Pedagogy

I found this hysterical and very effective instructional video over at FlautoNP's blog. Thank you, FlautoNP!





The ways we learn! I have always been a fan of outrageous teaching and made every effort, in my time, to underscore even the most arid of facts with some sort of demented presentation. Of course, there is only so much one can do with the French subjunctive, although I think collecting near-rotten fruits and vegetables for the students to throw in their inevitable frustration is an idea not without merit.

Adults learning a foreign language are very inhibited -- unwilling to throw caution (not to mention near-rotten fruits and vegetables) to the wind and make mistakes. The Effortlessly Poopy and Fluent Child is forever touted as the paradigm for the Tied-Up-In-Knots and Constipated Adult. Unleash that inner child, learning specialists cry, and language acquisition will have a recuperative and restorative effect (not unlike some revolutionary scheme for toilet training).

Those wacky learning specialists!

The idea, of course, is to trick the staid adult into risking just a little mimicry of the Crazy Educator in the hope that the over-the-top instruction would draw them out precisely to the point of what is correct.

Teaching language was always fun -- except when it was tedious, and even then, I [hope I] never let the tedium show. "Teaching" literature and a more enlightened form of contemplation, the critical essay, however, was perilous and nearly always tedious.



No, not so much tedium -- more like being flailed alive.



Like many people, I love En attendant Godot, Waiting for Godot. Beckett gives me shivers of delight, frissons of recognition. For some reason, we think his work is easily accessible and we offer it up on platters to new literature students, mint jelly on the side.



Class discussion of the play was abysmal. This being my first go with "teaching" literature at the university, and given my incurable optimism, I had done minimal direction of the discussions, vowing instead to follow my fearless students anywhere. Yes, I forgot that they were hopelessly constipated.



They talked about homeless people. Yes, Didi and Gogo served as exemplum of this "scourge taking over our cities and parks... " (I bought Maalox.)



Then, they decided to talk about the role of desire. (I contemplated a purchase of champagne.) However, this quickly devolved into a discussion of how brave it was for Beckett to present such openly gay characters. (I rolled a few joints, drank some more Maalox.)

What's the best way to "teach" Beckett's En attendant Godot? Certainly not by letting go of the reins and liberating student discussion! The next semester, I relied heavily on performance value -- we watched three different theatre presentations, we read it aloud as a class, not permitting anyone to fall behind in either reading or understanding (jusqu'à un certain niveau). They began to know Estragon et Vladimir, Pozzo et Lucky, understand the oblique references, and be comfortable in the silence of what they could not know.

I was psyched. The final papers were about to burn a hole in my briefcase. I pulled them out, stacked them neatly on my cleared dining room table, grabbed a Diet Coke. Found an ink pen, got a fresh legal pad. Deep breath of excitement.

"Vladimir and Estragon are two homosexual homeless men..."

How do I get in touch with this Mad German Doctor Dude?
In the interim, I find great comfort with the Parisian Sock:

BIENVENUE!

La Belle Bianca Castafiore ici! And the tired retired educator, too!

This blog was to have the airy nature of an aria, the skittishness of a morbidly obese diva tottering along on remarkable stilettos. Ah, but even La Belle Bianca turns up in a terrycloth robe and scuffy slippers of a morning, inclines her head my way and is, au fond, a good, dear friend.

We share this space.

CRPS/RSD was not to be a cornerstone, a building block, a brick, nor any other form of organizational control!

La Belle Bianca s'en moque de moi. She yells: "Ah! je ris de me voir, si belle en ce miroir" ("Ah! I laugh to see how lovely I look in this mirror!") It's a stock phrase, a rich phrase. It is Bianca Broth! It is a reminder about stuff -- like perception and reality, arrogance and fluff.

I need Bianca in my life, especially, I admit, in my life with CRPS/RSD.

You've likely seen the movie Harold and Maude, yes? Who doesn't love Maude? Who doesn't wish to be so free?

HAROLD: You hop in any car you wantand just drive off?
MAUDE: Not any car. I like a variety. I'm always looking for a new experience.
HAROLD: Maybe... Nevertheless,I think you're upsetting people. I don't know if that's right.
MAUDE:If people get upset because they feel they have a hold on some things,
I'm just acting as a gentle reminder,here today, gone tomorrow.
So don't get attached to things. Now, with that in mind,
I'm not against collecting stuff.
I've collected quite a lot of stuff in my time.
This is all memorabilia
but it's incidental, not integral,if you know what I mean.

That's what my friend does for me -- even if her reminders are not so gentle, even if she is -- well, l'emmerdeuse...*

Welcome, then, to any reader involved with CRPS/RSD -- you'll find here the usual kvetching and lamentable weakness -- ah! but you will also perhaps find distraction and fantaisie: just what the doctor ordered.



*Comme un entomologiste, l'auteur [d'un livre sur La Belle Bianca] observe la lente transformation de la cantatrice;
"Au début, elle est ridicule, commente-t-elle. Mais, ensuite, elle se nuance,
devient meme une héroine, comme dans L'Affaire Tournesol." [...]
Au bout de son considérable travail de recherche,
Moons pose la question qui divise les tintinophiles: «La Castafiore est-elle une
emmerdeuse?» L'auteur affirme que l'emmerdeuse, c'est «celle qui entend se
positionner comme une femme à part entière, non comme une moitié. Elle
assume le risque de ne pas plaire, ce qui est une expression d'honnêteté
personnelle». Haddock n'aurait pas pu mieux le dire.

Outsourcing

Simply because I can -- my rationale for almost everything these days -- I subscribe to MedWorm and receive a news feed for "CRPS" and a few other stray acronyms, synonyms. Every afternoon, I cull through whatever the offerings are. Usually, though, I will have already been alerted about things of substance by an email from Jim Broatch, Executive Director of RSDSA, a man with whom I have never spoken, and with whom I have never corresponded. Our doings are all one-way. Some time later, from a few days to a week, I am apt to receive some overlapping information from Anthony Tobin, grandfather and researcher extraordinaire. By the time I hear from Tony, another man with whom I have never spoken, and with whom I have never corresponded, the material referenced has the advantage of having been vetted by a number of "experts."

There is a difference, of course, in the content coming from Broatch & Tobin, and that sent winging my way by a random news feed.

Consider what I received today from each source.

Jim Broatch forwards an article from RSDSA's interactive content editor Jennifer Hlad entitled "Spinal implant helps Marine deal with pain from Iraq injury." I was immediately reminded that one of the rare positive results of war is a rapid advance in the treatment of traumatic injuries, and of wounds inflicted by whatever horrid new weapon has had its way in the current round of atrocities. The U.S. - Iraq War will be remembered for countless brain injuries and the emergence of PTSD as a terrible time bandit. IEDs have made severe orthopedic and neurological injuries to extremities an everyday threat. I remember wondering whether the incidence of CRPS would rise due to the prevalence of those potent and insidious homemade bombs. I guess it did.

It is not coincidental that the first sustained modern notice of CRPS dates from the Civil War.

Anyway, here's an excerpt of Hlad's article, which can be found at the RSDSA website:

Beep. Beep. Ahhh.

Bobby Joseph straightens his back, letting out a sigh of relief as electrical signals pulse through his leg, giving him respite from the piercing pain that has racked his body since Nov. 11, 2006.

"Oh, yeah," he says, grinning.

Before the surgery, 27-year-old Joseph woke up in pain every morning. Every step with his left leg brought with it a "shocking, stabbing pain." The drugs and the nerve blocks helped, but they didn't make the pain go away. Still, when Dr. Rick Foltz first proposed implanting a device in Joseph's spine to send pulses through his body, Joseph was skeptical.

"I've seen Robocop ... I was like, I don't want to be half man, half machine," he said.
Then he did the seven-day trial.

"I felt like I was Superman," he said. "I loved it. I wanted the real thing right then and there."

In early July, Foltz and another surgeon put the device in Joseph's spinal cord. Wires and electrodes send electric signals to his nerves, changing the way the pain is transmitted to the brain, Foltz said. Joseph controls the signals with a remote device, changing the pulses based on whether he is sitting, standing or walking.

"It is basically tricking your brain, so there's no pain there," Joseph said. "It is like a pulsing massage."
Joseph was three months into his fourth deployment, patrolling a street in Anan, Iraq, when the bomb went off. The blast blew him from the road's median, as shrapnel pierced his legs, his face, his arms.

"It ripped me apart," he said, showing off the massive scars on his left thigh and calf.
[....] Literal walking is a different challenge. Joseph suffers from complex regional pain syndrome, a syndrome in which a patient has pain that is disproportionate to the wounds. The syndrome is more common in patients with severe injuries, and Foltz said he sees more of it in wounded warriors because of their injuries.

In addition to the pain, patients may be so sensitive they can't even stand to have a bed sheet brush their leg or arm, Foltz said.

"It's very difficult to treat," Foltz said. "If we don't treat it right away, it can turn into a debilitating, long-term pain syndrome. So when the wounded warriors come back, we want to be very aggressive in the treatment, to get them better as fast as we can."

That's the nature of an electronic alert from Jim Broatch -- news of
progress, legislation updates, research fundraising efforts, or maybe the sharing of a new blog by one of those Obnoxious Incredible People With CRPS.
Although I've not heard from him for a few weeks, I might get some of the same from Tony Tobin of Essex, England, who was for a long time my sole source to research and the inner workings of the virtual CRPS world. He runs a news service through Yahoo! -- the impetus for which was: "Have started research into RSD after my 9 Yr old Granddaughter was diagnosed with it. Update. Said 9 yr old is now 13 and is doing well. I am proud of her." I said "some of the same," but really, what comes from Tony are vetted things -- things that he has personally looked into, things referred to him perhaps several times over from people he trusts. He is into whatever works, and is open to arguments about an idea's potential. From Tobin I get things like information on Mirror Box therapy, a journal paper, Lymphocyte Subsets and the Role of Th1/Th2 Balance in Stressed Chronic Pain Patients as well as an invitation to discuss the role of medicinal marijuana in controlling CRPS pain.
*cough*
When I am fielding the posts from the RSDSA Executive Director or the Research Grandfather Extraordinaire, I have a feeling of connectedness. Sure, I know that much of the time, material is being dumbed down for me... assumptions of my capacity for unpacking anything remotely scientific are made, and I am presumed lacking. To that end, I have my purely scientific sources. To wit: my various little Med Worms.
This afternoon I went from wanting to tie yellow ribbons around oak trees, and checking out the vibrant blogs of lithe young blond people mastering pain by sheer force of will and disposable income to... well, that place you go when you are sent this, an abstract of an article in Mediators of Inflammation:
Case Report
Expression of Endothelial Nitric Oxide Synthase and Endothelin-1 in Skin Tissue from Amputated Limbs of Patients with Complex Regional Pain Syndrome
Background and Objectives. Impaired microcirculation during the chronic stage of complex regional pain syndrome (CRPS) is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Endothelial dysfunction is suggested to be the main cause of diminished blood flow. The aim of this study was to examine the distribution of endothelial nitric oxide synthase (eNOS) and endothelin-1(ET-1) relative to vascular density represented by the endothelial marker CD31-immunoreactivity in the skin tissue of patients with chronic CRPS. Methods. We performed immunohistochemical staining on sections of skin specimens obtained from the amputated limbs (one arm and one leg) of two patients with CRPS. Results. In comparison to proximal specimens we found an increased number of migrated endothelial cells as well as an increase of eNOS activity in distal dermis specimens. Conclusions. We found indications that endothelial dysfunction plays a role in chronic CRPS.
One arm! One leg! Arg! There is a reason why I am more suited for the scientistic.
(Marmy adds a particularly strident Ack! Ack! La Belle Bianca Castafiore has been stricken with tonsillitis, and her neck is wrapped in flannels, the world temporarily stripped of her opinion. Nous esperons tous qu'elle se sent mieux bientôt! N'est-ce pas? tousse tousse N'est-ce pas?!)

Wordle

I stumbled upon the Wordle, stubbing a toe on some rough textual elements!

Wordle is a toy for generating “word clouds” from text that you provide. The
clouds give greater prominence to words that appear more frequently in the
source text. You can tweak your clouds with different fonts, layouts, and color
schemes. The images you create with Wordle are yours to use however you like.
You can print them out, or save them to the Wordle gallery to share with your
friends.

La Belle Bianca and I chose the "Au lecteur" of Baudelaire, his ostensible welcome to readers of Les fleurs du mal. "We" made the word cloud you see above, a reduction of which will remain in the blog marginalia at left.

For those wanting the more sensical [cough] version, here it is as Charles wanted you to see it:

Au lecteur

La sottise, l'erreur, le péché, la lésine,

Occupent nos esprits et travaillent nos corps,

Et nous alimentons nos aimables remords,

Comme les mendiants nourrissent leur vermine.

Nos péchés sont têtus, nos repentirs sont lâches ;

Nous nous faisons payer grassement nos aveux,

Et nous rentrons gaiement dans le chemin bourbeux,

Croyant par de vils pleurs laver toutes nos taches.

Sur l'oreiller du mal c'est Satan Trismégiste

Qui berce longuement notre esprit enchanté,

Et le riche métal de notre volonté

Est tout vaporisé par ce savant chimiste.

C'est le Diable qui tient les fils qui nous remuent !

Aux objets répugnants nous trouvons des appas ;

Chaque jour vers l'Enfer nous descendons d'un pas,

Sans horreur, à travers des ténèbres qui puent.

Ainsi qu'un débauché pauvre qui baise et mange

Le sein martyrisé d'une antique catin,

Nous volons au passage un plaisir clandestin

Que nous pressons bien fort comme une vieille orange.

Serré, fourmillant, comme un million d'helminthes,

Dans nos cerveaux ribote un peuple de Démons,

Et, quand nous respirons, la Mort dans nos poumons

Descend, fleuve invisible, avec de sourdes plaintes.

Si le viol, le poison, le poignard, l'incendie,

N'ont pas encor brodé de leurs plaisants dessins

Le canevas banal de nos piteux destins,

C'est que notre âme, hélas ! n'est pas assez hardie.

Mais parmi les chacals, les panthères, les lices,

Les singes, les scorpions, les vautours, les serpents,

Les monstres glapissants, hurlants, grognants, rampants,

Dans la ménagerie infâme de nos vices,

Il en est un plus laid, plus méchant, plus immonde !

Quoiqu'il ne pousse ni grands gestes ni grands cris,

Il ferait volontiers de la terre un débris

Et dans un bâillement avalerait le monde ;

C'est l'Ennui ! - l'oeil chargé d'un pleur involontaire,

Il rêve d'échafauds en fumant son houka.

Tu le connais, lecteur, ce monstre délicat,

- Hypocrite lecteur, - mon semblable, - mon frère !

Go here for excellent translation choices -- I heartily recommend the one by Robert Lowell. It has the right... feel.

Tour de France 2008

Incroyable! Google has created a virtual Tour de France 2008, using Google Maps Street View feature, the first use of that imaging in Europe. All 21 stages of the race are available, covering > 3500 kilometers.

As of today, July 17, the race is at stage 12: Lavelanet à Narbonne.

Mark Cavendish won the sprint finish at Narbonne, garnering him his third stage win. Cadel Evans keeps the maillot jaune.

Stage 12 results;

1 Mark Cavendish (GBr) Columbia

2 Sébastien Chavanel (Fra) Française des Jeux

3 Gert Steegmans (Bel) Quick Ste
4 Erik Zabel (Ger) Team Milram

5 Oscar Freire (Spa) Rabobank

6 Francesco Chicchi (Ita) Liquigas

7 Thor Hushovd (Nor) Crédit Agricole

8 Leonardo Duque (Col) Cofidis

9 Julian Dean (NZl) Garmin Chipotle - H30

10 Heinrich Haussler (Ger) Gerolsteiner

General classification after stage 12:

1 Cadel Evans (Aus) Silence - Lotto 50.23.05

2 Frank Schleck (Lux) Team CSC - Saxo Bank 0.01

3 Christian Vande Velde (USA) Team Garmin-Chipotle p/b H30 0.38

4 Bernhard Kohl (Aut) Gerolsteiner 0.46

5 Denis Menchov (Rus) Rabobank 0.57

6 Carlos Sastre (Spa) Team CSC - Saxo Bank 1.28

7 Kim Kirchen (Lux) Columbia 1.56

8 Juan José Cobo (Spa) Saunier Duval-Scott 2.10

9 Riccardo Riccò (Ita) Saunier Duval-Scott 2.29

10 Vladimir Efimkin (Rus) AG2R La Mondiale 2.32

And, in a Tour de France newsflash:

Italian rider Riccardo Riccò of Saunier Duval has tested positive for blood
booster Erythropoietin (EPO), French sports daily L'Equipe reported on its
website on Thursday. According to the paper's Damien Ressiot, one of the
climber's urine samples collected by the French Anti-Doping Agency AFLD showed
traces of a third generation EPO called CERA (Continuous Erythropoietin Receptor
Activator).

The team's buses and cars were reportedly stopped by gendarmes and
searched, and the police were seen taking bags of items away.

The Saunier Duval team has voluntarily withdrawn itself from the Tour
de France, and said it would not compete in any races until further notice.
Directeur sportif Joxean Fernandez Matxin said he was as surprised as anybody.
"We only found out ten minutes ago. The entire team will stop racing, not only
in the Tour de France. We suspend the activities of the team until we understand
what has happened."

Riccò, who won two stages in the Tour de France (the sixth and ninth),
was ninth on general classification before the news broke on Thursday morning.

The Italian's impressive performances have in
the past been explained by his naturally high hematocrit
level. hacking cough hacking cough . (bolded and
italicized hacking cough, mine.)

At the official Tour de France website, tucked in near the bottom is the Code of Ethics, which contains some great words, like unswerving, values, the test of time, and -- always my favorite -- intrinsic moral virtues. Also mentioned:

Illicitly favouring anyone runs counter to the sporting ethic. It is in this sense that doping, too often present at an ordinary social level, is inadmissible in sport.

La Belle Bianca Castafiore, decked out in fitted bicycle shorts (not quite long enough to cover her voluptuous quadriceps) snorts and sings:

"Ah, je ris de me voir si belle dans ce miroir..."

erythropoietin that, bay-bee

Pensées or How-the-Mind-Works-First-Thing-in-the-Morning

The cowardly writer's way out: Potpourri! Follow the bouncing thoughts, see if they will cohere.


It is 8:17 am and the temperature inside my mouth is 99.7. I've already had Tylenol, but hardly any vodka.

I woke to find Sam-I-Am neatly curled above my head on a spare pillow, gently snoring, Marmy Girl neatly tucked into the bend of my left arm -- but did not wake fast enough to catch Dobby dozing. He is so quick to peer into my eyes, paws planted on my chest, vocalizing his many plaintes. He has a lot to say, and Fred and I allow him all the time in the world to say it.

In lieu of a lilting "bonjour, t'as passé une bonne nuit?" La Belle Bianca fairly intoned that she had dreamt all night of dead philosophers: Barthes, Derrida, Foucault. Just those three. Of the three, she had met two, and felt she had actually *known* one. She had been in the living presence of them all.

Maybe that is why she did not dream of Abélard, Aquinas, or d'Alembert.

This brought to my mind, unbidden, a poem. I am suddenly terrified, because I do not know if this is a poem written by someone else, or that I wrote myself. It feels very much like me, like mine. This is it:

Il y avait un certain Blaise Pascal.

Yes, I will "google" it, of course. But I am telling you -- even if this is not mine, it is mine. I have never felt so close to a group of words before.

Ah, yes, well. I am glad La Belle Bianca is out ferreting a new supplier of confiture de cerise (We have recently undergone a crisis of confidence in our former source. Yes, I wrote crisis of confidence. No, the reference to Jimmy Carter's fabled 1979 diagnosis of the American soul is hardly oblique. Restoration of faith and confidence -- why, this blog is about nothing less. We will, once more, have superlative confiture de cerise.)

Were she here, Bianca, Ms. Thang, would be hooting in my ear, "Ah, je ris de me voir si belle dans ce miroir..." And she'd be right on every score, for it was Prévert, no less, who wrote:

Les paris stupides:

un certain Blaise Pascal

etc… etc...

Born of Bianca's dream, my desired authorship ends as a pari stupide (a stupid bet). So long as we can escape Pascal's insipid wager, right? I have always thought it the most disheartening of proposals, the kind of thing that only brings a gleam to a clever person's eye.

"You must wager; it is not optional... Let us weigh the gain and the loss in wagering that God exists... If you gain, you gain all; if you lose, you lose nothing. Wager, then, without hesitation, that He exists."

All the Christian apologists whom I have known have been blatant, flaming dyspeptics. Imagine if you were dedicated to defending "The Faith" by alleging it to be in happy accord with evidence that is, somewhere, on hand for examination. You'd be burping all over creation, too.

I don't know if anyone made it with me from onset to demise -- I hate to die alone -- but this actually played out quite well. It is an awesome organ, the brain, so supple.

Et la confiture de cerise? Un bon vieux classique dont on ne se lasse jamais...


************************************************************************************
In mathematics, computing, linguistics and related disciplines, an algorithm is a sequence of instructions, often used for calculation and data processing. It is formally a type of effective method in which a list of well-defined instructions for completing a task will, when given an initial state, proceed through a well-defined series of successive states, eventually terminating in an end-state. The transition from one state to the next is not necessarily deterministic; some algorithms, known as probabilistic algorithms, incorporate randomness.
-- Wikipedia, the free encyclopedia

This Star

Curieux, n'est-ce pas? What serendipity to check in at PostSecret, and find this -- by which I mean that the extraordinary challenges faced by workers in the field of emergency medicine seem lately to have found a widespread expression. Be it in the form of this anonymous postcard, be it in the form of a seemingly hateful rant in the blog of a caring EMT, nurse, doctor...

I cannot let my mind go, cannot let my mind's eye imagine what she has seen.

What are the things that one sees in the course of the practice of these professions that shake even a firm faith? Can you tell me? I would like to know, and promise simply to receive the information.

Obviously, my experience only comes from the intersection of my personal emergency with the health care system, and it travels the continuum from near sainted people who did nothing less than save my life to people who delighted in causing me pain. Emergency medicine is far from the sole field in which human nature is so exposed -- raw in its depravity, surprising in its splendor -- but its practitioners seem to feel proprietary, and cling to the resulting pain and awe as their own peculiar reward, or punishment.

It's almost an impossible conversation to have but God bless them for their willingness to try, to begin, and to muck around in the mud trying to translate it all for the rest of us.

Much easier, I know, to interpret an EKG or tally the I & O, bust a clot, stabilize a blood pressure, usher lives in, guide them out...

Emergency Department Blogging

After an arduous day. La Belle Bianca is enfin abed. Il est à souhaiter qu'elle y reste, *silente*.

Now, with my cup of tea -- in mismatched, crackly-glazed bone china -- I am ready to face this expanse of white, thinking it cool, thinking it calm, thinking it the balm my body needs. What a foolish person (though I do like my pluck).

At issue are my reading habits: The list of tangential blogs and websites to the left of the page needs judicious editing.

I enjoy reading medical blogs -- the snarkiest and most amusing tend to be derivative (HIPAA, huzzah! HIPAA, huzzah!) of experiences in emergency medicine. The bloggers are, for the most part, terrific story tellers, with a few not-so-talented moralists interspersed for local color.

Ach! A bump in the writerly road. I am, essentially, free associating and have been brought up short by my use of the term "local color." It's not a term that I groom and keep ready on my short list of lit crit terms.

That's my field, you see, kind reader: literary criticism and the sacrifice of said organizing principle to the development of superior critical thinking skills in the 18-24 year old population of francophones within a given academic enclave. Rarefied air? Cannot get your breath? Run along to the Emergency Department -- they will take care of you!

Local color can also known as regionalism -- and is most often, these days, code for Southern
Antebellum Literature (SAL), most often code for a not-so-secret smugness in which to dress up racism, classism (all yer basic -jizms). A world apart is the later movement of the early 20th century that hoped to shore up the notion of a core, almost antediluvian (way before -bellum, even), southern identity -- a unifying movement toward definition as straightforward as movements come. Still, there's an undeniable desire within the region's -izm for goshawks -- for falconry, filial crests, and the Old World tapestry of heraldry in general.

It's all about words, and how you use them, the dialect you adopt, the dialectic that ensues.

These incredibly fascinating blogs relating to the world of emergency medicine? They are couched in extremes of local color and regionalism.

The blogosphere: "It is the perception that blogs exist together as a connected community (or as a collection of connected communities) or as a social network."

Local color. Secret code, paternalistic assumption over the power of dialect. There are moments, even, of affected "Ebonic" dialect, a whole new venue for shucking and jiving. There are many approximations as to what the Undeserving are Entitled.

Regionalism. The assertion of a special geography, say? Local color may stand alone, indeed, and demand special attention, determined to stand out. But the regionalism of these medical blogs arises from several generally unacknowledged peculiarities and disparities that mark the ED as a very different locus in the medical sphere. Perhaps a free-standing building, perhaps connected to a main hospital by tunnels; Perhaps, a vital, irreplaceable buffer between outside (health management) insanity and the inner torpor of the hospital ward. The general presumption that the patient not perfectly defined by an established clinical picture (trauma, a surgical abdomen, a classic MI) is likely from the dregs, a despised bottom feeder -- either seeking drugs, a free visit, sympathy, or some other gain -- all this unwieldy presumption makes for easy derision, a quick shift into high-handed morality and a degradation of dialect.

But how do I expect medical professionals to perform under the many pressures of insufficient means (of space, hands), misuse, abuse, fated failures? (How dare I have any expectation of them at all is probably the better question! Easy, mes chers, I have come to like your writing and all that shines through.)

And now I find that I don't want links to some of these blogs to originate from my blog -- the seething resentment and anger being that bothersome. In a highly scientific crap shoot, I read 10 entries "at random" from ED-based blogs linked here, as well as those in my private Favorite's List, and each time easily found the rancor to which I am referring.

They've every right and cause for rancor! I want to assert that their life-saving work, filled as it is with perversion of their good intent, ought to allow for almost any expressions of frustration -- because I believe that I do GET IT.

I want to assert that, because as I said, I get it, but I can't. It is not about getting their pain, understanding their problems.

No, ultimately we are each stripped of out local ism, our local color, our regionalism, and asked only to be good and fair companions of the road.

Right now, these blogs are fascinating, in and of themselves, as small ecologies of inbred, insular, jealous, and competitive communities.

Enrico over at Mexico Medical Student put up a post entitled EM Blogger "Hate": Nature or Nurture that I found a rational, reasoned, and calm assessment of the increasingly disturbing dispositions coming out of Emergency Departments. Enrico opens with a reference to a post by Sid Schwab:

<<Sid Schwab posted an entry the other day about EM blogs (I’m including nurses in what I write here) and their penchant for not only being right-of-center politically, but “vitriolic." [....]

EM has been corrupted by being made into the PCP of the disenfranchised and uneducated, as well as the pressure valve for inpatient floor inefficiency as admitted patients crowd the ED, further straining things. I get it.>>

He gets it, too. Really, you'd have to be fairly thick not to... so why the overt resentment, meanness, anger? Have a read, and see if these two gents don't do a fine job of teasing out the reasons.

And I will wait to cull the URLs à gauche.

Grosses bises!

Bianca Bites the Big One

Sacré bordel! Holy whorehouse!

The medical saga continues. I saw my most excellent doctor last Tuesday, and it so happens that I was having one of my "bad" days. It turns out that this was a fortuitous encounter, as my bloodwork has returned showing signs of major infection, and the rather generalized aches and pains and fevers that I had been dealing with became more focused. Stress-dose steroids can mask infections, so I had been admonished to keep an eye out for just such an occurence.

Et ainsi de suite... et puis... yadda!

Yesterday, when all of this ought to have been reported and plans made -- my chart was misplaced.

Cough.

So I am out the door with the Fredster -- Bianca is threatening to belt out show tunes; She cannot handle the stress of probable hospitalizations. We are ruling out an infected prosthesis -- one of my three artificial joints.

I am febrile, exhausted, sweating, tachycardic, and in severe pain.

Would I even *consider* presenting to the Emergency Room? No way in hell. So I hope there are no more snafus with charts and telephone calls.

X-rays and a bone scan, although no one is heeding me -- a bone scan is a ridiculous idea that will supply no useful, specific information. I light up like a Christmas tree, just on principle.

Please think a good thought.

Adieu!

Forrest Griffin, Champ!

Oh, Happy Day!

As I sit propped up in bed, watching Nadal take the first set of the Wimbledon (or, in these parts: "Wimpleton") final, I rejoice in other sporting news.


[....Last night], at the sold out Mandalay Bay Events Center, [Forrest] Griffin took all the ‘buts’ out of the equation, overturning the odds and pounding out a thrilling unanimous five round decision win over Jackson to win the 205-pound world championship and etch his name in the history books.


“This is the greatest night of my life,” said Griffin, the first winner of The Ultimate Fighter reality show and now the second TUF winner to earn a world title, following former welterweight boss Matt Serra. “I want to thank Quinton Jackson. It was close and I think we’re gonna have to do it again.”


“He whupped my ass,” said a gracious Jackson. “Sometimes you win, sometimes you lose. He deserves it.”

Scores were 48-46 twice and 49-46 for Griffin who engaged in the front runner for 2008 Fight of The Year with Jackson.


And this one will be tough to top.


Griffin took the fight to the champion immediately, working behind his jab and some quick kicks to the head and legs. The challenger’s hand speed was impressive early, catching Jackson off guard. When the two would exchange at close range though, Jackson was in his element and he was able to land with more consistency, and with under three minutes left he was able to jar Griffin briefly with a left hook. The challenger recovered quickly and flurried back, but a right uppercut by Jackson with a little over a minute left dropped Griffin. Jackson pounced on his foe, but Griffin got his wits back and fought his way back up, where he continued to move forward and engage until the bell rang.


Continuing to be the aggressor, Griffin opened the second with more leg kicks, this time buckling Jackson’s left leg.


“He jacked my leg up,” said Jackson. “I’m not that good at acting. He knew he hurt me.”



As the champion staggered backward, Griffin moved in, clinching and landing knees at close range before trying to sink in a guillotine. Jackson escaped that trouble but wound up in more as the bout subsequently moved to the mat, with Griffin working for submissions and grounding and pounding Jackson steadily for the remainder of the round....

* * *

All day long I had been a regular fussbudget, worrying about poor Forrest getting beat to a pulp, a real bloody mess, by Quentin Rampage Jackson.



All of that scar tissue on his face, just waiting for an evil elbow, or the well-placed glancing blow off that beautiful brow.



Fred, however, was optimistic, reminding me that Forrest was developing a ground game, that he knew how to move out of range, that he was, in essence, "a big boy now." Harrumph. Fred has the most annoying habit of being right. Plus his Muay Thai is very sharp, and he keeps getting me in a clinch. Giggle. Imposing his will, as it were. Swoon.



Bianca Castafiore sat ogling various MMA fighters and their respective torsos. She was whistling, in the bright annoying way that a tea kettle whistles. "I wish everyone looked as good as Georges St.-Pierre in his tighty-whities," she yelled. Bianca always yells.


I whipped out a few spare rosaries and hailed Mary like a maniac. Despite my fame as a former international Vale Tudo champion, there's not much that still goes anymore. Hence, religion.


Marmy bowed her furry head, swished her bushy tail, cried "Ack! Ack!" and did her best imitation of Tank Abbott.



Sam-I-Am, just back from a stint at the Gracie Jiu-Jitsu Academy in Rio de Janeiro, fell asleep on his back, legs splayed, guard wide open.



Dobby, my little idiot, took his usual over-the-top approach, trying to slap a flying arm bar on the increasingly distracted Bianca. She was, by then, rocking back and forth, murmuring, singing, and it wasn't that damned Jewelry Aria, either. At least, not entirely. She can't help herself.


"Booooom! Bonjour, mon cher! O là là! You’re gonna get pinned.
Booooom! Voici un joli air! You’re gonna get knocked out.
You’re gonna feel it -- this is the ultimate -- moi! moi! moi!
Si belle... dans ce miroir!"

* * *

There is no substitute,

for the ultimate is what's in store.

Bear witness to the fitness

of the modern warrior!

And they go boom --

another hit is landing --

Boom another hit is landing --

There's nothing to stop

but the strike of a viper.

They're training to challenge

the ultimate fighter.

You're gonna get hit.

You're gonna get knocked out.

You're gonna feel it.

This is the ultimate...

* * *

Way to go, Forrest! Congratulations, Champ!


Much Love,
The Retired Educator
Fred
Bianca Castafiore
and The Felines

The Dobster and Sammy 2/5

Two observations:

• You, gentle reader, still don't know with whom you are exchanging mental fluids. This, of course, is not your fault. The author assumes all fault.

Here on Etterbeek Lane, where I am curled up under a favorite handmade quilt, laptop balanced on one knee, we are five.

There is a man. He is 15 years older than me; He is my way better half. What shall we call him? I tend to call everybody "Fred," much like Barbara Lewis Hare Krishna Beauregard calls everybody "Carl."

So, there is Fred.

There is me, the retired French prof -- and no, I will not apologize for using French in my own damn blog. Get over it. Suck it up! Boeuf bourguignon! Les Deux Magots! Jacques Cousteau and your mama!

Ah, but I am complicated. Worse still, I am in charge. MwaaaaHaaaHaaa!

So on occasion, I commune with Bianca Castafiore, and en revanche, au contraire, à l'inverse (Whoop Whoop Whoop! French alarm! Stop the insanity!) -- and, for her part, Bianca finds within me the wherewithal to sing the [same] sad song, one more time.

The rest is easy. Fred and I have three cats. Pictured above is Dobby (our little idiot) and Sam-I-Am. Dobby's mother, Marmy, is not particularly photogenic. Read: she thinks the camera may well siphon away her soul...

Oh God. I am a Crazy Cat Lady.

• The last thought and observation for today -- because today has been somewhat long -- is an acknowledgement of my verbal chaos.

Sure, I'll 'fess up. My writing is a mess, and my neurological pathways merely torturous. Nonetheless, I choose to be defensive and unyielding at this point in our relationship.

Let me undress in the dark for a while.

Faust Before Coffee

For someone who loves language, to be reduced to a series of acronyms is beyond insulting. For the divine Bianca Castafiore -- such a fate would be a horror, although I suppose it would ultimately be recuperated as aria, as Italian air.

Me, I do not often wake "in the morning," but to claim some measure of normality, I will prepositionally use the phrase (precious, precious, much too precious).

I'm sorry about that. I cannot, however, allow you to touch my sentence.

Get the hell away from my sentence!

Du calme, du calme, ma chère...

When I wake in the morning, there is no thunder of trumpets in my brain announcing the triumphant news that I remain the inimitable Bianca Castafiore -- as in "(blow blow flap lips) congratulations! you remain (lip buzz) Bianca Castafiore (slowly slide the pitch)!"

No, when I wake, I make no sudden sound, no sudden movement, and pray that none are made on or around me. The cats that have kept me safely in the bed all scatter, willing to let me face the risks of our little pocket of weak gravity in their strong feline hope of kibble. Bianca, she would break into song, she would dance the mirror before her Bianca-face, singing "ah, je ris de me voir si belle dans ce miroir..."

It is a rare woman who can bring off Faust before coffee.

My right hand snakes toward the bedside table and snags first the hillaryclinton.com red, white, and blue water bottle, and then the other (more amber) bottles of momentary import: of percocet, of ibuprofen.

There are days I need help taking the pills, and assistance drinking the water. But those days are rare. Mostly, I medicate myself by myself.

Not quite alone. There *are* those cats: Marmy, Dobby, and Sam-I-Am. Were my bed a raft out on the sea, those three would be... sharks, circling. They know from experience, though, that it will be a good half-hour before I budge, and they are kind. While we wait for the medicine to kick in, we gently pet, we purr. Yes, we vibrate!

Bianca Castafiore *only* sings L'air des bijoux of Marguerite from Gounod's Faust; She sings it loud and she sings it often. As she is not called on to sing a high C, we do not know if she can shatter glass. We do not know if *she* vibrates.

"Ah, je ris, de me voir si belle, dans ce miroir..." O! Marguerite! Beware! It is Méphistophélès who gives you jewels and a mirror! Infernal, insightful, so clever -- the devil. And there you are, decked out and loving what you see.

Looks can be deceiving. This post will bear the label of "The Acronyms." The acronyms to which I will usually be referring are:

SLE = Systemic Lupus Erythematosus
CRPS/RSD =Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
AVN = Avascular Necrosis
AI (times two: AI! AI!) = Adrenal Insufficiency & Aortic Insufficiency

Lupus is often treated with steroids, judiciously, it is hoped, as prolonged use of corticosteroids involves a good number of significant side effects. Somehow, I ended up on high doses of steroids over much too long a time. Not always for SLE. Sometimes for CHF. Sometimes for asthma.

As the kids say: Whatever.

It is possible, even probable, that treating my SLE in that manner resulted in a killer case of avascular necrosis, AVN. Don't suggest that to your average medico, though, as it will cause them to go dark and mutter something that sounds like "informedconsentinformedconsent..." and then they poop their pants.

AVN also serves as the acronym for an adult video organization. Porn. Not erotica. Pure unadulterated smut. The good stuff.

With AVN, the bones, in layman's terms, errr... well, they rot. They become necrotic.

(Yes, you genius! Exactly! As in necrosis. Very good. All of that Latin eventually pays off -- you can decipher much medical terminology thanks to the etymologies still swarming within the brain pan, that great bucket of os!)

It hurts quite a bit. Untreated, the involved joints eventually collapse. I had some joints replaced -- a few successfully -- a few badly. Then, when further treatment became impossible, my life was in large part subsumed by the pain of bone-on-bone. Bone-on-Bone like Stratford-on-Avon.

Ashton-under-Lyne. Bexhill-on-Sea. Stoke-on-Trent.

Where was I?

Tête de Hergé?

The arm that inches toward the water, the hand that pries the pills from their plastic home --they hurt more than I have the capacity to express.

The pain of AVN, though, pales next to the pain of CRPS/RSD.

There will be time for the packing and unpacking of these alphabets. For now, I am content to remember that first half hour, each minute that much closer to movement, to the chachacha of the hobble to the bathroom, the graceless kerplunk into the power chair.

Marmy, Dobby, and Sam-I-Am precede me and lead the way to good chow, good kibble, and mugs of snooty white liberal fair trade coffee, steaming. We are deceitful in our appearances; We hum as if we could sing; We smile as if we mean it; We feel so much more Bianca Castafiore now, and so much less a dumpy, dull, decrepit educator, retired.

"Ah, je ris de me voir si belle dans ce miroir..."

Hello, I am Bianca Castafiore. You may kiss my hand.

It should feel momentous, the initial post, n'est-ce pas? But it doesn't. In so many ways, the Internet has worn me out.

I am Bianca Castafiore, diva and scourge, known but little loved by tintinologistes the world over.

Yawn.

As a defunct and decrepit former French professor, the life of the mind becomes a rather childlike experience, replete with rapt sessions of navel-gazing. In truth, I've become childish -- the claim of childlike is outrageous. I have too much respect for children to carry that farce any further. Other farces? Sure... But not that one.

I have no children. I have adults instead. And cats.

Every day, I try to learn but am in dire need of systematization -- otherwise, I am but a dilettante of learning, and hardly an academician, ex officio.

How long before any readership that I may cull will revolt when they see my penchant for the foreign phrase? Will they think me... affected? Somewhat... false? Well, darlings, whose blog is it, anyway?

I think I am getting the hang of this. Yes, this will do nicely.

In the several minutes from there to *here*, the ringing refrain of Whose Life Is It Anyway? clambered into my brain. I am trying to ignore it, for introducing anything somber in an initial post hardly seems very hospitable. Nonetheless, you, my as yet nonexistent readership, are forewarned that the theme of being trapped in a body is one that will resurface.

Freud has forever been on my Shit List, the perspicacious son-of-a-bitch.

CRPS/RSD

Among the first words that Faust sings out are these:


Le ciel pâlit; devant l'aube nouvelle
La sombre nuit s'évanouit!
encore un jour, encore un jour qui luit!
Ô mort! quand viendras - tu
m'abriter sous ton aile?





Eh, bien! puisque la mort me fuit,
Pourquoi n'irais-je pas vers elle?
Salut! ô mon dernier matin!
Salut! ô mon dernier matin!





J'arrive sans terreur
au terme du voyage;
Et je suis, avec ce breuvage
Le seul maître de mon destin!





What is he moaning and kvetching about, and in such high gallic italic manner? He's being a big baby, signaling his intent for this day to be his last, his poison at hand. Faust is one of those people -- any little thing goes wrong and suicidal ideation is the name of the game. I closed out this little bit of select verbiage with his claim to be the "the (only) master of [his] destiny."





Were that the case, dear Faust, your previous attempts at dying would have succeeded, hmmm?





I tell you, friend, beware of those to whom the exclamation point comes easily, for they are likely victims of emotional lability, a little touch of insanity, their personality... borderline.





But Faust does not want to die. He wishes, mostly, to avoid pain, to be young again. The guy just wants to have fun.





And my darling Bianca fairly screams for Marguerite, always the same couplet, always rather awfully: "Ah! je ris de me voir si belle dans ce miroir!" A dependable narcissistic creature -- Bianca more than Marguerite!





I am somehow acutely ill on top of all my chronic mess, and this involves a seemingly unending fever.





The first symptom of my fevers is utter despair, and tears. Not so distant, really, from the pitiable plea for death I opened with, this stormy post-Independence Day: <<Ô mort! quand viendras - tu m'abriter sous ton aile? Eh, bien! puisque la mort me fuit, Pourquoi n'irais-je pas vers elle?>> You must remember that I do not share the Faust of Goethe! You must keep well in mind that this is the bubblegum of Gounod, source of Marguerite's bejeweled fantasy, keeper of my beloved Bianca's obsidian obsession, all sharp and shiny.





I feel *so* alliterative this afternoon.





I just happened to have a doctor's appointment this week, as I was getting more and more lost in pain and fever. Normally, I would have hunkered down at home, armed with appropriate medicines, and given myself over to Wimbledon coverage, old UFC matches (may God bless Forrest Griffin tonight!), and game upon game of Mahjong and Bridge.





The pain of washing, dressing, riding in the car (dear Fred at the wheel, Bianca struggling to chew through her red bandana gag), and even sitting in the waiting room -- I balanced all of that pain with the potential help my talented internist might provide. He's a great doctor.





No, be honest.





I needed a healthy dose of sympathy.





It turned out my thermometer was defective; My temperature was a good degree higher than it registered at home. It turned out my heart was racing along at too much of a clip, averaging 128 beats a minute, synchopated time. It turned out that I had little coping ability left.





When I first made mention in this rather sorry blog of The Acronyms that shorten so much of my life, I felt jocular, cute, a regular tease. No more.





The pain that I am in on a daily basis would make most of you desperate within an hour. Try to imagine such a pain not ending. The claim of such unending and severe pain earns many a rolled eye among the medical types with whom someone with CRPS/RSD has to deal. Odd, that the medicos tend to think that it is they who are "putting up with nonsense," when, in actuality, it is usually the other way around.





As I am hurting a lot this very moment, as my fever is taking its afternoon hike, I will whine on. As I noted initially, whose blog is it, anyway? My good doctor found that I am in a lupus flare -- and oh, how I wish the designation "flare" could be washed clean of the disrepute it currently bears -- and this lovely exascerbation has caused a worsening of the avascular necrosis present in all of my major joints (and some of the myriad minor). Worse, it has kicked the pain of CRPS/RSD up a notch or hundred.



I keep threatening you with that acronym, don't I? Much as my beloved Bianca sings the sad song one more time.



Complex Regional Pain Syndrome, Types 1 and 2, is the updated designation for the former Reflex Sympathetic Dystrophy and Causalgia. All of my limbs are involved, as is my face (the newest bit of fun). My right side is much worse than the left, although my left lower leg is trying for equality at an alarming rate.



Mine is a mixture of Types 1 *and* 2, in that I have demonstrable nerve damage/lesions in my right leg, left hand, and right arm. My left leg shows no such damage -- it seems to be going along just for the fun of it. My face has not been subjected yet to testing -- my nutty neurologist does not seem to want to subject me to facial shocks and needling, for which I am grateful.



There are some mental aberrations going on inside this head, too. Pure emotional garbage. As in my periodic insistance that we test and retest in order to find what we already know. It just comes over me, about once a year, this idea that maybe if we retest, maybe if we repeat that triphasic bone scan, it won't show as much involvement as it did the first time.



I also have been bothered by the distinctions between CRPS Type One and CRPS Type Two. All the research seems to have bearing only on the former RSD, now Type One. You know, all those people out there, suffering, yes, but suffering without demonstrable proof.



I am very ashamed of this example of my own discrimination.



You see, I am a fan of the many medical blogs, an interest that, until the last few weeks, was confined to the work of a few doctors and nurses whose incredible literary gifts allowed me insight into the frustrations and joys of their world, into which I have so often been an unwilling interloper. Plus, they are often a regular hoot.



Then I stumbled onto a scene reminiscent of a feeding frenzy of sharks drawn by chum.



Let me say, straight away, that I get it, that I understand the immense frustration of dealing with inveterate drug-seekers and general abusers of the system (the emergency room, in particular). I also get both the need, and the right, to *vent* this immense frustration.



Still, I was ill-prepared (That might be an intentional pun, I don't know, those moments are so fleeting with me.). I was ill-prepared for the venom, the hatred, the ridicule of people claiming pain, claiming fibromyalgia or some other auto-immune disorder that has yet to have diagnostic criteria.



Believe me, I don't have sympathy for the person lounging on a guerney, demanding a sammich or yakking on a cell phone, then claiming a 15 on the accursed 1-10 pain scale. Nor do I feel much for the woman who comes in the wee hours of the morning complaining of a wicked fibromyalgia flare-up, wanting/needing medication but amazingly allergic to the most appropriate non-narcotic ones. Neither one is making acceptable use of emergency facilities.



And really, I don't expect sympathy at all from emergency room personnel. Compassion, maybe, though at this precise moment I cannot find the words to define the difference. Anyone?



Back to me and my trek to the doctor this past week. Whose blog is it anyway, right? Right!



It would not have been inappropriate, I was told, to have gone to the Emergency Room over the previous weekend, when the pain had become so bad as to occasionally keep me from being able to stand, and when the fever first truly spiked.



Really?



What would the medical professionals have muttered under their breath?



I have had the misfortune to end up in ICU, on a ventilator, four times in the past three years. After the initial experience, it was absolutely a necessity that I be unconscious before being plopped down in any ER, any hospital.



I have many war stories that would shock, but for now? Just one story, and one that it will probably take another person with CRPS/RSD to understand: Still on the ventilator, but conscious, alert, oriented, the Nurse-From-Hell delights in informing me that CRPS/RSD does not exist, that I had spent the previous 6 years misdiagnosed. Her findings? I had massive cellulitis (in my purple, ice cold feet) and was lying about the extreme sensitivity and degree of pain. "I seen this before, up in Henry County. Yep, cellulitis, that's what this is."


My beloved Fred, following the whispered instructions of my beloved Bianca, had met with the hospitalist and the charge nurses, making sure that they all knew to take extra care not to manhandle my extremities, also letting them know that my "normal" should not make them freak out and order a slew of testing for clots or surgery for necrotizing fasciitis! Yes, my legs might be purple and ice-cold, the source of intense pain just by the weight of a sheet, but that was par for the course. Bianca directed him to make polite signs which he then posted on the bed and on the door to my little ICU cubicle.



Ah, but... "I seen this before, up in Henry County... cellulitis... and it don't hurt that bad."



She had a little game.



Remember that I cannot talk, all I can do is hope my eyes are bugging out enough for her to take pity.



She takes her hand, points with the index finger to a particularly swollen and purple section of my right foot. She laughs and brings it s-l-o-w-l-y toward my skin. She laughs some more, she wants to know if it hurts yet, she taunts, asks whether I want a "little mor-pheene" to ease the pain of her upcoming finger poke. The tension and fear have built up in my head to the point of desperation, and I do what she, no doubt, wants me to do -- I lose it. I flail, I kick, I scream -- the alarms go off -- cardiac, O2 sats, the vent. Other nurses and respiratory technicians stream in.



They see a patient gone berserk. The Nurse-From-Hell winks at me. She is my nurse twelve hours of the day for the next 3 days. I am extubated but cannot bring myself to make a complaint. Who am I compared to her?



So as my good doctor gently chastises me for awaiting my long-ago scheduled appointment with him instead of seeking to be seen on an emergent basis, I know inside that I will never willingly see a nurse or doctor who doesn't have some proficiency with CRPS/RSD, AVN, SLE, and all the other partridges in my pear tree.



Faust gives lip service to suicide. I don't do that.



I'm on a very high dose of steroids -- All Hail Prednisone. This on top of the cortef to treat my profound adrenal insufficiency. I think there may be a post or two on stress-dose corticosteroids but, believe me, I will try to refrain.

The pain? I would fix it at an 8. I never claim a 10 because it seems, by definition, impossible. Plus, I want to keep my options open.



Where is my damn sammich?



Ah! je ris de me voir si belle dans ce miroir!

*The photo is of my right foot, in spasm -- and in one of my sexier shades...