About ergeller57

Evan Geller is a surgeon and critical care specialist. He is happily married and the father of three extraordinarily pleasant children. He writes on the side. His blogging is inexplicable, unfocused, and not terribly prolific. Usually worth your time, however. Occasionally.

Death by Electronic Medical Record Keeping: Part 2

Sequel to Automated Malpractice and Digital Dishonesty, the first in a series dealing with the disaster which has befallen our health care system.

The single, most powerful tool employed by every physician in the care of patients is the medical record.  It is the tool that impacts the care of every single patient.  It is the tool that makes difficult diagnoses possible.  It organizes and makes possible treatment modalities of every type.  It allows collaboration between multiple health care practitioners.  It prevents redundancies, harmful treatment interactions, errors in therapy.  It makes possible quality improvement.  It is the basis of clinical research and the datum upon which discoveries are made and ineffective treatments eliminated.IMG_1302

The medical record is the fundamental instrument of all patient care.

Take away the medical record and you might as well eliminate the use of antibiotics, of vaccines, of anesthesia, of blood typing–because every aspect of these treatments and their safe implementation requires an accurate, accessible medical record.

We are currently in the process of destroying the patient medical record as an accurate, dependable tool in the care of patients.  As a direct consequence of our current actions, patients are being harmed.  Quality assurance programs are being compromised.  Future research will be flawed.

This phenomenon is being witnessed across every aspect of medical practice and in every patient care venue in this country.  It is being experienced by every physician, nurse, and allied health care provider.  It is incontrovertible.  It is, quite simply, a national disgrace and a health care emergency.

The previous system of writing notes and orders with a pen in a paper chart was flawed, of course.  It had the drawback of being, on occasion, uninterpretable.  This led to errors.  It had the drawback of being difficult to access.  This led to inadequate communication, redundant testing, inadequate treatment.  There was a definite and defined need for a better system.  No one would argue differently.  The new system needed to be:

i.  accurate, ie., legible

ii. accessible to all patient care providers, including physician offices, emergency departments, hospitals, clinics, researchers, auditers

iii. systematically better than a bunch of pieces of paper stapled together: that is, it should intrinsically avoid dosage errors, medication conflicts, redundancies, etc.

Obviously, the new electronic medical record should be better than paper.  Paper required health care practitioners in the form of nurses, PA’s, and pharmacists to interpret a physician’s desires and catch our mistakes before they reached the patient.  If I ordered an antibiotic for a patient and the patient had a history of allergy to that antibiotic, a key patient fact that I was not aware of at the time of treatment,  I relied on a clinically astute nurse or a pharmacist with the patient’s allergy flag to catch it and stop me before I injured the patient.  Obviously, this was a problem, because some nurses and pharmacists, just like some physicians, are more experienced, conscientious, knowledgable, and savvy than others.  Better to have a system that automatically and consistently checks every order against the patient’s documented record for such a life-threatening conflict.

The intent, at the national/governmental level, was to create and mandate the implementation of just such a system, a system to address the known failings of the existing paper-based system and improve patient care.  But the reality rapidly superceded the intent.  Through a tortured labyrinth of governmental committees and corporate boardrooms, we allowed the private, profit-motivated sector to leap into the gap between good standards and mandated implementation.  In retrospect, we all should have seen this coming from many miles away.  A government mandate that would require the purchase of a product by every doctor, hospital, and clinic in America?  How much was that worth?  Obviously, a great deal.  So why wait for standards?  Why develop a good system, a worthy product, when we can beat the competiton and sell a cheap, untested, poor product and require these guys to buy it whether they like or not, whether it works or not, even if it’s intrinsically dangerous?

Which is how we arrived to the point we find ourselves at now.  Hospitals, physican practices, and clinics have been forced to expend millions of dollars to purchase poorly designed electronic medical record systems.  Physicians across the country are now required to spend dozens of hours training up on a variety of unstandardized systems.  They are required to become facile in the care of patients utilizing deeply flawed instruments that do not approach the minimum level of quality to allow safe patient care.  The problems exhibited by the current state of the governmentally mandated art range from the simply irritating, to the amazingly stupid, and all the way to the point of the systematically murderous.  I do not exaggerate.  Allow me to provide examples:

The simply irritating:  Each hospital at which I care for patients has its own brand of electronic medical record (EMR).  Each EMR requires a unique user name and password.  But some of these hospitals also have a separate system for charting in their Emergency Department.  Many have a separate system to access electronic ordering, or another system to view radiology images, and another system to complete medical records, and yet another system to access labarotory results.  Additionally, a separate system exists for electronic prescribing (also mandated), not to mention the required State Narcotic Abuse Database Access, also with a unique user ID and password.  None of these systems, user names, or passwords are centralized or mutual in any way.  And in the name of patient security, every one of these systems requires that I change my password every thirty to ninety days.  But not in the same thirty day cycle.  And not to anything that remotely resembled my previous password.  Which leads to the constant juggling of multiple passwords with no chance of providing anything near efficient patient care.  Maddening.

In those practices that require efficient clinical care, the implementation of the EMR has been uniformly disastrous.  Patient office visits are now characterized by a screen interposed between the patient and the clinician, eye contact being a thing of past.  Documentation is terse, inadequate, and often plain untrue.  Most opthamologists and many other physicians have been forced to hire a new category of health care worker, the EMR documentician, to follow behind the physician and enter information into the computer.  This has led to enormous additional expense and a new avenue for inaccuracy.  I routinely hear from my colleagues how they have to spend their evenings at home doing EMR documentation from the patients that they saw during the office hours earlier that day, as if anyone could expect to recall the subtleties of dozens of patient interactions six hours later.  Simply insane.

Amazingly stupid:  Two of the hospitals I work in utilize the Allscripts EMR system.  This system features the amazingly stupid feature of not superceding previous orders when such a feature is obvious and required.  The diet order is a case in point.  When a physician enters a diet for a patient, the previous diet order should be stopped.  But no, this is not the case.  So my patients routinely have several, conflicting diet orders running contemporaneously.  I have discussed this on over a dozen occasions with the IT department, the physican IT laison, and presented to the IT/Patient services committee.  No patient, I explain repeatedly, ever needs more than one diet at a time.  They all patiently explain to me that such a change is not possible in this system.  So my patients routinely receive trays for clear liquid diets, full liquid diets, regular diets, specialty diets, all at the same time.  We depend on the dieticians to sort this all out on a daily basis.  The waste in effort and food, not to mention the costs associated with cancelled procedures and the morbidity of inappropriately administered diets, is intolerable, but apparently unfixable with the current state of technology.

Systematically murderous:  As I have mentioned, the key to good medical care is the conscientious application of patient information to allow informed decision making.  The old system of paper charting was deficient in this aspect.  A new, electronic system, should permit artificial intelligence applications to prevent many common errors, such as administration of inappropriate medications, wrong dosage, or duplication of treatments or testing.  The system should be designed to enhance patient care and safety.  Instead, we have a system that actually decreases patient safety and requires constant vigilance on the part of all health care providers to prevent system-incurred errors.  This is the exact opposite of what is needed and appropriate, but it is happening constantly.  In the postoperative setting, needed DVT prophylaxis medication is often ordered, but the system fails to reliably discontinue the same prophylaxis order from the preoperative period. This results in two or three doses of the blood-thinning medication arriving on the floor for administration to the patient.  Usually, the nurse is sharp enough to detect the duplication and send the extra doses back to the pharmacy, but if there has been a shift change or breakdown in communication, extra doses may be administered with resulting complications.  The system must be designed to make us better, not require us to police new, intrinsic challenges to good patient care.  The current situation is unacceptable.

Not to mention, medicolegally compromising:  One of the nationally implemented EMR systems fails to close out patient encounters when the patient is discharged.  This leads to the occasional situation wherein a treating physician accidentally places multiple orders into the system for a patient, not realizing that the orders are being entered into a patient encounter that is no longer appropriate.  There is no systemic prevention for such an error.  So in the middle of the night when an emergency patient requires admission to the ICU or is to be taken emergently to the OR, dozens of orders are entered, but not implemented.  The physician is told that his orders are missing, so he or his associate/resident/PA re-enters all the orders.  But now there exist a slew of orders added to a past encounter that were never acknowledged or administered.  Lord only knows what will be made of that when the chart is eventually reviewed for quality or legal concerns.  Good luck with that in a court five or six years after the occurrence.

What is obvious from the foregoing tirade is that the current implementation of the mandated EMR fails to meet the minimum requirements that I laid out in the beginning of this post.  It is legible, but it is inaccurate.  It is not accessible, due to a complete lack of interoperability standards.  As a system, it fails to improve patient care, but rather introduces an entire new class of systemic challenges to good, safe patient care.  The current system is simply unacceptable.  In the next post, we will discuss the remarkably simple solution to the current situation.

How science works

Yes, this (in anticipation of my upcoming series of blog rants on the state of clinical medical publications):

The Devil's Neuroscientist

My previous post discussed the myths surrounding the “replication crisis” in psychology/neuroscience research. As usual, it became way too long and I didn’t even cover several additional points I wanted to mention. I will leave most of these for a later post in which I will speculate about why failed replications, papers about incorrect/questionable procedures, and other actions by the Holy Warriors for Research Truth cause such a lot of bad blood. I will try to be quick in that one or split it up into parts. Before I can get around to this though, let me briefly (and I am really trying this time!) have a short intermission with practical examples of the largely theoretical and philosophical arguments I made in previous posts.

Science is self-correcting

I’ve said it before but it deserves saying again. Science self-corrects, no matter how much the Crusaders want to whine and claim that…

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You Drive Like a Sodding Slugfuck

This post was to be entitled, “You Drive Like a Dick,” but hey–it’s the holidays.  And in case you haven’t noticed, people drive even more dickishly (copyright, ERG) now than at other times of the year.  Hence, the new title.

Angry Cat Driver

In keeping with the holiday spirit, it is my considered opinion that people are now driving worse than ever.  Both of the regular followers of this blog know that I have a bit of a petulant streak when it comes to my fellow drivers, e.g.., “Overcourteous Assholes Like Me.”  Last year, I was irritated.  This year, I fear for my life.  This year, a new classless class of drivers has appeared, a class that adheres to the following three point credo:

I.  The rules of driving apply to you, not to me. 

II.  Get out of my way.  

III.  My car/truck is a two ton steel weapon on wheels which I am willing to use to injure, maim, or kill if you slow me down or generally do anything that pisses me off.

I refer to this new class of driver as “sodding slugfucks.”  But not to their face.  This is why I don’t refer to these people as “sodding slugfucks” to their face:  Detroit Driver Shot in Face in Road Rage Incident.  If you have ever been tempted to get out of your car to discuss driving etiquette with someone, this article will surely disabuse you of that silly notion.  Please don’t.

It has come to my attention that otherwise reasonable people can and do behave like sodding slugfucks when they drive.  I know this, because I live on an island.  When you live on an island, you occasionally find yourself in a situation of being assaulted by a sodding slugfuck while driving, only to subsequently realize that both of you are driving to the same destination.  On one occasion, that destination turned out to be our mutual place of employment.  We parked next to each other.  Somewhat awkward. On another occasion, the sodding slugfuck cut me off, tried to hit me, then screamed at me through my window before we both ended up in my neighborhood, only to realize that we live on the same block.  Even awkwarder.

With the foregoing in mind, perhaps it would be a holiday mitzvah to point out the type of activity that may lead to the realization that even you may be acting like a sodding slugfuck.  So you can stop.  As kind of a public service, I offer the following:

–Over the last six months, I have witnessed several guys who, in the middle of the day and at a busy intersection, decided that waiting for a traffic light to turn green was for losers, so they proceeded to just sprint across the intersection against the light. This causes every other driver to screech to a halt, wondering what the hell just happened and whether civilization as we know it has come to an end and nobody told us.  If you were one of these guys, and you didn’t jump the light because your wife was in active labor at a nearby hospital, then you, sir, are a sodding slugfuck.  Don’t do that anymore.

–I still pull over when I see an ambulance, lights flashing, come racing up behind me.  Call me old-fashioned, I know.  Other drivers may just drive faster to try to stay ahead of the ambulance, but last I checked that was kind of against the law.  What I’ve noticed now with frightening regularity, however, is that once the ambulance has passed, some sodding slugfuck (sometimes a whole string of sodding slugfucks) is chasing so closely behind the ambulance that I’m nearly killed when I try to pull back into my lane.  Unless you are related to the poor sap in the back of the ambulance, if you don’t let me back into my lane because you’re speeding behind the ambulance, you are a sodding slugfuck.  Or an ambulance-chasing lawyer, in which case you are also a sodding slugfuck.

–It appears that many drivers incur physical pain if they are required to use the brake while driving.  This must be some type of new epidemic, because I witness this ailment at least a half dozen times a day.  The symptoms are evident when a car slows to make a right hand turn and the car behind, instead of braking slightly to let the guy turn, swerves around him into the left turn lane.  Or in my recent experience, across the double yellow line to nearly hit me head-on, requiring me to veer off the road and almost hit a tree.  Main Street in my little hamlet is not the Nouvelle Chicane in Monaco, okay?  If you do this, please stop being a sogging slugfuck.   You’re going to kill someone.  Maybe me.

I could go on, but it’s the holidays.  I’ll save the rest for next year–like how your horn doesn’t make all the cars stuck in traffic ahead of you magically disappear.  Really.

Happy Holidays.  Don’t Drive Angry!

 

That Cat in Alien

Quote

 

Bulldog (small)

 

 

 

 

 

Feel like that damn cat in Alien. You know, at the end? Not a good feeling.  And you, buddy, are no Sigourney Weaver.   Just saying.

 

Jack the Bulldog

                                                                 The Problem with God 

by Evan Geller

 

The Contenders – Lewis Hamilton

For my fellow F1 followers, the following (and no, I won’t be reblogging anything about Rosberg):

The Buxton Blog

GP2 Testing, February 2006 GP2 Media Service GP2 Testing, February 2006
GP2 Media Service

I’d expected him to look older. I suppose its only natural with someone you’d been reading about for years, but he’d been such a constant part of the motorsport landscape for such a long time that I’d imagined he’d already be the finished article. He’d been a mini-megastar in England since his karting days. Even as a child I remember seeing his face on TV, on the news, on ITV’s karting show with DJ David ‘Kid’ Jensen, Blue Peter, through the pages of Autosport and Motoring News. He was a future world champion. That’s what we’d always been told. That’s what we’d always believed. And here he was, this future F1 superstar. I’d expected him to be taller. I’d expected him to be broader… I’d expected him to look older.

But there he stood on the pitwall in his ASM F3 overalls, a…

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Doctors Parking

I’m old enough to remember when physicians in general–and surgeons in particular–were held in high regard.  I mean, we used to have our own parking spaces and free coffee in the doctor’s lounge.  I remember when I was a resident in surgical training being taken to lunch between cases by my surgical attending at the hospital’s designated doctor’s only lunchroom, served a steak and fries by a waiter, then encouraged to finish my drink before running back to the OR to get the next patient ready for surgery.  And this was an inner city, midwest academic hospital! Table cloths and linen napkins!  I’m not making this up–it was the eighties.  Now that I’m an attending surgeon myself, I usually find myself wolfing down an Odwalla bar with cold coffee between cases. So I’m sensitive to the situation when one of my surgical colleagues is bent over the hood of a car, in handcuffs, with several guns pointed at him. How did we get to this?

MB2

Because, I hear you saying, you guys act like greedy, pompous dicks.  And while you are right (see “Mommas, Don’t Let Your Babies Grow Up to be Surgeons” for a start), that’s not the exact explanation.  Doctors used to run the hospital–literally and figuratively. In the twentieth century, successful hospital administrators were either grey-haired physicians who realized that the most important thing a hospital did was take care of patients, or no-nonsense nuns with MBA degrees who wouldn’t let anybody die in their facility, goddam it.  By the turn of the century, however, hospitals became “Medical Centers of Excellence” with “Program Initiatives” and extensive real estate investments, even the occasional shopping mall amidst the medical campus.  The CEO had bigger concerns than relieving suffering and curing disease, he had a big bottom line and a board to answer to.  That patient care stuff was delegated to a third-tier hospital administrator who could be found cowering in a windowless office, apologizing to the Chief of Cardiac Surgery for not getting his shiny new hospital wing finished on time, begging the surgeon not to make good on his threat to bankrupt the hospital by taking his skills across town.  Now the third-tier hospital administrators take home million dollar salaries as they lay off all the experienced nurses in that same, now careworn cardiac wing, because of the need to “trim the service line overhead.”  The center of power has shifted, you see.  Today, the Chief of Cardiac Surgery finds that his ID badge doesn’t even open the doors to the administrative wing.  And that’s where the nice cafeteria is.

Not so many years ago, I used to make a habit of leaving the hospital on my way home by walking out through the Emergency Room.  You learn after a decade of being the Chief of Trauma Surgery to look for trouble on the way out, because otherwise you had a pretty fair chance of getting called back in half an hour.  So on the way out I’d walk through the resuscitation bays and exit through the ambulance dock.  On one occasion, I was walking out this way when I noticed that a number of hospital security personnel were surrounding an individual, guns drawn.  The university had only recently granted our security personnel permission to carry weapons, and it wasn’t unusal at this time to see them working through the particulars of just when to employ their new, shiny Glocks.  It was dangerous to drop a candy wrapper in the lobby or complain too vocally about the lack of parking spaces.  So on seeing this little armed tableau, I just kept walking, somewhat ignoring the guy bent over the hood of his car, screaming obscenities.  I stopped, however, when I recognized the man’s voice.  That, I recall thinking, sounds like my colleague Mark.  Mark was a busy and talented surgeon who operated at several hospitals in the area.  I looked over.  Damn, I thought to myself, that looks like Mark, too.  I walked over to see a man struggling and cursing as he was bent double over the hood of a black Mercedes, being handcuffed by hospital security.  It was Mark.

“Mark,” I said, “what’s up, buddy?”  I noticed at this point that the big black Mercedes, Mark’s car, was parked on the helipad.

“Please stand back,” one of the security guys with his gun drawn admonished me.  “This is a dangerous situation.  I have to ask you to please step back, sir.”

“Geller, is that you?” Mark asked, his face being pressed into the hood of his car.

“Yeah, Mark, it’s me.”

The security guard waved his gun.  “Step back, sir.  Last warning.”  I’m not sure what he meant by that, so I stepped back.  He had the air of being the man in charge.

“Tell these assholes who I am, Evan!” Mark yelled.

“Do you know this man?” security guy asked.

“Maybe.  What’s going on, officer?”  They love to be called officer, because none of the security guys are real cops, you see.  They really, really, wanted to be real cops.  The guns helped.  New cars with the flashing lights also helped.

“Is he a doctor?”

“Might be a doctor,” I said.  “Why, what’d he do?”

“He tried to kill one of our officers,” the security guy explained.

“I just needed to park, so I could do a case!” Mark yelled over.

As I was later able to put together, it turns out that Mark was called to take care of a young patient with appendicitis.  When he got to the hospital, however, he couldn’t find a parking space in the ER lot or the designated doctor’s lot.  Being Mark, he elected not to pay to park in the visitor’s parking structure, deciding instead to park his black Mercedes 500 on the helipad.  This, it turned out, had made it rather difficult to land the helicopter with incoming trauma patients, so security had been called.  Mark finished his case and came out to see his car about to be towed so, being Mark, he got in his car. Being Mark, he assumed that this would resolve the problem.  ER security guy stepped in front of his car.  It seems that security guy, gun drawn, had decided that the goal was not so much to clear the helipad for the transportation of incoming trauma victims, as it was to make Mark pay for his effrontery by having his rich doctor car impounded.  At this point, Mark decided the wisest course of action was to drive away and hope everyone would just forget the whole silly episode, but unfortunately this involved nudging the officer gently with his large, black Mercedes.  Which quickly escalated to a lot more security guys with guns drawn deciding to arrest Mark’s rich doctor ass.

Once I understood exactly what happened, I had to explain to the security guy that no, I don’t think I know the guy after all.  Looked familar, but not the guy I thought he was.

And that’s kind of why things have changed for us doctors.

 

Mammographic Misery and the Plight of the Perpetual Patient

Mammograms save lives.  Despite several controversial studies over the last couple of years, there is no question in my mind or that of most other health care professionals that annual screening mammography for women over age forty has completely revolutionized the treatment of breast cancer.  Those studies can’t claim that people regularly receiving mammograms don’t have better rates of survival or cure from their disease–they claim, with mixed success, that providing a large population of women with mammographic screening is not cost effective.  What price a life, you ask?download

When I began performing surgery for patients with breast cancer in 1982, the typical patient presented with a mass she had felt herself.  By the time she came to me for surgery, her cancer was often in a relatively advanced stage.  Surgery involved complete mastectomy, usually with the removal of large numbers of her underarm lymph nodes, too often leading to disability and disfigurement.  This was followed by chemotherapy and radiation therapy. Worst of all, survival rates in this group of patients rarely reached 80% for the five years following surgery.

Fast-forward to my current practice.  Over 90% of women referred to me for surgical treatment of newly discovered breast cancer are now presenting with a lesion found on their annual screening mammogram.  Almost all of these lesions are about the size of a pea or smaller, having been discovered years before they grew to a size that could be felt on examination.  These early cancers have not spread to the patient’s lymph nodes or anywhere else in her body. There is no need for mastectomy to achieve a complete cure from this early stage of cancer.  Indeed, I can reassure patients that equivalent cure rates for such small cancers can be achieved by a small lumpectomy and a sampling of one or two lymph nodes, a procedure that takes less than an hour.  The patient is home later that morning and experiences minimal discomfort.  Newer forms of radiation therapy permitted by such early diagnosis expose only the localized tissue and can be achieved in five days, rather  than the whole breast radiation therapy over 4 to 6 weeks required in the past.  Most significant of all, this minimal therapy now provides cure rates well over 90% in these early stage patients.

All of this revolutionary success in the treatment of breast cancer has been made possible by earlier diagnosis due to routine screening mammography.  So don’t buy the hype–there is no controversy amongst practitioners over mammography:   A mammogram once a year can save your life.

But that’s not what this post is about.

Let’s talk about what happens after:  After that excruciating moment when I tell you that the biopsy showed cancer.  After the discussion of what we need to do, how soon we can do it (“Sorry, not yesterday”), what happens after the surgery.  Surgery for the treatment of breast cancer is safe, straight-forward, and relatively painless.  To be honest, surgery for breast cancer is the easiest operation I do.  Patients usually are surprised by their rapid recovery.  They come back to my office a couple of weeks after surgery feeling great.  Over the next several months, I see the patient as she completes her recovery and any additional therapy that’s recommended, usually a short course of radiation therapy and a daily estrogen-blocking pill.  By six months after her diagnosis, she’s feeling great and has her life back.   And then reality sets in:

The reality being that you are not really convinced you’re cured of cancer until the moment you die of something else.

We’ve moved from a paradigm of the valiant patient bravely battling her cancer to the successful breast cancer survivor–who now must live forever with her diagnosis.  It’s not a battle with cancer.  Battles are fought and won, and then we can move on. You don’t just fight cancer–you survive cancer, and then you live with having had cancer. This is a burden that few who have not experienced the diagnosis, or lived with someone who has survived cancer, can appreciate.  It doesn’t matter how great you feel, or how many times the doctors say that you’re doing great, or how great your spouse or friends say you look–you worry.  You worry every day.  Because you remember feeling pretty darn great just before the doctor told you that you had cancer.

Of course, we all worry about getting some disease or another.  We worry about that dark mole on our arm that might be a little bigger, particularly after we hear of a young friend recently diagnosed with melanoma.  We worry about heart attacks, because we get chest pain every time we eat Taco Bell or palpitations at the gym.  It’s not the same. It’s not the same because you’ve never been told by the doctor that the biopsy is positive, that your worst fear when you walked into the office was true.  You’ve heard of Post-Traumatic Stress Disorder?  This is Post-The Test Was Bad And You’re Totally Screwed But Now You’re Finally Better Stress Disorder.  And it’s every bit as bad. Maybe you didn’t experience faceless bad guys shooting bullets at you in Iraq, but you experienced some pretty heartless machines shooting xrays at you every day for a couple of months, or smiling nurses apologizing as they stabbed the needle in your vein for the third or fourth time, or watched the strange colored fluid dripping into your body knowing that in 24 hours you’d be doubled over the toilet vomiting because that’s just how this stuff works.  Cancer sucks, and it doesn’t stop sucking just because everyone tells you that you’re cured.

Sure, they say you’re cured.  But you don’t really believe it.  You don’t believe it because we keep sending you for more tests and more mammograms and more CAT scans and more PET scans.  If there were a PUPPY scan or a CUTE FUZZY BEAR scan, we’d send you for that, too.  If I’m cured, you keep wondering, why do we keep looking for it?  And every time you have to go for the test, it’s an opportunity to relive that special feeling you had that time when the test came back bad.  You relive that feeling for the week before you take the test, while you’re in the machine trying to breathe during the test, and for every single second until the doctor calls to tell you that it’s okay. This time, you think.  It’s okay this time.  The elephant steps off your chest–but he doesn’t leave the room, he just steps behind you for awhile.  Until the doctor says that it’s time to do another test.  And there is always another test.  If I’m cured, you think, why do we have to keep looking?

So here we are:  Surviving today.  The test was good.  Enjoy it.  You can run faster than any old elephant.

 

 

 

Magnificently Overrated: Whale Watching

My wife and I spent the day “whale watching” last weekend.  She had been anxious to pursue the great, wild whale ever since our last outing two years ago.  During that previous high seas adventure, we failed to spot the elusive, majestic whale.  This despite many, many hours tossing about the Atlantic Ocean, accompanied by seasick shipmates and an entourage of dolphins that made fun of us for even caring about whales.  No whales that day, alas.whale

On this sunny Sunday, however, we were successful.  We spotted a dozen whales!  Which was surprisingly similar to not seeing any whales at all the last time, just with more whales.

It became all too evident as we bobbed about the wide Atlantic Ocean, chasing from one sighting to another for hours, that these are not professional whales.  These guys are the ones that just happen to be lying about when the boat pulls up.  It’s as if you took your friends visiting from the Midwest into the city by driving for hours in hot, rush-hour traffic in your car with no air conditioning and four broken windows, but when you finally got into the city you decided not to take them to see Les Miserable or The Book of Mormon like you promised, but instead took them to a karaoke bar that was popular with taxi drivers recently emigrated from Eastern Europe.  Lack of stage presence is being kind.  Forget jumping over the boat in an arcing trail of crystalline spray.  No tail pirouettes or lunging jetes, either.  Those are the actions of the elite, highly-talented whales, it seems.  These guys were more circumspect.  More “log-like.”

The cruise was  narrated by a marine biologist with bubbling enthusiasm for all things whale.  This loud, incessant narration was piped over a battery of tinny, scratchy speakers set next to all available seating areas.  Some adjectives used by the marine biologist to describe the whales:  majestic, enormous, magnificent, playful, friendly, endangered.  Adjectives that crossed my mind as I stared at the same whales the biologist was pointing at:  grey, might-be-dead, abandoned-car-ish, and, again, grey.  Dr. Marine Biologist had names for all the regular whales, cute names like Susie and Eddie.  On this exciting cruise, however, two new whale friends were found and needed names, which the good doctor solicited from our ranks.  Sadly, he did not select my recommendations of “Roadkill” and “Old Rubber Boot,” preferring the much less apt “Pete” and “Pauline.”  He also did not invite me to become a volunteer marine biologist, though he seemed to encourage pretty much everyone else on board to do so.

The pedestrian whales such as we encountered were fairly limited in their entertainment skills.  The occasional sneeze, dramatized by the appearance of sneeze vapor wafting across the boat.  Sometimes, they slowly sink.  Every one of them totally ignored the  potato chips I threw their way.  Pretty aloof, actually.  A glaring lack of people skills.  Majestic?  Is a half-submerged Volkswagen beetle majestic?  Then, no.

Next week:  We go to a Mets game.  Woo-hoo!

DRONES ATTACK IN CENTRAL PARK!

We have seen the future:

A1a-1SQ-Quadcopter

Drones Mug Tourists in NYC

“My buddy and I were walking across the park, you know, and two of those drone copter things just came down right in front of us while we’re walking.  You know, those quad-copter things you see on Youtube.  So, we’re just walking but these two copter things keep buzzing right in front of us, so Steve kinda swats at one but it just dances away and gets right back up in our face and says, ‘Hey, asshole, don’t do that.’  Yeah, it called Steve an asshole, which we thought was pretty funny until the things stop right in front of our face and it says, ‘Give over your money and wallets.’  We didn’t even know what it was talking about, but every time we try to get away the things get in our face, you know?  Steve told the thing to fuck off, we’re not giving you anything and then, bam, the copter in front of Steve hits him square in the chest with a TASER!  Yeah, fuckin’ crazy, right?  Steve goes down and is screaming and the drone thing in front of me says I should take his wallet and his money and his phone and put it in the basket thing hanging under the copter that just TASER’d him.  I mean, the things menacing, you know what I mean?  So I did it.  Then I had to give it my phone and shit, too, and then they both just zoomed up over the trees and were gone, man.  Crazy, right?  That’s what the cops said.  They thought we were high.”