It's $94.50 or this: These are your options

Oh, I loves me some Fred! 

Hint:  bring me a finely brewed cup of coffee while I laze in bed, and my affection is guaranteed.  [Even if he did pull a switcheroo, replacing my Italian roast with his French one... the wild and crazy guy!]

Readers dear, I've not been remiss in posting breaking crps studies.  Rather, my medical feeds have been strangely silent on the subject -- until yesterday, when i received notice of three publications, all in PAIN®, the official journal of the International Association for the Study of Pain® (IASP).



Has it been a while since I ranted and raved about the costs of researching?  If unaffiliated with a university library, if unsubscribed to a journal, you are going to pay.  In this instance, the cost is $31.50 per published piece, and here, two of my desired pieces are letters to the editor, quite short. Not that length determines import -- not in this instance!

Anti-inflammatory treatment of Complex Regional Pain Syndrome
Volume 151, Issue 2, Pages 251-256 (November 2010)

Sigrid G.L. Fischer, Wouter W.A. Zuurmond, Frank Birklein, Stephan A. Loer, Roberto S.G.M. Perez

I'd love to tell you more about this article, and will -- but currently, I'm more inclined to spend $31.50 on kibble and catnip.  Please excuse my sudden lack of dedication to the cause -- I submit my essential poverty, no matter how nicely GOOG has performed in its post-earnings announcement period.  [Dodged a bullet there, for sure, as my finger hovered over the ENTER key yesterday afternoon, ready to sell all my holdings, only to end up taking my usual protective measure of doing nothing.  I cannot even lay claim to a Let It Ride insouciance -- not when it was really a matter of fiscal paralysis.] 

Ahem.
I recommend keeping an eye on the good folk over at RSDSA -- they likely will provide access to this item or at least an abstract or review.  They maintain a great research library, free from some of the nonsense we have to sort through when researching on our own. 

Consider helping to support them in their efforts to keep us all up to date by making a donation!

Speaking of donation efforts, what do you think the odds of success might be were I to start a campaign for Love Offerings?  Hmm?  Would you make a Love Offering on my behalf?   (No, I am not talking DNA, but thanks so much for the thought.)

{blush}

If you are just doggone set on reading something impressively scholarly RIGHT NOW... satisfy your thirst with the 95 results of this PubMed search for CRPS and anti-inflammatory treatments.  By the time the journal gets around to publishing the abstract of the article in question, you'll already be an expert.

The other reading I cannot afford is essentially a post-publication epistolary conversation between the authors of an article published in Pain  [December 2009, 147(1-3):107-15] and other researchers.  Dr. Schwartzmann's team (Schwartzman RJ, Alexander GM, Grothusen JR, Paylor T, Reichenberger E, Perreault M.) produced a long-awaited report on outpatient intravenous ketamine, concluding:

Subjects in both the ketamine and placebo groups were administered clonidine and versed. This study showed that intravenous ketamine administered in an outpatient setting resulted in statistically significant (p<0.05) reductions in many pain parameters. It also showed that subjects in our placebo group demonstrated no treatment effect in any parameter. The results of this study warrant a larger randomized placebo controlled trial using higher doses of ketamine and a longer follow-up period.

Drs. Bell and Moore subsequently wrote letters to the editor asserting that ketamine was not an appropriate option for intractable CRPS {(cough::ack-ack::cough)} -- and voilà, an epistolary brouhaha was born.  I would love to read the whole thang, especially as it includes a response from "the other CRPS expert," Dr. Anthony Kirkpatrick.

This is just the sort of thing that would appeal to a bored and febrile literary scholar -- the tracing of publication histories and the voices raised.  Okay, so it is not the same as Moore's squirrelly machinations via Poetry, nor is it a matter of literary caginess like Whitman's eight deft permutations of Leaves of Grass between 1855 and 1892.

I am going to bury a confession in the middle of this blah-blog post.  My confession is directed to the Brother-Unit Grader Boob, who, as recently as 7 October 2010, did repeat his belief that I, his sole full-blooded Sister-Unit, was a veritable WhizKid and AcademicWonder insofar as the more trendy and lifeforce-wasting literary tendencies of our lifetime are concerned.

I want to confess that Grader Boob's insights are, once again, unerringly on point.  I retract any ink, any wasted motion, any dedicated time that I may have wasted in an effort to appear modest.

Truth to power, friends, truth to power!

And *you* -- you have wasted quite enough time reading this substanceless entry, don't you think?  Move along, then, move along!

To make a Spontaneous Love Offering * , please donate HERE.

* From Stuff Christians Like, #72:  Love Offerings --

For those who don’t know, a love offering is kind of a “volunteer offering” the church takes up during special occasions like when a puppet group from Guam (named Strings of Mercy) is performing at your church. It’s really not that voluntary though because if you don’t contribute anything you’re essentially telling everyone you’re sitting near that your heart is not full of love. By not putting a couple of bucks in the offering plate you’re actually putting in a big fistful of hate. I wish when the ushers collected a love offering they would say out loud when someone didn’t give, “Oh, you don’t have any love for the magical world of puppetry? I guess love your neighbor doesn’t mean anything to you. Fine.”

the one where i wallow in it

i am way likely to delete this post when rational thought makes a reappearance; on the other hand, my growing, playful, and just darned whimsy-laden devil-may-care attitude might also win out, in which case i will likely shrug and deny everything.

of course, to shrug implies the possession of shoulders, and as i continue courting the opinions of every medic within a 150 mile radius of the Lone Alp smack-dab in the middle of Tête de Hergé (très décédé, d'ailleurs), the more i am convinced that The Shrug will not figure in my repertoire much longer.


--Opus for Shoulders (5 minutes) by Ruth Eshel.
Performed by Beta Dance Troupe from Haifa, Israel.

today, the fredster and i boogied over to the pain management people.  okay, so i am trying to sound important.  you know, like i actually have "pain management people."  what i *do* have is a wunnerful::wunnerful physician assistant with whom i meet monthly and discuss dogs, cats, ex-fiancés, life partners, the private lives of doctors, fred, the beach, the wunnerful::wunnerful-ness of being a bitch, sarcasm and sarcasm's failures, grandmas, the nature of pain, wii, and, occasionally, the pain of crps, avn, and the completely ape shit nutzoid condition of my infected and defective bones.

that's a lot to cover in just a little bit of time.  amazingly, she also manages to finesse the pharmaceutical management of my pain so that i exit their office with between four to six prescriptions, of which i usually fill two.

i consider her a friend, as she sometimes lets me weep, and does me the enormous favor of just letting me be.

it has been only in the last few months, though, that i've pumped her for insider information on The Shoulder Situation & Escapade.  see, she used to work for the brother of my orthopedic surgeon, as well as once having a position on the ortho floor (that'd be the fifth -- i know it well...) of his preferred hearsepital. oh, and i have deduced a quickie of a romantic relationship with my surgeon's PA.  it's a veritable hornet's nest of interwoven nonsense.

the short version of our october meeting can be read in my swollen red eyes, and this well-worn, well-loved quilt, completed by the memory of sammy nuggled in it to best share his warm commiseration.  i am admonished to take my pain medicines as ordered.  my vainglory is ridiculed, my legs, my arms, my face.

an antique kaleidoscope of broken bits of largely red glass.


--Opus for Shoulders 2 by Ruth Eshel.
Music: Deganit Elyakim. Costumes: Noga Weiss.

i watched fred -- in profile -- as he drove us home -- and knew as well as i know anything these days that i just cannot inflict much more of this on him.

or his beautiful profile.

with my indian rug and a pipe to share

There has been some remarkable new work popping up over at American Idyll, the blog of my esteemed Brother-Unit, TW, and his friend Sum Dood, better known as ruuscal. 

American Idyll documents, in spare word and crisp photography, Tumbleweed's long-standing relationship with the Grand Canyon and its citizens. 

Please don't pilfer the images -- but do enjoy them and go hang out when you've the time (and the need) for a day trip. 

Heed the admonition (but don't feed the animals):  yes, the river knows!

I like not only to be loved, but also to be told that I am loved.

I am not sure that you are of the same mind.

But the realm of silence is large enough beyond the grave.

This is the world of light and speech,

and I shall take leave to tell you that you are very dear.

~ George Eliot

[letter to Mrs. Burne-Jones, 11 May 1875]

Huxley Terrace and
Grand Scenic Divide

A bird does not sing because it has an answer. It sings because it has a song.

                     --Chinese proverb

Talking Ravens from David Old Duffer Rice on Vimeo.

Colorado River
above
Trinity Canyon



Tapeats Creek photos

 Aurora borealis
The icy sky at night
Paddles cut the water
In a long and hurried flight
From the white man
to the fields of green
And the homeland
we've never seen.

They killed us in our tepee
And they cut our women down
They might have left some babies
Cryin' on the ground
But the firesticks
and the wagons come
And the night falls
on the setting sun.

They massacred the buffalo
Kitty corner from the bank
The taxis run across my feet
And my eyes have turned to blanks
In my little box
at the top of the stairs
With my Indian rug
and a pipe to share.

I wish a was a trapper
I would give thousand pelts
To sleep with Pocahontas
And find out how she felt
In the mornin'
on the fields of green
In the homeland
we've never seen.

Tower of Ra, Tiyo Point and Shiva Temple

And maybe Marlon Brando
Will be there by the fire
We'll sit and talk of Hollywood
And the good things there for hire
And the Astrodome
and the first tepee
Marlon Brando, Pocahontas and me
Marlon Brando, Pocahontas and me
-- neil young





Thank you, TW. 
Thank you, ruuscal!

[Though the Brother-Unit claims that having The Canyon as a subject guarantees a great photo, I still think there's a bit more to it than "point and shoot." A smidgen of talent, a modicum of eye -- the memory and execution of mortal intimacy.]

If I Should Fall Behind...

We said we'd walk together baby come what may

That come the twilight should we lose our way

If as we're walkin a hand should slip free

I'll wait for you

And should I fall behind

Wait for me

We swore we'd travel darlin' side by side

We'd help each other stay in stride

But each lover's steps fall so differently

But I'll wait for you

And if I should fall behind

Wait for me

Now everyone dreams of a love lasting and true

But you and I know what this world can do

So let's make our steps clear that the other may see

And I'll wait for you

If I should fall behind

Wait for me

Now there's a beautiful river in the valley ahead

There 'neath the oak's bough soon we will be wed

Should we lose each other in the shadow of the evening trees

I'll wait for you

And should I fall behind

Wait for me

Darlin' I'll wait for you

Should I fall behind

my october friends

 you wonder whether i remember

whether i ever cared at all

oh, yes, i do remember

and i do still recall

oh, yes, i cared, care still

oh, yes be still

be still

oh yes i do remember oh yes i do recall

i ever cared

friends of my fall

oh how i miss you

oh how i ever cared at all

The Personal: Our Last Bastion

I am determined to trump my search engine.

I use Google, and, in general, love Google.  Being an investor, the health and happiness of Google is very important to my own wellbeing, and to that of my household, fond as we all are of shelter and regular meals, as well as to my persnickety creditors, insistent as they are on timely and complete payments. 

The interconnectedness we evidence shall serve as witness to the wondrousness of God's faithful creation!  Or something.

Sorry.  It's Sunday morning and I left the television on during my last nap session, which allowed Joel Osteen and other Smarty-Panted Religious Folk to tiptoe around my brain unsupervised.

Dangerous stuff, leading to weird wakeful convictions, like how Google may well be omnipotent.  Well, at least three-in-one.

It's become nigh*   unto impossible

[*  I suffered one of my usual distractions with the word "nigh," but can report that the most interesting return on my curiousity was learning that the oft-used comparative -- yes, that'd be nigher -- has been in force since the 1400s.  Mysteriously, The Erudite are convinced that there is no etymological relationship between the adjective in its evolved form (near) and that form's comparative, nearer.  Crazy stuff, huh?]

Okay, so it's getting hard to enter any search term without Google cracking wise and "suggesting" it before I finish pecking the letters out.  I fear that, eventually, out of self-defense, the lacunae of my vocabulary will be filled with short words and small expressions.

Challenged at such an elementary level of my ontological being, I am now engaged in a challenge: 

Rather than seeking to be as concise as possible in my search requests, I am now wordy.  Early frustrations have even prompted my wordiness to contain misspellings.  Most of which Holy Google manages to catch.  And for which, frequently, feigning indifference, Godly Google suggests corrections!  Oy.

I can't be the only one to have noticed that The Personal has assumed a position of prominence in the face of technology.  We litter Facebook with our particulars, we stick our tongues out (nyah, nyah, na-na-na!), we're united in false friendships based on homonyms -- we rape proper nouns, forcing our intimate meanings upon them.  I tell Facebook to find my friend Joe Smith*   and what tops the list of "over 500" that it returns is one Joel-with-a-middle-initial, because this person is a mutual friend of someone completely unknown to me.

*  The first haphazard Joe Smith, as I know no actual Joe Smith, is represented by a photo of a person, face hooded and mostly blocked.  Blocked by a big handgun from Winston-Salem, North Carolina, the barrel of which is trained on all 1854 of its closest friends.  [All of which goes to support my ongoing suspicions about persons from that state.  See my editorial reflections introducing the blog post Shawnna's Con.]

The Personal is bound to become our Good News, bound to eventually so muck up the informational machinery that even Google's error rate at reading our minds will skyrocket.  My Mother's maiden name?  Your last four?  Her favorite erotica?  Joel-with-a-middle-initial's preferred handgun?  * Aunt Eugenia's taste in college roomies?

*  We hear this as we wake: Ah! je ris de me voir si belle en ce miroir.
We hear this as we fall asleep: Ah! je ris de me voir si belle en ce miroir.

The Personal, The Last Bastion!  I wanted to clue you in, Dearest Readers, to the Upcoming Paradigm
Shift.

Of course, the Upcoming Paradigm Shift will be delayed a few days.  Don't expect much in the way of movement from The People's Brigade before Thursday, October 14, 2010 -- when Google makes its earnings announcement.  We're thinking there should be a few days' allowance for additional fluctuations in the market, as well.

HELEN and MARGARET's Pledge to America

Margaret and Helen are making promises and pledging all over the place.  Check it out: HERE.

Graphic Credit

Karma and Cole Slaw



NC Museum of Natural Sciences


Hinduism's version of reincarnation -- you know, karma as my only gift of inheritance, my sole happy-birthday-to-you present -- is definitely the view of existence that will be applied to my miserable excuse of a life;  That is, to my next one.

Um, as far as I know.

Which is exactly the point!

This morning, first thing, I opened a cheery, breezy, e-mailed invitation to a Memorial Service for two people (one an acquaintance, one a friend) I did not know had died, and quite some time ago, apparently.
It's wrong on so many levels.

So I hurried on over to the Reincarnation Station, took the test, held my breath, and was told I'll be coming back around as a bear, and that:

Almost 32% of people will be reincarnated as a higher form of life than [me].


[I'm] not perfect, but [I]'ve lead a better life than most. With a few changes now, [my] next life could be even better.

Oh, good, look:  Crime and Punishment is on!  Glover, Hurt, Redgrave, Kingsley, Kidder. That one.

Raskolnikov:  what a rookie to believe in his capacity to give karma a helping hand!  Surely something vegetal awaits my presumptuous, fictive kin -- a kumquat, a rutabaga.

In vegetable vein, I broke in my new refurbished Kitchen Aid Food Processor with remainders of cabbage, carrot, onion (more juiced than chopped) and broccoli stems, and with a frothy, weird, creamy vinaigrette.  Cole slaw.  It took me 40 minutes to clean up after the 5-minute process.  I was so tired, and before noon!

I fell back into bed.

In my dream, in my 55 minutes of nap, I relived an old nightmare. 

This really happened:  I had pneumonia, and was being put on a ventilator.  Apparently, I was bucking the process.  On my end of things, the rushing noises of the breathing machine became a mechanical voice that said, over and over, in the rhythm of  expiratory bellows, everywhere:

THIS IS WHERE
YOU HAVE ALWAYS
WANTED TO BE

Today's mourning dream changed The Machine's line, ruined its perfect syncopation, syllabication, so that it said:

IT IS NOT ALWAYS ABOUT YOU.

Cole slaw in the fridge, done.  Check.
RSVPs to make, for Ed K. and Michael P.

Vargas Llosa

The Nobel, he won. 

Hmm.

Not a fan, not a fan at all. 

Nary a bit.

But it's an Occasion and I'm nothing if not a Celebrant.  So while everyone is tippy-toeing around this decision, undoubtedly mentioning Garcia Marquez within their first two paragraphs, let's commemorate an entirely different event -- one that really did bring the two together, whirligigs, 34 years or so, ago.

For extra credit, who'd win in The Hulk v Vargas Llosa?
Okay, that was too easy...

For an honorary doctorate, then:  100 words on Vargas Llosa and deceit.  (Show your work.)


Vargas Llosa is teaching at Princeton this semester, How to write novels, or something like that.
In a feat of swell timing, he has a book coming out in November.

Feud sensation! Why Vargas Llosa thumped Márquez!Now it can be told: the amazing truth behind the Latin American literary giants' legendary ding-dong.


It is 31 years since Mario Vargas Llosa punched Gabriel García Márquez in the face. It happened like this. "Mario!" exclaimed Márquez happily on seeing his old literary chum after a film premiere in Mexico City. He marched towards the Peruvian, arms outstretched as if for an embrace. "How dare you come and greet me after what you did to Patricia in Barcelona!" Vargas Llosa reportedly shouted and decked the Colombian with a right hook. Mexican writers ran around looking for steaks to put on the Colombian's eye. Patricia, it turns out, was Mario's wife.

The two men have reportedly never spoken since. So began one of the greatest rows in literary history, right up there with the Gore Vidal-Truman Capote feud (in which Vidal suggested Capote had "raised lying into an art - a minor art". Capote retorted: "Of course, I'm always sad about Gore. Very sad that he has to breathe every day.")

But the details of what Mario said to Gabriel in Mexico City that emerged earlier this week beg more questions than they answer. What happened in Barcelona? What did Gabriel do to Patricia? Did Patricia like it? And what about the mystery Swedish woman? How does she fit into the story? Why didn't Márquez duck in Mexico City? How could Gabriel not know Mario was angry? Why didn't Gabriel hit Mario back? After all, Peruvian novelists punch like girls, don't they? [Read the rest of this Nobel-Announcement-Day-Worthy piece, HERE...]

[[Thank you, Stuart Jeffries!]]

The Three Truths of Grader Boob's Birthday Eve

1.  It is late, in that I haven't gone to yesterday's bed yet; 


2.  I'm desperate, in that loosey-goosey, self-referential, golden-red patina sort of way common only to the truly ultra-diuresed; and...


3.  The research citation, below, from title to conclusions, is hilarity, itself (although dependent on:


1.  bug-eyed insomnia; and...


2.  the attenuated aridity of my kidneys):

End-of-Life Treatment and Bacterial Antibiotic Resistance:
A Potential Association

Phillip D. Levin, MB, BChir, Andrew E. Simor, MD, Allon E. Moses, MD and Charles L. Sprung, MD, FCCP

Chest 2010 Sep 138:588

Correspondence to:
Phillip Levin, MB, BChir, Department of Anesthesiology and Critical Care Medicine, POB 12000, Jerusalem 91120, Israel; e-mail: phillipl@hadassah.org.il

Abstract
Background: Great variability exists in the occurrence of antibiotic-resistant bacteria in ICUs around the world. The contribution of specific ICU care variables to these geographic variations is unknown.

Methods: ICU patients from two ICUs (in Jerusalem and Toronto) who were admitted for > 48 h and who grew a resistant bacteria in any culture during ICU admission were compared with those without resistant organisms across a range of demographic and ICU care interventions. Significant variables were investigated with logistic regression to identify factors predictive of infection/colonization with a resistant organism.

Results: Resistant organisms were acquired by 82/423 (19%) patients. Patients acquiring a resistant organism had a higher incidence of diabetes mellitus (21/82, 26% vs 52/341, 15%; P = .026), were more frequently admitted from another ICU (17/82, 21% vs 33/341, 10%; P = .005), received more antibiotics in the ICU (19 ± 17 vs 14 ± 14 days; P = .005), and had more ventilator (10 ± 10 vs 7 ± 8; P = .031) and central line days (10 ± 8 vs 7 ± 8; P < .001). These patients had a lower incidence of limitation-of-therapy orders (9/82, 11% vs 78/341, 23%; P = .015). Only the absence of a limitation-of-therapy order (odds ratio, 2.62; 95% CI, 1.21-5.68; P = .014) was independently associated with the acquisition of resistant organisms. Further, among ICU fatalities, 5/45 (11%) patients acquired a resistant organism prior to withdrawal vs 17/44 (39%) nonwithdrawal fatalities (P = .003). Nonwithdrawal fatalities received significantly more third-line antibiotics (7 ± 14 vs 2 ± 4; P = .031) despite similar ICU lengths of stay (15 ± 21 days for nonwithdrawal fatalities vs 10 ± 11 for withdraw fatalities; P = .210)


Conclusions: End-of-life treatment is independently associated with acquisition of resistant bacteria. Patients dying without withdraw orders receive more antibiotics and develop more resistant organisms. These patients may represent a reservoir of resistant bacteria in the ICU.


In honor of Grader Boob's very literateness, in lieu of a gift card, in memory of all the poèmes trouvés (volés! volés!) in the cafés and bars of the East Bay Scene, a bit of poesy:

These patients may

represent a reservoir.

Of resistant

bacteria!  Of

resistant,

bacteria!

Bacteria

in

the

ICU, in the

ICU.

I dunno, Brother-Unit, it just struck me as funny.  You could have taken those same precious research dollars and used them in a way much more advantageous to The Species.  But, in that case, my pome wouldn'ae a-been borned. 

We'll be giving you the Birthday Buzz in the morning, before you head out to do your duty among The Uneducated, The Great Unwashed, The Hoi Polloi. 

Never forget, they pay your salary.  (I'm passing away from mirth.)

In any event, from the instant of your arrival in the back of that London cab, to the moment of your far off departure, a reservoir of resistant bacteria, you've been, among a good many things, a stringent proof of God's existence.  (With extra points for showing your work.)

NOTICE

From Graphis Annual 71/72 by Enrich Huguet, Ad for Diuretic
Courtesy of Jaime Morrison, The Former Nonist

There will be no further meandering blog posts of any substance here at elle est belle la seine la seine elle est belle,  until and unless I am allowed to lower my dose of Lasix from its present 80 mg to something that will allow a substantial block of time to be spent outside the bathroom.


(With a blood pressure.)
(And discernible ankles.)

Mur pourrit, trou s'y fit, rat s'y mit; chat l'y vit, rat s'enfuit; chat suivit, rat fut pris.

i'm doing a little (a very little) retail therapy online. 

this is an actual item description. try repeating it 3 times:

"sheer crinkle gauze hoodie over a adjustable lingerie strap opaque cami."

The Checklist: Pause and Reflection... FAIL!

As part of the eternal quest to identify the nasty pathogen causing infection and inflammation in my left shoulder (and hip), I underwent an aspiration of that shoulder joint last Monday.  The hospital radiologist used dye and a fluoroscope to guide the insertion of the needle.  A nurse and a radiology tech were there to assist him, as there were beaucoup bottles and slides that needed to be prepared once he managed to get a sample.

So there we were, the four of us.

Before getting started, we participated in a strange and wonderful ritual -- a Procedure Pause and Verification of Site Ceremony.  For short:  The Checklist, an adventure in Pause and Reflection.

Essentially, the head medico calls out for everyone's attention, then tediously goes over who the patient is and what procedure is to be performed and on what body part.  The site is marked and signed by the doc, and everyone is in accord about whether it is the north leg or the south toenail of the eastern ankle that is to be poked, cut, or otherwise handled and abused.

In my case, despite a desperate attempt on my part to shave a decade off of my date of birth, we all concurred that we were there to stick a large-bore needle into my left shoulder in an attempt to draw off some nasty fluid from which we hoped to farm some identifiable nasty bugs.  The radiologist signed my shoulder with a flourish, and we were off!

Having experienced the impact of medical errors, I did not find the Pause or the List or the Purposeful Redundancy to be any kind of imposition.  Quite the contrary -- I was impressed.  I even told a few people about it... Folks who know the extent to which I have suffered due to medical errors, and the attempt to cover up those errors.

Of course, I spoke with  Brother-Unit Grader Boob -- at some point in the 1990s, he supplemented his teaching salary by working at a hospital near his university -- a hospital most known for its surgical errors, by which I mean the amputation of THE WRONG LEG.  In the lingo:  wrong-side surgery.

What a horrible thing to happen!  And how upsetting when it happened again!  Yes, that was the reigning attitude -- the mistakes just somehow "happened." In my sad experience, I learned much about verbs in the passive, about hospital-acquired booboos.  [In one of the more sinister conversations Fred and I enjoyed during a riotous stay at Saint Joseph's Hospital of Atlanta back in 2002, the retort to our query regarding what, if anything, the orthopods planned to do about my "hospital-acquired" tibia fracture was:  "Oh.  So you know about that?" {with a beautifully arched eyebrow} It just made us mildly curious as to what we might NOT know, you know?  Beyond the initial medication owie, concussion, internal bleeding, and fractured ankle -- with CRPS onset within hours -- had we missed anything besides this tibial oopsie?]

As a Gimp, the attitude in play in these instances horrifies and pisses me off no end:  Well, this person already knows pain and disability, so it is no big deal that a little more pain and disability might be added to their lot.  They probably won't even notice!  Of that 1995 BooBoo, a NYTimes article noted:

"Some doctors who appeared as witnesses said that the leg Dr. Sanchez removed was in such poor shape that it would probably have been amputated in the future." 

What a pompous, convoluted, ass-saving and totally deflective (better than Teflon!) attitude! 

Okay, so I may have given some considerable prior thought to the impact such attitudes can have.

Back to our story!

Yes, it was an impressive display, last Monday, inside a tiny radiology suite.  So simple a thing as a pause and basic review of identities and of left or of right -- what a marvelous idea! 

So there I was this afternoon, getting an incredible amount of Face Time with a noted Infectious Disease Specialist, and we were reviewing the goings-on of the last few years.  Given the back-and-forth rhythm of the orthopedic surgeries I underwent, it was difficult to stay on top of which shoulder did what, when -- even in a fairly ordered conversation.  The ID Dood and I chuckled over the note sent by my Go-To-Guy, which clearly stated that the present culprit, in terms of pain and diminishing range o' motion... was my RIGHT arm. 

Chuckle, chuckle.

Good-natured guffaw!

He said, "Well, with so many shoulder surgeries, it is easy to get confused."  Spurfle!

Then ID Dood called the lab to check on culture growth from last week's aspiration.  So he's on the phone, all Chatty-Kathy, with some minion when his eyes go into Serious Squint.  He had asked for the results of my "left shoulder aspirate," identifying me by name and date of birth.  Lab Minion, however, informed him that there was no left shoulder aspirate being cultured.  There was, however, a sample from...

{YOU GUESSED IT!}

...a RIGHT shoulder aspiration!

So congratulations on the Careful Checklist, the Procedure Pause,the Reflection and the Verification of Site and all -- but if you are going to then mislabel your biopsy or culture samples, you are still chopping yourself off at the knees.

So to speak.

I was  making light of it as Fred and I climbed into Ruby, the Honda CRV, and loaded the power chair on Bruno's Lift, when he said:  "Yeah, but imagine...  you are brought into the ED unconscious and all they get is your name.  They plug that in and see that you have had a shitload of tests done on your RIGHT shoulder.  They can tell you have a raging infection somewhere... and that must be it -- your RIGHT freaking shoulder.  So they amputate..." Okay, so his scenario kind of fell apart at that point, but you get his drift.

The possibilities running through my mind were less extreme but equally catastrophic.  What if such an error had occurred before, but without such an obliging lab technician on the other end of the telephone?  What if, say, following one of the five surgeries on my right shoulder, SuperShoulderMan rang up to inquire about intraoperative cultures from said shoulder, only to be told something slippery like "no report of growth," when in actuality there was growth, but in a specimen mislabeled as left?  Hmm?  Before you get all pissy and dismissive, ask yourself if it could happen...

I still feel they are to be congratulated for these steps to stop medical error.  They just need to tweak a few straggling details -- like somehow including a review of labels on lab forms on the checklist.  Or something.

Marmy and the Elven Wood Smurf

For the Cat Lovers among you Fearless Readers, this is the first decent photograph -- ever -- of Ms. Marmy Fluffy Butt.

She has undergone a Personality Transplant since Sam-I-Am left us in early July.  Part of that process includes Severe Persistent Lovability and Charming Chirps -- and now, her first Posed Photo Shoot, with suitable Classic Prissy Paws.

World, allow me to present Your Queen, The Marmy. 

These were my Wee Hours -- I was in Desperate Pain and Worried about the ID consult.  In response, this Girly-Girl Cat posed The Stations of The Marmy and promised me Measured,Passionless Devotion.

Yes, I had the dreaded Infectious Disease Consult today, and wish to retract my statement describing the good doctor as an ancient Pillsbury Dough Boy with Liver Spots.  He was more of an Elven Wood Smurf.

More importantly, he has Ideas.  Based on those Ideas, we drew Blood, although not enough to get all the desired tests done.  When I left, they were still going round and round about whether 5 ml. of blood were sufficient for Immuno Goblins, or some such thang.  He's pretty convinced my Immune System is shot all to hell.

I was touched by how he understood my state -- how he said I probably cannot remember what it feels like to feel good -- by how he said "Oh my, oh my" when examining my legs.  I needed Sympathy, Empathy, Compassion and all in Ridiculous Measure... I was quite the Needy Bitch, baking along merrily at 101 degrees. 

He completely won me over when he said he would, at least, like to make me more comfortable, bring the fevers down, and convince my heart to beat at a rate below 128.

I think I am in love.

The Charles Prize for Poetry, 2010

The worst part of failing at blogging is the inevitable failure to keep one's promises.  I got you all hot and bothered about Dr. Charles' Contest and then went adrift before the deadline.

Here, belatedly, is the link to The Examining Room of Dr. Charles, and to his announcement of the winners in his wonderful poetry contest -- winning and notable poems included. Go give them a read, as there are some very talented folk telling truths in remarkable ways!  Then spend some time wandering around the archives -- An enjoyable prospect for a Sunday afternoon.

The Charles Prize for Poetry, 2010
September 12, 2010


It is with great pleasure that I announce the winner of the poetry contest. Over 125 poems were received with a general theme of medicine or science. 7 judges were consulted, representing a diversity of training in medicine, science, and the humanities. A few of the judges were moved to tears at times, and all expressed their wonder at the quality of writing.


What makes art, poetry, or literature special? Perhaps it is a combination of graceful observation and hopeful creation which lends light, perspective, and meaning to our existence. We know it’s good when a certain hum of neuro-electricity splashes brilliant colors across our satisfied brains, soothing ills, making us want more.  [Read the rest HERE.]

"I felt like he made me undress for fun."

You know those websites that "rate" or "evaluate" physicians? 

I landed on one while trying to find the address of the new Infectious Disease Dood I see tomorrow.  There were seven reviews, but only one person felt moved to leave a comment:

Pompous with a god complex! Hates women! I found him to be completely boorish while talking to me---talked to me like I was a little girl!! I felt like he made me undress for fun. He's a perv.

Not helpful.  Nope. No.  Not at all.

Plus he looks like an Expired Pillsbury Dough Boy with Liver Spots.

Oh, relax!  I employ sufficient discernment to realize that, were this woman's numerical evaluations taken away from the whole, Dough Boy would have near perfect marks.

(But how dare any doctor demand that she get nekkid!)