Monthly Archives: December 2008


The Big Book of Sleep

Chapters I’m looking forward to:

6. Chronic Sleep Deprivation. We always like reading about ourselves.

7. Phylogeny of Sleep Regulation.
Phylogeny . . . might that be code for evolution?

21. Host Defense.
I’m hoping this chapter will explain why sleep isn’t horribly maladaptive.

25. Neural Mechanisms of Sleep-Related Penile Erections. We always like reading about . . . oh, yeah, I said that already.

47. Why We Dream, the last of seven chapters all about dreams. And that’s not even counting the section on parasomnias!

55. Sleep Disruption in Jet Lag and Other Circadian Rhythm-Related Disorders
, which will likely be of great practical use.

77. Nightmares and Other Common Dream Disturbances (from the section on parasomnias).

80. Violent Parasomnias: Forensic Medicine Issues. I couldn’t have done it! I was asleep at the time!

Seriously, this book is huge, like nearly 1500 pages huge. If I carry it in to work every day, I may address both my continuing medical education and physical fitness needs.

D.

Laying on of hands

I saw my new primary care doc today. Admittedly, I only needed him to write my prescriptions for me, but still: whatever happened to the history and physical exam? He didn’t ask me any historical questions, unless you count, “What can I do for you?” And he didn’t lay a pinkie on me.

You have to understand that in med school, we’re taught to do everything. There’s a reason for that. When I did PCM (preparation for clinical medicine) at the VA, I once had to ask a guy in his 50s about his drug history. Here’s this vet who is only about ten years younger than my dad, and I’m asking him about marijuana! But he said yes, he did a little coke on weekends.

We were expected to poke and prod at everything, too. And we did.

The thing is, if you do a good history and physical, you will sometimes discover interesting things. Just the other day I looked up the snoot of a guy who saw me for a skin cancer. He has nasal polyps! He was unconscious of them, but it’s still a significant finding; some polyps behave aggressively, and can even become malignant.

I wonder if my doc adopted the hands-off approach because I’m a doc, too. Maybe he figures I’ve been feeling my own liver. Anyway, I’d be more critical of him except this has become a near-universal phenomenon. This is not the first time I’ve observed this sort of behavior (although Karen’s doc back in Crescent City used to listen to her lungs, and would do the occasional Pap smear), and I’ve heard it said more than once that today’s primary care docs diagnose by blood test.

So: whatever happened to the laying on of hands?

I’m a doc. I know better than anyone how fallible we are. I’m not too superstitious . . . and yet I must say it would be reassuring to have someone listen to my heart and lungs, prod my belly, and look up my snoot, and declare me Not Dead Yet.

Even a doc likes to hear he’s Not Dead Yet.

D.

Why didn’t I think of that?

Wish I knew who to credit for this one.

D.

Question

Isn’t homeschooling wonderful? You can inflict assign all manner of interesting things to your child. Take this week, for example. This week, Jake will be reading about Creationism. There are benefits to this way beyond a deepened understanding of evolutionary theory. He will gain a much better appreciation for logical thought, as well as practical experience recognizing and contending with flawed arguments.

I always research these things myself first. So tonight, I found this site, containing the gem:

The Word of God says we were created with Human bodies that are designed to live forever. Science has recently proven that if we were to learn something new every second, we would take well over 3 millions years to exhaust the memory capacity of our “post flood” brains. (Pre-flood brains were 3 times larger) On the other hand… Evolutionists say things evolve after there is a need for change.

Question… How is it possible for us to have a brain that could hold enough info to last over 3 millions years, when all we can live up to is 90 years? (Don’t expect and answer from them.)

Title of this bit: “The Human brain proves Evolution a lie.”

If we ignore all the hocus pocus (pre-flood brains were what?) and grant the writer’s premise that ‘we would take well over 3 millions years to exhaust the memory capacity of our “post flood” brains,’ this says far more about the redundancy of the human brain and nothing whatsoever about evolution. Nearly all of our organ systems have built-in redundancy. Skin and gastrointestinal tract lining constantly regenerates; we have far more liver, lung function, and kidney function that we could possibly need for our moment-to-moment existence. But that’s the point: we evolved so that we could last long enough to reproduce. Redundancy is a good thing — without it, an infant wouldn’t last 9 months, let alone 90 years.

Some folks argue that our longevity is a product of evolution, too. As a first approximation, we are useless once we’ve reproduced and then raised our children into their reproductive years. Let’s use Michelle Duggar as an example of the pinnacle of Darwinian success. I don’t know how old she was when she had her first, but she might have been 12. It’s possible. Allotting one child per annum, she would then be 30 at the birth of number 18. If number 18 is a girl (and I think she is), this daughter would hit her reproductive years by age 12. By this superficial “first approximation,” Michelle really doesn’t need to live much past the age of 42. Not unless she plans on having numbers nineteen and twenty, of course.

But you can make a strong argument that people should live longer than the minimum years necessary. Let’s remember what’s really important here: that your genes live on not just to the next generation, but to the one after that, and the one after that, and the one after that . . . And what better way to insure the success of your genetic inheritance than to be physically present for its protection?

This should make the Creationists very happy: natural selection favors an extended nuclear family (assuming the elders of that family aren’t psychopaths who, through their nutso behavior, reduce their offspring’s reproductive success).

So we’re built to last, but by “built” I don’t mean “designed,” unless by “designed” you mean “produced by millions of years of evolution.” Because we certainly weren’t designed intelligently — but that’s a discussion for another day.

D.

RIP, Bettie Page

Bettie Page died on December 11, at the age of 85. From the BBC news obit:

“Bettie Page, one of the most famous US pin-up models of the 1950s, has died in Los Angeles, aged 85.

Her provocative poses – often in bikinis – made her a cult figure and she was one of the first models to appear in Playboy magazine.

Bettie Page was credited with helping to pave the way for the sexual revolution of the 1960s.

Some pictures of her showing bondage and spanking generated controversy and attracted a congressional subpoena. ”

I hit puberty in the 70s, so Bettie was an icon of a previous generation. I remember first seeing her photos in books, the pin-up collections that would show up fleetingly in Berkeley’s used bookstores. In residency, I used to go to Amok, a way cool LA bookstore that catered to everything and anyone at the fringe. There I found whole books of Bettie.

The woman was amazing — to be doing the things she did, at the time she did them? BBC News’ “helping to pave the way for the sexual revolution of the 1960s” is no overstatement. I suspect it was rare in the 50s for a brunette to be considered pin-up material, though I could be wrong. But for a brunette with strong fetishist leanings to hit the mainstream? Truly remarkable.

Here’s her Wiki. There’s an interesting story of her fall from the limelight and her subsequent resurgence. Also, here’s a rare interview with the older Bettie (from the 1990s).

The interview is correct: it is the smile. Rest in peace, Bettie.

D.

Xmas Book Giveaway

. . . at PBW’s place, not here. 99% of my books are boxed and in storage. I miss our built-in bookshelves back in Harbor, Oregon. Other people get hard-ons for cars or yachts; I like to have lots and lots of books around me. I miss ’em.

***

Part of my commute is a stretch of 80 North to the Columbus Parkway, Highway 37. And Highway 37, too . . .

During college, I traveled this road once a week for a few years, doing volunteer work at Napa State Mental Hospital. Debbie (whom I had a brief thing for) & Tracy (a guy shorter than me) & Laura (whom Trace had a serious thing for), we were a team, and you’d think we would have kept in touch but we didn’t. Now I can’t even remember their last names, except for Debbie, and she had a common last name. Debbie Martin. You out there, Debbie? I hope she’s okay. I worried about her back then and she worried about me. That’s what friends do.

D.

Long time no meme?

From Tammy.

1. Wrapping paper or gift bags? Paper, although the best gifts are 100% edible.

2. Artificial or Real tree? I keep thinking about A. Whitney Brown’s shtick about how he loved torturing trees. Now that was different humor. But really, Tam, you ask a nice Jewish boy artificial vs. real?

Real of course. I’m sure the artificial ones aren’t kosher.

3. When do you put up a tree?
Every damn night, and it gets to be a bother sometimes.

4. When do you take it down? Whenever I get the chance.

5. Do you like eggnog? I used to. Do they make lactose-free eggnog?

6. Favorite gift received as a child? Typical: my favorite gift, and the memory is tainted. It was a collection of tiny little story books. (Remember that, Sis?) Why is the memory tainted? Because my mom gave me a few before Hanukkah arrived, one a day, and then my dad got wind of it, and then they had a big fight because he wanted it to be a surprise. And who felt guilty? Yours truly.

7. Hardest person to buy for? Karen. I keep wanting to give her a tree.

8. Easiest person to buy for?
My mother. Big, baggy, touristy, pastel sweatshirt with sequins. Works every time.

9. Do you have a nativity scene? I understand I was quite a screamer. Does that count?

10. Mail or email Christmas cards? Femail.

11. Worst Christmas gift you ever received? We did a “secret Santa” gift swap during residency. Always disappointing when I would drop $25 and get some regifted piece of crap in return.

13. When do you start shopping for Christmas? I’ll let you know when I start.

14. Have you ever recycled a Christmas present? No

15. Favorite thing to eat at Christmas? Chestnuts. Latkes.

16. Lights on the tree?
Wouldn’t that burn?

17. Favorite Christmas Song? Nine Inch Nails’ Closer.

18. Travel at Christmas or stay home? Stay home

19. Can you name all of Santa’s reindeer? Whose reindeer?

20. Angel on the tree top or a star? Enough double entendres. Okay, if I HAD to have a tree, I SUPPOSE I would put a star on it. Happy now?

21. Open presents on Christmas Eve or morning?
Huh?

22. Most annoying thing about this time of the year? Christmas music. Live-action creches. Feeling left out.

23. Favorite Ornament theme or color?
Those formalin-pickled ears I saved from med school. (Kidding, kidding!)

24. Favorite dessert for Christmas dinner?
I don’t think I’ve ever had a Christmas dinner. If I had, it would probably be pie. Pecan pie. Which gives me GERD from hell nowadays, so I have to be content with the memory of pecan pie.

25. What do you want for Christmas this year? Nice, warm gloves to wear on my morning commute.

26. Who is most likely to respond to this? Lyvvie

27. Who is least likely to respond to this?
Oh, I don’t know. Dean.

D.

The new boss, etc.

Do I even have a boss? I don’t know about that. I have a supervisor, but since he was my junior resident when I was a chief resident, I’m pretty sure I can still order him around. First time I try it, I’ll let you know how that goes.

He has a supervisor, too — what the organization calls a PIC (Physician In Charge). I don’t even know that doctor’s name. And I assume there are shadowy administrators lurking in their top-floor offices futzing with processes and action plans and talking about “drilling down on the numbers.” I get the sense I could work 25 years here and never once meet an administrator.

First day was all about benefits and IT. I’m gonna get a whole lot of IT in the next two days. Tomorrow’s all about EMR (electronic medical records) and HIPAA (government regulations, or maybe Highly Infectious Parasitic Anti-Aircraft devices — yeah, that’s it!) And more IT on Wednesday. Not exciting stuff. If I could fault them for anything today, it was the lack of coffee.

I spent the morning with two other new docs. One’s a psychiatrist and the other is a hospitalist. They’re both Chinese, so right away they had to compare notes as to what languages they understood. The guy spoke Mandarin, and the woman spoke Fukienese. This word, by the way, sounds like “foo king ease,” at least to my ears. It’s the language of people from Fujian, or Fukien, or Fu-chien. I have just enough Beavis and Butthead in me to WANT to chortle over the spoken word, “Fukienese.” If I were single, I’m sure I would have asked this woman, “Can you teach me Fukienese?” And then I would have laughed so hard, I would have sprayed her with saliva.

Good thing I’m not single.

The commute took 1 hr 20 min going in, 1 hr 30 min coming home. Kind of a drag, but you know what? I think I’m going to be happy there. And after what happened to me in Santa Rosa, I’ve decided I can put up with a lot if the job makes me happy.

I’ll keep you posted.

D.

Squealing balls

For all you parents with young kids (protected static, Dean, I’m talkin’ to you guys):

World of Goo

a wonderful physics game. You can download a shorter version for free, but the full length game will cost ya $20.

If Tim Burton and Danny Elfman got together to create a physics game, this is what they would make. The artwork and music are that good. Check out this review, if you like, but I have to warn you: there be spoilers here. Half the fun of World of Goo is figuring out what things do and how they interact. The video tells way too much.

D.

Introducing the HP TouchShmuck

This is the HP TouchSmart. I gather they’re available for around $1150. I would offer you a price comparison to non-touch-screen monitors of comparable size, except I can’t determine the size of this thing from HP’s description. Here’s the thing in action.

Explain to me, please, why a touch-screen monitor is a good idea. I guess the idea of stowing the keyboard would appeal to people with limited desk space, but really: who wants their monitor covered with fingerprints?

But my main objection is a good deal more practical than that. When you use a keyboard, your fingers are in motion, and your wrist serves as the fulcrum. Same thing happens when you use a mouse. If you use a touch-screen monitor, you’ll be putting the fulcrum at your elbow, or possibly your shoulder.

There’s a principle in surgery that says you want the shortest distance possible from your fingers to the fulcrum. Longer distances magnify tremor (which we all have to some degree) and larger muscles are recruited to do things smaller muscles ought to be doing. You’ll end up with a whole lot of strain.

The TouchSmart makes no ergonomic sense, that’s what I’m trying to say.

But beyond that, why would I want such a thing? Why do I need a different way to move stuff around on my screen when the old ways work just fine? There’s nothing novel or sexy about touch screens — it’s not like this is some kind of new technology. In contrast, flat panel monitors are GREAT. I like being able to pick up my monitor with one hand! I think it’s a plus that my little lightweight monitor can’t double as a murder weapon!

See, I’m not a Neo-Luddite; bring on those flat panel monitors. Please.

But keep your paw prints off of ’em.

D.

Next page →
← Previous page