Turtles On The Runway

new floor

2010-05-18T07:07:00.006-07:00

old carpet

bare concrete

new tile

I can't get the labels to line up with the photos, but you get the drift. Grout will be sealed today. =]

Moneyball: The SCIENCE of Winning an Unfair Game

2010-05-17T10:22:00.003-07:00

This is an email I sent to my boss this morning. Baseball really can be used to achieve everything you want in life.
(Dr. M is the Chief Medical Officer and I'm the Regional Director of Medical Education.)

Dear Dr. M,
I went to LA this weekend and listened to audiobooks on the drive. Yesterday I listened to Moneyball: The Art of Winning an Unfair Game, by Michael Lewis. I can't believe I hadn't read it before -- it's been on my list for a long time. It's about how Billy Beane, the General Manager of the Oakland As, put together consistently winning teams despite having the lowest payroll in baseball. The concepts described can be applied to medical education, the students being the baseball players. In my analogy, you are the team owner, I'm the GM, Dr. W is the assistant GM, the attendings are the coaches, and the students are the players.

First of all, the title of the book is wrong. It should be The SCIENCE of Winning an Unfair Game, not the ART. This is what I call Evidence Based Baseball. We are trying to practice Evidence Based Medicine when it comes to patient care, but I believe we should try to find a way to apply Evidenced Based Baseball principles to medical education. We should pick medical students the way Billy Beane picks baseball players.

The Billy Beane approach was not just unique in baseball, it was nearly heresy. For over a century, baseball has been run by tobacco-spittin old guys who did things because their coaches did it that way because their coaches did it that way. Just like in Medicine. We do it because our attendings did it because their attendings did it. Both in execution (baseball strategies/patient care) and personnel selection (players/students). Baseball was run by tradition and habit. Beane and his Harvard-educated-geeks-with-laptops wanted to look at the statistics, the evidence, and do things in a new way.

I'll try to distill this down.

The Oakland As had the lowest payroll in Baseball. The Yankees and Red Sox had the highest payroll. Billy Beane was the GM of the As. How could he get his team to compete? Conventional Wisdom said you: have a lot of money, you buy the best players, you win. But what exactly is "the best player"?

First: define your goal. The ultimate goal is to win the World Series. The practical goal is to get to the playoffs every year. How do you get to the playoffs? You win games. How many wins does it take to get to the playoffs? 95. Not a number picked out of the air, but by looking at statistics. Now, how do you win 95 games? Conventional Wisdom said it had to do with the team's ERA or batting average or home runs or steals or defense. The evidence said it was about one thing: run differential. At the end of the season, if your team scores a certain number of runs more than your opponents, you will win 95 games. (I don't remember the number, but it was a specific number.) Great. Now, how do you get that run differential? The statistical evidence showed that it's about On Base Percentage, Slugging Percentage, and the OPS, but primarily about OBP. How important is pitching and defense? Statistically, not as important as has traditionally been thought.

I'm skipping A LOT here for brevity, but let's talk about OBP. Beane didn't have much money, so he wanted to get the "best" player for his money. He wanted undervalued players, players with a high OBP who weren't considered top prospects by the old tobacco-spittin scouts that utilized their eyes to evaluate players and had no knowledge of sabermetrics.

Now: who has a high OBP? Specifically, what kind of player consistently has a high OBP? It all boils down to the strike zone and the players ability to see the strike zone, see the pitches, and make good choices at the plate. It's about PLATE DISCIPLINE.

Now back to medicine. I have all these ideas floating around that I need to organize and settle. We need to decide what our ultimate goal is. What is our equivalent of getting to the playoffs and winning games? Do we want to produce doctors who will score highest on the Boards? Do we want to produce doctors who can churn out a large volume of patients? Do we want to produce specialists? Do we want to produce doctors who will return to our health center to practice primary care medicine? We have to define our goal.

The next part will be harder: how to achieve the goal we've set. In baseball, there are statistics for everything going back to the 1800s. We'll have to do some research on what kind of medical student becomes the doctor we want to produce. Is it the kid with the highest MCAT scores and GPA? Probably not. Is it the kid who just barely made an acceptable MCAT score or GPA? Maybe not that kid, either, but we don't know that yet. Is it the kid who speaks Spanish or spent a summer in Honduras or who did research as an undergrad?

Back to baseball, the As trained their minor league coaches to teach plate discipline to their players in the farm system. It turns out, the player who naturally has plate discipline will always have it. It's easier in the long run to find a player with plate discipline than to create one.

We need to figure out the medical student equivalent of On Base Percentage (the result we're looking for) and Plate Discipline (the QUALITY that gets us to that result).

When we took a look at the first year medical students who wanted to be placed at our site, I made up a list of qualities I wanted in a student to choose from among them - our version of the Draft. We got 90% of the students we wanted. We'll see how that works out. By next year, I hope to work that out with more evidence and less "gut."

some things aren't intuitive

2010-05-08T09:57:00.000-07:00

Maybe some things aren’t intuitive. In traditional medical school there are always learners above you telling you what to do and what not to do. Dr. Smith likes it when the student does this. Dr. Jones hates it when the student does that. There’s nobody above you when you’re the first class to go through a brand new medical school. Of the nine students in my group, some intuitively know to work hard on the wards. Others, um, don’t. I’m shocked and dismayed at getting reports of a student leaving the hospital before the attending! The most s/he would do is NOTIFY the attending that s/he was done for the day. WTF? Student arriving late, leaving early, telling attendings they don’t want to [whatever] in the hospital because s/he has to study for the shelf exam! It’s not just one kid. All one kid cares about is the test. I was complaining to MSA that MSB actually walked out of a surgery! S/he wasn’t scrubbed in, but s/he left to do something else! MSA asked, “is that wrong?” YES! IT’S WRONG! Holy cow, it’s an honor and a privilege to be in the surgical suite. If you’re scrubbed in, you’d better scrub out only if you’re p physically ill. If you’re in the O.R. but not scrubbed in, you’d better have a f*ck*n good reason to leave, and you need to ASK PERMISSION TO BE EXCUSED for that f*ck*n good reason. A student should never say, “I’m done” on the wards. You’re never done. You’re just ready to ask what you can do next.

Bentley's House of Excellent Coffee and Great Food

2010-04-03T08:55:00.005-07:00

I'm having breakfast and coffee at Bentley's House of Coffee and Tea, on Speedway & Cherry in Tucson. I haven't found another place in town with excellent food (and a good variety of choices) and excellent coffee. Most coffee shops don't sell food, other than pastries, and most restaurant coffee isn't very good. I've been coming to Bentley's since I was an undergrad, when it was in another location, and to this location since I was in medical school in the early 90s.

Recently there have been signs on the wall: "No computers at tables between noon & 2pm, all computers must be at the communal table during these hours." That's reasonable. During the lunch hour, they want tables free for patrons who will order a meal. The guy who has been sipping on the same coffee since 9:30 a.m. should either buy a lunch or make some room for someone who will.

Now there's a new sign that says something like: "We are trying to run a business in this tough economy. If you are here for a meeting or to use the Internet, please at least buy a cup of coffee."

Wow. Unbelievable. This is a locally owned coffee shop, not the public library. Didn't these leeches have mothers who taught them right from wrong? The nerve of some people amazes me. The coffee is only a couple of bucks, fer cryin out loud. I asked the barista guy about this. He said that they'll sometimes ask a table full of people having a meeting for at least one of them to buy at least a cup of coffee, and some people are insulted at being asked. I asked the barista if they ever just ask people to leave who won't purchase anything. He said some of them are so indignant they just get up and leave on their own.

Some people can be such @$$holes.

So if you find yourself in Tucson, please go to Bentley's House of Coffee and Tea, 1730 E. Speedway, www.bentleyscoffeehouse.com. They have a terrific variety of breakfast, lunch and dinner options. And GOOD COFFEE, not industrial crap covered up by flavored syrups and foam.

And please buy something.

p.s. the people who work here are wonderful, down to earth people whom I DO NOT KNOW. I have no affiliation with this coffee shop, other than as a patron for nearly 20 years.

Steaks

2010-04-02T17:50:00.004-07:00

See prior post. We didn't end up trying for perfect steaks. The steaks they bought probably weren't the best quality and they were going on five days old by the time we were sitting down to dinner again. So I sliced them up and made delicious fajitas, with onions, several colors of bell pepper, some leftover rosemary potatoes, and a few other Mexican secrets. Served with rice, beans, and salad. It was a fun night, with 3 Aussie guys and 2 American women. While Adam was texting someone, I tweeted:

"How do you spell fajitas?" he asked between sips of absinthe.

Goldilocks and the Three Steaks

2010-03-28T20:37:00.004-07:00

So, Shane bought a LOT of steak the other day. Big fat 2-inch thick steaks. I fancy myself a pretty good amateur chef, but one thing I have never been able to master is The Steak. The guys like to grill, and usually Shane can make me a perfect steak, medium-rare to rare, but there must be a trick to cooking these really thick ones. BTW, I have no idea what cut of meat they got, and neither do they.

Since Shane spends a lot of time in "the city to the north" with his girlfriend, Adam and I have been experimenting with the steaks. Adam cooked for us last night. It was RARE. Even too bloody for me, and I like it pretty bloody. So I spent today looking at steak recipes from all my cookbooks and the Internet. I thought I'd give it a shot tonight, I even used a meat thermometer, but I went too far in the other direction.

Last night the steak was too rare. Tonight the steak was much too cooked.

We're gonna try again. Maybe it will be just right.

Oscars for 2009 films ( 3/7/10)

2010-03-07T15:10:00.001-07:00

Laura’s Oscar List, 2009 movies
Awards March 7, 2010
Not predictions necessarily, just assessments.
Categories in alphabetical order

Actor in a Leading Role
Colin Firth – A Single Man
Jeff Bridges – Crazy Heart
Morgan Freeman – Invictus
Jeremy Renner – The Hurt Locker.
George Clooney – Up in the Air

Morgan Freeman doesn’t look anything like Nelson Mandela, not in the face or the body, but it took very little time for me to forget that this was the American actor. Freeman really embodied the style and spirit of Mandela – in the way he held his shoulders, his stance, his walk, and his vocal cadence. Good job. Better performances were from Colin Firth, Jeff Bridges, and Jeremy Renner, who were equally brilliant. Colin Firth gave the most emotionally moving performance of his career. The Hurt Locker would not possibly have been as great a film without Renner’s compelling and understated performance. I think Jeff Bridges will win, as much for a body of amazing work, as for this particular (and particularly outstanding) performance. If I had a vote, that’s what I would cast. He is long overdue for recognition of an exceptional oeuvre.

Actor in a Supporting Role
Christoph Waltz – Inglourious Basterds
Matt Damon – Invictus
Christopher Plummer – The Last Station
Stanley Tucci – The Lovely Bones
Woody Harrelson – The Messenger

I hated The Lovely Bones. Hated, hated, hated. Stanley Tucci is a terrific actor. Why couldn’t he have been nominated for Julie & Julia this year? Or ANYTHING else in any other year? Not that his performance in TLB was bad, it just was an awful movie. I didn’t get a chance to see The Messenger. I don’t understand Christopher Plummer being in this category. He should have been a nominee for Actor in a Leading Role rather than Supporting. Fer cryin out loud, the movie was about Tolstoy! And he was wonderful! Christoph Waltz was noticeably good in Inglourious Basterds for playing Nazi Col. Hans Landa. I would submit that the better supporting performance in that same film came from French actor, Denis Menochet, for his portrayal of Perrier LaPadite, the farmer whom Hans Landa visits to find out if he was hiding Jews under his farmhouse. Menochet was only on screen for a few minutes, but his performance was exquisite. Quiet and tense, it’s one of the most powerful scenes on that subject that I have ever seen. If Christoph Waltz wins, as I suspect he will, he owes M. Menochet a debt of gratitude for making that scene as compelling as it was, and setting the tone for Landa’s character for the rest of the film.

By the way, Christopher Plummer was on a roll this year! He was the bad guy in Up. He was Doctor Parnassus. And he was Tolstoy in The Last Station. Hurray for older actors!

Actress in a Leading Role
Carey Mulligan – An Education
Meryl Streep – Julie & Julia
Gabourey Sidibe – Precious
Sandra Bullock – The Blind Side
Helen Mirren – The Last Station

See – Helen Mirren is nominated in the category for Leading Role for being Tolstoy’s wife Why was Plummer’s Tolstoy in the Supporting Role?. Mirren is as good as Meryl Streep overall as an actress. If there were awards for performance duets, my nominees would be Mirren & Plummer for The Last Station, Sidibe & Mo’Nique for Precious, and Streep & Tucci for Julie & Julia. Anyway, that’s not how it works.

I’ve seen all these films and my favorite performance is Helen Mirren’s. I liked Carey Mulligan, but it seemed more like great casting than great acting. I always love Meryl Streep and she really embodied Julia Child. Gabi Sidibe’s Precious was indescribably good. That’s especially evident when I’ve seen her on talk shows and interviews. The actress is NOTHING like the character. Seems like the odds are on Sandra Bullock to win. I really liked that movie. It spoke to me on a personal level. Bullock gave a terrific performance and was nothing like Miss Congeniality or the Proposal girl. My vote would have gone to Helen Mirren, though. If Sidibe pulls out a surprise win over the more established actresses, it would be a triumph both for African American actresses and plus-sized actresses.

Actress in a Supporting Role
Maggie Gyllenhaal – Crazy Heart
Penélope Cruz – Nine
Mo’Nique – Precious
Anna Kendrick – Up in the Air
Vera Farmiga – Up in the Air

The only one I didn’t see was Nine – because Roger Ebert didn’t like it and because one doesn’t re-do Fellini. Besides, Penélope Cruz just won an Oscar for Supporting Actress last year for an obnoxious, over-the-top performance of a crazy byatch in a mediocre movie, Vicky Cristina Barcelona. For me, this is a tossup between Maggie Gyllenhaal and Mo’Nique. Mo’Nique had a tough job to be a very abusive mother. It must not have been easy for her to do the things she was required to do in that movie. I think another hard to accomplish task, in another way entirely, was to be a believable girlfriend to Jeff Bridges in Crazy Heart. “The Girl” could have been a throwaway role in the hands of a lesser actress than Gyllenhaal. I believed that these two could get together and even love each other. Vera Farmiga was great in Up in the Air. Wonderful sex appeal from an “older” (i.e. over 30) woman character. Young Hot Chicks only aspire to that kind of sexual self-assurance. If I had a vote, I’d struggle up to the last minute to decide between Gyllenhaal and Mo’Nique and I’d end up casting my vote for the less volatile role. Academy voters tend to do the opposite. The more screaming and throwing things, the better your chances (see notes on Cruz last year). If that holds true this year, congratulations will be in order to Mo’Nique.

Animated Feature Film
Coraline
Fantastic Mr. Fox
The Princess and the Frog
The Secret of Kells
Up

I saw Coraline, Mr Fox, and Up. Still hoping to see The Princess & The Frog. The Secret of Kells will be at The Loft theater in a few months, and it looks terrific. It’s by the same folks who did The Triplets of Belleville, but it has more of a Persepolis look, only in color. Mr. Fox was just: very Wes Anderson. ‘Nuff said. Enjoyable, if you’re in a Wes Anderson mood, and not for kids. I loved Coraline. It was really freaky. I wish I had seen it in 3-D. Up was great, in spite of some dark and frightening scenes that were incongruous to the tone of the rest of the film. My favorite animated film was Coraline, but Up will win if for no other reason than for having one of the best opening sequences of any film, ever. Besides, if an animated film is nominated in both the Animated Film and Best Picture categories, it usually wins for best animated film.

Art Direction
Do I even have to mention the “other” nominees? (Nine, Sherlock Holmes, The Imaginarium of Doctor Parnassus, and The Young Victoria)
If Avatar doesn’t win, the voters were paid off.
And if you don’t see Avatar in a real theatre in 3D, you’re missing the point.

Cinematography
Avatar
Harry Potter and the Half-Blood Prince
Inglourious Basterds
The Hurt Locker
The White Ribbon

The above comments on Art Direction do not apply to Cinematography. There’s more to cinematography than great art direction and visual effects. I would love to see The White Ribbon, a black & white German film, win for being visually beautiful in a classic way. The use of light is underrated and misunderstood. That this film was in b&w allowed for a more textured use of light and dark. The film is set just before WWI, so the light would have been either from the sun or from lanterns. The DP had you see exactly what you were supposed to see, even in a dark room lit ostensibly by one lantern. Each scene was perfectly lit and the tone was what was needed for that scene in the film. I saw The Hurt Locker when it came out, last summer, I think. I don’t remember the details enough to give an analysis here. I didn’t see Harry Potter. I’m surprised that A Single Man wasn’t nominated for best cinematography. That was a beautiful film. I mean that literally. Especially if you like men and the male body. I don’t mean that in an overtly sexual way. There are scenes of a man swimming, and just nice shots of nonsexual body parts: a knee, a neck, a shoulder, a forearm. That was just the icing on the cake. I haven’t been as taken with the look of a film so much since Road To Perdition, which won the Oscar for Cinematography in 2002.

Costume Design

Bright Star – Sweet and sad film about John Keats and his romance with the love of his life.
Coco before Chanel – Hellooo! This is Chanel! I would vote for this one not just for a display of style but for letting the viewer peek into the Evolution of Style.
Nine – didn’t see it
The Imaginarium of Doctor Parnassus – good nominee for a film with a strange style.
The Young Victoria – didn’t see the whole thing but the costumes were intricate and wonderful. This is the kind of film that usually wins, but I think Coco will win this time.

Directing

James Cameron – Avatar
Quentin Tarantino – Inglourious Basterds
Lee Daniels – Precious
Kathryn Bigelow – The Hurt Locker
Jason Reitman – Up in the Air

Clearly the two front runners are ex-spouses Cameron and Bigelow. Avatar was a great achievement in special effects and 3D filmmaking. Cameron changed filmmaking once already with The Abyss and Terminator 2. This is another leap forward in special effects thanks to the hubris and determination of one man. However, the making of a film involves more than visual effects. I hope Kathryn Bigelow wins for good storytelling. The Hurt Locker was exquisitely put together in every way. That is a testament to the film’s director. Lee Daniels deserves recognition for Precious. It could have been melodramatic or exploitive, but it worked because of great acting and great directing. My vote: Kathryn Bigelow.

Documentary Feature

Burma VJ
The Cove
Food, Inc.
The Most Dangerous Man in America: Daniel Ellsberg and the Pentagon Papers
Which Way home

Front runners are The Cove and Food, Inc. I think The Cove will win. Many documentaries move the viewer emotionally because of the subject matter. This film moves the viewer also because of the way the story is told. There are scenes as tense as in any thriller, as touching as any romance, and as frightening as the rare “good” horror film. I was literally on the edge of my seat, heart racing, during some scenes. In the end, I cried. And gave money to a cause.

Documentary Short Subject

China’s Unnatural Disaster: The Tears of Sichuan Province
The Last Campaign of Governor Booth Gardner
The Last Truck: The Closing of a GM Plant
Music By Prudence
Rabbit à la Berlin

No idea. Didn’t see any of them. But they’ll be on my Netflix queue.

Film Editing

Avatar
District 9
Inglourious Basterds
Precious
The Hurt Locker

You’d think Avatar would be the clear winner here, but I think all these films are worthy contenders. My vote would go to The Hurt Locker. Editing to great tension with little action or props is probably more difficult than editing to tension with lots of scenery and explosions.

Foreign Language Film

Ajami – haven’t seen it, but it will be at The Loft soon.
The Milk of Sorrow – haven’t seen it
Un Prophète – haven’t seen it, but it will be at The Loft soon.
El Secreto de sus Ojos – haven’t seen it.
The White Ribbon – This is an instant classic.

The only one I’ve seen is The White Ribbon. Ajami and Un Prophète will be showing at The Loft in the next couple of months. The winner will either be Un Prophète or The White Ribbon.

Makeup

El Divo
Star Trek
The Young Victoria

What the heck, I’ll go for Star Trek.

Music – Original Score

Avatar
Fantastic Mr. Fox
The Hurt Locker
Sherlock Holmes
Up

Did The Hurt Locker even have a score? One of the things I loved about it was its lack of music directing the viewer’s emotions (well, except for the scene in the truck near the end). No prediction here from me.

Music – Original Song

“Almost There” – The Princess and the Frog
“Down In New Orleans” – The Princess and the Frog
“Loin de Paname” – Paris 36
“Take It All” – Nine
“The Weary Kind” – Crazy Heart

Of these films, I only saw Crazy Heart, and I’m surprised the cartoon has more nominated songs. Weren’t all the songs in Crazy Heart written specifically for the movie? I loved every song in that film, and I don’t even like Country music – anymore – I used to like it, but it hasn’t been the same since about 1990. This is old school Country, which reminds me, I should go to iTunes to see if I can buy that soundtrack.

Picture

A Serious Man
An Education
Avatar
District 9
Inglourious Basterds
Precious
The Blind Side
The Hurt Locker
Up
Up in the Air

There used to be ten nominees for Best Picture in the early days of the Academy Awards. The last year there were ten was 1943, the year Casablanca won. My favorite films of this past year were: The Hurt Locker, District 9, A Single Man (which wasn’t nominated), Precious, and Crazy Heart. I liked Avatar, Inglourious Basterds, The Blind Side, Up in the Air, and Up. I also liked The Men Who Stare at Goats. I only saw half of A Serious Man because it was so painful to tolerate, I could only handle so much before I had to just get up and leave the theatre.

I’m thrilled that District 9 was nominated. It was a wonderful examination of humanity, good and bad. I wish Sharlto Copley had been nominated for best actor as Wikus van der Merwe. He was, as the film progressed, weasly, incompetent, prejudiced, cowardly, frightened, desperate, selfish, angry, loving, manipulative, courageous, selfless, powerful and peaceful.

Am I making a prediction here? My vote would go for the Hurt Locker and I hope it wins.

Short Film (animated)

A Matter of Loaf and Death
French Roast
Granny O’Grimm’s Sleeping Beauty
Logorama
The Lady and the Reaper (La Dama y La Muerte)

This was a good crop of animated films. I liked A Matter of Loaf And Death, a Wallace and Gromit film. French Roast was really cute. My personal favorite was La Dama y La Muerte. I wouldn’t know what to predict. Seems like, with the exception of The Danish Poet in 2006, my favorite is never the same as the winner.

Short Film (Live Action)

Instead of Abracadabra
Kavi
Miracle Fish
The Door
The New Tenants

In general, I did not like this crop of films as a group. They were all so depressing! There was blood in every one except the one with cancer! I thought The New Tenants was like every dark comedy indie I’ve seen for twenty years. Instead of Abracadabra was like the Scandinavian Napoleon Dynamite. The audience loved it and I suspect it will win. Kavi and Miracle Fish were good films featuring terrific child actors. The Door was very sad. I thought about The Door a lot in the days after seeing all of these.

Sound Editing (the art of recording sound effects, the production of sounds from scratch)

Avatar
Inglourious Basterds
Star Trek
The Hurt Locker
Up

Sound Mixing (refers to how the sounds of a film are put together)

Avatar
Inglourious Basterds
Star Trek
The Hurt Locker
Transformers: Revenge of the Fallen

I’d like to see Avatar win for Sound Editing and The Hurt Locker win for Sound Mixing.

Visual Effects

Avatar
District 9
Star Trek

Take a wild guess.

Writing (adapted screenplay)

An Education
District 9
In The Loop
Precious
Up in the Air

Writing (original screenplay)
A Serious Man
Inglourious Basterds
The Hurt Locker
The Messenger
Up

Often the writing awards are like runners up or consolation prizes for films that won’t win the big prize. Usually if there’s a kooky comedy, that will win. Recent examples include Juno, Little Miss Sunshine, and Sideways. There isn’t one of “those” types in these nominees.

For adapted screenplay, I would personally vote for District 9, but it won’t win. I predict Precious or Up in the Air. By the way, I rented In The Loop and shut it off after ten minutes.

For original screenplay, I would vote for The Hurt Locker. I didn’t see The Messenger. I suspect The Hurt Locker will win.

The Cove

2010-03-01T12:59:00.003-07:00

My tweets from the last couple of hours:

About to watch DVD "The Cove" - Oscar nominated documentary about dolphins in captivity.

Documntry makes me think the self destruction of human kind will be an ok thing -- if there's anything left of nature to recuperate from us.

The Cove: in addition to the topic, it's a well crafted film. some scenes are as tense as any thriller or as touching as any romance.

"You're either an activist or an inactivist."

Dolphin killers sitting around talking about how there used to be so many more whales years ago.

Oh, God. I want to vomit. This is horrible.

Text DOLPHIN to 44144 or go to TakePart.com/TheCove

New shoes

2010-02-26T09:46:00.002-07:00

I love my new pair of shoes! Dansko Solstice-Sausalito in color "cordovan" (reddish brown). SO comfortable! This is the best pair of shoes I've bought since those 4-inch pink Mary Janes!

Maurice Grossman, Rest in Peace

2010-01-22T14:33:00.004-07:00

3:44 a.m.

2010-01-22T03:45:00.002-07:00

Up in the middle of the night. At 3 a.m., Mom called me instead of 911. Dad yelling that he's dying. This is unfortunately becoming familiar. Sugar's probably low. I told her to give him some juice. I didn't panic. Got some clothes on and drove over, not slowly but not dangerously fast, either. He looked "low." I got his testing supplies and checked his sugar. 44. He was alert enough to drink juice and eat cookies and ice cream. Came up to 57 after that, and would continue to rise. Twice we've had to call the paramedics to give him IV glucose. Those times his BG was in the 20s. Those times I was in a panic. He really looked like he was gonna die. He has bad CHF and a leaky mitral valve, low EF, etc etc etc. The ticker ain't gonna last. Mom is more scared than she tries to let on. Now it's not quite 4 a.m. Raining. Dog was waiting for me when I got home. I've got Miles Davis on. I'll go back to sleep for the next couple of hours.

I'm with Coco

2010-01-15T16:46:00.001-07:00

That's all.

movies of the 2000s

2010-01-11T00:04:00.000-07:00

I've been working on this for a week and I keep adding more. Lists like these will never be "right" or "finished" so I'm looking forward to your comments, additions, and disagreements

BEST WAR MOVIES
Letters from Iwo Jima
The Hurt Locker
runners up:
Inglourious Basterds
The Good Shepherd

BEST GANGSTER MOVIES
American Gangster
The Departed

BEST CRIME MOVIES
ZODIAC
No Country for Old Men
Traffic
Memento
Mystic River
Frozen River
Monster
In Bruges
Gone Baby Gone

BEST VISUAL EFFECTS
Avatar in Digital 3D
Crouching Tiger, Hidden Dragon
The Lord of the Rings Trilogy

BEST movies from WRITER/DIRECTOR Tom McCarthy
The Station Agent, The Visitor

BEST LOVE STORIES
Brokeback Mountain
Love, Actually
Moulin Rouge

BEST SORT-OF ROMANTIC MOVIES, though not exactly love stories
Up In The Air
Lost In Translation
Paris, Je T'aime (romance with Paris)

BEST POLITICAL MOVIES
The Last King of Scotland
Breach

BEST COMEDIES
Sideways
The 40 Year Old Virgin
Little Miss Sunshine
Juno
Best In Show

BEST DOWNBEAT SO-CALLED COMEDY WITH AN UPBEAT ENDING
Happy-Go-Lucky

BEST COMING OF AGE MOVIES
Whale Rider
Wonder Boys
Almost Famous

BEST QUIET DEPRESSING MOVIE
Elephant

BEST FAMILY DRAMAS
The Savages
You Can Count On Me
Monsoon Wedding
About Schmidt

BEST TERRENCE MALICK FILM
The New World

BEST BIO-PIC
The Queen
Milk

BEST MOVIES ABOUT STUFF WE SHOULD KNOW ABOUT OTHER COUNTRIES
Rabbit Proof Fence
Rwanda
Blood Diamond
Slumdog Millionaire

BEST CONFUSING INTERNATIONAL MOVIES
Syriana
Babel

BEST ANIMATED FILMS
Wall-E
The Incredibles
Finding Nemo

BEST PERSONAL DOWNFALL MOVIES
Breach
Shattered Glass
Michael Clayton

BEST DEPRESSING DRAMAS
In The Bedroom
21 Grams

Best movies with Senator McCarthy as villain
Good Night, and Good Luck
Julie & Julia

BEST COWBOY MOVIES
The Assassination of Jesse James by the Coward Robert Ford
3:10 to Yuma

Best Meryl Streep performances
The Devil Wears Prada
Doubt
Julie & Julia

Best Phillip Seymour Hoffman performances
Charlie Wilson's war ("It was much funnier in the original Pashtu.")
Doubt
Love Liza

BEST FILMS NOT ELSEWHERE CATEGORIZED
Y tu mama tambien
Donnie Darko
Adaptation
Happy Accidents
High Fidelity

PROBABLY THE BEST MOVIES I HAVEN'T SEEN YET
25th Hour
Up In The Air
City of God
Snow Angels
The Lives of Others

reposted from Dr. Wes

2010-01-08T13:31:00.001-07:00

from the blog of Dr. Wes
this is pretty cool.
http://drwes.blogspot.com/2010/01/song-american-heart-association-will.html

SLEEP apnea

2010-01-04T22:53:00.005-07:00

Dad had a panic attack, so I went over. Short PMHx is: 79 y.o. w/ CHF, DM, HTN, pacer/AICD, paroxysmal a-fib on Coumadin, DJD, GAD, OSA. Did I miss anything? For the last several months the SLEEP apnea (he says it with a stress on the word SLEEP) is torturing him. It's like two well-established forms of torture: suffocation and sleep deprivation. He has been an anxious person all his life, but it's worse, if that's even possible, with the OSA. There was nothing I could do for him, so we went outside, wrapped him in some blankets for the frigid 55 degree weather, and did some slow, deep breathing. We'll try to get him in to see "that SLEEP apnea lady" to see if she can adjust his CPAP. I wanted him to start at 12 cmwp, but she started him at 8 and inched him up to 10. Shoulda started him at 12 like I said.

2009 movies: Inglourious Basterds and Synecdoche, New York

2010-01-03T08:47:00.002-07:00

I've started the annual catch up on movies before the awards season starts.

I finally saw Inglourious Basterds, or however you spell it. I thought it was great. I had already convinced myself that Quentin Tarantino would never come close to Pulp Fiction. I liked Jackie Brown and Kill Bill, very much, but it seemed like he was trying to recreate PF every time. I did not see any of his ultra-violent-for-the-sake-of-being-ultra-violent-isnt-that-fun films. (Apologies to QT & fans if those films were considered good, it's just not my cup of tea.) Inglourious Basterds was a step in a new direction, which is a good thing. A director needs range, just like an actor needs range. Not every character in every film should talk like Jules & Vincent. I wish QT hadn't felt the need to resort to some QT devices like "chapters" and PF-esque title font. The movie was terrific without those things. It wasn't even that violent, other than the baseball bat to the head scene. But if you're gonna bash someone's head in with a baseball bat, it should definitely be a justified Jew smashing in the head of an unremorseful Nazi. Contrary to what I thought from the ubiquitous clip of Brad Pitt saying Na-tzi with a short a, the film is mostly about the French and German characters, speaking French and German. The scene at the beginning where the French farmer is interrogated by the politely evil Nazi officer about where the Jews are hiding is one of the most painful scenes of that nature I've seen in years. Both actors were understated and powerful. If you haven't seen this film yet, put it on your Netflix queue!

Now, Synecdoche, New York. Not Schenectady, New York, a real city, but SYNECDOCHE, a real, if obscure, word meaning "a play on words in which a part may be used for the whole or the whole for a part." You can see where this is going. The beginning was good and somewhat realistic in its depiction of a married couple whose relationship has lost its luster. Phillip Seymour Hoffman is a genius, and so is Katherine Keener. Keener is always realistic in her characters, which is why her character leaves after about the first third of the movie. Then it's just a descent into the tortured mind of the Hoffman character, which is a descent into the tortured mind of Charlie Kaufman, the writer-director. Kaufman is the disturbed genius behind the screenplays for Adaptation, Being John Malkovich, and Eternal Sunshine of the Spotless Mind. It must suck to be Charlie. During the excruciating latter 2/3rds of the film, I thought, "My God, Vincent Van Gogh must have suffered terribly." Mental illness is something no one can understand who is not going through it. If this film had any value to me, it was to increase my empathy for the mentally ill. One of the several things I admired about the film was that the actresses had "real" bodies, a euphemism for being heavier than a bikini model. Samantha Morton has gained a lot of weight and it has kept her out of a number of roles, so it's good to see her back on film again.

These reviews explain Synecdoche and its "navel-gazing" better than I can:

http://blogs.suntimes.com/scanners/2009/01/synecdoche_acting_and_reenacti.html#more
http://maguiresmovies.blogspot.com/2009/05/synecdoche-new-york.html

I like self-absorbed artsy fartsy independent films about artists making art as much as the next hippie liberal. But too much is too much. I trudged through the film waiting for it to end and when it finally did, I felt relief for the characters and for myself. But mostly for myself.

Long Time No See

2009-12-29T03:33:00.003-07:00

My last post was a couple of months ago, but it seems longer. I keep thinking I need to do a catch-up post but there's not much sense in recounting everything. I'm not sure this is supposed to be a "diary" anyway. Main event after my last post was health issues for my 79 year old dad. His jumper cables gave him a shock, which is his way of saying that his AICD (defibrillator) fired. Long story. Short version is that he's home now after a week in hospital and step-down. Both parents are elderly now. (Gosh, I almost feel guilty using that word on them but it's true). When people ask, how are your parents? My answer is: They're still waking up every morning!

Boring post, but this will give me a jumpstart into getting back into the blog.

H1N1, flu, cold viruses, & my advice

2009-09-23T16:39:00.002-07:00

Dear friends,

The H1N1 flu is here, as well as run-of-the-mill cold and flu viruses. Please accept my unsolicited advice:

Wash your hands with appropriate frequency. Use soap and water. Get hands wet, add soap, work the suds for a full 20 seconds (outside of the water stream), then rinse. You'd be surprised how many people put a little water on their fingertips and call that washing -- or start rinsing the soap off as soon as they touch it.

Use sanitizing hand gel, especially after touching people or using public equipment of any kind (public computers, phones, etc). Work the gel into your hands (back and front & between fingers) until the gel disappears. It doesn't work if you rinse or wipe off the gel right away because you think it's slimy. It's supposed to be that way.

Spray or wipe phones, keyboards, computer mice, and your TV remote controls with something like Lysol or those sanitizing wipes. If someone is sick at home, go through the house once per day and wipe/spray things like the refrigerator door handle, light switches, doorknobs, cabinet handles, and other things that everyone touches. This will decrease the spread of cold & flu viruses within the household. For businesses, also pay attention to things like copy machines, fax machines, and printers. No need to get paranoid, but do this when someone is sick or in public/work environments.

It is not necessary to buy soap & sanitizers labeled "antibacterial." Cold and flu viruses are viruses, not bacteria. All soaps are sanitizing, anyway. The word "antibacterial" usually indicates that the product contains Triclosan, which is harmful to the bio-environment. Use it if you already have it, but you don't have to seek out those labels.

If your doctor has recommended that you get the flu shot, please take that advice. This is a decision between you and your doctor based on your personal risk factors. If you have been advised to get either the regular flu shot or the H1N1 shot, please do so.

Thanks for putting up with my advice!

Good luck and stay healthy!

"The Good Dr. Laura"

Feel free to forward.

The Dog Whisperer

2009-09-08T21:55:00.002-07:00

What I've learned from Cesar Millan:
1. Exercise, discipline, and affection, in that order.
2. You must be the alpha dog, the leader of the pack. If you give up leadership, it's very difficult to get it back.
3. Maintain a calm and assertive demeanor at all times.
4. Correction must be done immediately -- instantaneously, in fact. Cesar uses a curt noise of some kind and a deeper/serious vocal tone. Once you've made your correction, give immediate reward with affection and a gentle tone of voice.

The Physics of Vampire Sex

2009-08-31T23:21:00.003-07:00

(dare I post this?) A new blog's first entry was sent to me by a friend via Twitter. Here is my comment/response:

http://physicsofvampiresex.blogspot.com/2009/08/to-start-this-blog-off-on-right-foot.html

love the vampires, hate the maenad

2009-08-30T22:11:00.002-07:00

True Blood:
I can't wait for that maenad bitch to get devoured or whatever so I can have my normal vampires back.
I had to turn on all the lights in the living room tonight during the show cuz I was askared.
Eric and Bill are hot in different ways. Eric is &#%$in' hot to look at but I'd rather have Bill feed from my vasculature.
Queen Sophie looks the part but her voice is too anachronistic. She has that gravelly deep vocal thing that is just too late 20th century San Fernando Valley. Nobody thousands of years old would talk like that. Too bad. She could have passed for a Botticelli model, or a model for one of those Greek statues. It all stops working when she opens her mouth. Then I remember I'm watching a TV show.
Poor Lafayette. If it weren't fer bad luck he'd have no luck at all.
WTF is that egg?

I actually did give blood at a Red Cross event last week. It was the first time I wasn't disqualified. No recent travel. My life is boring. Almost got dinged on old Ghana stuff or that trip to Nigeria a few years ago, but they gave me a pass. Anyway, I did fine that day -- no fainting or diaphoresis or anything -- but I was flippin' WEAK AND TIRED for 3 or 4 days. By my calculations, I probably gave away about 13% of my blood volume. Dude, Sookie must be tired all the time! How can she run around and fight bad guys like that if she's chronically anemic?

Class of 2012

2009-08-28T08:26:00.003-07:00

So far, so good, with the new class of 2nd year students. We've had orientation all week. The clinics, docs, and staff are much more welcoming to this class than the inaugural class last year. Last year everything was new and the clinics were under stress from several other major, simultaneous changes at the health center, so there were reasons for their apprehension. Now, after a year of this program, the culture of the health center is starting to include the medical students as part of the family. I think we still have a long way to go, but we're moving in the right direction.

Senator Edward Kennedy

2009-08-25T22:44:00.004-07:00

I just found out, through Twitter, of course, that Senator Ted Kennedy has passed away. I had the opportunity to meet him in 2004 when he was stumping for John Kerry. It was early in the primary season, so it was a fairly small crowd and I was able to be just a couple of metres away from him. He was amazing. First of all, really handsome! More handsome than I expected given his age and more handsome than he looked on TV. His body looked just really worn and tired. I guess he had terrible back problems. But his spirit and mind were vibrant! He had quite a powerful voice to carry his eloquence. I got to shake his hand. It was a humbling experience to be in the presence of greatness.

Now our task is to carry on his legacy by passing a good health care reform bill, one with at least a few teeth! He lived his life doing great work, but also the often tedious work in Congress to get lines in bills and getting bills passed that serve the American people, ALL of the American people. At the VERY LEAST, we need to make illegal any discrimination by health insurance providers against people with pre-existing conditions. End of life counseling is a compassionate way to touch the lives of our patients and we should not shy away from it because stupid people have made ridiculous and outrageous misinterpretations of this. There should be the availability of a publicly funded segment of health insurance if not delivery. We already have this in the forms of Medicare, Medicaid, KidsCare, and the V.A. These kinds of options should be available to every American who chooses to utilize them. Health insurance should never have been linked to employment, certainly not as the primary method of coverage for the country. Most importantly, for-profit health insurance companies and health care institutions should absolutely not exist. Why? Because in a for-profit system, illness will always pay better than wellness.

Healthcare reform was the Senator's last crusade. Let us carry on that mission and help him achieve one of his last goals.

Minnie Ripperton

2009-08-25T22:27:00.002-07:00

@yayayarndiva said she was listening to "Loving You" by Minnie Ripperton. I tweeted a short version of a story about that song and she wanted to learn more, so here's a longer version.

I was in Chile in a town in the mountains in what I thought was supposed to be their summer, or at least their spring. It was too fkncold for me and I got sick and I needed a break to a warmer climate, so I took a 25 hour bus ride from Santiago de Chile to Arica, the northernmost town in the country (and on the beach and, therefore, warmer). Somewhere in the middle of that amazing journey through, among other things, the most desolate landscape I've ever seen (the Atacama desert), we stopped at a little cafe/diner. There was nothing else around, at least in my memory, but this little restaurant. We had a half hour to eat and use the facilities. It was close to the time to get back on the bus, I was sitting on a bench outside the restaurant. A beautiful little girl was sitting next to me. Minnie Ripperton was singing "Loving You" on the radio. It was a peaceful and lovely few minutes.

So, Mimi, that song reminds me of that day.

Week 2 in Review

2009-08-19T07:26:00.005-07:00

Busy week!

Baseball: Trent started off his major league career with a bang, to say the least. I heard it was the best debut since 1954, but I heard that from his mom, and I don't know the original source, but he still had an incredible debut. At one point his batting average was .500, but he's cooled off to a human, but respectable .314. That's where he usually lives, anyway.

His mother flew in from Sydney and it was a delight to meet her. We hugged as if we had known each other for years. Seriously, I've been in tears for a week. Mom & Sis are in Philadelphia, where the Dbacks are playing now. What a great way to spend a holiday!

Work: Crunch time. Stress. Too much to do. No time to do it. Gotta see patients tomorrow, when I have too many other things to do to prepare for the new medical students next week. And I need to get to work now to give a presentation, so I'd better get going. Just wanted to give a catch up for all five of my loyal followers. =]

There IS crying in baseball!

2009-08-10T21:43:00.010-07:00

I'm so proud of Trent. I've been crying off & on since the home run tonight - his 3rd in 5 days! He's worked so hard. Spent so many years in the minor leagues. Stuck in AAA for 3 seasons watching other guys pass him by. He was not a power guy last season. He's naturally a good top of the order guy, a table setter. Overall, he did better there than when they had him hitting at the bottom of the order, which was most of the time. He's always been fast. Used to be a bit impatient at the plate. It was sometimes a struggle for him to lay off. I haven't had a chance to actually see him this season because he's been in another city, but watching him on the Dbacks I can really see how much he has matured as a hitter, even since one year ago. So many nights last season he'd come home after a game, tired, frustrated. We'd talk about hitting. When to swing, whether to swing, whether or not to think about it. He had some really unhappy, frustrated times. He also had a lot of great games, offensively and defensively. We all thought he was ready at the beginning of this season, but the extra time and experience seem to have paid off.

Minor leagues suck. It's just hard. Medical school and residency suck too, but at least you know for sure you'll be a doctor, and you keep going in one direction. In baseball, you never know what will happen, you go up, you go down, you ... just never know.

Here's the link to his first post-game interview. There's my boy - great smile, familiar voice and accent. Sounds normal to me, of course, because I've had Aussies in my house for 3 seasons.

His mom (his real mom) will be flying in from Sydney this week. I can't wait to meet her. (I'm crying again!)

Pain in the B...elly

2009-08-10T09:11:00.002-07:00

Urgent care doc friend says that he saw a patient over the weekend with a 3 month history of abdominal pain. He asked, after three months, what made you decide to seek care today? (in the E.R.) She answered, "Well, we were in the neighborhood."

Nurse Jackie

2009-08-08T20:25:00.003-07:00

DirecTV's synopsis of an episode:
"Jackie admits a dying patient she previously treated; O'Hara tells her sister Jackie's secrets; an organ donation form is forged. Comedy."

Oeltjen

2009-08-08T12:19:00.002-07:00

My Aussie kid, Trent Oeltjen, has had quite a first 2 days in the major leagues. In his first game, he got a hit in his first ML at bat. Went 2 for 6 and the other hit was his first ML home run! He stole TWO bases. His first ever fielding opportunity in the majors led to an out at 2nd base. Wow! Not many guys have a first game like that one. See boxscore, one to keep!

In his second game, he was already 0 for 3 when he was called out at first, but it was a bad call. Replay shows he made it. His manager got in the umpires face. They were screaming at each other and you could see the bad words on the TV closeups. Manager A.J. Hinch got tossed. Cool! Trent got a hit on his next at bat.

I know I'm not his real mom, but I feel like a proud mama!

Goin' to the Show!

2009-08-06T07:23:00.003-07:00

One of my baseball players is going to the Majors!

I suppose I should explain. I live within walking distance from the Colorado Rockies Spring Training site. I've been hosting minor league players at Spring Training for several seasons - all Aussies. They call me their American Mum. Another Aussie who's with the Arizona Diamondbacks (they train in town but at another site) joined our little family in 2008. Trent Oeltjen has been in AAA for 3 seasons. It's been tough to watch a number of his AAA buddies go up for their taste of coffee without him. But last night he finally got the call!

He's goin' to the Show!

The Diamondbacks are in Pittsburgh today, Washington DC for the weekend, and home on Monday. You'd better believe I'll be there! I'll take my 10 year old nephew and Harry Potter (the new 15 year old). I'm sure Trent's girlfriend will come in from San Diego for the game. Can't wait to cheer him on!

The Brain of an 18 Year Old

2009-08-03T22:56:00.000-07:00

Yesterday I was getting ready for a party - actually a fundraiser that I was hosting, but at someone else's house. I made the mistake of FIRST getting ready, THEN loading up the car. Lemme tell ya, not a great idea. So, I'm wearing the 4-1/2 inch shoes - wedge, not skinny heels, but still. I loaded up my arms with platters that I was going to take over for our "wine & cheese potluck," so we would have a place to place the cheese & crackers. I tripped stepping out of my house, fell forward, platters shattered in my arms, and I realized that my head had just smacked right into the concrete in my carport. F***. If my head is split open, how am I going to take care of this party? I wobbled to the bathroom - no lacerations - a miracle. Not on my face and not on my arms from the broken ceramic. Somehow I managed to sweep up and get to the event. In flats.

If I say so myself, I was fabulous. Friendly, normal, interactive. But I had a headache and felt a little off balance. At the end of the event, when most people had left, I had a crying spell over some confusion about the dishwasher. I finally had to come clean. I'd had a closed head injury. (Emotional lability can be one symptom of a concussion.)

My friends were great- shocked at me but helpful. Luckily, many people I know are doctors. Friend wrote me an order for a non-con head CT. Got a ride home. Another friend stayed the night and checked up on me intermittently. Dude, that is a good friend, to set an alarm for 2 am to check to see if I was still alive.

Yeah, yeah, I know, I chose not to go to the E.R. But only because I knew what would happen. They would ask me some questions to check my mental status. I pulled off hostessing that party, I would say my mental status was adequate. They would ask me if I was vomiting -- I wasn't. They would see if I was dizzy -- I felt a tiny bit off balance, but no true vertigo. They would ask about the headache. It was about a 3/10. Not "worst headache of my life" territory. And they would order a scan.

So this morning I called my boss, got a sick day. Called the Radiology place, got an appointment. Called my office, got the scan ordered in our EMR. Called my old referrals clerk, got the prior auth. All before 9 a.m.

To shorten this long story, I got that head CT and the radiologist was nice enough to call me back to look at the scan with him. No subdural hematoma. He said I had nice sulci - a beautiful brain. Said I had the brain of an 18 year old. From a radiologist, that's a compliment.

I went home, had lunch, and slept all day. Broken platter parts still in the carport. I'll clean that up tomorrow. Head still hurts, but not too bad. Not feeling as woozy. But I have unattractive abrasions on my forehead and nose.

All in all, I think I got lucky.

Turtles On The Runway

2009-08-03T22:43:00.000-07:00

Hello everyone! So, I've been commenting on other people's blogs, but finally decided to start my own. I'm watching David Letterman right now while I'm trying to think of a name for this blog. He was talking about a 90 minute plane delay at JFK airport today due to turtles on the runway. Sounded cool. So there it is.

I suppose I'll write about medicine, teaching medical students, baseball, and movies. I follow some nurses and docs, both on Blogspot and on Twitter. I also follow a number of Peace Corps blogs because I used to be a PCV (Peace Corps Volunteer) in Ghana. (That's a country in West Africa where Barack Obama went to visit recently. That is NOT the country in South America where Jim Jones killed all those people with Kool-Aid.)

I'm looking forward to comments. I'm new at this. Can't possibly be as cool or funny as Dr. Grumpy, but we'll see where it goes.