club drug as antidepressant

Good morning. I would like to expose myself. No, wait, there's more!

I would like to expose myself as a person who knows and understands things scientific in a very limited and prejudicial manner. It's just the truth --my capacity is in the realm of the pseudo-, of pretense.

Of course, this being my blog, and this blog representing my real interests, when I present medical information pertaining to CRPS/RSD, I try to educate myself enough that I am not, at the least, being irresponsible.

Okay, okay, except perhaps as pertains to Jose Ochoa, who is clearly a turd but I don't see passing that fact on to my few readers as even remotely irresponsible. It's more like a Public Service Announcement.

I am trying to say that I am more humble than you might think when I set about to read and digest medical studies/announcements.

Even so, sometimes I just want to scream, and possibly shake someone silly.

On the off chance that some CRPS-related information is listed under the search term ketamine, one of my medical feeds checks for daily references to the drug. Most studies relate either to abuse of ketamine, its deleterious side effects, or to proposals of novel uses for the anesthetic.

Today? Well, there is something on the harmful effects of ketamine on the urinary tract ("a new radiological challenge"!), a bit about partial tripolar cochlear implant stimulation in ketamine/xylazine anesthetized guinea pigs, a veterinary medicine label update for KETAMINE HYDROCHLORIDE injection,/solution ("for Intramuscular Use in Cats and Subhuman Primates Only"!), and something about how ketamine can reverse "the expression of tolerance to the anticonvulsant effects of morphine."

Not stuff terribly applicable to CRPS;  Not stuff terribly accessible to a non-medico such as myself.

But then there was this -- An article in Nature, titled Neuroscience: Quick mood lift, with this come-hither statement serving as tantalizing abstract:  Patients taking traditional antidepressants have to wait several weeks for the drugs to kick in. However, a few severely depressed patients taking ketamine, an anaesthetic and recreational drug, have shown improvement within hours.

Okay, so I don't have a subscription to Nature... and cannot access the current edition without forking over $32.  By a search of the terms ketamine and antidepressants, limited to the past week, I feel pretty confident that I understand the claims of the Yale researchers.

A quick search of the journal finds this Nature article -- from 2006, about another study (at the National Institute of Mental Health) that revealed the exact same results and engendered the same excitement:

Club drug finds use as antidepressant:  Psychedelic ketamine hits the blues surprisingly fast

The 'club drug' ketamine may be the fastest-acting antidepressant ever tested, researchers report today.

A team based at the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, studied ketamine in 17 people with major depression. All the subjects had failed to respond to treatment with standard antidepressant drugs or more drastic methods, such as electroshock therapy. But 71% felt better the day after taking ketamine, and 35% still felt better a week later. None improved when dosed with a placebo.

Most striking, the scientists say, was that some patients felt better less than 2 hours after taking ketamine. Currently approved drugs can take weeks to remedy depression. The work is published in the Archives of General Psychiatry.

"It's almost like there's a sound barrier for those us who do depression research, and we have not been able to break it," says Carlos Zarate, chief of the mood and anxiety disorders research unit at the NIMH, and first author of the study. "That's the exciting part of this — now there is evidence that we can."

Zarate and his colleagues are not advocating that doctors start giving depressed patients ketamine right away. Large doses of the drug can cause brain damage in rodents, and its long-term health effects have not been studied in people.

"We don't want to give anyone the message to run out on the street and use ketamine," says Nuri Farber, a psychiatrist at Washington University in St Louis, who was not involved with the work. "It makes you crazy — that's why it's a banned drug."

Scientists are currently testing a wide range of recreationally used-and-abused drugs, including ecstasy (MDMA; see 'The ups and downs of ecstasy') and psilocybin, the active ingredient of magic mushrooms, as potential therapeutics.

Ketamine, invented in 1962 as an anaesthetic, is chemically related to phencyclidine (PCP), also known as angel dust. Both induce hallucinations and out-of-body experiences, hence their use as illegal psychedelics.

Ketamine has milder psychotic effects than PCP and is therefore also used as a legal anesthetic and horse tranquillizer. Scientists are studying whether it can be used to treat alcoholism and chronic pain, as well as depression.

Ketamine targets a brain protein called the N-methyl-D-aspartate (NMDA) receptor. Existing antidepressants target brain chemicals such as serotonin, but there is growing evidence that these drugs eventually affect NMDA receptors. Ketamine may work so quickly because it takes a short-cut straight to this part of the brain.

The psychotic effects of ketamine, such as euphoria, wore off before the antidepressant effects kicked in, Zarate's team found, suggesting that the drug's psychotic and antidepressant effects are separate. One surprising aspect is that other drugs that induce euphoria, such as cocaine, usually lead to a depressive crash once the high wears off.

Zarate's group is looking for substances with some of the chemical properties of ketamine, such as the ability to target NMDA, without the psychedelic effects.

Oh, well, good.

Worried about, ummm, side effects?  No sweat!

Other scientists, including Farber, have developed drugs that can be taken with ketamine to damp its side effects. Giving these drugs together might help patients feel better without getting high.

Of course, in the same issue, there's an article about "what it means to be an ant."

"It's like a magic drug — one dose can work rapidly and last for seven to 10 days," said Dr. Ronald Duman, professor of psychiatry and pharmacology at Yale University, who led the study.

Oh, dear Lord.

One final admonition -- to myself. Keep an open mind. The Ketamine Coma protocol for intractable CRPS has actually allowed some people to mumble the C-word -- cure.

Remember, too, though, that there have been deaths and other bad outcomes in both the Mexican and German research sites.

That ought to attest to the horrors of this disease, that people are willing to be injected with ketamine in an amount sufficient to maintain a coma for 5-7 days, risking their lives to have a chance at lessening the pain of CRPS.

Hmmm.  Here's a thought:  Maybe I should try putting myself in the place of someone so depressed, clinically, that they, too, would choose ketamine...

But I would still find this research more bother than boon.

I still want to shake someone silly.

Stephen Bruehl, Rock Star

Stephen Bruehl is fast becoming a rock star in the world of CRPS research. Here is an excellent review article, available in its entirety here.

[This article may be accessed for personal use at no charge through the Journal Web site.  Hooray for free access to all!]




Anesthesiology:
September 2010 - Volume 113 - Issue 3 - pp 713-725


An Update on the Pathophysiology of Complex Regional Pain Syndrome
Bruehl, Stephen Ph.D.

ABSTRACT:
Complex regional pain syndrome (CRPS) is a neuropathic pain disorder with significant autonomic features. Few treatments have proven effective, in part, because of a historically poor understanding of the mechanisms underlying the disorder. CRPS research largely conducted during the past decade has substantially increased knowledge regarding its pathophysiologic mechanisms, indicating that they are multifactorial. Both peripheral and central nervous system mechanisms are involved. These include peripheral and central sensitization, inflammation, altered sympathetic and catecholaminergic function, altered somatosensory representation in the brain, genetic factors, and psychophysiologic interactions. Relative contributions of the mechanisms underlying CRPS may differ across patients and even within a patient over time, particularly in the transition from “warm CRPS” (acute) to “cold CRPS” (chronic). Enhanced knowledge regarding the pathophysiology of CRPS increases the possibility of eventually achieving the goal of mechanism-based CRPS diagnosis and treatment.

Articles in PubMed by Stephen Bruehl
Articles in Google Scholar by Stephen Bruehl

Correspondance:  Dr. Bruehl: Vanderbilt University Medical Center, 701 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, Tennessee 37212. stephen.bruehl@vanderbilt.edu.

WTF, squared

U.S. Court Rules Against Obama’s Stem Cell Policy

By GARDINER HARRIS
Published: August 23, 2010


WASHINGTON — A federal district judge on Monday blocked President Obama’s 2009 executive order that expanded embryonic stem cell research, saying it violated a ban on federal money being used to destroy embryos.

Regula Benedicti: Ora et labora

We've requested a Special Mass to be held at the Monastery-Down-The-Road on behalf of my brother Grader Boob (his preferred form of address). We do this every year on the first day of classes at his university.

Of course, we haven't always had the luck to live next door to a Catholic Prayer Factory. Back in the States, we sometimes had to improvise. The things we had to do to get the Jehovah's Witnesses on board! Only for Grader Boob would I deny Plato and my firm belief that I will suffer the fires of Hell.

On the other hand, it was hard to get the Presbyterians to stop hosting Prayer Vigils for Beleaguered Educators every hour, on the hour -- once they get stuff out of committee, Presbyterians are a fearsome force.

One year we were kind of in a religious snit, and went with the Council for Secular Humanism. Okay, so they kicked us out when I began screaming "What do you mean there’s no such thing as spirit? And Grader Boob, he's undesigned, unintended, and responsible for [himself]? Since when? I don't think so! And, furthermore: Harrumph."

Since we've been in occupancy at The Manor, and since Marlinspike Hall borders the monastery, Fred and I have been treated to catechisms and concordances, hagiography and the Regula Benedicti, The Rule of Saint Benedict.

The Rule of Saint Benedict is my Bible -- and in so saying, I am not cracking wise. I mean, who needs a little structure, some guidance to monastic life in community, more than Fred, La Bonne et Belle Bianca, The Remnant Felines {waving to Celestial Sammy} -- and myself? Who needs help in the practice of hospitality more than Manor Mavens? And who has benefited from the commandment to welcome guests to the monastery more than I have -- a woman choosing monastery over easily accessible convents? Receiving the stranger as Christ -- now *that* is a huge break and boon for the visitor such as myself.

[Once-upon-a-time, I developed the habit of vacationing at monasteries, staying between 7 and 10 days, usually silent and observing the hours.  Very refreshing, envigorating.  I hope to have shown sensitivity as a lone woman visitor to the manly monks.]

Ora et labora, people, ora et labora!

The monks, for this year's celebration of Grader Boob and the return to school, have decided to go with the theme of Patron Saints: Whose Your Daddy? (The Brother-in-Charge of Event Planning just blinked when we pointed out the sexism of that title. He'll regret that when the Militant Existential Lesbian Feminists show up in their picket gear, with chains and styrofoam coolers full of Evian, Power Bars, the leftover canapés from Joan and Karen's Commitment Ceremony, and huge chunks of dark chocolate [made from fairly traded, organic cocoa].)

Turns out the traditional choice for Patron Saint of Teachers is St. John Cantius. No problems there. No, the problem came from my request to include, for parity's sake, the uppity Ste. Catherine of Alexandria. I've been pretty insistent that she be included in any rite performed for the benefit of educative souls. 

Okay, so The Church denies her existence, claiming she is but the Christianized version of the amazing Greek philosopher/scholar Hypatia who, as it happens, was killed by a mob of Christians.  Monks, to be specific.

Called "premodern," Saint Catherine of Alexandria, before being shuffled off to Buffalo, was the patron saint of "royal" women, professors, scholars, libraries, archives, Balliol College, and the University of Paris -- as well as patron to milliners, millers, potters, spinners, tanners, a whole host of important crafts.

She is supposed to have been a babe, too, which is probably why we are blessed with a rich iconography:

Her principal symbol is the spiked wheel, which has become known as the Catherine wheel. Saint Catherine is also represented in Christian Art with a wheel. The wheel is generally broken, because, after she was bound upon it, by the intervention of Heaven it was shattered, and the flying fragments dealt death to her executioners. Under her feet is seen the turbaned head of the tyrant Maximinus, symbolical of the triumph of Christianity over the Infidel. Instead of the sword, the actual instrument of her martyrdom, a book is placed in her hand, in token of her learning. The crown upon her head bespeaks her royal dignity. As a noble's daughter she is patroness of princesses and ladies of noble birth. She is patroness also of students, philosophers, and theologians, because she put to confusion all the rhetoricians and scholars who came to dispute with her from all parts of the empire.

You can read the texts for her feast celebration on November 25 here.

St Catherine of Alexandria: Scenes from Her Life
Donato D' and Gregorio D' Arezzo, about 1330

Those Cistercians! All you have to do is cross their palms with silver and presto! Special Mass!  Just kidding -- I think it is less that I have convinced the good brothers of Catherine's perfect fit, religiously, and more the living expression of the Rule of Saint Benedict.  Always looking for the easy way to be kind, these guys.

So we're going to walk over to the Abbey Church about 5 -- provided I charge my wheelchair battery -- and commune with some living saints, while raising for God's consideration the difficulties of teachers, everywhere, but especially the challenges faced by the one, the only, Grader Boob.

With incense wafting (our inhalers at the ready), royal purple and insouciant pink tapers lit and in full flicker, we place Brother-Unit Grader Boob under the protection of St. John Cantius, professor of Scripture and Physics at the Kraków Academy noted for his good cheer and humility -- traits that also leap to mind about GB.  We will further invoke the fiery, feisty St. Catherine of Alexandria, intellectual superstar, not afraid to speak truth to power, calling out emperor Maximinus Daja when he went against the faith.  We hope for Grader Boob a semester without the need to face off against an administration that would compromise academic standards and impede the free application of earned grades!  Rah!

Much thank to The Cistercians for the Annual Blessing of the Prof!  In return we usually participate in the Annual Hiding of the Abbot -- he gets fed up once or twice a year, so we stash him in some regal suites and pamper the hell out of him, until he is ready to square off against eager airhead postulants and ancient wrinkled scholar monks fallen prey to Alzheimer's.  Last year, after the warehouse fire (they run a lucrative internet business), after they discovered that mild-mannered Father Clem was a pyromaniac, Abbot Steve came and hid in Marlinspike Hall until the Papal Envoys returned to their palatial digs.

Have a great semester, Grader Boob -- We love you!

beggars *can* be choosers: repost

Perhaps you are in denial, perhaps you were brought up in a barn: whatever, as the kids say, in a tri-syllabic and weirdly stressed fashion.

what-ev-er. {roll eyes::purse lips}

I'd never heard it codified, or even noted an attempt to put it into words, before attending the memorial service for a homeless man named Joe who managed to touch many lives in the large city where we lived and slaved -- back in 1997, the Pre-Marlinspike Hall years.

Yes, his name was Joe.

Every charitable institution and person in the area wanted to claim special status for having known, loved, served, worried over, and self-defined by... Joe.

I was Homeless Guy Joe's best bud... Homeless Guy Joe came to me first when in need... I volunteered to be Homeless Guy Joe's payee back when we knew where he was most of the time... And so on, and so forth.

It turned out that Homeless Guy Joe made out like a bandit. Or perhaps it is better put that he made out like Robin Hood, for he was a generous fellow, was Joe. Very polite, unless agitated, sometimes by circumstances apparent only to his psychotic self. Good table manners.

I am going to stop italicizing "Joe" because, well, because it really was his name. Joe Coppage. He lived in our neighborhood long before we did -- an intelligent and, by all accounts, normal young man who went off to college to study architecture, only to be cruelly consumed by the sudden onset of schizophrenia. He was a slender white man, very unkempt, and was probably in his mid-40s when he died. Ah, wait. I have a photograph, famous now among my particular do-gooder group. It was taken by Charles Hinkle, who likely would bop you one if you intimated that he did any good for anyone, ever. You'll find his photo next to "curmudgeon."

He was beaten to death -- Joe, not Charles!

What Joe could possibly have possessed that would prompt someone to rob him -- or what he might have said to so enrage another -- is impossible for me to imagine, because Joe was decidedly mild-mannered and certainly destitute. We don't really know the scenario, the context, for his murder -- he was found on the sidewalk. I believe he spent about a week in the ICU, on a ventilator, without ever regaining consciousness, before one of the nurses recognized him. I am sure he was hard to recognize at that point.

[Wow. I just flashed on the memory of another man, John, who died of complications from AIDS. We managed to get him into a marvelous hospice -- and it was shameful how relieved and delighted he was by having his own room, a view of the courtyard full of flowers and a large fountain -- but mostly? Mostly he cried over having clean sheets and enough blankets, and over being clean between those sheets, under those blankets. After admission, John was only cogent for a day or two and spent the rest of his time hallucinating. He incorporated birds from the courtyard into his visions and seemed to consider them potent omens. He told me what bird I would see before I died. (I keep an eye out.) The day he died, he was demanding and yelling for an Arby's roast beef sandwich, which we got on our way to see him. You could say we were in denial -- we knew the state of his mouth, his esophagus, his stomach -- we were, in fact, intimately familiar with his entire gastrointestinal tract. You could say we were desperate to assuage our feelings of guilt and shame. You could even say that the only real grief we felt was for ourselves.]

Speaking of do-gooder guilt and shame, the opportunity to speak was extended to everyone at the memorial and Celebration of Life for Joe Coppage, and it took a long while to work through the apocrypha. Almost everyone shared a funny or touching anecdote -- Joe's life story was full of them:

In the early hours of one Christmas morning, Joe found a suicidal man huddled on the floor in the communal bathroom, heroin at the ready. The man told us later that day that Joe went to the bathroom, then turned, as if in afterthought, and said "Jesus was homeless, too." [If I hear this story again, I may be ill. It's true, though.]

Joe sat down at the piano one day and riffed off a jazz improvisation that left jaws hanging lax. And ask though we did, he wouldn't play again.

Then there were all those cute occasions when Joe refused to take his clothes off before showering. He always wore a donated suit, although he eschewed vests. His clothes ended up encrusted with the stuff of life -- feces, cigarette ashe, highly sugared coffee. Pellets of that ubiquitous non-dairy creamer stuff.

My most special memory of Joe? That would be the last time I saw him. He had not been around for weeks, but showed up for a hearty evening soup (plus salad and bread sticks!) on a night so cold that all the city shelters agreed to function over capacity. For some odd reason, I remember that we were "over" by five. Joe had frostbite on the very tip of his nose, and on his ear lobes. I did not get to see his feet, but I suspect they might have been bitten too. He was more cogent than he had been in years and we talked as he ate, the conversation being so normal that I don't recollect it. This memory is very visual -- my eyes kept straying to his ear lobes, black and swollen. A couple of the volunteers physically struggled with him after dinner to get him out of his nasty suit, into the shower, then dressed in a brand new ensemble, complete with fresh newspaper -- he liked to wear layers of newspaper with his clothing -- a common enough practice and wise, as it insulates against the cold.

There were two people who spoke the night of Joe's well-attended memorial whose words profoundly impacted me.

The first person, although unknown to you, needs no introduction. He knows best and has always known best. He walks the talk and disdains those who just sort of stumble along the roadway. He is a prophet, and looks down on the rest of us confused do-gooders, down the length of his long, long nose. (I'm implying that he fibs.) I'll call him Ed because that's Ed's name.

There were a lot of preachers there, and he was one, as well, although he is loathe to lump himself among his fellow sermonizers. You see, he left mainstream pastoring in order to live in community and among the poor, hungry, homeless, sick. He can be very annoying because he makes my conscience hurt.

He spoke near the end, after all the feel-good Joe stories that had people sniffing and dabbing at their eyes while gently laughing about the good old days.

Ed told us that we had helped to kill Joe, that we used him up like some lucky totem. Never once in all the years of "ministering" to him had we seen to it that he get consistent treatment for his severe mental illness, that he take the meds to counteract his psychoses.

Ed said that we wanted Joe to remain sick, that the Joe we liked was Crazy Joe. When Joe was medicated, he wasn't really all that cute, he didn't say the darnedest things.

Ed said that Joe was the city's homeless mascot and that we had used him as publicity, a white man from the neighborhood being a better emblem for fundraising than the black crack addict with HIV who was our more representative guest.

The second person who spoke to my heart was Marilyn. She is a complicated thing, is Marilyn, but that is a separate blog entry.

She told us a story of long ago -- maybe 20 years ago or more. Like Joe, she had lived in the neighborhood most of her life. For a while, he would wander among the streets, remembering who knows what, and looking for God knows whom. As time went by, his behavior became more and more erratic and he began to do things like gift his former neighbors with piles of excrement, neatly deposited by their front doors.

In those days, the shelter staff held informal weekly meetings and potluck suppers at Marilyn's house. Joe developed the habit of dropping by -- usually he just sat on her porch swing, muttering over and over the words by which he was best known: Pray for me. Pray for me. Please pray for me. (He drove otherwise even-tempered people insane with this incessant request. One minister of my acquaintance actually interrupted his sermon to yell: "I will NOT pray for you right now. Shush!")

But there came a summer night when Joe was hungry. He didn't want shelter food, so he decided to check out the staff meal over at Marilyn's house. Knocking on the door, he made his request known.

He was ushered in, and Marilyn set herself the task of making him a plate.

"We have egg salad, veggie lasagne, rice noodles with peanut sauce, meatballs, squash casserole, and crusty bread. What would you like?"

"A cheeseburger," said Joe.

"No, we don't have any burgers tonight. How about some meatballs and squash casserole. Nancy-Kate made the casserole, so you know it's good!" continued Marilyn.

"A cheeseburger," reiterated Joe, who seemed to know what he wanted.

She was losing patience. Finally, after a few more rounds of obstinance, Marilyn put a little of this and that on the paper plate, grabbed some napkins and a spoon, and thrust it all at Joe.

He looked a little frightened at that point, and held out his hands as if to push it away.

"That's okay, no, no, no. Pray for me?"

And with that, Joe went off into the warm fragrant night, unfed.

Marilyn told it better -- she laced it with funny details and had a timing that rivaled the best of raconteurs. But the punchline, the lesson, does not need any decoration:

Beggars can be choosers.

Walking home after the service, I remember trying to reconcile Ed and Marilyn's messages, trying to marry them together.

Were we to override Joe's wishes and force pharmaceutical normalcy on him, place him in adult day care for the sake of sanity? Were we to offer him a smorgasbord of choices, and delight in his choices, even when we did not understand them, even when he went away hungry?

And why, oh why, had we not had these conversations while he was still with us?

"when I came first to know that there were flowers also in hell"

Vahan Bego's [Saint] Sebastian:

Hoo boy. Shooting pains, followed by a little intimate throb::throb in the left shoulder. shivering from fever. is the night really over? I sent Fred off to worship with the militant existential feminist lesbians just a moment ago;  For the first time in years, we failed to wish each other a good morning -- we failed at every nicety of habit.

"See you," he said.
"Bye," said I.

He knows that I am teetering on the edge and he just doesn't need it right now -- no one does.

So, how sad is this? My insurance coverage does not kick in until (we think) 15 september... 24 days away. I have managed to stay out of the hospital since last October... which has been a real struggle plus a work of genius by my doctors -- true grit! -- only to fail at the attempt in the last few weeks before being covered again. No-o-o!

Just ignore me. [Have you ever gone to the top of a Blogger blog and clicked on Next Blog?  It takes me back to my days as a kid, traveling via National Geographic, a budding wheelchair anthropologist...]

I am emotionally needy when afraid, when I reach this point -- {what point?} -- When my attempt to control everything looks to be failing. I cannot even get my temp down to normal these days. Doc said to alternate ibuprofen with the acetaminophen in Percocet... I can get it down to about 100 but it just hovers there and i am worn thin (Oh, now, that would be nice; I had to raise the steroid doses and am hungry, always).

Okay, change the subject.  At least, for a few paragraphs.  There is a need -- not to be ignored -- to write about Hell, but it can be deferred a while.  Maybe I can even bury it in a big pile o' persnickety verbiage.

One of the ways I exercise and exorcise my various moral complacencies is by following the joys and resonant sadnesses inherent in the living work done at The Open Door. 

(Hmm.  At the words "living work," through the brain shot "Asphodel, that greeny flower"!  And so I went to renew that poetic friendship, one of my first.  Who does not grow up, at least in America, at the precise moment that red wheelbarrow depends?  As I reread most of Asphodel -- and is it any wonder that I don't get much done? -- I came to respect my memory, and the need to tell you about my Hell evaporated.  It's been done, as is said.  And so much better:

Of asphodel, that greeny flower,
like a buttercup
upon its branching stem-
save that it's green and wooden-
I come, my sweet,
to sing to you.
We lived long together
a life filled,
if you will,
with flowers. So that
I was cheered
when I came first to know
that there were flowers also
in hell.

I remember, once, an grad student in American Lit having a cocktail party moment, saying that WCW was so pedestrian. I wish! I wish!

So anyway, yes, I think of greens shooting in the spring from thin, bare branches when I think of The Open Door Community. Their needs are always, and never, met. Hey, I have an idea! If you have money to spare, send it to them:

Online donations can be made through Donate Now, a service of Network for Good.

They also need walking shoes, sizes 11-15, especially, and sandwiches, meat & cheese on whole wheat bread.  (I cannot remember if I have blogged on how beggers can be choosers?  It would have been a piece on Joe Coppage... and Ha! Ha!  I found it.  It's called:  beggars *can* be choosers!  I will repost it, as it is part and parcel of an offshoot to The Open Door.  Also?  Everyone knows a Joe, we just don't want to think about it.  That's why I am here, perhaps.  Sometimes?) 

I look forward to reading their monthly newspaper, Hospitality, as much to follow the health and well-being of founders Murphy Davis and Ed Loring as to keep an eye out for my own stuck-in-the-mud-ed-ness. Stucked-in-the-muddity? Fred and I are no longer part of the struggle, and yet are, of course. (We all are.)  It's just that we are out of practice, our hospitality is not crisp, is stale.  There are no homeless people in Tête de Hergé (très décédé, d'ailleurs).  Those who flirt with that sad state quickly find succor, usually with The Cistercians, sometimes here at The Manor, in Marlinspike Hall, where we can always use a hand -- but where we also can lend one, to the tired, to the sick, the worn out, to those teetering out-of-balance.  We aren't terribly different from The Cistercians, when push comes to shove.  They just operate with more of a theme.  Every room has a twin bed, a dresser, a bedside table -- all made of fiberboard -- with a Book of Psalms and a New Testament.  (The Old Testament causes the monks both dyspepsia and nightmares) In the Manor bedrooms, we have everything from rickety day beds to king-sized waterbeds, tables from consoles to converted one-of-a-kind medieval reliquaries, not to mention a mind-boggling assortment of religious reading material (often first editions, autographed) as well as every underground issue of Keep on Truckin'.

Anyway, the last pages of Hospitality are for Grace and Peaces of Mail, wherein I sometimes see the names of old friends and death row inmates.

In the latest issue of Hospitality, my eyes bugged out to see a letter from Father Tom Francis of the Monastery of the Holy Spirit. I mean, it is not unusual to see Father Tom's words out in the world, as I think the brothers are all wonderfully worldly, in spite of, or because of, being cloistered.  It's what he wrote that took my breath away... simple, to the point, and right. He probably doesn't consider himself brave, but I do.

Dear Gospel-friends, Ed and Murphy,
Even though I winced at the article Dear Pope: Call Me in the May-June Hospitality, it is all so very true, completely accurate, and needs to be read by most Catholics, who tend to blindly side "with our Holy Father." The multiplicity of [sexual abuse] cases and the extent of the cover-up by the bishops are ghastly evidence that even church institutions "protect" their reputations and money bags, ignoring grievous injustice to children and parents and the betrayal of the trust given to clergypersons. I hope this rightful exposure will bring our Catholic Church to complete transparency on these matters, now and in the future.
Father Tom Francis
Monastery of the Holy Spirit

Cistercians, those wacky Trappists! They keep you guessing.  Fred theorized that were we to drop in unexpectedly, we might well find Father Tom scrubbing the flagstones with a toothbrush.

Ah, it's now late in the afternoon, and my Hell begins to descend again.  I will do all I can to fight it off, starting with poetry.  Funny, but I am unfamiliar with Kora in Hell, Improvisations.  Dare I say that those poems are too young to help me, written before hell was properly understood? 

Yes, I do dare.

All these images in my hot head: Father Tom scrubbing floors for denouncing the Holy Father;  Ed and Murphy blessing people with big pots of grits and available toilets;  Joe Coppage, still crazy and still dead; Bottles of bitter white tablets, methadone;  Flaming arrows thudding against my body, stuck deep inside my pus-filled joints, female counterpoint to Saint Sebastian.

Take a few moments and enjoy this excerpt from Asphodel -- so lovely, so basic to our poetics, a protection against chaos.

Asphodel, That Greeny Flower
by William Carlos Williams


Of asphodel, that greeny flower,
like a buttercup
upon its branching stem-
save that it's green and wooden-
I come, my sweet,
to sing to you.
We lived long together
a life filled,
if you will,
with flowers. So that
I was cheered
when I came first to know
that there were flowers also
in hell.
Today
I'm filled with the fading memory of those flowers
that we both loved,
even to this poor
colorless thing-
I saw it
when I was a child-
little prized among the living
but the dead see,
asking among themselves:
What do I remember
that was shaped
as this thing is shaped?
while our eyes fill
with tears.
Of love, abiding love
it will be telling
though too weak a wash of crimson
colors it
to make it wholly credible.
There is something
something urgent
I have to say to you
and you alone
but it must wait
while I drink in
the joy of your approach,
perhaps for the last time.
And so
with fear in my heart
I drag it out
and keep on talking
for I dare not stop.
Listen while I talk on
against time.
It will not be
for long.
I have forgot
and yet I see clearly enough
something
central to the sky
which ranges round it.
An odor
springs from it!
A sweetest odor!
Honeysuckle! And now
there comes the buzzing of a bee!
and a whole flood
of sister memories!
Only give me time,
time to recall them
before I shall speak out.
Give me time,
time.
When I was a boy
I kept a book
to which, from time
to time,
I added pressed flowers
until, after a time,
I had a good collection.
The asphodel,
forebodingly,
among them.
I bring you,
reawakened,
a memory of those flowers.
They were sweet
when I pressed them
and retained
something of their sweetness
a long time.
It is a curious odor,
a moral odor,
that brings me
near to you.
The color
was the first to go.
There had come to me
a challenge,
your dear self,
mortal as I was,
the lily's throat
to the hummingbird!
Endless wealth,
I thought,
held out its arms to me.
A thousand tropics
in an apple blossom.
The generous earth itself
gave us lief.
The whole world
became my garden!
But the sea
which no one tends
is also a garden
when the sun strikes it
and the waves
are wakened.
I have seen it
and so have you
when it puts all flowers
to shame.
Too, there are the starfish
stiffened by the sun
and other sea wrack
and weeds. We knew that
along with the rest of it
for we were born by the sea,
knew its rose hedges
to the very water's brink.
There the pink mallow grows
and in their season
strawberries
and there, later,
we went to gather
the wild plum.
I cannot say
that I have gone to hell
for your love
but often
found myself there
in your pursuit.
I do not like it
and wanted to be
in heaven. Hear me out.
Do not turn away.
I have learned much in my life
from books
and out of them
about love.
Death
is not the end of it.
There is a hierarchy
which can be attained,
I think,
in its service.
Its guerdon
is a fairy flower;
a cat of twenty lives.
If no one came to try it
the world
would be the loser.
It has been
for you and me
as one who watches a storm
come in over the water.
We have stood
from year to year
before the spectacle of our lives
with joined hands.
The storm unfolds.
Lightning
plays about the edges of the clouds.
The sky to the north
is placid,
blue in the afterglow
as the storm piles up.
It is a flower
that will soon reach
the apex of its bloom.
We danced,
in our minds,
and read a book together.
You remember?
It was a serious book.
And so books
entered our lives.
The sea! The sea!
Always
when I think of the sea
there comes to mind
the Iliad
and Helen's public fault
that bred it.
Were it not for that
there would have been
no poem but the world
if we had remembered,
those crimson petals
spilled among the stones,
would have called it simply
murder.
The sexual orchid that bloomed then
sending so many
disinterested
men to their graves
has left its memory
to a race of fools
or heroes
if silence is a virtue.
The sea alone
with its multiplicity
holds any hope.
The storm
has proven abortive
but we remain
after the thoughts it roused
to
re-cement our lives.
It is the mind
the mind
that must be cured
short of death's
intervention,
and the will becomes again
a garden. The poem
is complex and the place made
in our lives
for the poem.
Silence can be complex too,
but you do not get far
with silence.
Begin again.
It is like Homer's
catalogue of ships:
it fills up the time.
I speak in figures,
well enough, the dresses
you wear are figures also,
we could not meet
otherwise. When I speak
of flowers
it is to recall
that at one time
we were young.
All women are not Helen,
I know that,
but have Helen in their hearts.
My sweet,
you have it also, therefore
I love you
and could not love you otherwise.
Imagine you saw
a field made up of women
all silver-white.
What should you do
but love them?
The storm bursts
or fades! it is not
the end of the world.
Love is something else,
or so I thought it,
a garden which expands,
though I knew you as a woman
and never thought otherwise,
until the whole sea
has been taken up
and all its gardens.
It was the love of love,
the love that swallows up all else,
a grateful love,
a love of nature, of people,
of animals,
a love engendering
gentleness and goodness
that moved me
and that I saw in you.
I should have known,
though I did not,
that the lily-of-the-valley
is a flower makes many ill
who whiff it.
We had our children,
rivals in the general onslaught.
I put them aside
though I cared for them.
as well as any man
could care for his children
according to my lights.
You understand
I had to meet you
after the event
and have still to meet you.
Love
to which you too shall bow
along with me-
a flower
a weakest flower
shall be our trust
and not because
we are too feeble
to do otherwise
but because
at the height of my power
I risked what I had to do,
therefore to prove
that we love each other
while my very bones sweated
that I could not cry to you
in the act.
Of asphodel, that greeny flower,
I come, my sweet,
to sing to you!
My heart rouses
thinking to bring you news
of something
that concerns you
and concerns many men. Look at
what passes for the new.
You will not find it there but in
despised poems.
It is difficult
to get the news from poems
yet men die miserably every day
for lack
of what is found there.
Hear me out
for I too am concerned
and every man
who wants to die at peace in his bed
besides.


[excerpt from Poets.org -- I apologize for not reproducing the versification accurately.]

More Specialty Wars!

Okay, so Happy Hospitalist took on ER physicians in a recent Xtranormal text-to-video creation a few days ago and ERP answered pretty quickly on behalf of ER docs worldwide.  See their directorial débuts here.

I did not know, though, that the Medical Specialty "Movie" Wars have been going on for a good while.  (Eventually, these vids will achieve the same sub-genre cult status as zit-popping masterpieces.  Okay, so that was a shameless, gratuitous plug for Emilbus20...)  Now that I am no longer an unappreciated, oft-maligned scout for PTZ (I specialized in misspelled foreign word searches), I am enjoying my YouTube excursions much more!  And HS now has a snowball's chance to catch a new vid as the first viewer ever, the stuff of her dreams... {{waving at my PTZ friends!}}

En tout cas -- I've put together a sampling of these medical tantrums, in order of publication.  In the course of rediscovering the world of medical bloggers, one thought keeps recurring -- how much easier it is to understand and empathize the many challenges these folk face when they choose to couch their frustrations in humor instead of snarky venom.

GI vs Anesthesia

Uploaded to YouTube by addormitus on July 20, 2010: "Case Discussion"


Anesthesia vs Neurosurgery

Uploaded to YouTube by hautegirll on July 21, 2010:
"An animated discussion in the OR. Inspired Orthopaedics vs Anaesthesia."


OB/GYN & Anesthesia

Uploaded to YouTube by ETHERBUNNY2010 on July 25, 2010: "She would like an epidural..."


ER officer Vs Surgeon

Uploaded to YouTube by tubelessbra on July 26, 2010:
"An almost everyday slightly over exaggerated referral"

Orthopedia vs Anesthesia (There are several of these specialists battling one another; I chose this one because of the Anthropology Consult!)

Uploaded to YouTube by tedparksmd on July 27, 2010: "As an orthopod, I had to respond to this!"

Orthopaedics Consult (There are some HILARIOUS ones by orthos dealing with ER docs... One has the call for a consult justified by the fact that "the patient has bones.")

Uploaded to YouTube by randomta22 on July 29, 2010: "Orthopaedic hillarity"


ER vs. Surgery

Uploaded to YouTube by phatman23 on July 31, 2010:
"Life as a surgical resident."


COLORECTAL SURGEON VS HOSPITALIST

Uploaded to YouTuby by troymartin13 on August 02, 2010.


HOSPITALIST VERSUS CARDIOLOGIST (Happy strikes again!)

Uploaded to YouTube by dequervains on August 18, 2010: "Hospitalist battles the cardiologist as the Xtranormal medical specialty battle continues."



In addition to Specialty vs Specialty, there are a good number of "Typical ER Patient" creations that you should check out, most dealing with drug-seekers. Clearly, these good health care professionals need access to some serious means of decompression... I hope these vids are therapeutic for them.

The Philpot Shoots the Schlessinger and I Need Yogurt

I felt so strange this morning. Thought I was jonesing for some plain lowfat yogurt hit with a teaspoon of pure vanilla extract and a kiss of fake sugar... but no! It turns out what I was really wanting was a word from Helen Philpot, of Helen and Margaret fame.

Not that I would compare The Philpot to Plain Lowfat Yogurt. That would be ridiculous.

God, I hope Fred will make a run into Tête de Hergé to nab a bit of bacterial fermentation. Or milk one of the oddly oversized bovines that have broken through the weaker sections of the Olde Stone Wall that keeps us safe from The Cistercians...

I am glad that Helen sort of echos my own take on the Laura Schlessinger affair -- and on Talking Heads, in general: A great big hearty... meh.

Shooting the Schlessinger

Margaret, your letters have been a source of comfort these past few weeks. I really have not felt like writing until your nephew called me to tell me that lots of people actually read this thing and many of them think that I am dead. Goodness gracious. I had no idea that once I started I couldn’t stop. But if this is my lot in life, I guess things could be worse. It keeps me busy and right now I probably don’t need a lot of time on my hands.

I saw in the news today that one of your radio shows is coming to an end. That Dr. Laura lunatic you like has finally gone one step too far and used the N-word a few too many times… well actually one too many times if you think about it. It’s just not one of those words a crazy white woman should let slip. You’d think she would know that.  (read the rest here... where she doesn't mention yogurt even once...)

I don't think I will ruin a surprise by telling you that Helen mentions Sarah Palin -- why not? One crazy white woman invites another! It's like... well, plain lowfat yogurt without the perfume of vanilla or the kiss of sweetness that can only come from a good aged chlorinated artificial confection.

I don't want Palin to feel left out of my own little publicity piece, and I was fairly certain she would have weighed in by now in support of her Sister AirHead... via Twitter, of course.

Were I unfamiliar with Sarah Palin, her advice to Schlessinger ("don't retreat...reload!") might take my breath away. 

SarahPalinUSA
Dr.Laura=even more powerful & effective w/out the shackles, so watch out Constitutional obstructionists. And b thankful 4 her voice,America!

Dr.Laura:don't retreat...reload! (Steps aside bc her 1st Amend.rights ceased 2exist thx 2activists trying 2silence"isn't American,not fair")

Forget Laura -- Listen to Jonathan McCoy

I don't like or enjoy Laura Schlessinger's radio show, so I am glad she's off the air.  It's not hard to take her apart over the n-word incident that did her in, so I'd rather showcase someone else, someone *really* up-and-coming and worthy of your time -- Jonathan McCoy. 

But you are probably already familiar with him and the speech he made last year (September 2009?), when he was but a lad of eleven! As the numerous video postings here lately attest?  I am just trying to catch up on the wealth of talent, information, and captured events out there.

Do the BIG cats like a little nip?

Saw this at Shadowfax's blog, Movin' Meat... and now, I'm thinking that I need to tote some Nepeta cataria along with my Bear Repellent...





This video is from Big Cat Rescue, a big cat sanctuary.

From their FAQ section: "Why keep animals in cages or have them on display?"

A: I hate to see cats in cages as well. My ultimate goal is that places like Big Cat Rescue do not have to exist. Most places that call themselves sanctuaries or refuges are neither and are a fate worse than death. We do the best we can to overcome that by offering a lot of enrichment for the cats. It is sad that they no longer are wanted by the people who bought them as cute little cubs. The purpose of exposing the public to them is to show people who are contemplating big cat ownership that it never works out for the cat's benefit. This was our original purpose for allowing guests. When you see that you can never turn your back on even a bobcat, without being sprayed or how small the 1200 square foot cages look when they have a 150 pound cat in them, or how quick and powerful these cats are, then it's got to make you rethink the whole idea of buying that little bundle of fur. You can tell people it's a bad idea all day and be ignored, but when they see it for themselves and they see how many people came before them and failed, it is an eye opening experience. Couple that with the fact that we turn down approximately 100 cats per year for lack of space and funds and you can start to see the whole picture.

Major Hoots from Happy and ERP

The Happy Hospitalist must feel better after getting this off his chest!  He may have found his creative niche with this Xtranormal video production -- "battling medical specialty vs specialty. This one is Hospitalist vs ER."





ERP decided to defend the honor of ER docs (Or ED, if you're WhiteCoat; But you aren't WhiteCoat, and even if you were, do you think I'd pander to the likes of such a rightwing dogmatic? So, ER it is!) with "ERP Tries to Admit a Patient":






The funniest text-to-video production I've seen is Patient Faking Seizure in ER, something that apparently is all too common, as the producer, uncenicidem, notes that this is pretty much how it is!

Just Because

Surprised Kitty (original)


Uploaded to YouTube by rozzzafly on October 13, 2009



Re: Surprised Kitty


Uploaded to YouTube by 1Click2Fame on December 02, 2009


Surprised turtle

From Cheeseburger.com -- LOL


Surprised Dog


Uploaded to Youtube by OkGo on January 08, 2010:
"Bunny the dog doing her 'surprised kitten' impression."

2010 Charles Prize for Poetry

This blog risks being overcome by negativity, drowning in The Acerbic (that Northern Sea).

Poetry has saved us before, no doubt it can ably throw a line over the bow (Though would it not make more sense that we'd be now floating, now drowning in the rear, behind, off the stern?.  Who would fall from the bow, how and why?).

If I continue to worry about where I am in relation to my salvation, I'll be lucky if I am even deemed somewhere overboard, and worth rescuing.

Thank goodness for people of clarity, and good humor.  Also, there's an expanse, a general bigness, in these generous people.  There's room enough.

Such is Doctor Charles, Physician Writer, Healer.  I've been reading the entries to a poetry competition he's sponsoring, and enjoying them very much.  They are affirmative and rich, spare and true.

Ah, but there is not, as yet, a villanelle.

Why don't you enter?  Here is what he has to say about the contest -- take a moment and visit his blog, take the measure of the place, and then consider trusting him and his readership with a poetic creation that treats "health, science, or medicine."

Fred and I will stick to what we do best:  Interpretive Dance (As Performed In The Moat).  Good luck and happy reading over at The Examining Room of Dr. Charles.

[I can already feel the snark begin to calm ~ that morsel of marine excrement, Ochoa, sink into watery oblivion ~ that Reuben-oid Scamster ride the swell, only to drift, away.]

Announcing the first annual 2010 Charles Prize for Poetry. Bold and pretentious name aside, the award will be given to the writer who submits for consideration the most outstanding poem within the context of health, science, or medicine.


Open to everyone (patients, doctors, science people, nurses, students, etc.). 1 or 2 entries per person.


Poems should be related to experiencing, practicing, or reflecting upon a medical, scientific, or health-related matter.


The winner will be selected by a panel of three judges, including me. These other judges may or may not be Nobel Laureates, you never know, but all appreciate poetry. I may ask for your permission to post a copy of your poem on this blog as we go, with or without attribution as you wish.


Is such an eponymous contest grandiose? Yes. Does the limited poetry I’ve written carry the gravitas needed to make me an authority on the subject? No way.


But should your poem be selected as the winner, you shall receive a plaque, an award of $500, and a tasty cherry tomato from my garden. Seriously. At least one person has written that winning the cherry tomato is more important to her than all the gold in the world. I’m sorry that my budget is not higher, but I thought I could swing $500 without enlisting sponsorship. Who needs an iPhone anyway?


Update – with so many great poems in so far, I think I’ll award a few surprise prizes for honorable mentions


So have fun, find inspiration, and send your entry to:


drcharles.examining *at* gmail.com


Contest closes August 31st.

PHOTO CREDIT: NASA, Stormy Weather in the North Sea, with Sweden, Denmark, and Norway, featured.

Stormy weather over the North Sea is not uncommon, and so the powerful winds that swept over the European ocean basin on October 27, 2006, were not extraordinary. Winds gusting to hurricane force raged over the sea for several hours, and by the time that the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA’s Aqua satellite flew over at 1:00 p.m. local time, the sea had turned a foamy, white-flecked green off the shore of Denmark. Westerly winds were driving waves into shore, creating a fringe of white where waves crashed onto the beach. In the image, glimmers of white glint in the murky waters offshore where waves break over the shallow continental shelf. The violent sea churned up clouds of sediment, giving the water the brown and green color seen here. Clearer, deep water farther north is nearly black, by contrast.

Grizzly Prospects

I used my vast collection of Thanks-For-Charging-It VISA Points for a gift card to use online at Cabela's.
If that seems an odd choice on my part, you're right!  A Brit might cry out:  "Spot on!"

Hunting, archery, and shooting -- not the favored pasttimes you'll have noted here at elle est belle la seine. 

What does Cabela's offer for someone as refined as myself?  What might I actually order from an outfitter of camouflaged Bambi assasins? 

{sniff}

Why, Bear Repellent, of course!

Not the wimpy 1.9 ounce spray designed for suburban joggers to bring down some average and unimaginative -- though admittedly fast -- miscreant... Not that fifth-of-a-second's bit of perfumed spray that hangs on a keychain, either.  We are talking over 13 ounces of Predator Defense, enough to erect a Wall of Wicked WhoopAss from 35 feet away.

If I could walk, I'd swagger.

My WhoopAss Bear Repellent was not designed to be used on humans. Nowhere in the sales points or in the WhoopAss Bear Repellent literature is use on humans condoned or advised.

Therefore, I immediately set to work on a moving, yet clearly exculpatory, Penitent Confession to commit to memory -- because I fully intend to release my beast on Mortal Man. 

(Unless Marlinspike Hall is invaded by grizzlies ineluctably drawn by the abundance of Koi and MoatMonster Fish.  Grizzlies are, il faut le dire, not exactly common in Tête de Hergé [très décédé, d'ailleurs].)

The Former-Inmate-Turned-Security-Advisor consulted by an alarmed -- but notably absent -- Captain Haddock, has directed me to attach the Bear Repellent to the right arm of the wheelchair, within easy reach but sufficiently out of the way that it won't be set off accidentally.  I am also instructed to always have a phone on board -- though if it takes the police an hour to respond, I am not sure that matters.  I get the sense, from the epic number of winks winked my way, that the old Haddock family charm may have reached out to local law enforcement... so, fine, I will give Tante Louise a buzz during or after our next break-in.  (Tante Louise is our area's version of an early response system!)  During or after, but not before I unleash The Beast and deliver my personal brand of WhoopAss upon the Intrepid Interloper!

The spray comes with a handy guide, called "Bear Safety Tips." I set about reading it straight away, of course.

You know those humor segments that feature "the world's dumbest X" -- robbers that choose to enter via the ceiling and get stuck between floors, the thief who leaves his wallet behind, the calculus teacher that can't do basic math?  The common element, what makes us guffaw, is the lack of expertise exhibited by the purported expert -- the trapped robber, the identified thief, the ignorant schoolteacher.

Consider the parents described in my handy "Bear Safety Tips" booklet by UDAP Bear Defense Spray President Mark Matheny:

In the past, bear spray has received some negative press because, when used incorrectly, the odor of the bear pepper spray can actually attract bears.  Some individuals, under the mistaken impression that bear spray acts as a repellant, have sprayed their personal items with it in an attempt to deter bears from getting into their gear.  Parents have even sprayed it on their children and themselves like it is OFF or DEET insect repellent.  DO NOT SPRAY PEPPER POWER BEAR DETERRENT ON PEOPLE!

Can you imagine spraying your child with anything without knowing what it was, without any idea of what it might do?  I mean, if you wish to be an idiot, do it on your own time, and on your own mucous membranes...

What?

Did I notice that last sentence?  "DO NOT SPRAY... ON PEOPLE"?  I've already stated my intentions and not even a phrase in all CAPS is going to make me act any differently.  My Penitent Confession isn't quite ready for use, but in the meantime, should another Intrepid Intruder decide to climb through our glassless Fresh Air Access Modules (preceded by his useless hammer), were I to accidentally confuse him for a rabid grizzly bear, who is going to cry "Foul"?

I promise that during the hour spent waiting for the police to finish their Monks Fudge down at the Cistercians' Place I will gently bathe the eyes of the whimpering behemoth that I mistook for Ursus arctos horribilis... while La Bonne et Belle Bianca Castafiore serenades the savage beast, most likely with a selection from Gounod's Faust.

I wonder what else my Thanks-For-Charging-It Points on my Tête de Hergé VISA might deliver, in terms of protecting The Manor?


photo credit:  Mathieu Belanger/Reuters

Rivulets of Pluckiness: My Psychopathology (WITH UPDATE)

In the week since sending off my application for health insurance under the Pre-Existing Condition Insurance Plan * , I am feeling much worse.  In the course of the day, my mind wanders back to my last conversation with one of the world's most talented shoulder surgeons -- and my ludicrous questions to the very patient man.

"How will I know if it gets worse, if I need to come in?" and another 5 permutations of the same inquiry were met with a muttered:  "You'll know." 

Eyes downcast. 
No charge for the office visit.
Orders for joint aspiration under fluoroscopy -- the sixth -- which the hospital refused to schedule due to my lack of insurance.

My Teacherly Self has assured you many times, Faithful Reader, that there are, indeed, stupid questions.  My question'to ShoulderMan, however obtuse it might sound to you, was not stupid. It just didn't have an answer.

Given that fever, pain, sweats, and fatigue are daily occurrences, nothing to write home about, and certainly nothing to call the doctor over, how am I supposed to gauge... change?  That's one version of my question.  The throbbing, throbbing version?  How much can I stand?  How much, in the Name of God, should I stand?  What am I worth?

For instance, what am I to do or think when the pain begins to have that unmistakable infected ::twinge:: again, when using my left arm to do anything beyond putting a masterful grip on a paperback (currently The Cider House Rules by John Irving) causes an increase in fever and pain, even brings on The Febrile Shivers, when my hair is plastered to my head by what can only be called RIVULETS of salty sweat?  I confess that I cannot squelch the feeling that something ought to be done, that there ought to be some sort of response.  Hello?  Hello?

If you would like to make a call, please hang up, and try again.

Hey... I just noticed something:  It's a sign of my innate PLUCKINESS that I came up with RIVULETS.

[Possibly from Italian rivoletto, diminutive of rivolo, small stream, from Latin rvulus, diminutive of rvus, stream; see rei- in Indo-European roots.]

So, Friend.  What kind of psychological disorder is this, then?  Are my mind and my body in collusion? Are psyche and soma permitting a worsening of things now that addressing this bone infection won't q:u:i:t:e ruin me financially?  Or is it that now I am allowed, by a hyper-protective subconscious, to perceive just how bad things really are, and have been?  Whatever the underlying psychology, psychopathology -- I don't want to go down this road.  I don't want things to get harder. 

Yes, I hear that annoying high-pitched whine, too. 

I cannot go on like this -- this daily descent into Hell.  Have I garnered no new skills?  Why can't I look the other way, play the Polyanna Glad Game? 

I haven't phoned in my distress, nor emailed my Go-To-Guy Internist, because the one detail that never quite leaves me is the one where both ShoulderMan and Go-To-Guy cough-and-blurt that there is nothing more to do, except to remove my prostheses.  Permanently.

I can see how that would prevent the hardware from serving as petri dishes for further bonzo-bacteria... but it doesn't address the little buggers already in the humerus... Y'know? 

Impending Implosion Warning.  Impending Implosion Warning.  Impending Implosion Warning.

Thanks for the space and time to vent. 

{you know i want to apologize.  you know i do.  and so i ask myself:  whose blog is it anyway?  hmmm?}

* AUGUST 12, 2010: If you happen to be sporting your Dancing Shoes, prepare to do the Happy Dance! 

Today's mail included a slender envelope from the Pre-Existing Condition Insurance Plan, Administered by GEHA. 

 I admit that Fred was asked to pray before I opened it -- not some wimpy WASP-y mumblejumble, no!  Fred incorporates kippah, tallit, and tefillin -- and he looks quite fetching in his spiritual armor -- while he performs an impeccable High Mass in medieval Latin.  To cover all bases, we set out large baguette-shaped baskets full of French Existential classics, a sort of tired homage to Christ as the Bread of Life, and a nod-with-a-wink to actual bread to keep the actually living... alive. 

La Bonne et Belle Bianca felt it imperative that she don a long, white linen tunic, à la Isadora Duncan, and run on her tippy-toes -- in a weird crisscross pattern abbreviated by what might have been S.O.S. signals -- while waving smoking fronds of sage.

Marmy Fluffy Butt, after her great swath of tail was sufficiently poofed, led Dobby and Uncle Kitty Big Balls in a decorous purred rendition of Hymn of Hope, the famed devotional commissioned for the 150th anniversary of the First Baptist Church of Lapeer, Missouri.  Marmy is particularly keen on the musical notation for the piece that dictates it be done "reverently with quiet strength."

Thus fortified, I carefully slit open the envelope, hands trembling.  It was a flashback to the long ago days of college acceptances, with the significant improvement that the word approved was greatly bolded.

 As in:  approved approved approved !

When the sage ash settled, and the sacramental music faded into a bit of impressive jazzy scat, a few inconsistencies between the promised item and the item delivered were noted -- the monthly premium that was only to change when one shifted from one age bracket to another now may possibly change due to "market" forces; the deductible paid between now and the end of the year does not appear to be applied to next year's due, and a few other odd notes.  Each problem may be resolved by the more complete language of the full policy, which I haven't yet received.

Anyway, Dear Reader -- dance!  Dance with abandon, dance with joy -- I am insured! 

President Obama?  Thank you!