hemodynamics

The marching bands of the radical left

noreply@blogger.com (Joe Wright) — Mon, 12 Oct 2009 03:43:00 +0000

At a bit after noon today, I heard some kind of big drum beat outside, and remembered--today was the day of the Honk! festival in which a bunch of radical leftist marching bands march down Massachusetts Avenue. They go from Somerville to Cambridge's Oktoberfest, a street festival with no particular political approach. Our apartment, near Mass Ave, is equidistant between the two points, and therefore ideally suited to notice the arrival of the Honk! parade.

What the Honk! festival lacks in polish--one band's website earnestly stated that it did not discriminate on the basis of musical ability, bless their hearts--it makes up for in enthusiasm and anarchic charm. As someone who grew up on the left, I was always viscerally bothered when people decided to go to protests and behave like a bunch of wierdos. But for all my normalcy since then, what have I accomplished politically? And despite recognizing that I have accomplished little in political terms, I am not a member of a ragged marching band with a dance troupe of slacker girls and gay boys doing cheerleader moves in front. So, in the end, I've had the worst of both worlds: I do not get to hang around and dance in the streets with a bunch of radical wierdos, because I'm not radical enough politically or culturally; but yet, I also do not get to enter the halls of power and really get things done, because, well, because of a lot of reasons.

The Honk! festival is a great community event, though, uniting Cambridge and Somerville in a Somerville confluence of radical leftist marching bands and a random Cambridge street festival. This allows the radical leftist marching bands to gather and play in different little pockets of fans and casual onlookers throughout Harvard Square; and also, presumably, allows the radical leftist marching bands to eat jerk chicken, vegetarian samosas, pad thai, caramel apples, and the other things that are served at the booths of any street fair in a big city.

Relevant to medicine? Well, there was a group called the "Pink Puffers"--a medical slang phrase indicating people with emphysema-predominant chronic obstructive lung disease, as opposed to bronchitis-predominant "blue bloaters".

By the looks of the Honk! festival, radical leftist marching bands can be found in many different places in the world; the Pink Puffers are from Italy.

Here, on YouTube already! are the Pink Puffers rocking Somerville in preparation for the festival, showing off their radical leftist marching band ways:

Representative videos from last year (we randomly bumped into the Honk! festival last year, too--it's in the neighborhood, and hard to miss once you hear it): here we have New York's Rude Mechanical Orchestra. This year they were standouts, playing this same song, "Matador", by Los Fabulosos Cadillacs, as they marched down the street.

Apparently "Push It" is also a favorite:

This does make me think that just as this emerging tradition among the radical left is doubtlessly fuelled by the many former marching band nerds who went on to read Gramsci and Emma Goldman in college, surely too the medical community also contains many former marching band nerds. The medical community's events would doubtlessly be more entertaining with medical marching bands as part of our professional and cultural tradition. I suspect the psychiatrists would blow everyone else out of the water, but I bet that infectious diseases has a lot of closet marching band geeks, and they could be contenders. And I'm sure surgical specialties, if combined, could roust up a fair number of brass players.

No, I don't see it coming any time soon. But, you never know.

Our farmer

noreply@blogger.com (Joe Wright) — Thu, 08 Oct 2009 23:35:00 +0000

A member of our CSA, on our farm's Facebook page, laying out a week's small share on the counter, and sharing the photo with the world.

Today was the last day of the year to pick up produce from our farmer. Our farmer is an old punk rocker, now a single dad and farmer. His son (who is maybe 6?) was enthusiastically shilling the hen-of-the-woods mushrooms that our farmer was selling as an extra if we wanted to add it to our regular farm share: "It's fifteen dollars! You have to buy them!" No thank you, I said, bemused.

This last couple of pick-ups are extras beyond what we originally expected. We'd negotiated which of our two-out-of-three bonus sessions we'd attend, because we're going off on vacation soon, and getting married. He remembered this, and cut me off a hunk of hen-of-the-woods mushroom and said, "You're getting married, right?" Yep. "It's a gift." His son, still in salesman mode, shouted, "Fifteen dollars!" No, our farmer told him, it's a gift.

Our farmer has been frustrated and disappointed all season. Earlier this summer, the weather was so lousy that even our NPR station had started doing lengthy stories about the fact that it was raining; and we heard him on the radio talking about how the rainy weather had flooded out his corn. That was how we knew we were able to prepare ourselves for the disappointment of not getting any corn from our farmer later in the summer. We did get lots of good greens, though, and turnips, and radishes, and green beans, and cilantro, and kale, and some green tomatoes and some red ones. It was a tough year for our farmer. He was a little bitter, a little sad-seeming, and a lot apologetic at the end of the season.

But we were happy. It was our first season with a community supported agriculture program, and although it was apparently a bad year for our farmer, it made a tough summer a little sweeter to go get our produce from our farmer every week. Every Thursday we'd go to a corner about six blocks from our house, where he'd have a truck pulled into someone's driveway, handing out produce, often with some other guy who looked like he was probably an old punk rocker too. (Old punk rockers don't wear punk clothes any more. I'm not sure why old punk rockers look like they were once punk rockers, but there's a look. I think there are a lot of people in Narcotics Anonymous who look like that.)

"Large or small?" he'd ask when we approached--the two categories of shares. We had a small share for the two of us, so we'd hear instructions something like "One each of each of these, then a pound of the beans, and three peppers." We'd fill one of those reusable grocery bags with our loot for the week, and come home and have farm dinner--this year, very often roasted root vegetables and a salad, and then from the big store, maybe some turkey sausage or some chicken. Everything tasted great, and it was pleasing too: it was from our farmer.

There is no particular reason that all kinds of people couldn't have a farmer. Back in my hometown in California, there were Hmong families taking spots of empty land in poor neighborhoods, and farming the hell out of those little spots, suddenly bursting with green. They fed their own families, I'm sure; but with just a bit more land--knock down a couple foreclosed homes that aren't getting sold, till the land, and make a neighborhood farm--you could imagine these folks becoming neighborhood farmers, so that people would amble down the street and pick up the week's produce from their farmer.

I know from my dad--who's spent his life thinking about stuff like this, and in many ways dreaming of the day that ordinary people would be talking about going to their farmer like they talk about going to their doctor or their hair cutter--that there are all kinds of reasons this is harder than it sounds. Still, I'm kind of incredulous and pleased that by paying a sum up front that is almost certainly less than what we spent on produce last year over the same amount of time, we got great produce every week, from an old punk rocker who we can call our farmer.

Our farmer: there is something about these kinds of relationships that is different than the more fragmented retail marketplace, something that is important and good. It is how I want people to feel about having me as their doctor; I want them to see me in good times and bad. And even when they see that I'm frustrated with the insurance system, or apologetic that I'm running late, I want them to feel that I am their doctor, like I feel that my farmer is my farmer; and to feel like, at the end of the summer, they got a decent deal even in a bum year.

Joe Wilson's war

noreply@blogger.com (Joe Wright) — Sat, 12 Sep 2009 03:21:00 +0000

For all the fuss about Joe Wilson disrespecting Obama by shouting "You lie!" (to which, it can only be said, he never would have said that to a white president)--

the biggest crime is not disrespecting the president, but that he was doing so in the cause of trying to make sure some Guatemalan girl can't deliver her baby, and some Chinese guy can't get treatment for HIV infection, and some old Mexican lady is going to die for reasons regular medical care could have prevented.

And now, politicians are bending over backwards to say, Joe Wilson is disrespectful, but to his larger point, they only respond, please, fellow Americans, be assured, we won't be taking this love your neighbor thing too far.

Night float

noreply@blogger.com (Joe Wright) — Sat, 01 Aug 2009 06:35:00 +0000

Our department chair decided at some point that the people on night float shifts--interns who cover the medicine patients overnight, and residents who admit new patients coming in after the regular teams have stopped admitting--should have a teaching session. And so we met this morning, all the night float residents and interns. I've been doing a pinch hitter sort of job, in which I do overnight medicine consults and also support the night float interns; next week I'll be doing admissions. The relationship among all of these people is an odd one. Except for me (because I spend a reasonable amount of time checking in with my early-in-the-year interns and backing them up in various medical crises), we are mostly working alone. But we see each other through the night, crossing paths in the hallways or sharing a workroom for an hour here or an hour there.

In our conference this morning, we started talking about a patient. It turned out she'd been admitted two days prior by one of the admitting residents. An ICU resident on call overnight came down to evaluate her when we thought she might go to the ICU, and spent a good long time afterwards thinking about the patient's situation. In a workroom, thinking aloud, getting excited about some ideas about the patient's situation, the ICU resident talked to another nightfloat resident, and had pitched her theory to a couple of us. One of the interns had been called a couple of times to go see her overnight, and I'd gone to back him up for some of the hairier calls, and I had helped arrange the patient's possible transfer to the ICU before we decided she was OK to stay on the regular medical floor.

In conference, then, the admitting resident presented the case, but the group started talking about it in an engaged and interested way, because so many of us had thought about the patient, cared for the patient, or heard about the patient already. I'd seen the admitting resident a couple of nights before and had talked about this patient even then, because the resident was excited about the admission. She wasn't too busy and with an interesting case to think about and read about, she got the chance to do real medicine instead of setting up a holding pattern to be handed off to the day team. I'd spent a long time thinking about the patient when I was trying to figure out whether she should go to the ICU. And the nightfloat intern had spent a lot of time seeing the patient because of multiple problems over several nights, trying to figure out which of the calls represented real crises and which ones didn't.

I was reminded of another time I was in the ICU and a patient came in with an unusual problem; within a couple of hours, cardiologists, pulmonologists, and oncologists had mobilized for procedures and studies, teams were passing the chart back and forth as they worked on plans and notes and recommendations, and people kept buzzing in and out of our MICU team rounds to give updates on the latest detail of the plan. A cardiology fellow showed up and so did an echo tech, and within an hour of us asking for the study, there was a detailed echocardiogram and an attending reading it. Someone else was planning for a biopsy. One consult team was calling another consult team to help work out details.

"This is when I love being at a teaching hospital," I said quietly to one of my fellow residents, as our intern was presenting data and we were watching out of the sides of our eyes as one of the consult teams was bustling about nearby. "These moments of this massive mobilization of expertise, all of these people with this insane amount of training, coming together for one sick person. It's beautiful."

Overnight, the hospital often seems like it's in a holding pattern. We try to keep people alive until care can be advanced during the day. So it was a surprise to me to find myself in conference with a little bit of that teaching hospital feeling: the feeling that there were all of these smart and engaged and caring people watching the progress of one sick patient and sometimes being a part of her care, wondering how it would turn out, wondering whether she would come to the unit or stay on the floor, wondering whether she'd get sicker or better, hoping for the best.

The senior admitting resident had come up with a long set of possibilities for what might explain the patient's symptoms, and ordered a bunch of tests right away to start sorting them out. The ICU resident was pitching an obscure diagnosis but one with some credibility; though I wasn't buying it, I had to give her props for zeroing in on a particularly striking lab value which I had skimmed over. I was pitching another theory, but at the same time telling the intern to cover for gram-negative infection, which was actually a counter-move to anticipate what could happen if I was wrong. The attending, writing a note in the morning when we emerged back onto the floor from our conference, thought we were all wrong, was stopping the antibiotics I'd told the intern to start, and had another theory entirely. But we all had opinions without certainty, which meant that we really listened to each other, and we all had a sense of suspense:

"Poor lady," said the attending, "I haven't seen a case like this for a while";

"I really think the team should start treating now, even without knowing everything!" opined the department chair;

"I know what you mean, but they could get in trouble with that in other ways," said the chief resident, deferential but firm;

and the intern, new to it all, was listening to the primary attending with eyes much brighter than his fatigue should have permitted, truly a part of this thing that we all had spent so much time working towards, and which he had finally just joined a few weeks before.

We felt ourselves to be a part of a community of highly trained people, late at night when others are asleep, part of the world of doctors as doctors themselves hope for and imagine it should be. A team of experts and people becoming experts, mobilizing, caring, theorizing, arguing; and at the same time, perhaps above all, walking briskly down the hall towards the patient's room after getting a page from the nurse about low blood pressure.

Becoming the Fat Man.

noreply@blogger.com (Joe Wright) — Sat, 11 Jul 2009 18:15:00 +0000

Sleep-deprived and worried for my interns, I start spouting half-true or all-wrong or kind of right aphorisms as if I was aspiring to be the new Fat Man:

"All patients lie. All patients are crazy. And it is our job to love them anyway."

(Said to an intern who is tempted to believe everything his patients tell him, to his patients' potential detriment.)

A pair of nurses, overhearing this, do a double take and tighten up as they hear me start this, then visibly relax as I finish. One says, "You saved yourself with the last part there." I try to save myself a bit more: "Well, we all lie sometimes, even when we don't realize it, and we're all a little bit crazy, right?"

Still, I thought, Am I really the resident who blurts out cheap half-truths as if they were wisdom?

It is an inevitable temptation of power--even the minor power of a senior resident at the beginning of an intern's year--to start spouting bullshit. On reflection, I think I succumbed.

At the same time, I don't think it does any favors to patients to subscribe to a false humanism, some kind of big happy medical friendship bracelet of co-dependence between needy doctor and needy patient.

I got at what I was trying to say a little better a couple of days later, with the help of talking to Dr. Ms. Hemodynamics, who had more clear things to say about this problem, which I then said to an intern, with words something like this:

"It is inevitable that when we are feeling doubtful about ourselves as doctors, we want our patients to like us, because that makes us feel like we are good people. But it's not the point of being a doctor to have your patients like you. Your patients should come to trust you, and to respect your counsel, and value your role in their life. But liking you is beside the point, and it's dangerous to them for you to need that from them."

This I do believe.

To boil it down to a Fat Man-style law:

"It's not your job to have your patients like you. It's your job to love your patients enough not to care."

100% true dialogue from the wards

noreply@blogger.com (Joe Wright) — Sat, 11 Jul 2009 02:16:00 +0000

The attending, the senior resident, and the intern are sitting in the work area, discussing a patient. The senior resident, a bespectacled and bearded graduate of Harvard Medical School, is cautioning the intern on jumping to conclusions:

"I understand that you're taking the evidence and trying to see if it matches your theory. But actually, you want to do the opposite. You don't want to try to prove yourself right. In the philosophy of science, Karl Popper wrote about 'falsification'--the idea that you take your hypothesis and try to prove it wrong, until, failing to prove it wrong, you decide that it's the best theory for now."

The intern: "OK, yeah, I see your point."

The attending: "Karl Popper, huh? You've read Karl Popper?"

The resident: "No. But I've read about Karl Popper on Wikipedia."

Attending: Falls out laughing; retells the incident for laughs to another attending on rounds a couple of days later.

Resident: Laughs too; retells the incident on his blog a couple of days later.

Doctors, nurses, and medical students in Iran, June 16

noreply@blogger.com (Joe Wright) — Wed, 17 Jun 2009 01:37:00 +0000

Above: a video from YouTube, with the title
16 JUNE 2009 - Doctors and nurses are protesting in a major hospital in Tehran - Iran
with the following caption:

At 1:41 one of nurses is shouting "8 people died in this hospital last night". of them1 died by a headshot...which said that poor brave man shoted by sniper. at 1:35 you can see on that board which writen in persian "28 wounded...8 died"

Morning of 16 June...Rasoul Akram Hospital's doctors and nurses are protesting about what happened in the last night gunshots by Goverment's militia (basij) and police. 36 people shots By Gun 8 dies and 28 injured .

And...
From Nico Pitney at the Huffington Post, an email from an Iranian medical student:

Hello,

It's painful to watch what's happening.

I don't want anything to do with what has been said this far, as I neither have the strength nor the resilience to face all these unfathomable events.

I only want to speak about what I have witnessed. I am a medical student. There was chaos last night at the trauma section in one of our main hospitals. Although by decree, all riot-related injuries were supposed to be sent to military hospitals, all other hospitals were filled to the rim. Last night, nine people died at our hospital and another 28 had gunshot wounds. All hospital employees were crying till dawn. They (government) removed the dead bodies on back of trucks, before we were even able to get their names or other information. What can you even say to the people who don't even respect the dead. No one was allowed to speak to the wounded or get any information from them. This morning the faculty and the students protested by gathering at the lobby of the hospital where they were confronted by plain cloths anti-riot militia, who in turn closed off the hospital and imprisoned the staff. The extent of injuries are so grave, that despite being one of the most staffed emergency rooms, they've asked everyone to stay and help--I'm sure it will even be worst tonight.

What can anyone say in face of all these atrocities? What can you say to the family of the 13 year old boy who died from gunshots and whose dead body then disappeared?

This issue is not about cheating(election) anymore. This is not about stealing votes anymore. The issue is about a vast injustice inflected on the people. They've put a baton in the hand of every 13-14 year old to smash the faces of "the bunches who are less than dirt" (government is calling the people who are uprising dried-up torn and weeds) .

This is what sickens me from dealing with these issues. And from those who shut their eyes and close their ears and claim the riots are in opposition of the government and presidency!! No! The people's complaint is against the egregious injustices committed against the people.

The AMA doesn't speak for me

noreply@blogger.com (Joe Wright) — Tue, 16 Jun 2009 02:54:00 +0000

I've started a Facebook group:
"I'm a doctor, and the AMA doesn't speak for me"
I hope my colleagues will consider joining.

One of the group members linked to this article:
Abraham Verghese on the AMA

the future of the future

noreply@blogger.com (Joe Wright) — Tue, 09 Jun 2009 02:53:00 +0000

Wikimedia commons photo: Samuel Delany. NASA photo: Charles Bolden in 1992

Yesterday, I was registering the fact that President Obama has appointed Charles Bolden, an African American astronaut, to run NASA. I googled him, thinking about how it's not that incredible anymore to have black people go up in space, and that therefore it doesn't seem incredible that there's a black astronaut in charge of NASA. And then one article, which included various people gushing about Bolden, included a comment from his astronaut buddy Franklin Chang-Diaz, whose daughter is a Massachusetts politician with the same last name.

I don't want to dwell on the point, but "Franklin Chang-Diaz" used to not be an astronaut kind of name, nor a Boston politician name either. In fact, it is hard to know which would have seemed more improbable in 1950, or 1960, or even 1970.

I don't want to be the white guy who looks on in wondrous rapture about little victories of diversity as a way of ignoring inequality and discrimination. So let me pause and register that the world is still what it is; inequality still is the rule, not the exception. At the same time, the world is different than it used to be.

NASA made a decision, when it started the shuttle program, to change what astronauts looked like. Now, many years later, there are a fair number of black astronauts, women astronauts, astronauts from different parts of the world. Some of them are rising through the ranks. There are still plenty of white guy astronauts and white guys slapping each other five in Mission Control--the world hasn't changed so much--but it's different than Apollo.

This got me thinking about science fiction. I've mostly left the genre behind in my own reading over the last few years. My friend S. knows it better and is able to write about it more seriously. Still, from the reading I did in years past, I can say there are a few different versions of the society of space in science fiction. One of those versions comes from an often quietly utopian impulse, which involves more small-bore problems of dealing with difference, or of trying to make a better society, or of living in a different way than we now imagine. It does not describe utopias, but its broad imagination, its sense of possibility, is a form of utopianism. It is a way of saying, anything is possible. This genre uses science fiction as a way of stretching our imaginations about what could be. Some of the practitioners of this kind of science fiction, people like Octavia Butler or Samuel Delany, were African American, and the humans who inhabited their worlds were often of many colors, not to mention genders and sexual orientations. In fact, not at the time, but retrospectively, some people call them pioneers of Afrofuturism.

There is no immediate relationship between Samuel Delany, a gay man with a big unruly beard who now teaches creative writing at Temple, and Charles Bolden, a former Marine and astronaut, who will now run NASA. They are both black men who are interested in outer space, but then, so was Sun Ra. I can't really imagine Borden and Delany at the same event. And though there must be someone who knows them both, I don't think they travel in overlapping circles. They have outer space in common, sort of (though Samuel Delany does not even depend on that trope). But one of them is interested in imagining different planets as metaphors for different ways of living. The other is interested in specific real different planets as places we might drive a space ship to. Delany is wildly progressive; Bolden is not, at all.

When NASA chose its astronaut corps for the shuttle program, it did so for political reasons that were very much of the here and now. NASA understood then and understands now that its work can either seem like an inspiration, a bold project of building human capacity, a project on behalf of nothing smaller than humanity itself; or, alternatively, a wasteful boondoggle and gadget racket that has nothing to do with anyone's concrete problems. Choosing a diverse astronaut corps helped keep NASA looking like it was staying on the right side of that line. That has nothing to do with anything as edgy or visionary as Samuel Delany. Yet, if you would have written a science fiction story, in 1969, that imagined a black president and NASA chief, you would have placed yourself firmly in the left wing of the genre.

There are all sorts of possibilities come true lately, which I've been noticing simultaneously. Less lofty but maybe more spectacular: in my pocket, my iPhone seems more spectacular than a lot of gadgets I read about in science fiction books when I was a kid, exactly because it is an everyday device. Without any mythic resonance, an improbable-seeming thing I carry in my pocket, the iPhone is not a super phaser or a scanning diagnostic tool that instantly does my medical work for me. It's just a phone, a newspaper, a street map of the developed world, a global positioning device (the very existence of which is improbable, much less that it is in my pocket), a massive encyclopedia written by a global collective, a camera, some video games, a music player, a way to write people brief letters or read letters from others, and other things as well. And I put it in my pocket and carry it around! Every so often, we do make note of how incredible this seems. Perhaps I'm just getting older, and remember more and more time, more and more of my own history, that took place before we could take such things for granted.

Whether for the head of NASA, or my iPhone, the future is harder to accurately imagine than it first seems, and not just because you thought the phone/clock/navigational device would be a Dick Tracy-style watch and not some pocket version of the monoliths from 2001: A Space Odyssey. Once the future arrives it seems ordinary. To imagine the future puts a wondrous glow on it.

The future is not simply a time like other times; it is a time when anything is possible and therefore it is a time made up of a larger-than-appropriate proportion of our hopes and fears. When we find ourselves in the time that used to be the future, there is no such resonance. Some things are newly possible, others not possible anymore, and we simply find ourselves in a new set of circumstances. We fear and hope for new things. AT&T sends a bill for the iPhone minutes. The future is no longer the future.

But there is something about this year, and I know I'm not the only person to feel this way, that feels a bit more like science fiction than most years. The dull apocalyptic dread of the American economic empire in collapse; a black president with a Muslim name; iPhones in our pockets; gay marriage through all of New England but not in California or New York; a black astronaut in charge of NASA. Some Puerto Rican lady gets appointed to the Supreme Court and it is the exact person that the press has been predicting all along, which makes her appointment seem like an almost unadventurous boring political move by our president, who--we're almost used to it now--is a black man named Barack Obama. (Afrofuturism, indeed.) We take the internet for granted but we're still figuring out how to use it; we're also now used to things like dance music made entirely by computer programming; and we forget how extraordinary it is that in so many ways, from dumb television to crucial navigation, we depend on satellites orbiting the earth.

It's not future shock I feel; just a sense that the present is improbable, and thus, that the future must be even more so, for better, for worse, or, simply, for different. Really different. All possibilities remain possible. We are in a time that feels like the future even as it arrives. This year, more than most years, I find myself in the future, still catching up.

selfish HMS scientists

noreply@blogger.com (Joe Wright) — Sat, 16 May 2009 00:01:00 +0000

another House of God

noreply@blogger.com (Joe Wright) — Mon, 04 May 2009 02:19:00 +0000

A very dear family member of mine, a secular Jew, had chest pain which led to a bunch of interventions. This led to me flying back home to California one recent weekend to see him in the hospital.

His primary care doctor's practice, and his HMO, use a hospital run by a Catholic healthcare network. It has excellent cardiac outcomes, says the Medicare data. So keeping in mind that quality should be measured by outcomes and not by tenure, I haven't pushed for him to go to the academic hospital in town. I think for most people these days, the religious affiliation of a hospital, or the former affiliation, is just kind of a quirky detail. A hospital is a hospital. The HMOs are more powerful than the church. The doctors and nurses matter more than the priests and the nuns.

As far as the doctors, I was frustrated by the hospitalist, who had a Muslim name, and reassured by the pulmonologist, who also had a Muslim name; and I liked the Chinese American cardiologist just fine too. (The experience reminded me that for patients and patients' families, doctors loom large because they are very rarely seen; and nurses loom large because they are always around.)

Their nurses are unionized, but order their scrubs from the same mail order catalogs that our nurses order them from, and probably drive the same kinds of minivans too. There were fewer young nurses with those kinda cooler scrub patterns, more nurse's union pins, more Filipina accents, no one saying "myocahdial infahction". In other words, the variations from my own hospital only emphasized that it too was a hospital above all else, much more than it was a Catholic institution.

But still, on Sunday, there was a prayer over the loudspeaker. "It goes on just long enough for you to start to get irritated, but stops right before you are about to go ballistic," another (definitely not Catholic) beloved family member observed. "They've clearly timed it very carefully."

My dear family member is back home, now back in the warm embrace of secular humanism. Phew.

The hospital focuses on cardiac care...

...but doesn't let you forget that for this hospital administration, there is a celestial nurse manager above all others.

My family didn't know that "S.O.B" stood for "short of breath" so they thought this clinical plan, written next to the bed by the nurse to explain the plan for the day, seemed out of character for the hospital.

Nightfloat pictures from my phone

noreply@blogger.com (Joe Wright) — Mon, 04 May 2009 02:05:00 +0000

From a few weeks ago when I was working nightfloat...

From top to bottom:
the hospital at night
hallways
and a sign put outside the rooms of patients on fall precautions.

Don't walk. Sit.

noreply@blogger.com (Joe Wright) — Wed, 25 Mar 2009 02:02:00 +0000

Above: employees of an Indiana health plan promote "breast cancer awareness" by wearing pink and making themselves into a ribbon. Below: from Rex Wockner at wockner.blogspot.com; the AIDS Coalition to Unleash Power in Chicago. AIDS activists demanded national healthcare, but mostly didn't figure out how to make common cause with other people with other illnesses.

Over at DuncanCross.net, a blog I've just started reading, the pseudonymous Mr. Cross urges us to consider not walking. Not going on breast cancer walks, Crohn's disease walks, polycystic kidney disease walks, etc, etc. Don't walk, he says:

To me, as a sick person, one of the worst aspects of these organizations is their aggressive insistence that the best way to help sick people is by funding for-cure research. That is a lie. Sick people face a lot of challenges, most of which cannot be deferred until a cure is found. If you’re sick, start talking about those challenges as you face them, and try asking for help.

If your concern is a specific person, get more involved in their life; ask them what you, specifically, can do to help them, specifically. For my friends who are sick, I make an effort to be there - to be available, to help them when they need it, maybe cook a meal or drive them to an appointment, but mostly to remain a presence in their lives. Look at the posters and the ads for these organizations: they’re clearly suggesting that sick people can only find community among their fellow-sufferers, as if our only hope to rejoin humanity is via the distant promise of a cure. That, of course, is false - and you can prove it false simply by refusing to be marginalized if you’re sick, or by being a friend to someone who is sick.

I hope you'll consider heading over there to read this essay in full.

One thing that Mr. Cross briefly considers is the origin of all of this walking, and of this marketing strategy. He traces it to breast cancer. My own read is that the breast cancer marketers (as opposed to breast cancer activists) got it from certain parts of the gay community's efforts to respond to AIDS in the 1980s. It seems to me that the Avon-sponsored pink ribbon element of the response to breast cancer must have looked quite closely at AIDS, then tried to find all of the elements of the successful response to AIDS that could be made completely banal.

There are always people in every disease organization who try to defy the vague sense of corporate uplift to have some relationship to the real lived experience of people with the disease. That's because the basic impulse of these organizations--try to work to stop diseases that make people suffer--is a genuinely decent one. But once they start taking sponsorships and decide to stop making tough political choices they will inevitably succumb to banality, because that is what they believe is required to make this kind of fundraising strategy work.

In the case of breast cancer, it is also partly a a story of how the practical innovations of feminism are often appropriated and then depoliticized. Barbara Ehrenreich has a brilliant description of her own reaction to the kitschification of breast cancer in a now-classic essay, Welcome to Cancerland. A brief excerpt of this essay, which merits reading by anyone who has felt a vague discomfort about pink ribbons but has never been able to say exactly why:

It is the very blandness of breast cancer, at least in mainstream perceptions, that makes it an attractive object of corporate charity and a way for companies to brand themselves friends of the middle-aged female market. With breast cancer, "there was no concern that you might actually turn off your audience because of the life style or sexual connotations that AIDS has," Amy Langer, director of the National Alliance of Breast Cancer Organizations, told the New York Times in 1996. 'That gives corporations a certain freedom and a certain relief in supporting the cause." Or as Cindy Pearson, director of the National Women's Health Network, the organizational progeny of the Women's Health Movement, puts it more caustically: "Breast cancer provides a way of doing something for women, without being feminist."

There have actually been plenty of AIDS versions of this kind of strategy--but that is for a longer post than this one.

Seeing the worst excesses of these ways of doing things, one would wonder, as Duncan Cross does, why anyone would want to do disease-specific activism of any kind. In the case of AIDS it was because of the very specific stigma associated with the disease. People with AIDS in the early 1980s died social deaths--people wrote them off as essentially dead before they were biologically dead, and ostracized them--unless they demanded a place both in their own communities and in the larger world. The medical community mostly avoided AIDS whenever it could and often responded poorly when they couldn't avoid it. And most leading researchers were uninterested in the problem; pharmaceutical companies had not yet jumped in because they couldn't see that there was going to be any significant market to be gained out of it. Organizing around their disease identity was built around a very specific and urgent political situation. And the urgency of AIDS activism came not only from the agenda of advocating for people with the disease, but also from trying to defend the communities that were under the threat of so many people dying.

The question is, does that situation exist anymore? Or is there more hope in people with different diagnoses banding together?

The disability rights movement in its modern form did not exist before the late 1960s and early 1970s. The seminal moment in the United States came in 1977 when the various disability organizations--organizations for the blind, the deaf, disabled veterans, and so on--came together to fight for implementation of Section 504 of the Rehabilitation Act of 1974. It was a relatively obscure piece of legislation but it made a huge difference in employment opportunities for people with disabilities, forced school systems to provide real education for a new generation of disabled people, and ultimately led the way to the Americans with Disabilities Act. A dramatic sit-in in San Francisco, including people with all kinds of disabilities, got the legislation passed and created the new face of the new, united, and militant disability rights movement. The movement saw a political opening--Jimmy Carter getting elected--and used it. ( Joseph Shapiro is a fantastic NPR reporter who has made disability his beat: his description of the 504 sit-in is here.) The key element of this movement and its success was the decision by many different disability constituencies to unite.

For people who need change because their own bodily circumstances require assistance from society and from the healthcare system, the history of AIDS activism and the disability rights movement show two things:

1. the credibility of your own circumstances can be a potent political weapon.
2. though that first central tactic can win victories, the largest and most enduring gains are won by tying your own circumstances to those of others.

***

I hope to write more about these two points, but in the meantime, here is an 18-minute documentary about the 504 protests that shows these two points in action. And below, a link to what the folks over at Breast Cancer Action are up to these days: their annual Think Before You Pink effort to end what they describe as "pinkwashing". ThinkBeforeYouPink.Org

The Power of 504:
part 1, followed by part 2

If your car gets towed, and a nearby psychologist makes note of your reaction, do you get your car back?

noreply@blogger.com (Joe Wright) — Sat, 21 Mar 2009 21:56:00 +0000

photo by Dr. Ms. Hemodynamics

God and intubation

noreply@blogger.com (Joe Wright) — Thu, 19 Mar 2009 04:54:00 +0000

One of my colleagues was the first author of this study. This is an underappreciated and understudied issue, which torments residents and nurses greatly: why do people end up choosing pointless treatments which will only minimally prolong life but substantially increase suffering? One of the answers appears to be associated with what my colleague and her co-authors describe as "positive religious coping"--i.e., seeking support from God--which appears to predict a choice to also favor aggressive treatment at the end of life.

Only in Boston

noreply@blogger.com (Joe Wright) — Mon, 23 Feb 2009 04:19:00 +0000

Boston Globe story

There could be few moments that are more distinctly Bostonian than this one. By that, I don't mean that it couldn't happen anywhere else--it probably has already. Someone not from here might see a simple sweet sentimental moment. But there all kinds of undertones that make it distinct and local.

The combination of:
Harvard teaching hospital as one of the major industries in town+
building yet another medical building named after the former owner of the Red Sox (much memorialized, though also remembered as the last of the major league owners to start hiring black ballplayers) +
the medical building being built by members of Ironworkers Local 7 (the link gives you a list of names of union officers that tells you plenty about Boston construction union history, down to the South Boston location for the local) +
located across from another Harvard hospital trying to fend off a unionization campaign +
a nurse from the cancer clinic, married to one of those ironworkers...

in not only the gesture itself, but in its details, associations, and meanings, in its beauty and its underlying tensions, this is a nearly pure Boston moment.

Pop culture round-up: kissing girls, black president, our goals in life

noreply@blogger.com (Joe Wright) — Fri, 06 Feb 2009 02:27:00 +0000

Pop music reflects social change and also rides it like a surfer on a wave, not in it, only on top of it, reflecting its contours, but using the wave for its own purposes.

The summer, with Barack Obama locking up the nomination, was full of hope and excitement. And two songs were on the charts that are worth looking back at now. They're going to define this last year in a funny kind of way, even though they're dumb songs--maybe because they're dumb songs.

1.
Katy Perry will perform at the Grammy Awards this weekend, performing her song "I Kissed A Girl", which is simultaneously:
* one of the stupidest songs I've ever heard;
* one of the catchiest pop songs of last year, with a great guitar hook along with a great synthesizer bass throb underneath it;
* and, in its totally stupid way, maybe some small part of the decades-long process of queer liberation, in a "gateway drug" kind of way. For better or for worse there are cheerleaders in Texas singing along to this song, and you can make what you will of that.

The sentiment of the song--a straight girl tries on kissing girls because, hey, it's kinda cute and cool and why not?--was sort of dumb even fifteen years ago. Or, more precisely, in 1995, it was Jill Sobule's song "I Kissed a Girl". That song was folkier, a little more alterna, with smarter and more emotionally honest lyrics (the protagonist just had a marriage proposal from a guy and doesn't want to say yes, then goes and makes out with a friend of hers) and a pretty catchy melody of its own.

Still, it was a small little song in its lyrical ambitions and its musical sound. And ultimately, it was just as dumb as Katy Perry's song in its relationship to what it means to be a lesbian or an enduringly bisexual woman, someone who has to actually live queer instead of flirting with it.

More importantly, it had nowhere near as much pure pop power as 2008's "I Kissed a Girl". Sobule's variation on the theme was an alternative radio novelty song for coffeehouses and college girls; Katy Perry sings for all of America, though perhaps first and foremost for strippers. And presumably, for the coffeehouse college girls who work as strippers.

But the song is definitely for all of America's pop music fans; from the moment the first guitar attacks of the chorus start up (at 33 seconds into it, in true pop music factory production-line formula style), you know it's a big pop hit. It's perfectly designed. The lyrics could have been about a Toyota Corolla and that beat still would have rocked some dance floors.

The only reason I think this is oddly subversive--as opposed to just being a #1 hit song destined to be played in strip clubs for the next twenty years--is that CBS has now sponsored a contest for ordinary people to record their videos, you're supposed to vote on them, and the winner gets to perform with Katy Perry.

In other words, this song is about same-sex kissing and it is officially totally banal.

Here's the kind of contender you'd expect:

And then you realize, it's inevitable that this song would need to be lip-synched by a gay man.

(If you want this guy to be rocking with Katy Perry in her Grammy performance, as I do, vote here)

Just to give Jill Sobule her due, here she is with her song:

2.
Speaking of pop culture, after the big Obama love-in, and a bit of an Obama let-down as his health policy point man turns out to be (surprise!) a huge ho, I'm trying to reclaim the Obama love by going through iTunes and looking at all the songs that reference this new moment.

This summer, somehow I wasn't listening to pop radio enough. Because I missed June 08's "My President", in which Young Jeezy, bless his soul, gets excited about the coming of a black president, with the following lyrics:

"My president is black
My Lambo's blue
I'll be god-damned if my rims ain't too"

The video involves Young Jeezy and some of his associates dancing around Mr. Jeezy's blue Lamborghini (which--god damn!--has blue rims) along with swelling inspirational movie-soundtrack strings and pictures of people marching, mobilizing, bringing a new day in politics. Also--hells yeah!--a blue Lamborghini with blue rims. And, John Lewis! Jumping up in the air! (As one music website puts it, "If all that's okay with John Lewis, it's okay with us.")

I think this song will turn out to be one of the smartest songs about the Obama age.

will.i.am is rocking it with "It's a New Day" in which he namechecks Harriet Tubman along with Lincoln, Kennedy and King: "The dreams that I've been dreaming have finally come true," he sings. (I hope the New York Times refers to him as Mr. am; I know I will, from now on). This is a very sincere song, and the sort of thing you can sing at the inauguration, which Mr. am did.

But Young Jeezy kind of had it nailed. The song is a combination of sentiments: I'm really excited about this amazing thing happening, and also, I'm the same knucklehead I always was, and really, what I've managed to accomplish is get a bunch of thugs to love me and give me enough money to buy myself a Lamborghini; but then, on the other hand, all things considered, it's a pretty great car.

Of course, hip-hop makes things bigger, blows up the parody until it's not even parody any more, and you're not sure when it's a joke and when it's just stupid. At the end of the song, Young Jeezy makes clear he knows it's a joke, kind of, when he starts listing black heroes, then tries to go back and give himself a role in black history, for being the first guy to drive a Lamborghini through his neighborhood. He's laughing and delivering the lines in a way that makes it clear he understands the comparatively smaller scale of this accomplishment, even though he himself is pretty proud of it.

In a remix, Jay-Z added on some more pointed lyrics, while also just adding in some comments about the color of his Porsche.

But though having a more direct political element changes the song, maybe Young Jeezy's June '08 song anticipates a more core American impulse that will doubtlessly persist. All the nobility of hope and change and a young black president inspires us. And at the same time, most of us are all just trying to live our own stupid lives, with our own self-centered goals, hoping the president manages to get the economy back to the point where we can start imagining not just getting by, but living large. In a hybrid, maybe, but--if he is truly a great president--it'll be a fast shiny blue turbo hybrid with 22-inch blue rims.

Here's Jay-Z and Young Jeezy at an inaugural party. On January 19th, the enthusiasm was sweeping over Young Jeezy, and he wasn't joking anymore--just really really psyched.

I don't want to forget the sincerity of this moment. And I don't want to shortchange the sincerity of the Texas cheerleader who's dancing around her room singing along with that Katy Perry song, thinking something different about what it means to kiss a girl than her predecessors might have. Like all of the best pop songs, these two songs are both dumb songs, but also get their momentum from reflecting a new moment, a new way of thinking, a new time in which these songs are allowed to exist as dumb songs, climbing the pop charts.

Hey! We've got a black president! I can kiss who I want to! It's a new day!

Pop music's insidious but undeniable power comes from being banal, stupid and meaningless, while at the same time, meaningful and sincere and in some way perceptive about who we are when we are young. Even if social change brings black presidents and queer love, those new elements are just the picture frame for more stable and eternal elements of American pop culture, dominating the pop charts since at least the middle of the last century. In this case, those elements are:
1. awesome cars; and
2. hot girls, as in:
being one
making out with one
or--
genius! great bass line! love the guitar hook! sexy video!
--both.

Facebook in the hospital

noreply@blogger.com (Joe Wright) — Sat, 17 Jan 2009 03:24:00 +0000

For whatever reason, Boston nurses love Facebook. Maybe elsewhere too. Especially at night. If you go to a night ward or even the ICU at night, there's a bunch of nurses on Facebook.

Also, residents and interns have pagers, which nurses use to get a hold of them. But nurses don't have pagers, and sometimes it's hard to track a nurse down.

So it was inevitable that someone would think of it. Right now it's a joke told by one resident to another: "I'm going to start using Facebook to page nurses."

Soon it will be a Facebook app which will spread like wildfire through the hospitals.

The Blagojevich complaint: hospitals and political corruption

noreply@blogger.com (Joe Wright) — Fri, 12 Dec 2008 18:17:00 +0000

The news about Governor Blagojevich's alleged corrupt behavior has focused, understandably, on his scams to try to get payback for Obama's Senate seat. Intrigued by some incidental details about a shakedown of a children's hospital CEO, I searched for the word "hospital" in the affidavit. It appears 22 times, with two separate incidents, the first being about a "Certificate of Need" for another hospital and the other being the Children's Memorial incident. The "Certificate of Need" saga will be familiar to those who were already following the Tony Rezko trial, but since I hadn't realized how deeply the Rezko trial was entangled in hospital construction, I include this along with the Children's Hospital CEO.

It's just a reminder that healthcare, perhaps the largest segment of our GDP, is just another industry, immune neither to shakedowns by the corrupt, or corruption of its own.

Here are the appearances of the word "hospital" in the affidavit.

<<>>

The first group of references concerns a small hospital which a planning board staff felt was unnecessary because there were already plenty of hospitals in the area. The hospital chain wanted to build a hospital anyway. Imad Almanaseer, who provided the crucial vote from the planning board to overrule the staff recommendation not to allow the hospital to be built, is a physician. It was his vote that allowed political corruption to overrule any semblance of the sensible allocation of healthcare resources. For handy reference I've inserted the title "Doctor" before his name, although the affidavit does not do this in the original.

35. As described more fully in the following paragraphs, Mercy Hospital, which sought permission from the Planning Board to build a hospital in Illinois, received that permission through Rezko’s exercise of his influence at the Planning Board after Rezko was promised that Mercy Hospital would make a substantial campaign contribution to ROD BLAGOJEVICH. Rezko later told a member of the Planning Board that Mercy Hospital received the permit because ROD BLAGOJEVICH wanted the organization to receive the permit.

36. Levine’s criminal activities included his abuse of his position on the Planning Board to enrich both himself and Friends of Blagojevich. The Planning Board was a commission of the State of Illinois, established by statute, whose members were appointed by the Governor of the State of Illinois. At the relevant time period, the Planning Board consisted of nine individuals. State law required an entity seeking to build a hospital, medical office building, or other medical facility in Illinois to obtain a permit, known as a “Certificate of Need” (“CON”), from the Planning Board prior to beginning construction.

37. Levine, as well as Planning Board members Thomas Beck and [Dr.] Imad Almanaseer, testified under oath at the Rezko Trial. Beck testified that he asked Rezko to reappoint him to the Planning Board and that Beck thereafter followed Rezko’s directions regarding which CON applications Rezko wanted approved. Beck testified that it was his job to communicate Rezko’s interest in particular CONs to other members of the Planning Board, including [Dr.] Almanaseer, who were loyal to Rezko. Beck testified that he understood that Rezko spoke for the Blagojevich administration when Rezko spoke to Beck about particular CONs. [Dr.] Almanaseer testified that Beck instructed him that Rezko wanted [Dr.] Almanaseer to vote a particular way and that [Dr.] Almanaseer should follow Levine’s lead in voting on CONs. [Dr.] Almanaseer testified that before certain Planning Board meetings, he received notecards from Beck indicating how to vote on certain CON applications. Beck testified he provided these notecards to [Dr.] Almanaseer and certain other members of the Planning Board to communicate Rezko’s directions about certain CON applications.

38. During his testimony, Levine described a plan to manipulate the Planning Board to enrich himself and Friends of Blagojevich. The plan centered on an entity commonly known as Mercy Hospital (“Mercy”) that was attempting to obtain a CON to build a new hospital in Illinois. Levine knew the contractor hired to help build the hospital. In approximately November 2003, on behalf of the contractor, Levine checked with Rezko to determine whether Rezko wanted Mercy to obtain its CON. Rezko informed Levine that Mercy was not going to receive its CON. According to Levine, he asked Rezko whether it would matter to Rezko if Mercy’s construction contractor paid a bribe to Rezko and Levine and, in addition, made a contribution to ROD BLAGOJEVICH. Levine testified that Rezko indicated that such an arrangement would change his view on the Mercy CON.

39. Levine’s testimony regarding Rezko’s actions to change the Planning Board decision concerning Mercy’s application for a CON based on contributions for ROD BLAGOJEVICH is confirmed by attorney Steven Loren. Loren testified at Rezko’s criminal trial and, before that, in the grand jury. According to Loren, in approximately December 2003, Levine informed Loren that Rezko was against the Mercy CON. According to Loren, Levine relayed to Loren a conversation between Rezko and Levine during which Levine asked Rezko whether a political contribution to ROD BLAGOJEVICH would make a difference for Mercy’s CON, and Rezko responded to Levine that such a contribution might make a difference.

40. Thereafter, and confirmed by the testimony of Levine, Beck, and [Dr.] Almanaseer, as well as recorded conversations, Rezko switched his directions to Beck and informed Beck that Mercy was to receive its CON. According to [Dr.] Almanaseer, although he previously had been told by Beck that Rezko did not want Mercy to receive its CON, he was later told that there had been a change and that Rezko now wanted Mercy to receive its CON.

41. Mercy received its CON as a result of a controversial and irregular vote at a public Planning Board meeting. [footnote: There was extensive testimony regarding the irregularity of the vote at the Planning Board meeting. In summary, during the vote, Levine got up from his seat and went to speak to Beck and to [Dr.] Almanaseer. After these discussions, [Dr.] Almanaseer then changed his vote to be in favor of Mercy receiving its CON. Beck then voted in favor as well and by a vote of 5 to 4, Mercy’s application for a CON passed.] The vote brought significant publicity to the Planning Board and ultimately led to the disbanding of the Planning Board. [Dr.] Almanaseer testified under oath in the grand jury that not long after the Planning Board vote on Mercy’s CON he saw Rezko at a fundraiser. According to [Dr.] Almanaseer, he was still embarrassed about what had occurred at the Planning Board vote on Mercy’s CON and Rezko’s role in the vote. [Dr.] Almanaseer testified that he asked Rezko why Rezko had switched the vote on the Mercy CON. According to Almanaseer, Rezko stated: “The Governor wanted it to pass.” [Dr.] Almanaseer understood the reference to “Governor” to be a reference to ROD BLAGOJEVICH.

[Before moving on, let's celebrate the internet's ability to provide some historical context, here from Crain's Chicago Business. Here's an excerpt from a 2004 article I found about the original decision:

Mr. Levine and Jacob Kiferbaum, president of Deerfield-based Kiferbaum Construction Corp., serve together as trustees of Rosalind Franklin University of Medicine and Science, formerly known as Chicago Medical School. Mr. Kiferbaum also contributed $45,000 to former state Attorney General Jim Ryan's 2002 campaign for governor, for which Mr. Levine served as finance director.

Mr. Levine, an attorney and investor from Highland Park, didn't return calls seeking comment for this story. A transcript of the April 21 meeting shows he led the board in discussing the Mercy application, encouraging members to vote in favor of the hospital and to disregard approval criteria he called "hopelessly outdated.''

During the roll call vote on the application, Mr. Levine voted for approval and walked across the room to talk with Imad Y. Almanaseer, a Glenview physician, who had abstained, according to two people who attended the meeting. After the conversation with Mr. Levine, Dr. Almanaseer changed his vote to "yes,'' giving the Mercy project the fifth vote needed for approval.

Dr. Almanaseer is resigning from the board July 1, when his term expires. He didn't return calls last week, but in an interview several weeks ago, he denied feeling pressured to vote in favor of Mercy.

"I honestly don't feel it,'' he said. "(Mercy) made a case for the need for more physicians in that area, and we agreed.'']

<<>>

The second group of references comes in relationship to the desire of the governor to exchange an increase in reimbursements for pediatric care for a campaign contribution from a Children's Hospital CEO:

65. According to Individual A, on October 8, 2008, during a discussion of fundraising from various individuals and entities, the discussion turned to Children’s Memorial Hospital, and ROD BLAGOJEVICH told Individual A words to the effect of “I’m going to do $8 million for them. I want to get [Hospital Executive 1] for 50.” Individual A understood this to be a reference to a desire to obtain a $50,000 campaign contribution from Hospital Executive 1, the Chief Executive Officer of Children’s Memorial Hospital. Individual A said that he/she understood ROD BLAGOJEVICH’s reference to $8 million to relate to his recent commitment to obtain for Children’s Memorial Hospital $8 million in state funds through some type of pediatric care reimbursement. As described in further detail below, intercepted phone conversations between ROD BLAGOJEVICH and others indicate that ROD BLAGOJEVICH is contemplating rescinding his commitment of state funds to benefit Children’s Memorial Hospital because Hospital Executive 1 has not made a recent campaign contribution to ROD BLAGOJEVICH.

66. According to Individual A, during this same meeting, ROD BLAGOJEVICH began discussing recent media reports about the possibility that Antoin “Tony” Rezko was cooperating with the government. According to Individual A, at one point in the
conversation, ROD BLAGOJEVICH said words to the effect that he was not concerned about Rezko’s cooperation because he was not involved in illegal activity with Rezko. According to the Individual A, Fundraiser A then said words to the effect of, “unless
prospectively somebody gets you on a wire.”

...
a. On the morning of November 12, 2008, ROD BLAGOJEVICH talked to Fundraiser A. During the course of the conversation, which principally concerned the status of campaign fundraising efforts, Fundraiser A told ROD BLAGOJEVICH that Fundraiser A had never heard from Hospital Executive 1. Fundraiser A said, “I’ve left three messages there so I’m gonna quit calling. I feel stupid now.” ROD BLAGOJEVICH asked when the most recent call was, and Fundraiser A replied that it was two days ago. ROD BLAGOJEVICH said that if “they don’t get back to you, then, then, last resort is, I’ll call.”

b. Later on November 12, 2008, at approximately 2:14 p.m., ROD BLAGOJEVICH spoke with Deputy Governor A, a Deputy Governor of the State of Illinois. The following exchange began the conversation:
ROD BLAGOJEVICH: The pediatric doctors – the reimbursement. Has that gone out yet, or is that still on hold?”
DEPUTY GOVERNOR A: The rate increase?
ROD BLAGOJEVICH: Yeah.
DEPUTY GOVERNOR A: It’s January 1.
ROD BLAGOJEVICH: And we have total discretion over it?
DEPUTY GOVERNOR A: Yep.
ROD BLAGOJEVICH: We could pull it back if we needed to – budgetary
concerns – right?
DEPUTY GOVERNOR A: We sure could. Yep.
ROD BLAGOJEVICH: Ok. That’s good to know.

c. On November 12, 2008, at approximately 8:26 p.m., Fundraiser A called ROD BLAGOJEVICH and reported the status of fundraising efforts. During the conversation ROD BLAGOJEVICH instructed Fundraiser A to call Lobbyist 1 the following day and ask Lobbyist 1 what to do about the fact that Hospital Executive 1 is not calling Fundraiser A back and inquire whether it was possible that Individual A had instructed Hospital Executive 1 not to call back (see Paragraph 65). ROD BLAGOJEVICH asked, “what do we do with this guy, [Hospital Executive 1]?”

d. On November 13, 2008, at approximately 10:05 a.m., ROD BLAGOJEVICH talked with Fundraiser A. The discussion concerned the status of fundraising efforts. During this call, ROD BLAGOJEVICH asked about Highway Contractor 1. Fundraiser A stated that Lobbyist 1 is still working with Highway Contractor 1. Fundraiser A also advised ROD BLAGOJEVICH that he will be meeting Lobbyist 2 to meet with an individual at Weiss Memorial Hospital. ROD BLAGOJEVICH states: “Yeah, now be real careful there. I mean, the FBI went to see [Lobbyist 2]. You understand?” Fundraiser A also said that he had a call into Individual A and that Fundraiser A will talk to Individual A about Hospital Executive 1.

...
g. On November 14, 2008, ROD BLAGOJEVICH talked to Fundraiser A. During the conversation Fundraiser A told ROD BLAGOJEVICH that he had spoken with Individual A, and that ROD BLAGOJEVICH needed to call Hospital Executive 1. ROD BLAGOJEVICH said that he would call him.

variation on a theme: romance of long hours

noreply@blogger.com (Joe Wright) — Fri, 12 Dec 2008 02:18:00 +0000

written post-call after a long ICU shift, which after I wrote it I realize is a reworking of some things I've written before

I used to work at a public health job, working for the city, with good benefits, and time to go to the gym before going home to make myself dinner. When I started talking about becoming a doctor, a lot of people said that was nuts, most of all some doctors who looked back on their experience bitterly. Others were more encouraging, and I chose medicine.

I have no idea what my life would have been like if I hadn't chosen medicine; but what I usually tell people is that although I've sometimes been exhausted or miserable or depressed or discouraged, I've almost never been bored. I hated being bored at work. Now I'm not bored.

But aside from medical training being totally absorbing, part of the dirty little secret of long work hours is that it is part of a romance that doctors and patients have with each other. Many of my patients look at me sympathetically and ask whether I ever go home, and even shake their heads over my working conditions. But many of them also seem to sort of appreciate the romantic idea that I'm some sort of insanely dedicated nut who cares only about helping people and has no life other than worrying about their telemetry alarms. I'm there all night, yes; but I'm there for them.

On the flip side, as I'm complaining to my friends with regular jobs, I'm also a little proud of myself for making a different choice. I joined the few and the proud; my life is full of drama and a sense of importance. In the dark early morning hours in my academic hospital, the halls begin sputtering with the energy of people working really hard to become who they are going to become. That's kind of beautiful, and I am proud to be a part of it. And, though usually I would only tell my mom this, I'm proud of myself. I'm proud of myself for choosing something tough. This is a common impulse: it is the basic idea of most military recruiting pitches, and it has worked to convince people to do difficult or even insane things for many generations before this one.

When I worked in a regular job, I felt that my life lacked significance or importance somehow, even though I was doing important work. That was because I lacked this sense of drama.

The sense of drama that draws doctors to our training--even as the conditions that make our training dramatic also sometimes make us bitter or depressed--is probably in the end a fiendish tool of The Man to make us work harder for cheaper, and like it.

It's also part of how doctors become self-justifying later; other people can just suck up whatever hardship they face, because we did. (As if a few years of earning an average American wage and working insane hours in preparation for joining the top tier of wage-earners and gaining inestimable social prestige is really a form of enduring suffering.)

Change won't occur until the rest of the society stops appreciating the beauty and the drama of the dedication that the medical training process represents, and starts viewing residents as participants in a high-stakes industrial process that must eliminate systemic sources of error. But the latter view is much less romantic, and much less beautiful.

For almost everyone involved, it is more emotionally satisfying and less safe to romanticize the difficulty of medical training. Perhaps this is not surprising: in many other parts of life, emotional appeal often wins out over sensible decisions. But that appeal is part of why doctors choose this life; and I think that the romance of the doctor as a special breed of person is part of what seduces patients of academic hospitals into accepting a system that is not always designed in their best interest.

Cat and mouse and us

noreply@blogger.com (Joe Wright) — Sat, 06 Dec 2008 04:26:00 +0000

The Hemodynamic Cat battling a swinging light switch, photos by Ms. Dr. Hemodynamics; the HC in a quiet time.

Recently, the Hemodynamic Cat did something surprising: she caught a mouse.

I would like to say that I have never doubted the Hemodynamic Cat's mouse-catching abilities, but this is not the case. She spends a lot of time pouncing on and batting around her toy mice, in a way that suggests some inner ferocity. But her record on watching cockroaches with interest rather than hitting them, and her failure to show any evidence of actual mouse-catching, left me a little skeptical. I've come to love the HC for other reasons.

Recently, I was coming to bed and saw that the HC had a mouse in front of her, and was looking up at me expectantly, as she sometimes does when she wants me to play with her and her toy mice. Then I looked more closely and saw that it was too thin and small to be one of her toys; and that in fact it was breathing.

My experiences in an immunology lab left me well-prepared for this moment; I picked up the mouse by its tail, and eventually delivered it to a warm spot outside our apartment where I hoped it might be able to recover and go on living outside our apartment. It wasn't moving much, and I thought about more definitively snapping its neck--to finish the job that the HC had clearly started and end its suffering--but I wasn't sure that it might not be able to rally once no longer stressed and stunned, so I left it. I later found it definitively dead, in the same spot. The HC had killed the mouse.

I know that some cat owners think that the cat's habit of bringing dispatched prey to display to their owner is some outgrowth of wild cat mothering habits. In terms of the original wiring for the behavior, that's probably true--there has to be some "little tasty things I don't eat right away" circuit available to build on. But the wild forebears of domestic dogs also feed their puppies, and domestic dogs don't make a point of sharing their catch with their people in the same way that cats do.

I've always thought that this behavior is actually part of the social contract that cats and people developed with the origins of agricultural society. Recent genetic work confirms what can be surmised from history, archaeology, and anthropology: cats go with agriculture, not with hunting and gathering. When people started having grain silos, field mice started becoming silo mice, moving to where the concentrated bounty of the fields were stored. Cats followed the mice.

This seems like the moment in which the "show the mice" strategy would have been most useful. The social bond would not have come first, and so the showing of the mice is not a process of mistaking people for kittens. It is an act of seeking patronage. A cat who just seemed to wander around the village but did not show the mice she caught to anyone might be tolerated or even enjoyed. But I'm not sure that early agrarian societies would have put much energy into caring for that cat.

On the other hand, the cat who comes to the peasant farmer, drops mice at the door, and meows loudly with enthusiasm, is saying, "I am worth keeping around." What the cat loses in protein from the mouse not eaten, she gains in protein from the people who want to encourage her mouse-killing. People, and especially grain-farming people, want cats to kill many more mice than they need to support themselves; they want cats to kill every mouse in sight. The cat that brings mice is showing her dedication to this shared mission. The cats that are also social and charming get to live inside and sleep next to the warm bodies of the giant primates, but the "show the mouse" strategy might well have been the first step in the evolution of cat domestication.

Cat experts sometimes say that cats, unlike other domestic animals, domesticated themselves. This explains their more ambivalent attitude about human attention; cats have eliminated only the wildness that kept them out of the house, and sometimes not even that. The Hemodynamic Cat, her ancestors having been bred for the company of princesses, is an extremely social creature with the people she knows, but she still has a wariness of new people that shows the not-so-ancient wild cat inside her.

As I held the mouse by its tail, its lungs expanded and contracted and its little legs kicked. In retrospect, given that the mouse could not get up and walk anywhere after I set it down, I think the legs kicking might have been a lower spinal cord reflex arc. Maybe if something grabs a mouse's tail there is no need to wait for the brain to tell the leg muscles to start making running motions; but the mouse needs the brain to communicate with the spinal cord in order to coordinate its movements. A mouse is a tiny thing, but with all the wonder of mammalian evolution, and of its own special qualities. From scores of dissections, I could imagine its heart; its thin, wide diaphragm; and, as I found again and again in the lab, its comparatively large spleen, full of blood and immune cells. I didn't want to touch its fur--I didn't want to give it a chance to turn and bite me--but I could remember what touching a mouse felt like, the warm softness of it, the vitality of the quick-moving lungs and heart. The mouse was beautiful, as all mice are, and I mourned its demise.

Still, I don't want mice eating our food and having the run of our house. And so when the Hemodynamic Cat looked up at me, with the little gray field mouse breathing but laying still in front of her, I saw our cat with a new respect, and felt something ancient: our cat was earning her keep.

Our social contract forged between two species, once seemingly consisting only of bonds of affection, had renewed its ancient preamble. I had thought that I loved the Hemodynamic Cat for her inherent value as a creature, and for her love of us, whether or not she caught mice. As I took the mouse out of the apartment, I realized that I now not only loved her, but respected her in a new way. Good job, I told the Hemodynamic Cat, and she said, "Mrowww!" back. I had killed mice for science. The Hemodynamic Cat had done something much more intimate and powerful: she killed a mouse for us.

Thankfulness, after the fire

noreply@blogger.com (Joe Wright) — Thu, 27 Nov 2008 23:05:00 +0000

photo from Cambridge Chronicle

Of course I'm thankful for the usual things, which are no less important for being usual: the love of my honey, the excellence of our cat, the support and love of my family, privileges and gifts, education, job, paycheck, safety, health. Among other things.

Still, much of my life this fall has been shadowed by the effects of our apartment building's fire. I never noticed how many fires there are in a city, until we were displaced by the fire in our apartment. So, now I don't pass by articles about fires, but instead read them with a little knot of sadness and dread, vividly imagining what they describe: recently a large fire destroyed everything for many residents of a nearby neighborhood--a much worse outcome than we had, given that we only lost our home but not most of our belongings. (Water damage made us homeless, not the flames themselves.)

Earlier today, while I was still at work, a fellow resident was looking for her stethoscope and smelled one that looked like hers. "What are you doing?" another resident asked her. She said, "Mine looks just like this but it smells like barbeque because it was one of the only things that survived the fire." When we had our fire, she told me about hers; she had lost almost everything. I hope she finds her stethoscope soon.

Someone else I know had her house burned down by a lightning strike; she's still waiting for it to be rebuilt. Of course, each of our experiences was different; still, like any little club of survivors, we feel alone in what we've experienced, and relieved to find others who have some understanding of what we feel.

Today I'm thankful for what was not lost in the fire: our lives, our health, most of our things. Thankful that it was not worse. But this is a refugee's thankfulness, an it-could-have-been-worse relief tinged with the sometimes angry, sometimes bitter, sometimes just sad knowledge that it certainly could have been a lot better.

This week, we received an organic turkey we'd ordered a long time ago from the farmer's market. Getting the turkey was an adventure, including waiting all evening two nights in a row for the turkey farmer to bring the turkey to us, With some kind of non-functioning email confirmation system and orders written on the back of envelopes, he'd unsurprisingly run out by the time I got to the farmer's market to pick up the one we'd ordered, then was driving around the city with a broken GPS system and a borrowed cell phone, with his wife at the farm reassuring me he would surely be coming very soon. One more thing to be thankful for: I'm not a turkey farmer. Anyway, after we'd ordered the turkey but long before it was delivered, we'd decided that with our schedules and the limits of the apartment we're subletting now, it wouldn't work to cook Thanksgiving dinner. So we have a turkey but not a Thanksgiving turkey. (We're going out for dinner.)

That's OK. We're soon to sign a lease for a new apartment, starting in the first week of the new year if all goes well. I think once we have a real home again, we will feel more thankful. We'll be thankful for things that we are gaining, and not for things that we didn't lose. We're going to keep the turkey in the freezer; like other more important things, getting this turkey was harder than it probably should have been. We'll eat the turkey in our new home, when we're feeling thankful in a new way: in this way, among others, part of Thanksgiving will come late this year.

Mbeki as Macbeth

noreply@blogger.com (Joe Wright) — Wed, 26 Nov 2008 12:55:00 +0000

Someone has actually tried to do the math now that he's gone: how many people died as the direct result of Thabo Mbeki's AIDS policies? This particular estimate puts it at 365,000 lives and 3.8 million years of life.

Whatever the number, it was a lot:

As Zackie Achmat says in this NYT article:

“He is like Macbeth. It’s easier to walk through the blood than to turn back and admit you made a mistake.”

NEJM: say no to electoral genomics

noreply@blogger.com (Joe Wright) — Sun, 23 Nov 2008 04:45:00 +0000

Here's a NEJM commentary on the idea that presidential candidates' genetics shouldn't be used against them, a variation of the point I was making in an earlier post and its follow-up.

Hank Wilson, community organizer.

noreply@blogger.com (Joe Wright) — Thu, 20 Nov 2008 02:25:00 +0000

I wrote in my last post about Hank Wilson. Here's a much more lovely long remembrance of Hank Wilson, by his friend Bob Ostertag. Read it.

Here's the last paragraph:
What, exactly, is a "community?" At the university where I teach, there are "experts" in this matter who will give you definitions of community that use so many big words, you will need a PhD of your own just to figure out what they are talking about. Hank Wilson had a definition his kindergarten students could understand: a community was something that took care of its least privileged members. If this simple thing could not be done, then you didn't have much in the way of community. This was Hank's life project, his singular, profound contribution to the gay and lesbian community, and to the city of Saint Francis.

Also, some memories at the San Francisco Bay Guardian's web site (read the comments section);

the Chronicle's article;

for the historians in the crowd, here's the finding aid to the Hank Wilson Papers, which Hank donated when he thought he was about to die of AIDS in 1996, right before highly active antiretroviral therapy saved his life;

and finally, a Magnum Photos photo essay about the Ambassador Hotel.

Of course, you can always help out with the Wikipedia page, in progress.