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Archive for May 2010

Wyatt Wednesday

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Look…it’s not my fault.   Ok, so I did take the loaf of bread off the counter and eat it on the rug.  And, there are soggy crumbs smooshed into the carpet that will never come up.  But, look, I’ve tried to put the remaining slices back in the bag.  I just can’t seem to stuff them back in there…..

What about your role in this?  You left the loaf right there on the counter behind the tomatoes.  Why aren’t you taking any responsibility?  And Max?  He nudged it closer to the edge of the counter where I could clearly see and smell it. Does he get ANY blame in this?  Don’t forget about Petey….his stomach growled which totally reminded me that I was hungry…why are you still yelling at me????

This worked so much better for BP.

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Written by composthaste

May 27, 2010 at 12:26 am

Posted in Uncategorized

The Thirteenth Time Is the Charm

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I’m not someone who runs to see the sights of any new city to which I travel.  Sure, I’ll hit a museum or two but my greatest joy is sitting in restaurants, wandering around and getting a feel of what it might be like to live there.   My second greatest joy is reading the guidebooks.  I tend to skim through the overall history of the place.  Sure, there were some riots, Evita was beloved and be-hated, they can never get the economy off the ground, etc.  But, it’s the little stories tucked in that can make an entire trip worthwhile.  On our third day in Buenos Aires, after my master class was missed (more about that on another day), we went to Ricoleta.  This is a beautiful part of the city, with great shopping, a huge park and the famous cemetery.  There were wonderful parts about that day, from seeing the huge gum tree where I had a picture taken of me at the age of 6, to the dogs (which, by the way, take themselves very seriously in the capital city….don’t laugh at them) but I loved the cemetery.

The Ricoleta cemetery is one of those beautiful and yet creepy and questionably sanitary mini-city of above-ground mausoleums.  Much like above-ground pools, they call into question the judgment of their owners.  At first, there is the shock of seeing some rotting coffins just behind a gap in the marble.  Then there is the gross factor of seeing that they have an impressive drainage system that must mean that seepage must occur.    Then you realize that each mausoleum has an underground area to keep the majority of the family that begs the question: “who ranks highest in the family to get the above-ground digs?”.  Then you see the coffin gourneys strewn about which implies recent additions.   Then you pet the “death kitties” which roam around before you realize that they can get into the mausoleums and probably do some mean ratting down there.  But none of these activities were my favorite part.

There is a mausoleum in Ricoleta dedicated to Ruffina Something.  Stop if you’ve heard this story before.  Ruffina had a cataplectic fit and was buried at the age of 19.  At some point after the initial burial, or as I like to call it “Death.1”, she woke up and realized she was in a bad situation.  She attempted to claw her way out but was unsuccessful.  “Death.2” occurred as a result of some serious splinters under her fingers, anoxia and a heart attack.  There are many questions I have about this scenario.  Did they not check pulses in the 18th century?  How long did they wait after the fit before they threw her in the box…thirty minutes?  An hour?  How did they know that she had not died before they tossed her into the ground?  I’m imagining a few possibilities.  “Antonio? Did you hear something?”  “No, I just have a little gas”.  “Has that coffin lid always been askew?”.

But this isn’t the best part of the story.  Apparently, some well-meaning friend of the family, or neighbor, heard about poor Ruffina and made a vow to never allow something this tragic to ever happen again.  So, he set to work, designing a coffin with an alarm system and a release.  Now, this gentleman was tenacious and he wanted to make absolutely sure that his new contraption would work.   So, like any good engineer, he tested it….12 times.  Not satisfied with a mere 12, he decided to give it another go and, on the thirteenth time, his design failed him and he died inside the coffin, of finger splinters, anoxia and a heart attack.   I don’t know about you, but I have more questions now.   Were twelve attempts not enough to reassure him that his product was safe?  Did he not tell anyone what he was working on?   Why on earth would he do this by himself?  It would be a simple favor…”Hi Antonio, I’m going to be testing a new coffin, would you mind hanging out in case it doesn’t work?”  Maybe they did hang out for a while but got bored after test #8 and decided to head to Cabreras for a glass of Malbec and a tenderloin.

When you stand in front of Ruffina’s grave (a substantial upgrade as only guilt can buy), you are struck by the statue of the young woman with her hand on the door handle.  It’s as if she is saying in a bored tone, “Hi.  Come on in.  I’ve got a story to tell you.”



Written by composthaste

May 24, 2010 at 12:43 am

Posted in Uncategorized

Conferencia!

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Today, I went from “local lecturer” to “World Speaker”.  This is not to be confused with “world narrator”…you know the type; they read all the building signs as you drive by, comment on everything they see.  This is not to be confused with “low talker”…you know the type; they sit too close to you at a party and comment on everything in a running monologue, right into your tympanic membrane, despite the conversation you are in the middle of with someone else.

Nope.  Today, I gave my first lecture outside of my own little microcosm of residents.  I flew out of the nest.  I left the farm for the first time.  I left the hive behind and buzzed out into the world.  It’s important here not to confuse “world speaker” with “international renown”.  More accurately, I am like Celine Dion, working out the kinks in my performance overseas before I bring it back to the US.

So, standing in front of a room full of Argentine physicians, I dazzled them with my brilliance.  I also learned a few things.  For example, despite the simultaneous translation, jokes don’t really translate well.  During the talk, a paparazzi-esque photographer kept snapping photos of me while I droned on about metabolic diseases in infants.  Angeline Jolie?  Yeah, I feel her pain. After the morning session, the woman organizing the event planned a “meet and greet” lunch.  This was my favorite part of the day.  Sitting in a circle and discussing the various pleasures and problems we found with medicine in our respective cultures.  Their socialized medicine structure appears very much intact and I couldn’t tell at times whether they are behind us or our future.

If you’re ever planning a little lunch for people who speak different languages allow me to suggest getting an official interpreter.  I speak Spanish a little bit.   Essentially, I understand 8-9 out of every 10 words people say.  This means that I can carry on a conversation without difficulty at times and that I can also completely miss the point.  For example “We’re so excited to have you here sharing your ideas of emergency medicine” can also be “We’re so excited to have you here sharing your diseases in our emergency department”.  Despite my imperfections though, I think I would have done a better job than the interpreter we had.  The organizer, a completely lovely and enthusiastic woman, made the most lovely introductory speech that went something along the lines of “On behalf of the physicians here, we would like to extend a warm welcome to our American colleagues.  We are so excited that you travelled all the way to Buenos Aires to speak with us and to sit with us here to share ideas.  I would like this time to be about asking each other questions about the way medicine works in our very different systems.”  The interpreter then “translated” this to be “She welcomes you to Buenos Aires, if you have questions for each other, ask.”

Really, it appears that their issues are similar to ours.  How do you do research in a busy clinical practice, how do you keep patients happy when there are so many inefficiencies and waits, and how do you practice medicine for 30 years without becoming burnt out.  One of my colleagues addressed the last question with the basis of academic medicine in the US.  You can avoid burn out by staying in an academic setting and decreasing slightly the number of clinical hours you work by pursuing loftier goals: research, advocacy, administration, etc.  They were all nodding their heads until he stated “….and this way, you’re not seeing patients for 40 hours per week”.  At that point, we lost them.  The woman next to me, coyly remarked that she works 12-15 hour days at three different jobs.  It turns out the “part time” physician here works 36 hours per week and that is only because her husband works more and makes enough to support them.  I’m no health care czar but I think that if you went to most American physicians and said “Look, good job and everything on your eight years of graduate studies and 5 years of residency.   You’re now going to need to take a second job to make ends meet.  Maybe a third…it’s hard to say right now”….you would have a riot on your hands.  Not a violent one, more of a conservative physician, sulking in the corner type of riot….holding signs that said “we don’t want to play anymore” and “I’m taking my stethoscope and my pen and I’m going home”.

12-15 hours per day.   That is unreal!  Now, I’m sure they don’t have the same stringent rules about documentation.  I’m sure their nurses don’t spend 2/3 of their time writing in charts as opposed to taking care of patients.  And, you don’t hear a lot about big payout Argentine malpractice suits.  So, maybe medicine here is actually fun to practice.  Maybe they spend the majority of their time making decisions based on medical necessity and not patient satisfaction scores.  If I didn’t have to coach my patients to say that they received “excellent” care today when they were phone surveyed a month from now, after they recovered their health and received their $1000 bill, maybe, I wouldn’t mind working 12 hours a day.   Doctors in the US used to practice this way.  Round at the “public hospitals” before you went to see their patients in your clinics.  So I really couldn’t tell if these fine and brilliant physicians were behind us or if this will be our future.

Written by composthaste

May 21, 2010 at 1:48 pm

Posted in Uncategorized