Monday, November 27, 2006
I want a Wii
Don't you? I haven't even seen one in the real, and I want it. Check out the videos from the Rayman Raving Rabbids website (the one about a games convention doesn't work), especially the gameplay ones. How cool is that?
Sunday, November 26, 2006
Back from the dead
For now. I've grown more interested in the speaking side of the conversation than I have ever been, and I'm acting accordingly.
You (by which I mean the one person I know to have visited this blog, who commented on the Terri Schiavo post before being eaten by the ether) have seen a bit of me below. I've not changed much. I'm in my second year of residency (of four total), and am doing anesthesia on a daily basis.
What else do you need to know? Well, let's see...
I'm a Republican. If you think we're all Satan's minions, move along now. I'm not a conservative. If you think that renders me unsuitable for citizenship, move along now. This is not the droid you're looking for. I harbor true geekiness within; my undergrad degree was chemistry because I thought it was interesting.
And the email? It's a very, very loose French translation of "Devil Bunny", the singular of "Devil Bunnies", a very very very strange song by My Life With The Thrill Kill Kult that I liked in high school.
I'm married. Mrs. Bunny Powered is a doctor as well; she's a first-year resident in neurology. She was an English major in undergrad, and has a reading list that would impress anyone. I don't; I think the Harry Potter books and Terry Pratchett's Discworld novels are the epitome of current fiction, because they're fun.
Spinach Madeleine is still one of the finest dishes ever created.
You (by which I mean the one person I know to have visited this blog, who commented on the Terri Schiavo post before being eaten by the ether) have seen a bit of me below. I've not changed much. I'm in my second year of residency (of four total), and am doing anesthesia on a daily basis.
What else do you need to know? Well, let's see...
I'm a Republican. If you think we're all Satan's minions, move along now. I'm not a conservative. If you think that renders me unsuitable for citizenship, move along now. This is not the droid you're looking for. I harbor true geekiness within; my undergrad degree was chemistry because I thought it was interesting.
And the email? It's a very, very loose French translation of "Devil Bunny", the singular of "Devil Bunnies", a very very very strange song by My Life With The Thrill Kill Kult that I liked in high school.
I'm married. Mrs. Bunny Powered is a doctor as well; she's a first-year resident in neurology. She was an English major in undergrad, and has a reading list that would impress anyone. I don't; I think the Harry Potter books and Terry Pratchett's Discworld novels are the epitome of current fiction, because they're fun.
Spinach Madeleine is still one of the finest dishes ever created.
Wednesday, August 03, 2005
Bumper stickers that should never go on your car...
... no matter how much you might agree with the sentiment, it's just a little too would you like some cannnndy? to have one that says:
I [HEART] GIRL SCOUTS
firmly attached to the posterior of your minivan.
It's like the scary (badly) hand-painted ice-cream van.
I [HEART] GIRL SCOUTS
firmly attached to the posterior of your minivan.
It's like the scary (badly) hand-painted ice-cream van.
Wednesday, March 23, 2005
Terri Schiavo
Okay, essentials first: nobody really knows what she wanted.
Second, the law: a judge was convinced by testimony that she would not have wanted to live this way, and on appeal he was found to have made no error at law.
Third, the result: we have a great many people very disturbed over the fact that she will die of hunger or thirst, that it is indeed too cruel an end. They demand that life should be the default option because it seems likely to them that she is at least the equivalent of a severely retarded child, and we don't kill them.
Well, within the confines of my knowledge of the case - which is quite limited, as is that of everyone else on the outside - it's different. See, the thing is, people stop feeding themselves all the time. It's virtually universal in terminal cancer patients, and not uncommon in other chronic states. We have no problem letting them do so. So, in full recognition that this is a slightly different medical condition:
Would those who oppose removing Mrs. Schiavo's feeding tube on the grounds that the resultant death would be more cruel than, say, suffocation (because of its duration), and would in fact be murder as she's otherwise healthy, support the prosecution of people with terminal illnesses who reject tube feeding when they are too nauseous to eat normal food? Should they too be forced to feed? Suicide is, after all, illegal in most if not all US jurisdictions.
Honestly, the way that medical ethics are held, a competent person can make a decision to revert to stone-age treatment if they so choose. By any account I've seen, Mrs. Schiavo would die with stone-age treatment, because she could not be fed. So why is this murder? Indeed, why are conservatives who have watched the liberal establishment use special pleading in legislatures and courts to push horrible precedents through now so eager to use the full power of the nation-state to force a medical treatment? Is there no sanctity of oneself?
Or is it that they just don't like the decision that was reached?
I've been deeply disappointed by this whole matter. I wholly understand those who believe, deeply, that she would want to remain this way. I think you're wrong - the comments to her husband may have been a meaningless aside, but they probably weren't. Until they have seen an elderly family member in that state, most people have never considered whether they would consider life worth living if they were incontinent of urine and feces, unable to swallow (and therefore drooling), and with nil to minimal consciousness of the world. By age 28, she was very unlikely to do so.
I've seen those people. I never want to be one. (Ed: but this is an anonymous blog! How will they ever know?--Good question, time to write the living will.) I've got other reasons for thinking differently about the matter. I'm estranged from my family for matters not worth repeating here, but I can honestly say that I trust none of them to make rational, informed decisions in line with my wishes. I've left my wife in charge; in her absence, taking a detailed list of my wishes, her parents are to carry out my wishes in consultation with the ethics board of whatever hospital I'm in.
So, until we have euthanasia legalized - something that, for several reasons, I'm not particularly enthusiastic about - that means that we have to do things like pull the feeding tube. But don't tell me it's cruel; just don't. Forty years trapped in a mind that can no longer think, no longer move, no longer communicate. Forty years alone with what little remains of your thoughts, watching your family slowly drift along trying to keep you going. That's cruel.
Second, the law: a judge was convinced by testimony that she would not have wanted to live this way, and on appeal he was found to have made no error at law.
Third, the result: we have a great many people very disturbed over the fact that she will die of hunger or thirst, that it is indeed too cruel an end. They demand that life should be the default option because it seems likely to them that she is at least the equivalent of a severely retarded child, and we don't kill them.
Well, within the confines of my knowledge of the case - which is quite limited, as is that of everyone else on the outside - it's different. See, the thing is, people stop feeding themselves all the time. It's virtually universal in terminal cancer patients, and not uncommon in other chronic states. We have no problem letting them do so. So, in full recognition that this is a slightly different medical condition:
Would those who oppose removing Mrs. Schiavo's feeding tube on the grounds that the resultant death would be more cruel than, say, suffocation (because of its duration), and would in fact be murder as she's otherwise healthy, support the prosecution of people with terminal illnesses who reject tube feeding when they are too nauseous to eat normal food? Should they too be forced to feed? Suicide is, after all, illegal in most if not all US jurisdictions.
Honestly, the way that medical ethics are held, a competent person can make a decision to revert to stone-age treatment if they so choose. By any account I've seen, Mrs. Schiavo would die with stone-age treatment, because she could not be fed. So why is this murder? Indeed, why are conservatives who have watched the liberal establishment use special pleading in legislatures and courts to push horrible precedents through now so eager to use the full power of the nation-state to force a medical treatment? Is there no sanctity of oneself?
Or is it that they just don't like the decision that was reached?
I've been deeply disappointed by this whole matter. I wholly understand those who believe, deeply, that she would want to remain this way. I think you're wrong - the comments to her husband may have been a meaningless aside, but they probably weren't. Until they have seen an elderly family member in that state, most people have never considered whether they would consider life worth living if they were incontinent of urine and feces, unable to swallow (and therefore drooling), and with nil to minimal consciousness of the world. By age 28, she was very unlikely to do so.
I've seen those people. I never want to be one. (Ed: but this is an anonymous blog! How will they ever know?--Good question, time to write the living will.) I've got other reasons for thinking differently about the matter. I'm estranged from my family for matters not worth repeating here, but I can honestly say that I trust none of them to make rational, informed decisions in line with my wishes. I've left my wife in charge; in her absence, taking a detailed list of my wishes, her parents are to carry out my wishes in consultation with the ethics board of whatever hospital I'm in.
So, until we have euthanasia legalized - something that, for several reasons, I'm not particularly enthusiastic about - that means that we have to do things like pull the feeding tube. But don't tell me it's cruel; just don't. Forty years trapped in a mind that can no longer think, no longer move, no longer communicate. Forty years alone with what little remains of your thoughts, watching your family slowly drift along trying to keep you going. That's cruel.
Tuesday, March 15, 2005
Woo hoo!
I matched!
Bunny Powered, MD, anesthesiology.
Mrs. Bunny Powered is still thinking, but she has another year to go.
Bunny Powered, MD, anesthesiology.
Mrs. Bunny Powered is still thinking, but she has another year to go.
Wednesday, March 09, 2005
Hey, it's March!
March! Not yet March 17, Match Day! But March!
Grooving to a bit of Solar Power Sessions at the moment. Good station, if you're into trance. They have a prog channel too, just haven't really listened to it much.
Took the USMLE Step 2 CS last Friday; those who have it waiting, beware. It's a total waste of your time and money. One case I just couldn't figure out. Two others were, well, a little curious. But the other nine were so clear-cut (at least, once you asked The Right Question) that the diagnosis was easy. Coming up with a big differential was somewhat difficult for some problems, but that's life. Anyway, got there at 8, was out by 4:30. Layout: Orientation - 5 cases - 30 min lunch (sandwiches, chips, drinks provided) - 4 cases - 15 min break - 3 cases - final survey - out of there. I'm just hoping I passed; it really seems like the sort of situation where making the correct diagnosis still isn't enough to guarantee success, as your eval is dependent on what the patient remembers your asking or not. I will say this: from past experience with similar situations at my school, if you can charm a simulated patient they will likely think that you did more than you actually did. Don't be smarmy, but if you've got it, use it. Little old ladies, for example, are butter in my hands.
Grooving to a bit of Solar Power Sessions at the moment. Good station, if you're into trance. They have a prog channel too, just haven't really listened to it much.
Took the USMLE Step 2 CS last Friday; those who have it waiting, beware. It's a total waste of your time and money. One case I just couldn't figure out. Two others were, well, a little curious. But the other nine were so clear-cut (at least, once you asked The Right Question) that the diagnosis was easy. Coming up with a big differential was somewhat difficult for some problems, but that's life. Anyway, got there at 8, was out by 4:30. Layout: Orientation - 5 cases - 30 min lunch (sandwiches, chips, drinks provided) - 4 cases - 15 min break - 3 cases - final survey - out of there. I'm just hoping I passed; it really seems like the sort of situation where making the correct diagnosis still isn't enough to guarantee success, as your eval is dependent on what the patient remembers your asking or not. I will say this: from past experience with similar situations at my school, if you can charm a simulated patient they will likely think that you did more than you actually did. Don't be smarmy, but if you've got it, use it. Little old ladies, for example, are butter in my hands.
Tuesday, November 23, 2004
Holiday time - recipe!
It's too late for you to do this proper justice for Thanksgiving, but for [your December holiday of choice] it's going to be just perfect.
Spinach Madeleine
A Louisiana recipe made famous in River Road Recipes from the Junior League of Baton Rouge, LA. Adjusted according to my experience.
Step 1:
2 10-oz packages frozen spinach
Cook per package directions and squeeze as dry as possible by method of choice (mesh colander, cheesecloth). Retain spinach liquor. Set both aside.
Step 2:
4 T butter
1/8 C flour (2 T)
2 T chopped onions
1/2 C evaporated milk, room temperature.
1/2 C retained spinach liquor
1 tsp Worcestershire sauce
Step 3:
6 oz Velveeta Mexican Hot
1/2 tsp black pepper
3/4 tsp garlic salt
3/4 tsp celery salt
Melt the butter over low-med heat. Add flour and stir until smooth - do not brown this roux. Increase heat to medium and add onions. Cook, stirring constantly, until onions wilt to desired mushiness (my preference is ~10 minutes). Slowly stir in the evaporated milk, retained spinach liquor, and Worcestershire sauce bit by bit. Be sure to stir constantly to avoid lump formation.
Cook down until base is thick and consistent. This is of necessity a subjective decision, but here's my guideline. My spatula is ~2 1/2 inches wide, and a double recipe of this (which is what I always make) is about 1/3" deep in the pan I use. If I drag the spatula through the base broadside-on, it takes about 4 seconds to fill in the void created. Compare to reasonably thick cake batter. Remember: better too thick than too thin; you can always dilute it at the end (using some of the rest of the spinach liquor).
Cube 6 oz of Velveeta Mexican Hot (or Mild, if your taste buds aren't up to speed - it's not blistering, but I'm more accustomed to spicy foods than a lot of, say, Northeasterners) and add it, along with celery salt, black pepper, and garlic salt, to the pan. Stir constantly until smooth and fully melted. Remove from heat and fold in spinach.
You're done with the hard part now. It can be served as-is as a spinach dip; it may be placed in a casserole dish and topped with breadcrumbs, then toasted, as a main dish. Taste is noticeably improved if you let it sit for at least a day in the refrigerator before serving, as the flavors meld. N.B.: if you choose to let it sit, remember that some liquid will leach out of the spinach overnight. This is why it is so critical to eliminate fluid at the end of Step 2.
It freezes well, which makes it great for guests that just happen to stop by - in 20 minutes, you can heat it on the stovetop (microwaving probably works just as well, but my microwave tends to burn things).
Don't be afraid to tinker. Add more jalapenos if you want more kick; add a little fresh chopped garlic to the onions if you want a little more of that. The only crucial step in replicating the dish is to make sure you cook it down to the same consistency every time at the end of step 2 - you will be amazed how much its thickness just after the liquids have been added will vary.
Chef John Folse, from whose website I originally took the recipe, has a number of other suggestions. Check them out.
Spinach Madeleine
A Louisiana recipe made famous in River Road Recipes from the Junior League of Baton Rouge, LA. Adjusted according to my experience.
Step 1:
2 10-oz packages frozen spinach
Cook per package directions and squeeze as dry as possible by method of choice (mesh colander, cheesecloth). Retain spinach liquor. Set both aside.
Step 2:
4 T butter
1/8 C flour (2 T)
2 T chopped onions
1/2 C evaporated milk, room temperature.
1/2 C retained spinach liquor
1 tsp Worcestershire sauce
Step 3:
6 oz Velveeta Mexican Hot
1/2 tsp black pepper
3/4 tsp garlic salt
3/4 tsp celery salt
Melt the butter over low-med heat. Add flour and stir until smooth - do not brown this roux. Increase heat to medium and add onions. Cook, stirring constantly, until onions wilt to desired mushiness (my preference is ~10 minutes). Slowly stir in the evaporated milk, retained spinach liquor, and Worcestershire sauce bit by bit. Be sure to stir constantly to avoid lump formation.
Cook down until base is thick and consistent. This is of necessity a subjective decision, but here's my guideline. My spatula is ~2 1/2 inches wide, and a double recipe of this (which is what I always make) is about 1/3" deep in the pan I use. If I drag the spatula through the base broadside-on, it takes about 4 seconds to fill in the void created. Compare to reasonably thick cake batter. Remember: better too thick than too thin; you can always dilute it at the end (using some of the rest of the spinach liquor).
Cube 6 oz of Velveeta Mexican Hot (or Mild, if your taste buds aren't up to speed - it's not blistering, but I'm more accustomed to spicy foods than a lot of, say, Northeasterners) and add it, along with celery salt, black pepper, and garlic salt, to the pan. Stir constantly until smooth and fully melted. Remove from heat and fold in spinach.
You're done with the hard part now. It can be served as-is as a spinach dip; it may be placed in a casserole dish and topped with breadcrumbs, then toasted, as a main dish. Taste is noticeably improved if you let it sit for at least a day in the refrigerator before serving, as the flavors meld. N.B.: if you choose to let it sit, remember that some liquid will leach out of the spinach overnight. This is why it is so critical to eliminate fluid at the end of Step 2.
It freezes well, which makes it great for guests that just happen to stop by - in 20 minutes, you can heat it on the stovetop (microwaving probably works just as well, but my microwave tends to burn things).
Don't be afraid to tinker. Add more jalapenos if you want more kick; add a little fresh chopped garlic to the onions if you want a little more of that. The only crucial step in replicating the dish is to make sure you cook it down to the same consistency every time at the end of step 2 - you will be amazed how much its thickness just after the liquids have been added will vary.
Chef John Folse, from whose website I originally took the recipe, has a number of other suggestions. Check them out.
Sunday, November 21, 2004
Late nights
11-7 am shift tonight, tomorrow night, and the next. It's not actually all that bad - but not many people are still coming in at 5 am. Those that are unfortunately tend toward the "really bad" end of the spectrum - we just had a guy come in with a gunshot to his back and no sensation or movement below his navel. I wasn't in the room to hear, but prior experience suggests that the nefarious Some Dude was responsible for this shooting. Mr. Dude is a criminal well known to emergency personnel around the country; he is known to commit multiple offenses in cities nationwide every night.
Sunday, November 14, 2004
Wednesday, November 10, 2004
The adventure continues
I just heard about someone they wanted to fly in for treatment here. Unfortunately, they died at the outside hospital before our helicopter got there. It was diabetic ketoacidosis (DKA), a nasty complication of type I diabetes (which has been known as juvenile-onset or insulin-dependent, though those have become less accurate as America fattens and plenty of teens get type II diabetes, and plenty of type II's need insulin for control).
For the medically aware: FSG 1890. Gap was 40. No word on pH.
For the laymen: a normal FSG (=finger-stick glucose) is around 100. With most diabetics, we aim to keep it at or below 150 (as a practical matter). "Bad" is around 180. "Really bad" is around 220. She was an order of magnitude out from normal. Gap (short for anion gap) is sodium - (chloride + bicarbonate), and should be <12. It reflects unmeasured negative ions in the blood, which mostly consist of proteins in normal people. In DKA, it's high because their blood is full of acids that are negatively charged at blood pH.
Anyway, a regular bout of DKA is FSG of 500 with a gap of maybe 20. (At least, that's the case here. YMMV.)
For the medically aware: FSG 1890. Gap was 40. No word on pH.
For the laymen: a normal FSG (=finger-stick glucose) is around 100. With most diabetics, we aim to keep it at or below 150 (as a practical matter). "Bad" is around 180. "Really bad" is around 220. She was an order of magnitude out from normal. Gap (short for anion gap) is sodium - (chloride + bicarbonate), and should be <12. It reflects unmeasured negative ions in the blood, which mostly consist of proteins in normal people. In DKA, it's high because their blood is full of acids that are negatively charged at blood pH.
Anyway, a regular bout of DKA is FSG of 500 with a gap of maybe 20. (At least, that's the case here. YMMV.)
Sunday, October 31, 2004
Sunday
It's Sunday. It's a nice day out; the sun keeps playing with the clouds, which is as it should be. Two days until the election starts. Hopefully, it will end soon thereafter, but I don't hold out much hope, given that the DNC has already sent out teams of lawyers and mapped out preliminary strategies.
This isn't likely to be a strongly political blog. To use Steven den Beste's categorization, I'm more thinker than linker, because I just don't have the time to stay up to date on everything that's going on to the point that I can do a better job than [your choice of pundit/news/whatever]. And frankly, though I do have some strong opinions, I'm just not into doing that thing here - this should be fun, not work, and not a place that I vent.
I am human, however, and this is one of the times that it will get the better of me. If you don't like politics, or you don't like my politics, consider yourself warned. Charming stories return later.
I sort-of understand the Bush hatred. Sort of. As in, I know that he pushes all the wrong buttons on some people, and they just can't bear the thought that he's still sucking up their oxygen. But why that justifies the kind of stuff that's happened over the past year or so - the suave sleight-of-hand of F9/11, 60 Minutes airing a story based on blisteringly obvious fakes, the idiotic Lancet story estimating 100k deaths in Iraq, and all the other ones that aren't coming to mind right now - that I just don't get. It's as if the traditional media had a death wish.
In the past, I always assumed that the liberal bias of the traditional media (no comments about this, please, folks; the existence of Fox News doesn't mean that CNN isn't liberal) was limited primarily to op-ed's and the choice of which stories to cover. I always thought that, when the story was being researched, they were quite honest about the process. Boy, was I wrong. I now generally assume that anything reported in certain sectors of the press (NY Times and CBS being the most prominent, but by no means alone) that's more sophisticated than "x killed y last night, and police have arrested x" is likely to be a politically motivated hit piece on somebody. Maybe not GWB. Maybe not even a Republican. But definitely someone.
Why? It's televised seppuku. It will, at best, warm the hearts of those who can't stand the guy already. It will confirm the opposition's belief that the news is biased against them and can't be trusted. And it will drive away swing voters. That's a lesson the Republicans learned in the aftermath of 1996.
Actually, it's a great time for one of my favorite political sayings: despite eight years of inestimably valuable education from William J. Clinton, the Democratic Party didn't learn a damned thing. The Republicans did. Bush, in particular, did, and in spades. Why? I'm not sure we'll ever know. I remain convinced that I will never see another person with the raw political acumen of Bill Clinton. If I do, I'll lay a huge chunk of money down at Tradesports that he (or she) gets elected.
Anyway, it's infuriating, patently obvious, and counterproductive. (And there you have it folks. Pure, unadulterated wisdom. I mean, I couldn't possibly be wrong. It wouldn't be me.)
This isn't likely to be a strongly political blog. To use Steven den Beste's categorization, I'm more thinker than linker, because I just don't have the time to stay up to date on everything that's going on to the point that I can do a better job than [your choice of pundit/news/whatever]. And frankly, though I do have some strong opinions, I'm just not into doing that thing here - this should be fun, not work, and not a place that I vent.
I am human, however, and this is one of the times that it will get the better of me. If you don't like politics, or you don't like my politics, consider yourself warned. Charming stories return later.
I sort-of understand the Bush hatred. Sort of. As in, I know that he pushes all the wrong buttons on some people, and they just can't bear the thought that he's still sucking up their oxygen. But why that justifies the kind of stuff that's happened over the past year or so - the suave sleight-of-hand of F9/11, 60 Minutes airing a story based on blisteringly obvious fakes, the idiotic Lancet story estimating 100k deaths in Iraq, and all the other ones that aren't coming to mind right now - that I just don't get. It's as if the traditional media had a death wish.
In the past, I always assumed that the liberal bias of the traditional media (no comments about this, please, folks; the existence of Fox News doesn't mean that CNN isn't liberal) was limited primarily to op-ed's and the choice of which stories to cover. I always thought that, when the story was being researched, they were quite honest about the process. Boy, was I wrong. I now generally assume that anything reported in certain sectors of the press (NY Times and CBS being the most prominent, but by no means alone) that's more sophisticated than "x killed y last night, and police have arrested x" is likely to be a politically motivated hit piece on somebody. Maybe not GWB. Maybe not even a Republican. But definitely someone.
Why? It's televised seppuku. It will, at best, warm the hearts of those who can't stand the guy already. It will confirm the opposition's belief that the news is biased against them and can't be trusted. And it will drive away swing voters. That's a lesson the Republicans learned in the aftermath of 1996.
Actually, it's a great time for one of my favorite political sayings: despite eight years of inestimably valuable education from William J. Clinton, the Democratic Party didn't learn a damned thing. The Republicans did. Bush, in particular, did, and in spades. Why? I'm not sure we'll ever know. I remain convinced that I will never see another person with the raw political acumen of Bill Clinton. If I do, I'll lay a huge chunk of money down at Tradesports that he (or she) gets elected.
Anyway, it's infuriating, patently obvious, and counterproductive. (And there you have it folks. Pure, unadulterated wisdom. I mean, I couldn't possibly be wrong. It wouldn't be me.)
Saturday, October 30, 2004
No.More.Ellipses.
That's the plural of ellipsis, not ellipse. I just noticed that I used them in the title of the blog and 2 of the first 3 entries. Must Not Do So. Must Vary Style. (See? Great ripoff of Helen Fielding there.)
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