included in such a creative edition!

My kind of American hero

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50 years ago this month, a lanky 23-year-old young man from the small town of Kilgore, Texas went on Soviet soil and conquered an entire nation–truly winning their hearts and minds–at the height of the Cold War, a mere six months after the Soviets launched Sputnik I to start the space race–not with military might, but with music. I am, of course, speaking of Van Cliburn, one of the most famous pianists this century.

Story short, the Soviets decided they were to host a grand competition for the world’s finest pianists, violinists and cellists, all in honor of the famous Russian composer Tchaikovsky. Premier Khrushchev was certain that the Soviets would illuminate the musical world as Soviet musicians would compete and emerge victorious on an open stage for the world to see. I’m sure the Soviet Ministry of Culture had their “hand picked” winner, but the crowds were chanting Cliburn’s name. He was the obvious choice among the jury, and the shock wave was enormous. The soft-spoken Cliburn literally had women screaming as if it were a rock concert, yet Cliburn’s stage presence then and now has always been one of austere sincerity.

So powerful was the “note heard ’round the world,” that the jury had to ask Khrushchev personally to approve naming Cliburn the competition winner. And lets examine some of the luminaries on that jury: Emil Gilels, jury chairman (photo w/Cliburn), Dmitri Shostakovich, Sviatoslav Richter, to name a few: to have won over these geniuses, regardless of nationality or politics, was a feat unto itself. Imagine it! The gold medal of the inaugural Soviet competition in honor of the grandfather of Russian classical music–going to a practically unknown American at a time when the USSR was spilling over with national communist pride. So powerful was this weaponless and honest victory, that Cliburn received a ticker-tape parade in New York upon his return. Usually reserved for sports champions, military heroes, or pop-culture icons, no other classical artist before or since has ever received that honor. Cliburn’s live recording of the Tchaikovsky First Piano Concerto made upon returning back to the USA (with the Soviet conductor and orchestra from the competition no less) was the first classical album to go platinum, selling over a million copies. A classical album!!

No longer making recordings but still playing limited engagements, he is more known now for the international piano competition that bears his name. It shows his character that Cliburn stayed true to his roots and had the competition held in Fort Worth (ie, not neighboring Dallas or any other “big” city) where this small, humble city becomes the musical capital of the world for two weeks every four years. The Cliburn Foundation also hosts a competition for amateur pianists on off-years, something I have always had on my “Have to do before I die” list–just to participate.

Below is a video clip of Cliburn playing the last movement of Tchaikovsky’s Concerto No. 1 in 1962 during one of Cliburn’s numerous tours of the Soviet Union. This one happens to be in Moscow, with the same conductor and orchestra, and in the same hall as when he won the competition four years earlier. You can even see Khrushchev himself applauding during the last few seconds of the video. Understand that this was the same year as when the world was on the brink of nuclear holocaust from the Cuban missile crisis, yet there Cliburn was on Russian soil, wowing Soviet audiences with their own national composers. Seeing the video, it’s not hard to understand how Cliburn was and is a true musical ambassador of peace in the name of great music and art. Enjoy!

(For more, go to the Van Cliburn Foundation page and follow “50th Anniversary” links for more videos and interviews of Van Cliburn then and now)