Would’ve been 32 years today.
For both of us, the wedding was an annoyance (we thought the Buddhist reverend was a twit) and the reception was chaotic. We didn’t get to enjoy the string quartet we’d insisted upon. I have a dim memory of us roaming from table to table, socializing with Karen’s relatives. There was a mini-scandal when one of her female relatives combed her hair with a dinner fork. Another mini-scandal afterwards, when one of the presents was a vase with WITH THANKS FROM SUMITOMO BANK written on its underside.
It was a blur, even at the time — not just a matter of the passing years smudging it all into a kaleidoscopic memory; it was kaleidoscopic even then. The hotel where we had the reception gave us a honeymoon suite with an enormous hot tub. Karen always claimed that her dad looked sick when he saw the honeymoon suite, as if he could imagine his little girl getting defiled soon afterward. We had an okay wedding night, no major olympic feats; we were both tired, and even then she lacked the stamina to have a full day of excitement followed by a night of the same.
She was a beautiful bride. She always did pretty-up nicely with makeup, and she did it so rarely I’d joke she was a different woman. The woman I fell in love with didn’t wear makeup. Not that I minded . . . although there was always that little trace of “what the hell are you doing with me” in the back of my mind.
And even now there are flashes when I don’t realize she’s gone. I was looking at a locum tenens headhunter email the other day. They wanted someone to cover a Northern California facility for various dates in the Fall. I thought about what life might be like post-retirement, and whether I might want to do a gig like that . . . and I had a moment’s concern about how rough it might be for Karen to accompany me on such trips. Travel wasn’t easy for her.
Such moments are rare nowadays. They’re brief, sudden, like involuntary reflexes.
They like me. They really like me.
Here at California’s biggest and best HMO, physicians put in three years before they make partner. Partnership means a little more money and a lot more job security. Job security is, of course, worth far more than that little bit of extra money.
Some (like Karen) would say that there was never any doubt that I’d make partner, particularly since they keep showering me with leadership roles. I’m chief of my department, and as of June 1 looks like they’re gonna make me the Physician In Charge for our building. They jumped over a lot of docs with far more seniority than me for the latter job, which either means (A) the boss sees remarkable leadership qualities in me, or (B) I’m still naive enough to say ‘yes’ to an offer like that. It would have been odd (understatement) to make me chief and PIC, only to then dump me from the organization. But it’s the partners who vote people on or off the island, not the big boss, and it wouldn’t be inconceivable for a difference of opinion to exist.
As it was, the boss told me they had to delay the decision on me because the partners were slow to vote. But I think that has more to do with the I-never-read-my-damn-emails problem than with any reluctance to jump me in to the gang.
What can I do differently, now that I’ve made partner?
* Buy a saltwater aquarium. No one wants to buy a saltwater aquarium if he thinks he’s gonna have to find a new job and MOVE.
* Hang my partnership plaque up on the wall.
* Deduct things on my income taxes, apparently, and oh . . .
* Start paying income taxes quarterly, yay! because the organization will no longer take automatic deductions.
* Breathe a little easier. Except, this area of the country has the worst particulate smog of anywhere, so strike that last thought.
I think we’ll go to Santa Barbara next weekend to celebrate . . . it’s been about 20 years since we last went to the Palace Cafe.
This is not a funny story. I think it says something about human nature, but it doesn’t say anything particularly nice about human nature.
Once when Jake was young and we were still into traveling a lot by car, we were driving down the 101 to visit Karen’s parents, and we stopped for dinner at a hotel restaurant. It was someplace between Garberville and Santa Rosa . . . Ukiah perhaps. We were one of about six families there. The place had a window-wall overlooking the pool, and it was early enough and warm enough for there to be people at the pool.
The odd thing is, we — all of us, all six tables at the restaurant — noticed at the same time a woman wearing a bikini who really should not have worn a bikini. You know those tiny rubber bands we use to put jaw fracture patients into elastics? Well, maybe you don’t know. So imagine a rubber band, the loop of which has perhaps a 1 centimeter diameter. Now imagine a few of those rubber bands stretched around a marshmallow. Not an ordinary marshmallow, either, but one of those new and improved humongous marshmallows that comes eight to a package.
Every time she got up out of her lounge chair, there would be a collective over-dramatic gasp followed by laughter. We couldn’t have coordinated it better if there had been one of those live studio audience prompters telling us to LAUGH or GASP. It was really uncanny and really mean but many people there were near tears and it just kept going on and on, maybe for twenty minutes or longer before she finally went back to her hotel room.
We weren’t the only young family in that restaurant. We weren’t the only ones who had apparently forgotten our responsibility as example-setters. I’m quite sure that if you cornered any one of us and asked him if it was okay to laugh at a fat person, he would disagree strenuously. And yet there we were, laughing.
I think about this scene every now and then, and I still don’t quite understand it. I’m guessing that if we had seen this in a movie, very few of us would have laughed. If we had been out there past the window-wall, sitting pool-side with her, no closer nor farther than we were in that restaurant, we definitely would not have laughed. Something about the fact that it was real and we had that wall of glass between us. Something.
I’d compare it to the sleazy feeling you might get laughing along with an audience for a racist or misogynistic comedian, except I know (from experience) that I don’t laugh in such circumstances. Do we have a less well developed sense of political correctness regarding obesity? Or is obesity not the issue here — were we merely laughing at someone with poor taste in swimwear?
I like that last possibility, of course. But it seems overly generous.
Karen trashing Jon Scalzi’s first novel drove a great deal of traffic to my site — something like 1000 hits per day for a while? I don’t remember precisely. But it was hit and run stuff that generated no enduring readers.
What really got me rolling was another Karen-inspired blog, this one about tarantula sex. Somehow the Smart Bitches got wind of it, gave me a shout out, and that’s how many of my long-time readers found me.
You know the saddest thing about this story? Karen has never had a successful mating. Intercourse (such as it is) but no conception. No pitter patter of several hundred hairy legs. But it wasn’t for want of trying.
From 2005, hot tarantula sex . . . below the fold.
It’s been over five years since I wrote a blog about foreign bodies. That’s remarkable enough (considering how fun* and interesting** and sometimes outright terrifying*** foreign bodies can be), but what I find really surprising is that no one has ever dedicated a blog to foreign bodies. Think of it: doctors around the world could submit photos and stories to the blog’s manager, who would after a year or two write a large format / coffee table book on foreign bodies, make oodles of money, then get his medical license revoked for violating patient confidentiality, and then lose oodles of money when he is sued by umpteen patients whose clinical photos showed up in the book (Damn you, I just know that was MY colonic can of Budweiser you included on page 135!), and then recoup all of his lost wealth and respectability when Quentin Tarantino directs a movie about his travails featuring Johnny Depp as the doctor-turned-coffee-table-book-author.
In med school, a well worn photocopy of an article from the Journal of Gastroenterology made the rounds among us budding surgeons. The article detailed a number of case histories of colonic foreign bodies, but the most memorable one concerned a gay couple who were celebrating the New York Yankees’ victory in the 1978 World Series by putting to good use a baseball signed by Catfish Hunter****. If I remember correctly, the non-incapacitated half of this couple was insistent that the baseball be removed unscathed. (Which brings to mind the apocryphal story of the ER patient with an electric vibrator located just past the reach of his fingers. The surgeon, so the story goes, asked him whether he wanted the vibrator removed, “or do you want me to change the batteries.”)
Most foreign body stories are not as much fun as these, particularly at my end of the body. It’s hard to laugh at a toddler’s misfortune, after all. And betting on the date of a swallowed penny has limited entertainment value.
Not many blogs on foreign body extraction, I’m afraid. Here’s one from rural Nepal, and here’s another from a blog oddly entitled, “Dr Ko Ko Gyi’s Blog /
Autobiography of Dr Abdul Rahman Zafrudin.” Dr. Gyi/Zafrudin has a number of disturbing images on that site, but here’s the money quote:
Rectal foreign bodies are typically inserted and the majority of cases are the result of erotic activity. Typically found objects are vibrators, dildoes, light bulbs, candles, shot glasses, and bottles. Patients may be very embarrassed to disclose the circumstances regarding the foreign body insertion and there may have been multiple attempts at removal. The image shown demonstrates a vibrator in the rectum along with a pair of salad tongs that became lodged after attempts at self-removal.
He also includes a nasal foreign body story from House, and it’s anyone’s guess why he included a fictional story amongst a number of true ones.
The author of the Sermo Blog solicited “most interesting foreign body” stories from a number of physicians. My favorite quote:
Response from a Urologist: “At our hospital recently the general surgeons removed from the stomach a bound and gagged barbie doll that the patient had swallowed.”
All this talk of rectal foreign bodies has made me hungry. Time to make dinner.
* My favorite: beads. The trick is to hook the hole. Close runner-up: any nasal foreign body that can be extracted by tricking the patient into sneezing it out (I have my ways!)
** Most interesting: the piedrito, which I blogged back in 2005.
*** Most terrifying: half of a pigeon skull wedged between the vocal cords of a two-year-old. Terrifying because this easily could have turned into a lethal situation.
**** Details made up by yours truly. Except I’m pretty sure the cause of celebration was, indeed, the Yankees’ victory.
On an intellectual level, I’ve been aware of an increased rate of oropharyngeal cancers in nonsmokers in the last ten years or so, but I only really woke up to it after having two such patients fall into my lap within the last several weeks. Seems I can no longer say, “If you’ve never been a big smoker or drinker, you have extremely little chance of getting throat cancer.” I’ll have to modify it to say, “If you’ve never been a big smoker or drinker, and if you’ve never had sex, you have extremely little chance of getting throat cancer.”
Yeah, you heard me. This is the bugger:
That’s the human papillomavirus, or at least it’s a fetchingly colored depiction of HPV. And for today’s public service announcement, the key facts are these:
1. HPV is an important cause of cervical cancer. Apparently, and not surprisingly (since mucosa is mucosa, after all), it’s also associated with many oropharyngeal squamous cell carcinomas.
2. The HPV2 and HPV4 vaccines protect against most of the HPV serotypes causing cervical cancer and genital warts. Safety data is quite favorable:
Serious adverse events and deaths were evaluated in a pooled safety analysis that included 29,953 females aged 10 through 72 years (16,142 received HPV2). Proportions of persons reporting a serious adverse event were similar in vaccine and control groups (5.3% and 5.9%, respectively), as were the types of serious adverse events reported. In the pooled safety analysis, including 12,533 women who received HPV2 and over 10,730 in the control groups, incidence of potential new autoimmune disorders did not differ (0.8% in both groups).
3. HPV-related oropharyngeal cancers are on the rise. Unlike the typical throat cancers, which are associated with heavy alcohol and tobacco use and poor oral hygiene, HPV-related oropharyngeal cancers are associated with having multiple sexual partners. (But all it takes is one bad apple, you know?)
4. It does not seem like such a great stretch to argue that boys as well as girls should receive the HPV vaccine, particularly since HPV is also associated with anal and penile cancers. It’s safe and effective, so why not do it? Seems logical to me, but there are people who take the other side. (For the “pro” side of the vaccinate-boys argument, click here.) As best I can tell, the arguments against vaccinating boys comes down to: it’s too much trouble, it’s too expensive, boys will benefit anyway if enough girls get vaccinated, and HPV-related cancers really aren’t that big of a deal.
5. On that last point: while it is true that the HPV-associated throat cancers are more sensitive to radiation therapy and have a better prognosis than the smoking-and-drinking throat cancers, people can still die from HPV throat cancer.
So I think it boils down to “what is the worth of a life.” Cost effectiveness arguments make a lot more sense when there are two edges to the sword*. For example, should all men above a certain age be tested for PSA, the tumor marker for prostate cancer? It’s a little controversial, and it’s more than the cost of the test that is debated. The issue is whether an elevated PSA leads to unnecessary tests or treatments, all with potential for harm. (The LA Times has a good piece on this issue.)
I don’t see the double-edge to this sword. These are safe, effective vaccines.
I know what I’m recommending to my son.
*In which case the cost, as a matter of public health policy, is still only one small part of the overall debate.
One thing about age: you can’t function as well with a cold or with too little sleep. So while my cold may be in its last gasp, I still need my sleep. Oh yeah do I need it.
I had an emergency case last night. The case didn’t run late, but it was one of those situations where despite my best efforts, things could still turn bad. When my pager went off at 11:30, my heart started pounding because of course I thought the worst. In fact, the ER doc from the local hospital was calling me out of desperation because none of the other Bako ENTs would answer his call. I couldn’t help him, and he was grateful to me for returning his call (probably frustrated as hell that the only person to return his call was the one person who contractually couldn’t help him), but my heart was still pounding.
I managed to get to sleep by 12:30, but it was a fitful sleep filled with fantasies of things going wrong. I’d wake up hoping it was morning, that many hours had passed, because the more time that passed, the more likely it was that my patient had gotten past that interval of risk. That he had, in fact, been discharged, sent home, hopefully sleeping more comfortably in his bed than I was in mine. Eventually I settled into something resembling a more restful sleep, only to be roused at 5:45 by some officious little dweeb of a nurse who needed a verbal order to extend my patient to 23-hour observation status. He couldn’t have waited another hour to call? Apparently not.
There’s no sleeping after a call like that. I contemplated getting up early (main advantage being, I could take myself out to breakfast) but I was just too tired. So I lay there exhausted, half dead, too tired to get up, too wired to sleep.
All day, I kept forgetting to finish things. No patient “quality issues” of course, just some sloppiness . . . blanks not filled in, messages not sent. I remembered, sometimes hours later, to pick up the threads. Things never quite flew apart.
Take out food was made for days like this.
One of the neat ideas China Mieville spins in Kraken is that of memory angels, supernatural beings brought into existence by long-in-the-tooth objects. Museums spawn memory angels, and they in turn guard their museums, sometimes with deadly force.
Not sure if my blog has enough personal history to spawn its own memory angel, but I do think that if I developed movie-amnesia* tomorrow, I could recover most of what I needed to know by re-reading this blog. Case in point: tonight, after watching the first half of David Lynch’s Eraserhead**, I searched my blog for references to Eraserhead and found this old Thirteen about my sophomore year in college. Rereading it, I’d be hard pressed to write a better reminiscence of that year.
Sometimes I think that the purpose of this blog was memoir. Memoir was and is its reason for being. In worried fantasies of my premature death, I see this as a way part of me can live on for my wife and son. And when I exhausted those memories***, the drive to write daily dissipated.
Back to Eraserhead, a movie I think I have to see once per decade to discover whether it’s any less creepy. Nope. Here’s the Lady in the Radiator singing “In Heaven,” a short song that has been covered by scads of bands including Devo, Bauhaus, and the Pixies.
Yes, I know what Eraserhead means. I suspect anyone would — the symbolism is none too subtle. But like David Lynch, I’m not telling.
*You know — something that happens only in movies: I’m fine, neurologically, except that my memories are zapped.
**Forty-five minutes being about all Karen could stand . . .
***No. Of course not. But the safer memories, the better memories are all here.
Found this one through Cracked.com’s “Letterman’s 9 Most Hilariously Awkward Interviews.”
In residency, I had a fan. I took care of her after a car accident and after that she became my senior year project. She was cute and zaftig and she always dressed to the nines, and she was one of those rare women who (A) seemed to have a crush on me and (B) still had all of her teeth. If ever I could have had an affair, she was it. I remember being so flattered by the whole thing that it never occurred to me that I might be hurting her feelings by NOT coming on to her. But hey, that’s not me. One of my classmates — no, wait, TWO of my classmates — would have jumped her in an instant. But not me.
Anyway. One day, she brought in Madonna’s book so that she could show me the black and white photo of the guy with the airbrushed asshole. Maybe this was her way to share a laugh with me (because it was pretty damn funny, that picture) or maybe it was her awkward way of making one last attempt. So we looked at that photo and the other photos and laughed about it, and that was all. I don’t think she ever came back to my clinic.
That’s my Madonna story.