Pedometer Chronicles 1

The GoWalking Sportline pedometer costing $3.99 at Walmart may be about as close to a plastic piece of crap as one can get. Either that or my patients are essentially inert. I recommend getting a pedometer and walking 10,000 steps a day over and over and over all day long. My patients come back with their diaries and describe heroic efforts to accomplish a measly 3,000 steps a day. The first day I wore this pedometer I did practically nothing. I went to the coffee shop. I walked the dog. I went grocery shopping. I supposedly walked over 3,000 steps doing so. Today is my first day wearing it at work. A few people have heard it rattling at my hip and given me quizzical looks but no one yet has asked me what is making that noise. It's 2pm and I've gone 4,000 steps if this this thing is to be believed.

medicine

Chicago O'Hare

If they didn't want me to leave home, why did they give me luggage (Samsonite, hard-sided, no wheels) when I graduated from high school?
The restrooms in Chicago O'Hare give me the weirdest deja vu experience. The floor to ceiling stainless steel stalls and the weird little rotating plastic sheath over the toilet seat remind me of the 18 year old me. I remember being very tired. Probably from carrying my own weight in carry-on luggage and from not having slept the night before due to excitement. I certainly wasn't travel weary since the flight to Chicago was less than an hour. Those toilet stalls say so much about the kid I was. One who came from a family of people who's bottoms never touched public toilet seats. One who was taught that the world away from home was absolutely crawling from one end to the other with thieves and perverts. Those stalls were little cubes of midwestern heaven. Safe, sanitary and private. I think I might have hung out there had I not been too concerned about the huge distance still seperating me and my departure gate. It was years and years before I appreciated the fact that my mom had let the plane carrying me leave the ground without throwing herself in front of it. I can conjure up a very plausible image of her being physically restrained by my step-dad, of her escaping his grasp and sprinting on her determined little mom-legs ahead of baffled airport security onto the tarmac. Sometimes I think this might have actually happened only they decided not to tell me.

travel

I met 'em where they were at

No one seems to have noticed how nervous I was giving a talk before my largest audience thus far. It seems to me that my voice was quaky and shaky and that I ran out of breath in mid-sentence rather often. I am proud to say I finished on time. I think I'm getting a little better at public speaking. I seem to recall laughter from the audience from time to time and I don't think it was because I'd suddenly turned green or sprouted horns or anything. (I am reminded of those horrible class presentations in about 8th grade when it took heroic efforts to simply stand and walk to the front of the room and then you gave the entire talk staring at a spot on the floor.) I sure hope I'm doing some good with my schtick on buprenorphine. On my optimistic days I image drug users and people with HIV getting slightly more compassionate and respectful care a few at a time here and there in my wake. I like to imagine other doctors hearing how I prescribe buprenorphine and thinking: "That sounds great. So easy. So common sense. I'm going to do it just like she does." Other times I imagine my jaded, bitter colleagues stuffed into their suits thinking: "My God! She's a fanatic. She lost her mind. Drug addicts in MY office? Perish the thought!" Fortunately, aside from delivering my message (Meet'em where they're at. If at first you don't succeed, redefine success.) I get to hang out with truly gifted and noble people who work hard for little pay and no thanks to try to make a difference for the last true outcasts of western civilization. Thank you HIV North Society!

Not the World's Smallest Airport

Greetings from the frozen north where apparently warm hearted people are the greatest national resource. The town of Grand Prairie is like Bizarro Pittsburgh. They have more 4 year olds than 65 year olds here. 75% of the population is under 45. Pittsburgh of course is in Allegheny County which has the second oldest population in the US after Dade Co. Florida. I wonder what it would be like to live in a place that is building more schools instead of closing them.

Grand Prairie does not get the prize for world's smallest airport however. That honor is still proudly held by Morgantown West Virginia. Each has only one gate it is true but Grand Prairie has something that passes for baggage claim complete with conveyor belt. In Morgantown there is a garage door in the side of the terminal through which they simply shove the bags.

A clean, well lighted place

Golly, I had forgotten how NICE Canadians are. Even the airport here in Edmondton is a pleasant place. The fellow at passport control seems genuinely interested in your planned activities in his country more than he does suspicious. The customs guy gives painfully detailed AND accurate directions to the airline ticket counters. Even security is a civilized experience. Everybody follows the rules. Which, I might add, are clearly posted in two languages. No whining. Shoes on feet. Marvelous. The guy who searched my carry-on was so nice he made me feel like I was doing him a favor letting him inspect my shabby old cosmetics bag. Everybody says "hello" AND "bonjour" like they really really want you to feel acknowleged.
The teeny-tiny aircraft I'm about to board has taxied up to the gate. It's still further north for me.

travel

Killer gets a bell

It must be spring. The suicidal chirpings of the birds have gotten the attention of my otherwise shy and retiring cat: Killer. Killer has spent the winter methodically plotting his escape from and the destruction of his bell collar. He's been slippping out of it and leaving it in conspicuous places like a taunt. Yesterday I went and got him a new improved safety collar with bell. I hope it gives the birds a fighting chance.

cats

Mom, I don't ever want to be Terry Schiavo

I just got off the phone with my mother. She cried but then she is very sentimental. I am very perplexed and dismayed by the current situation with Ms. Schiavo, her family and our government. My dismay arises from our hands-off government suddenly wanting to micromanage somebody's existence. I am perplexed by arguments that removing a feeding tube is somehow different from removing a ventilator or life sustaining medications. I have had many a painful conversation with individuals and rooms full of disparate family members when a loved one has met tragedy. I do not claim to be particularly gifted in this regard but I do have courage. It takes courage to bring up painful and divisive things with shocked and grieving people but it is a disservice not to do so. (The other important ingredient is timing. Early in an illness is best of course but that was an opportunity Ms. Schiavo did not have. Immediately upon the cessation of her heart would not have been too soon, however. I will not speculate here as to how a healthy adult woman gets a potassium deficiency sufficient to stop her heart.) While I have no knowledge of her care or the conversations which might have happened, her hypoxic brain injury would have been obvious from the initial insult forward. I fear that efforts to identify her wishes and who should speak for her at that moment may have been missed. I am chilled when I hear Ms. Schiavo's mother say that her daughter is her life. My heart goes out to her. I can easily picture my mother in her place. But, sad as it may be, it is not appropriate to prolong someone else's dying for what you get out of that person's existence. That I'm afraid is supremely selfish.

End of Life

What would you do?

Let's say you are shopping at the local grocery store late one Sunday morning. Whilst contemplating the tea selection you reach into your cart to take a sip from your travel mug. It's not there! First you think: "Who the hell would take my nasty old cup?" Then you realize ITS NOT YOUR CART! For some unknown period of time you've been strolling the aisles adding items to somebody else's cart. What to do? Do you back away slowly and break into a run at the end of the aisle abandoning the cart? Do you retrace your steps cart in tow until you locate your cart?

Well, just let me say that if you are the person who returns from the line at the deli counter to find your cart missing and someone else's shabby cup containing cart in its place, you would appreciate it if the spacey shopper would retrace her/his steps with the damn cart. You will slink back to where you last knew you had your cart and find it sitting there right where you left it. Call me a great big meany but if I find you (remember I know you by your nasty cup) before I find my cart I am not going to put a whole lotta effort into not making you feel stupid.

If it hadn't been the last bag of kiwis I wouldn't have gone looking for it at all.

Age 13

In the NewYorker dated Feb 28 last, Johnathan Lethem wrote in his personal history "The Beards":

I tried to obliterate my teen-age years in movie theatres because my teenage years both embarrassed and saddened me. Between double features of French films, between putting down one book and picking up the next, I'd glance at my wristwatch to see if I was in my twenties yet.

I lived in a suburban apartment complex called the "Colonial Village" It consisted of row after row of pink brick 3 story buildings mostly occupied by newly divorced women and their children. To the north was the interstate. West, a corn field. South a maze of white paved streets with no buildings on them. It was a 45 minute sidewalkless walk to the nearest store of ANY kind. My sister and I shared a room which we divided in half by placing our dressers back to back in the middle. I spent most weekends with my grandparents so mom could go on dates and my sister could be completely unsupervised and because I loved them. I read alot, too. I would have given my right arm for French films.

X-tremely old

I think it was last Sunday's New York Times that had an amusing story about a new show on the Style network called "Craftcorner Deathmatch". If I had cable I'd probably check the show out if for no other reason than to see if it has the same amazing power as "American Idol" to cause the immediate and blissful cessation of all higher brain function. Alas, this is not truly the topic of this posting. The fine young professionals who developed the concept for this show also had an idea rejected by MTV for a show called something like "Xtremely Old" in which the elderly would dispense advice to lovelorn twenty-somethings. Now THAT'S a brilliant idea! I have the privilege of interacting with lots and lots more old folks than most. By this I mean people in their 80's and above, kids. These are some fascinating people. Not only can they tell you give you eye-witness to history stories about war, the flu-pandemic of 1918, death in childbirth and other horrors. They can tell you delightful and impressively relevant stories about romance, the birth and cultivation of something as rare and corny as true-love, the weathering of hardships as a united couple, and how to keep love (and sexual interest) alive for 50 plus years. I can't tell you the amount of viagra and such this population is burning through. Clearly they are on to something. Something that the twenty-somethings will have to stumble upon or never find without the wisdom of our oldsters. What could be so great about being married to the same person for 50 years? I wouldn't know. You'll have to ask one of them. But, I think any honest person would rather have someone sit tearfully a year after he/she has been put in the ground and reminisce about the secret nude pictures they'd taken 40 years before and regret destroying in a misguided fit of "what will the children think" than not.

Don't forget to live right up until the day you die.

aging

A note to myself

In the course of a day's work I learn a lot from those around me. If I shut up and let my patient speak she will tell me exactly what is wrong. Virtually hand me her diagnosis. This exercise, this blog, will be me talking to and learning from myself alone most likely but also to anyone else who happens to wander in.
Meanwhile let me say that while my experience as a physician will surely inform everything I ever say, think or do, nothing you read here is about a real person unless that person is me. Absolutely everything is made-up. And, by the way, everything written here is mine, mine, mine.
That said, can anyone tell me how to put a little disclaimer in my sidebar?

blogging