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.

Blog Tour: Therin Knite’s Othella

It is a pleasure to host the blog tour of Therin Knite as she promotes her new novel, Othella.
Othella
Book Description:
Georgette:  Pulitzer Prize-winning journalist Georgette McClain can’t resist a juicy tip. So when a rumored crazy ex-CEO gifts her evidence of a vast conspiracy involving the world’s premier scientific community, Arcadian Heights, she sets her sights on the story of a lifetime. And all she has to do to grab it by the reins is sneak into the most secure facility in the world—and expose it for the slaughter house it is.
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Marco:  Tech company CEO Marco Salt has it all. Fame. Fortune. Family. But not long after Marco’s beloved genius daughter is invited to join Arcadian Heights, a rogue agent reveals to him the horrifying truth about the revered scientific community. Forced to flee for his life, Marco finds himself on the run with a deadly secret in his grasp and a single goal in mind: destroy Arcadian Heights.
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Quentin:  Quentin Belmont has been the Arcadian Heights spokesman for the better part of two decades, and his singular motivation is to keep the community safe at all costs. So when an internal incursion leaks vital information to an outside party, Quentin preps a “cleanup” without a second thought. But what at first appears to be a simple task turns out to be anything but, and Quentin comes face to face with the unthinkable—a threat that could annihilate the community.

About the author, Therin Knite:

Therin Knite is a 22-year-old recent college graduate who occasionally writes speculative fiction and has the odd delusion of literary stardom. Knite lives in a humble little place known as the Middle of Nowhere, VA, where she spends most of her days reading books and writing what may possibly qualify as books.

Knite is a graduate of the College of William and Mary and holds a BBA in Finance and English. In August 2014, Knite will begin work as an underwriting analyst at a large insurance company, where she intends to stay for the foreseeable future.

Knite, who’s been writing seriously for seven years, is an avid book reviewer, blogger, and the sort of person who spends far too much time imagining epic sci-fi battles in her head. Knite intends to publish 3 to 4 novels per year, ever year, until she runs out of ideas…which is highly unlikely, so she’ll probably be writing forever.

Finally, Therin Knite has a simple writing philosphy you may want to know before you pick up one of her books:

“50% Dark, 50% Snark”

Purchase the paperback:  http://www.amazon.com/Othella-Arcadian-Heights-Therin-Knite/dp/1499551258/

Purchase the kindle version:  http://www.amazon.com/Othella-Arcadian-Heights-Book-1-ebook/dp/B00L7DCTA8/

Website: http://www.therinknite.com/

Blog: http://knitewrites.com/
Twitter: https://twitter.com/TherinKnite
Goodreads: https://www.goodreads.com/author/show/7760963.Therin_Knite
Amazon Page: http://www.amazon.com/Therin-Knite/e/B00HRL0CXA/
Facebook: https://www.facebook.com/pages/Therin-Knite/663841677010575

I invite you to explore Therin’s excellent blog or try the sample of this new novel available on Amazon.

Best of luck to Therin on her new novel.

Anniversary of a Tragedy

In memory of those lost one year ago today, I reprise my earlier post:

Superman is a Myth

It was a classic Superman moment. A train of seventy-two railroad cars filled with highly flammable liquid was poised precariously on a hill above a sleepy town filled with innocent Canadians. It was dark. There was no driver or attendant to witness that the airbrakes preventing the train from slipping are slowly draining pressure. The train begins to slowly roll downhill, picking up momentum as it ponderously but inevitably begins to roll faster and faster towards the center of town, disaster looming–but wait! Here he comes, streaking out of sky! A red and blue caped blur, a powerful hand braced against the lead locomotive, a grimace and then, with a squeal–all is saved, disaster averted.Minolta DSC

Only it didn’t happen. No Superman. Instead, disaster, death, and destruction. Innocent lives lost. The classic Superman moment, one I had witnessed in comics and onscreen since my wide-eyed youth, went horribly wrong. No Superman.Minolta DSC

At first, I hoped and believed that Superman could not save the day because he was otherwise occupied achieving even greater goodliness, saving even larger populations of threatened innocents. But I checked–it seems that North Korea had not simultaneously launched a nuclear tipped missile aimed at a New York museum at the exact moment that Lois Lane was visiting with her little nephew’s fourth grade class. The only other possible explanation, that Lex Luthor had Superman incapacitated under a geodesic dome made of Kryptonite, was also disproved by a quick Google search. No Superman.

How could it be that Evil had triumphed? How could the sinister forces of darkness and malevolence succeed, unchecked by our heroes? Such a situation is contrary to the workings of a moral universe, would require the balance beam of justice to be bent beyond all reasonable fairness. Not possible; the Fates are not so cruel.

But, hold on a second. Deep investigation reveals no Fates, cruel or otherwise, in the immediate vicinity at the time of the accident. Reviews of salient radar logs show a sky clear of evil, flying monkeys. Overhead satellite imaging clearly indicates that a demonic miasma did not dissolve the critical feedlines to the airbrakes. Not at all. No Evil, either, it seems.

No, upon further investigation it appears that a well-meaning crew of volunteer firemen, responding to a fire on the train, skillfully extinguished the blaze. They did their best, including following the protocol which required them to shut down the engine to the burning train. The engine that provided the pressure necessary to maintain the airbrakes. And then they went home.

No evil. Not even an absence of good intent. But no Superman.

It makes me sad.

My heartfelt sympathy to the families of the victims of the Canadian railway tragedy.

Requiem en pace

The Alternate Reality We Live In

In light of this past week’s incomprehensible ruling by the Supreme Court of the United States, and since I am still intellectually stuttering in my attempts at a reasoned response, I instead present a very old essay that pays tribute to another of our Supreme Court’s auspicious decisions.  Hindsight is easy, I know, so please take this with the sense of irony with which it was conceived.  Have a happy and safe Fourth of July holiday.

BROUGHT TO YOU BY THE THOSE FINE FOLKS AT  THE SUPREME COURT OF THE UNITED STATES OF AMERICA

REALITY  (JANUARY 22, 2001):

“Gee, Dick, is this the first damn meeting in this office?  The tags are still on the chairs.”

“You know, Bill, now that you mention it, I think it is.”

“Well, Dick, I want to just say how great it is to finally have a couple of real Americans running this country.  And Texans, to boot!”

“Not just Texans, Bobby, Texas oil men!”

“Gentlemen, thank you.  And I know you know how much me and George deeply appreciate all you’ve done to make this a reality.  Now you know why you’re all here–our country needs an energy policy, and we’re here to write it.  This is our first and highest priority.”

“We appreciate the opportunity to participate at such an early stage.”

“Hey, Dick.  Since we’re talking about oil–you and George ever notice how Iraq is just about the same size as Texas?”

“Yeah–we could call it East Texas, Dick!  Way East Texas–I think Jeb’s gonna need a new state to run soon.  Term limits, you know.”

“Whoa, whoa.  This would be a prudent time to point out that this meeting is being transcribed and will be subject to discovery under the rules of the Freedom of Information Act.”

“Yeah, Dick.  Like you’d let that happen in this century…”

ALTERNATE REALITY (January 22, 2001):IMG_1114

“Mr. President, I appreciate you seeing me so early on in your Presidency.  I know you’re very busy.”

“I certainly am, Mr. Pickens. My staff tells me you’ve been calling nonstop since I finished my acceptance speech. You’re my token meeting with Big Oil.  Talk fast.”

“Yes, thank you Mr. President.  Please call me Boone.  Mr. President, our country’s highest priority is a new energy policy.  I believe our very survival as a nation will depend on what we do in the next decade.”

“I couldn’t agree more, Boone.  I said as much at my inauguration.  But drilling for more oil all over ANWAR is not the approach this administration is going to take.”

“I’m not here to talk about oil, Mr. President.  I’m here to talk about natural gas.”

“Gas?  I was hoping for something a little more imaginative from you, Boone.  Nothing renewable about gas. At least pretend you listened to my speech.”

“Mr. President, the technology does not yet exist to obtain any meaningful relief from our nation’s energy crisis from renewable resources.  That’s just reality, Mr. President.  What we do have, sir, is a breakthrough in our ability to tap our nation’s reserves of natural gas.  I believe that my plan will make our country independent of foreign sources of oil by 2020.”

“You have a plan?  Do your buddies in Texas know about this plan?”

“Mr. President, I think it would be best not to involve too many oil execs during these early critical months.”

“Hell, couldn’t agree with you more.  Let’s ask the Secretary of Energy to come in and listen to your plan.  I think we can find some extra time in the schedule–I only pencilled you in for five minutes.  Not wind power, huh?”

“Not in our lifetime, Mr. President.”

~~~~~

REALITY (September 12, 2001 AM)

“Bill, you’re my goddamn head of CIA.  How in God’s name could you let this happen?

“I’m sorry, sir.  We screwed up.  We had these guys on the radar.  FBI, too.  We didn’t know they were this close.”

“Close?  There’s a goddam smoking hole in the ground where the Trade Center used to be!  Over three thousand people dead, probably more by the time this is over.  On my watch!”

“Yes, Mr. President.  Let me just say that the CIA feels devastated by this.  I’ve got senior analysts in tears at their desks.  But we are all over this.  Nobody has gone home since this happened. We’re working our assets and configuring our response–”

“That’s just bull and you know it.  After the fact.  Hell, they should be in tears.  They failed.  They let down America.”

“Mr. President, it’s not that simple.  But if that’s how you feel, sir, you will have my resignation on your desk in the next hour.”

“It is that simple and that is how I feel.  But Dick and Karl and I have been talking and now isn’t the time to change horses.  No resignations, not right now–that would just send the message that we screwed up.  No–you stay.  But, Bill, I want a good old-fashioned house cleaning.  I want everybody who failed our country out!”

“Mr. President, it’s not like that.  These people are professionals, they are the best in the world.  I stand by my–”

“House cleaning!  Or I’ll put somebody over CIA who’ll do it.  And Bill–”

“Yes, Mr. President?”

“Don’t go signing any long-term leases in this town, you hear me?”

ALTERNATE REALITY (September 12, 2001 AM)

“What happened, Bill?  We’ve been talking about this coming for over a year.”

“Yes, Mr. President.  We knew.  We knew these guys–we just didn’t know enough.  And CIA didn’t know they were in country.”

“What are you saying?”

“FBI knew they were in the country.  But they didn’t know who they were.  We blew it–we all blew it.  Three thousand dead.  My God.”

“Mueller told me the same thing just now.  My God.”

“It’s not the people, Mr. President.  We’ve got the best.  Mueller’s got the best.  It’s the system–the system failed.  It’s gotta be fixed.”

“Can you do it?”

“I’m not your man–you need a systems guy.  Somebody younger–I’ve got a couple of names.”

“Thank you for not making me  say it.  Mueller’s getting me his letter in the morning.”

“You’ll have mine in the morning as well.  I’m sorry, Mr. President.  We let down the country.”

“I know it wasn’t your fault, Bill.”

“Three thousand people dead–you tell me whose fault it is, Mr. President.”

~~~~~

REALITY (September 12, 2001 PM)

“Gentlemen, America has been attacked.  I know it’s soon, but I want to go around this table and have your thoughts.  Please speak freely.”

“Mr. President, as you say, America has been attacked.  This is our generation’s Pearl Harbor.  We are at war.  We must respond.”

“That’s easy to say.  But at war with who?  How do we respond?  Dick?”

“SecDef is right, Mr. President.  We’ve pussyfooted around this too long and this is the result.  Clinton wouldn’t do it, last time around.  Hell, the last guys who tried to knock down the Trade Towers are eating three squares in San Quentin.  This changes the game.  We take it to the next level–no more police actions, no more trials.  They wanted a war–let’s give it to them.”

“You mean bomb those bases you showed me pictures of?”

“No, Mr. President.  That’s not enough.   That’s what the last administration did. This is a game changer.”

“Yeah–a game changer.  I get that.”

“Mr. President, we need a new policy on terrorism.  The Bush policy–we bring the full force of the world’s most powerful military to bear on any country contributing to terrorism.”

“Dick, that’s half the countries in the Middle East.”

“We know where these guys came from–we hold the state responsible for the actions of its citizens.  Providing safe harbors, that sort of thing.  And we don’t stop there–we take the offensive.  We go after them before they do this again.”

“The Bush policy?”

“Yes, Mr. President.  Pre-emption.  Offense, not defense.”

“There’s still the problem of which state to hold responsible–hell, you told me half these guys were from Saudi Arabia.  You’re not saying we bomb Riyadh, are you?”

“No, Mr. President, not at all.  But there are targets worth considering.  I’d like you listen to Mr. Wolfowitz, from the Pentagon.  I asked him to prepare a short presentation.”

“Thank you, Mr. Vice President.  Mr. President, gentlemen.  While the events we are discussing this morning are truly tragic, I believe we are now presented with the opportunity to directly confront the greatest danger currently facing our country–I am referring to Saddam Hussein and Iraq.  Could I have the lights down, please?”

“Did he say Iraq?”

ALTERNATE REALITY (September 12, 2001 PM)

“Mr. President, the people of the United States demand a response.”

“I know that, Mike.  But I’m the President and I’ll tell you something–this is not Pearl Harbor.  We are not going to treat these guys like the Imperial Empire of Japan.  This was horrible, I know.  But we’re not the first country to be attacked.  I’m going to weigh our options.”

“We have very few options, Mr. President.  I believe it is imperative that we immediately respond with overwhelming force.”

“Where?  Against whom do we respond with overwhelming force?”

“To start, Afghanistan.  We know Bin Laden was behind this.  We know he’s there.”

“So we bomb the whole country?”

“Not just bomb, Mr. President.  It will take a major land force to take out Al Queda.  Not to mention toppling their government–the Taliban have been supporting them all along.”

“Invade Afghanistan?  Are you nuts?  My Secretary of Defense is recommending I recreate the biggest military fiasco of the twentieth century?”

“No sir, I’m just saying…”

“Is that what you’re saying, Joint Chief?”

“Absolutely not, Mr. President.”

“Well, maybe you could share your thoughts, then.”

“As the Secretary said, we know who’s behind this, Mr. President.  We know where they live.  Al Queda isn’t an army–it won’t take an army to take them out.  We know how to do this.  I need additional assets, additional funding–and time.  We’ll take them out, completely and permanently.  But there won’t be any headlines.  It’ll take six months, maybe a year.”

“A year?  The American people won’t wait a year for revenge for yesterday.”

“Revenge, Mr. President?  Revenge I can do in six weeks–very loud, lots of explosions.  It’ll look great on the evening news–shock and awe, the whole works.  But if you want us to really take care of this–six months, at least.  A doubling of funds for special forces.  Creation of a new special forces command, complete international integration–the Israelis, the Brits, the French, the Saudis.  And no headlines–completely dark.”

“Can we sell this, Mike?”

“Your’re the president, Mr. President.  You tell me.”

~~~~~

REALITY (August 25, 2005)

“Mr. President, I’m sorry, I know you’re very busy.”

“Not at all.  Just getting ready to head to the ranch for a couple weeks of R and R, you know.  Gawd, I hate this town in the summer.  Feels like we’re living in a swamp.”

“Yes it does, Mr. President.  I wanted to just quickly mention one thing.  I’ve got a guy over at the National Weather Center who’s called about a hundred times about this hurricane in the gulf.  He’s bending everybody’s ear about a real disaster scenario.”

“Really?  Did you know about this, Karl?  Does this mean the weather’s gonna suck down in Texas?”

“Yes, Mr. President, I heard about it.  He’s called about every department in the government.  He thinks New Orleans could be hit hard.  It’s just one possibility–he’s a weatherman.  Twenty percent probability sort of thing.

“What do you think, Karl?  Get a task force together like we did in Texas?  Let’s get FEMA on it–who is FEMA, anyway, Karl?

“Michael Brown, Mr. President.”

“You’re kidding!  Brownie?  That Michael Brown?  Couldn’t find his office for the first six weeks when he was head of the racing commission?  Head of FEMA?  You have got to be kidding.”

“No Mr. President.”

“Karl, this is bad.  You’ve got to get Brownie some help.  Hell, he probably couldn’t find New Orleans on a map.  Put together an emergency task force, mobilize the Guard.  Let’s get on this!”

“Of course, Mr. President.  But could we discuss some of the other aspects of this, Mr. President?”

“Other aspects?  Karl, it’s a hurricane.  We’ve seen our share while I was governor.  We know how to do this.”

“This isn’t Austin, Mr. President.  There are bigger ramifications to how we handle this.  A big difference between state and federal authority.  This is a problem to be handled at the state level.  If we go charging up at the federal level, what kind of message does that send?

“Your losing me, Karl.  The man said this could be really bad for New Orleans.  What if they can’t handle this at their level?”

“Of course, Mr. President.  But we’re talking only possibilities.  Nothing’s definite.  Do we want to send a message that the federal government is willing to charge in, take care of all your problems?  That’s not us, Mr. President.  Remember, smaller government.  Compassionate conservatism.  Responsibility to the states.   Let’s see how this plays out.  If things look bad, we can always have Brownie come to the rescue.”

“Gee, Karl, you’re always seeing the political side.  It’s just a hurricane, for crissakes.”

“That’s what you pay me for, Mr. President.”

ALTERNATE REALITY (August 25, 2005)

“Mr. President, one more thing.”

“If I had a buck for every time somebody said that…”

“Yes, Mr. President.  It seems the Chief Meteorologist at the National Weather Service is having a conniption over this storm in the Gulf.  He’s called everybody with a phone, telling  a doom and gloom scenario about New Orleans.”

“When?  I haven’t heard about this.  What’s he saying?

“Evidently, this guy’s an authority on New Orleans.  He says there’s about a twenty percent chance that this is the big one–broken levees, massive flooding, hundreds of thousands homeless.”

“Holy cow!  When?  How come I’m just hearing about this now?”

“It’s not definite, Mr. President, just a possibility.  Nobody really thinks it’s gonna happen.”

“You don’t think so?  This is just the kind of thing I’ve been talking about for twenty years, dammit.  This is global warming taking a swing at us.”

“I’m sorry, sir, you’re losing me.  Global what?”

“Are you kidding me?  You’re my Chief of Staff?  What are you doing about this?”

“Well, nothing yet, sir.  I wanted to get your take on how you’d like to proceed.  As I see it, there are two approaches.  Traditionally, this sort of thing falls to the states.  We could let them handle it.”

“Have you ever been to Louisiana, Elliot?”

“Uh, no sir.”

“What’s your other approach?”

“Well, just the opposite, I guess.  Full court press.  Activate FEMA, call out the Guard.  Though, of course, we’d have to do that in cooperation with the governor and all.  Don’t want to offend–”

“Offend?  Don’t you think the sight of a few hundred bloated bodies floating in the bayou on the six o’clock news might offend?  Listen, Elliot.  This is what you’re going to do–who’s at FEMA, anyway?”

“Actually, I don’t know, sir.”

“Oh for crissakes!  Remind me to look for a new Chief of Staff.  Find FEMA and light a fire under his ass.  I want bigger than full court press–you put together a damn federal emergency task force.  I’m talking the army, not just the reserves.  Put somebody you know in charge–don’t screw this up.  Get a general, somebody in uniform.  I want helicopters and those big Starlifters we use when there’s a disaster in Somalia or whatever.  If we can send them to India every time there’s a goddam monsoon, we can sure as shit send them to Louisiana.  Use less gas, too.  And I want press notified–get them on this hard.”

“But, Mr. President–he’s a weatherman.  What if he’s wrong?”

“Then we’ll call it a damn training exercise for when the big one really does come.  You’re kidding about not knowing about global warming, right?  And Elliot–”

“Yes, Mr. President?”

“If this guy’s right, I’m gonna give him a medal in the Rose Garden.”

END

Anesthesia is Hard-3

The Subtle Science of Sedation

As a general sugeon trained in a specific era and at a particular type of academic institution, I was taught that I should be able to do everybody’s job in the hospital just a little better than the folks whose job it was to do just that thing full time and to the exclusion of everything else after spending many years learning to do just that stuff.  It was believed that in this manner, we could protect our vulnerable, recovering patients from all the other doctors and health care professionals who didn’t care as much about the patient as we did.  With the foregoing mindset, I launched upon a two month rotation on the anesthesia service of a very large, very academic medical center.  One can easily foresee that this was not to go very well.  Not well at all.  Anesthesia practice is predicated on a team approach, an “all-for-one,” “we’re all in this together for the good of the patient,” approach. If an anesthesiolgist (or anesthetist) is having difficulty with an intubation or the patient takes a sudden turn, he or she is trained to immediately seek the assistance of a colleague.  Ego is put aside for the good of the patient.   I was trained to take a different approach.Top Gun

For reasons that still elude me to this day, during this anesthesia rotation I was permitted to manage patients with an extraordinary degree of independence.  This may have something to do with the fact that I had no official supervisor.  I fell through the cracks, in a way, and the result was that I managed the anesthetic of quite a number of patients with a degree of independence not even given to anesthesia residents until their last year of training.  The physicians directing me thought that everything would be okay if they just assigned me the simplest, most straight-forward cases.  Interesting point, though, is that there is no such thing as an easy case for the truly incompetent.

Many cases come to mind.  It should be noted that I did this anesthesia rotation during a time period and in an institution that held the technique of regional anesthesia in very high regard.  That is, every case was approached with the attitude of “Why not use a spinal?”  So I did a lot of spinal anesthesia.  I got, I thought, very good at spinal anesthesia.  I could place a spinal in a couple of minutes on patients of every age and body type.  I was instructed in various approaches and was fairly skilled at several of them.  Wherein lies the problem.  The technique of anesthesia is not difficult to master, it is the practice.  As a surgeon in training, learning technique was what I did.  I didn’t have a clue about anesthesia practice, however.

On one Monday morning, I was assigned to provide anesthesia to a patient undergoing an open knee procedure to be performed by the Chairman of Orthopedics.  It should be noted that the Chairman of Orthopedic Surgery was equivalent to Tutenkamen of ancient Egypt.  He was easily the institutional equivalent of The Chaiman of Thoracic Surgery (see “Mommas, Don’t Let Your Babies Grow Up to be Surgeons”), but more powerful.  Therefore, this assignment surprised me.  I had been on the anesthesia service for several weeks and was looking good. (Definition of looking good:  Nobody knew who I was.  That is, I hadn’t been noticed at all since I hadn’t killed anyone yet.  Close, but no permanent loss of life.)  Even so, this was a plum case, usually assigned to a senior anesthesia resident.  But the seniors were all away at conference and the administrative anesthesiologist had no idea who I was, he just knew that I wasn’t a junior anesthesia resident and assumed I, therefore, must be the guy.  I shrugged and trundled off to see the patient.  He turned out to be a twenty year old football player who had blown out his knee in practice.  Nice guy. Very large.  Muscular.   I introduced myself, did my preop assessment, and informed him that I’d be giving him a spinal anesthetic, of course, since I gave everybody a spinal anesthetic.  The patient was fine with this.

Placement of the spinal went great.  It always did, I was pretty good at it.  I got the patient comfortably positioned on the OR table and started in on my hypnotic “You are getting sleepy” dialogue with the young patient as I began to infuse a little hypnotic potion in his IV.  Again, this was the eighties, when about the only IV drug for this sort of thing was Valium, a drug which was notorious for its great variability in effect when given IV, particularly on young, anxious individuals.  Like football players undergoing sugery.  I checked the efficacy of my spinal anesthetic and was pleased to note that I had achieved a unilateral (one sided) block to a level of about the groin.  It was even on the side to be operated on.  Perfect.  I was proud of myself.  I had dosed the spinal for a duration of two hours, as the Chief Orthopedic resident doing the case with the Chairman of Orthopedic Surgery told me the case would take “about an hour, hour and a half, tops.”  I gave the patient a little more Valium in the IV and murmured sweet nothings in his ear.  He was asleep.  All good, I started my charting.

I turned away from my charting when the patient asked what was going on.  I was annoyed, as the patient had been nicely sedated and asleep.  Nothing should be going on.  I looked over the screen to see the Chief Ortho resident putting a pneumatic tourniquet high on the thigh of my patient.  “Hey,” I said.  “You’re operating on his knee.”  The ortho resident smiled at this information.  “Orthopods hate blood,” was his response.  This was a little problem.  A pneumatic tourniquet inflated to twice my patient’s blood pressure did not feel good.  While it was within the region of my block, it was much closer than I had anticipated.  I dialed the OR table to trendelenburg (head down) position, hoping that I could get the local anesthetic bathing the patient’s spinal cord to drift a little more upstream, giving him a higher level of numbness.  This only works for a few minutes after the spinal was placed, however, so I wasn’t feeling terribly confident at this point.  And I couldn’t recheck the level of anesthesia, because now the nurse was starting to prep the patient’s leg with antibacterial solution.  Just to be safe, I elected to give the patient more Valium.  And some intravenous morphine, too.  Just in case.  Back to charting as the patient began to snore.

The case began uneventfully.  The patient snored peacefully through the initial incision and exposure, my spinal having achieved a nice, dense block.  The chief ortho resident, like all chief ortho residents at institutions of great learning such as this one, was brilliant and highly skilled.  I watched over the sterile drapes as the chief resident put down his instruments and started to do nothing.

“I’m pretty sure you’re supposed to fix it, too.  That’s what it said on the consent, you know,” I said to the ortho chief.  Ortho chief smiled at me.  “Gotta wait for The Big Man.  That’s his job,” ortho chief replied.  I looked at my watch.  One hour into the case.  I looked at the upside down face of my linebacker patient.  He was smiling through a nice, drug-induced dream.  I shrugged and went back to charting.  Half an hour later, the Chairman of Orthopedic Surgery had still not arrived.  “Call him,”  I told the ortho chief resident.  “Yeah, right,” was his response.  “How long once he gets here?” I asked, looking at my watch.  ‘Hour and a half, tops, the guy had said. I began thinking that I might have to switch to a general anesthetic if this went on too long.  For that, I would have to call in my attending to let him know what I was doing.  That would be embarrassing.  I existed on the technique of staying inconspicuous.  If I called in my attending, I would have to explain that I had miscalculated the dose on the spinal.  Embarrassing.  “Once he gets here?  Not long,” ortho resident said.  He went back to doing nothing.  My patient chortled.

Chairman of Orthopedic Surgery swept into the room ten minutes later.  Finally, I thought.  I checked the patient.  He seemed comfortable, though his heart rate was up a bit.  More Valium.  A touch more narcotic.  I looked over the drapes.  Chairman of Orthopedic Surgery was still not scrubbed in.  “Where’d he go?” I asked.  Ortho resident shrugged.  Ten minutes later, Chairman of Orthopedic Surgery, gray haired and dashingly handsome, re-entered the OR, hands held up and dripping.  “Let’s get this man back on the field!” he boomed.  “Go Yellow!”  I rolled my eyes.  Finally, I murmured under my breath.

“It hurts,” my patient said.  I looked down.  His eyes were open.  “My leg hurts,” he said.  I looked over the screen.  Chairman of Orthopedic Surgery was finally thinking about maybe doing some surgery.  I looked at my watch.  Ninety minutes of tourniquet time.  Ouch.  “No problem,” I told the patient.  I infused narcotics. More Valium.  His eyes closed.  This was going to be close.  “Not long once he gets here,” the resident had said.  Just in case, I started drawing up drugs for a general anesthetic.  Just in case.

The patient murmured something unintelligible.  His heart rate was up.  His eyes were closed.  “What did you say?” I asked softly, mouth close to his ear.  “Fucking son-of-a-bitch,” he murmured softly.  Oh, that’s what you said. I gave more Valium.  I looked over the drape.  Chairman of Orthopedic Surgery was chatting up the scrub nurse as he slowly repaired linebacker ligaments.  I made a hurry-up gesture to ortho resident.  He smiled and shrugged sheepishly.

That’s it, I thought.  Embarrassing or not, I better call my attending and switch to general anesthesia.  It wasn’t my fault that the Chairman of Orthopedic Surgery was a molasses-slow, late-arriving horse’s ass.  We were over two hours on my spinal.  No way I had any anesthetic left at the level of the tourniquet.  We were on borrowed time.  I started to turn around to use the phone to call in my attending.

Now every anesthesiologist (and anesthetist, okay?) knows that there is a perfect plane of sedation that you don’t ever want your patient to achieve.  It is that level of sedation where the patient is confused and completely disinhibited, but not asleep.  If this were Top Gun, and I was a taller version of Tom Cruise, the Maverick of brash anesthesiologists in training, it is at this exact moment that the soundtrack switches to a very loud rendition of “Danger Zone.”  As I dialed the phone with my back to my patient, I heard the sound of Velcro arm restraints being ripped in two.  Then I heard my patient say, very loudly, “FUCKING SON OF A BITCH.”  I turned back to see my very large, linebacker patient sitting bolt upright on the OR table.  He had ripped down the drapes between us and the operating field.  The patient stared at his open knee.  He repeated “FUCKING SON OF A BITCH.”  The Chairman of Orthopedic Surgery, the ortho chief resident, the scrub nurse, and the medical student hoping to some day become an orthopedic surgeon, all stared back at the patient, incredulous.  In the words which would later be stolen by Goose in that classic movie, I said, “This is not good.”

I grabbed the full syringe of Surital that I had just drawn up in anticipation of having to induce general anesthesia.  A “stick” of Surital, a short-acting barbiturate, was our general anesthetic induction of choice in those days.  I rapidly pushed the whole stick into the patient’s IV.  He flopped back with a thud onto his pillow, deeply unconcious.  I readjusted the sterile drapes to once again separate my world from the sterile operating field.  I infused a muscle relaxant into the patient’s IV and proceeded to intubate the patient and connect him to the ventilator.  There was complete silence in the OR.

The Chairman of Orthopedic Surgery broke the silence.  “What the FUCK was that?” he asked.  I returned to charting my new anesthetic technique.  Not a good time to call my attending just yet.  “You there,” the Chairman of Orthopedic Surgery bellowed.  “Behind the drapes!”  I stood up.  “Yes, sir?”  “What the FUCK was that?” he repeated.  “What?”  I asked.  He looked at me, astonished.  “What?  What, what?  That!”  he said, pointing at me, then down at the patient.  “Not sure what you mean,” I said.  The Chairman of Orthopedic Surgery looked around at the others scrubbed at the OR table.  “Didn’t you guys see that?” he asked.  Ortho resident shrugged.  Med student nodded.  Scrub nurse chose to straighten the instruments on her back table.  This just made the Chairman of Orthopedic Surgery a bit more pissed off.  He strode over to the wall and mashed the bright red code blue button on the wall with his bloody, gloved hand.  No less than five attending anesthesiologists came crashing through the door.

“WHAT?”  “What’s going on?”  “What’s wrong?”  “Is it a code?”  “Aarhgh?”  They each said, surrounding me.  I shrugged and pointed to the Chairman of Orthopedic Surgery.  Two nurses rolled the code cart into the room.  More anesthesia attendings and residents entered.  Everyone looked around.  Everything looked okay.  The patient was asleep, under anesthesia.  The ventilator sighed assuringly.  The monitors beeped happily.  I reapplied the Velcro arm restraints and said nothing.  The anesthesia attendings turned to the Chairman of Orthopedic Surgery.  “What’s wrong?” the senior anesthesia attending, my attending, asked him.  The Chairman of Orthopedic Surgery stammered, “The patient, he was awake, he screamed at me, he called me a fucking son-of-a-bitch!”  The anesthesia attendings all turned to me.  “I had to switch to a general.  The tourniquet time is over two hours.”  I raised my eyebrows significantly and rolled my eyes toward the Chairman of Orthopedic Surgery.  “We had to wait over a half hour for What’s His Name, here.”  The Chairman of Orthopedic Surgery began to turn bright red.  “Do you know who I am?” he seethed at me.  I shrugged.  Went back to charting.  My attending stepped over and began to assess the patient.  Everyone else drifted out, shaking their heads.  The code cart was withdrawn.  My attending went over my anesthesia record, which was perfect, by he way.  I loved charting.  It made everything look so neat.

The Chairman of Orthopedic Surgery was still seething, arms crossed.  “Well?” he demanded of my attending.  My attending straightened up from the chart and looked at the Chairman of Orthopedic Surgery.  “You’re pretty long on the tourniquet, Bill.  Maybe you should try to finish up?” my attending said.

“That’s it?” the Chairman of Orthopedic Surgery asked.  “That’s all you’re going to say?”

“Yeah,” my attending said.  “And now I’m leaving.”  He turned to me before he left.  “Give me a call if you need a break, Geller.”  He winked at me.

 

 

No country for young women: Honour crimes and infanticide in Ireland

While I do not agree with every point made by this author, she certainly brings a more cogent viewpoint to this most recent horrific discovery than has been presented in the press to date.

Feminist Ire

magdalene

When I was in first year in secondary school in 1997, a girl in the year above me was pregnant. She was 14. The only people who I ever heard say anything negative about her were a group of older girls who wore their tiny feet “pro-life” pins on their uniforms with pride. They slagged her behind her back, and said she would be a bad mother. They positioned themselves as the morally superior ones who cared for the baby, but not the unmarried mother. They are the remnants of an Ireland, a quasi-clerical fascist state, that we’d like to believe is in the past, but still lingers on.

The news broke last week of a septic tank filled with the remains of 796 children and babies in Galway. The remains were accumulated from the years 1925 to 1961 and a common cause of death was malnutrition and preventable disease…

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Anti-Homeless Spikes. What the actual fuck?

As usual, the Brits are a step ahead of us. Here’s to not following them down this road.

Thought Scratchings

homelessspikes

I wasn’t going to comment on this, because I thought, it’s obviously horrible.  I thought no human could possibly convince themselves that putting spikes beneath other human beings is an act of mercy. I thought not even the most cold-hearted intellectuals (you know, the ones with hooks for faces, and scars that run across their souls) could see spikes on the ground, and reach the conclusion that they are for the benefit of the homeless.

I was wrong.

There are some in this wonderful world of the armchair genius who believe that putting spikes under the mentally ill is a good thing. They think that if people can’t sleep where they usually do, they will be encouraged to stop sleeping rough. Like, it’s a choice. Imagine Homeless Doug. Doug often sleeps in doorway 34. Doorway 34 isn’t much. But it’s all Doug has. One night Doug returns to…

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(CRNA)nesthesia isn’t Easy-2

Sunday at the VA edition

[N.B.:  As our troubled VA system is currently in the news, I should say that this post makes reference to a very bygone era, by which I mean the Eighties.  The conditions described herein in no way reflect the status of our modern VA system.  I’m sure.  I hope.]

Not surprisingly, it took less than 48 hours after posting “Anesthesia isn’t Easy-1” before I heard from my nurse anesthetist friends.  And a few other anesthetists.  Quite a few, actually.  Unfortunately, the awkwardness of our medical lexicon precluded the appropriate repeated reference to our anesthetist colleagues (how many times can I write “anesthesiologist/anesthetist” in a 500 word blog post before even I stop reading the thing?).  It goes without saying (since it seems I didn’t say it) that pretty much everything I wrote in AIE-1 applies to our CRNA brethren.  There, I said it.Tinc of Cocaine

As I mentioned in that last post, a doctor’s early training is formative in many, many ways.  In my own experience, I came to love CRNA’s in general (and one in particular) during the second year of my general surgical residency. No, not the CRNA my future wife kept trying to fix me up with so that I’d quit asking her out. Different CRNA.

I was doing a rotation at the enormous VA Medical Center associated with my residency.  This was an institution that could easily serve as a setting for Game of Thrones or, maybe more appropriately, The Desolation of Smaug.  Built in medieval times, this fortress hospital was over a thousand beds and could be seen from space. It was somewhat past its prime.  By about a half century.  Many dusty corners, so to speak.  Actually, entire haunted wards.  Scary.  Dark.  Huge.  On one occasion I remember, when we sent a medical student to go find the patient who was using the central venous catheter so that we could clean it off and use it on another, really sick patient, the student got so lost we didn’t see him for almost a week.  We had to send a posse to a neighboring VA hospital for the catheter, I think.

Despite the incredible hugeness of the facility, it possessed an Emergency Room about the size of a broom closet.  This was specifically designed, I believe, to discourage our veteran  patients from considering the VA hospital as a potential site for emergency care. Which was an especially good thing, since despite the overwhelming hugeness of the facility, there was only one junior surgical resident on call in house on weekends. For all surgical specialties.  All of them.

Surgery call was especially exhausting due to the ridiculous policy that the surgery resident was required to respond to all Code Blue calls throughout the hospital, specifically because there were no respiratory therapists or anesthesia personnel in house.   So the surgery resident was required to do all intubations (establishing emergency airways in patients).  This was particularly problematic since many (most) junior surgery residents pretty much suck at intubations.  And since nobody else on the code team could do anything until the patient was intubated, some codes were very, very brief.  And even though over half of the wards had been closed down, there was no consolidation of the active wards.  Patients were scattered through two towers of a dozen stories each, with an elevator system dating back to the Civil War.  Any attempt to wait for the one functioning elevator car and you’d invariably arrive in time to pronounce the patient dead.  And since this was the VA hospital, it wasn’t unusual for there to be two or three codes in an hour, at any time of day or night. We were all in great shape as a result.  The original stairmasters.

One time as a second year resident,I found myself on call, alone, on a sunny Sunday afternoon.  I was running around doing all the scut work that we had to do in those days, drawing arterial gases on the ICU patients, admitting the preop patients who would have surgery during the coming week, that sort of thing.  The sort of thing that could easily keep four or five junior residents too busy to eat or sit down.  I was doing pretty well, thanking my lucky stars that there miraculously hadn’t been any codes to interrupt my work, when I simultaneously heard myself stat paged overhead and my beeper went berserk.  I didn’t recognize the number.  Which turned out to be the ER.  “We have an ER?” I asked the frantic nurse on the other end of the phone.  “Get down here STAT!”  was her reply.

I had to ask a janitor where the ER was, but I got there.  When I arrived, I saw an elderly internist/ED doctor and several nurses crammed into the tiny space around the one stretcher.  Sitting up on the stretcher was the largest vet I had ever seen.  Easily over 400 pounds and like six six, he was hunched over and breathing really, really fast.  He was also making a sound that no person should be making–a high-pitched crowing sound called stridor.  This, I remember thinking, is not good.  “Thank god you’re here,” the ancient internist said, turning to me.  Nobody had ever said anything like that to me before.  “Not really,” I remember thinking.  “His dentist sent him over,” the internist continued over the loud crowing sound of the man struggling to breathe.  “Really?” I said, trying to sound calm.  “His dentist?”  “Yes, yes,” the internist continued, pulling me up to the stretcher in an effort to get me to take charge.  “He thinks he might have Ludwig’s angina.”  I nodded sagely.  “Could be.  He might.”  No idea what Ludwig’s angina might be.  Looked bad, though. “What would you like me to do?  He need a line?” I asked.  I was really good at starting IV’s.  “No, no,” the internist said, gobsmacked.  “He’s got an IV.  You need to take care of his airway.  Right now!  Or he’s gonna die!”  Oh.  I remember the patient following this conversation with great concern.  I think he felt pretty much as the internist did.  “Of course,” I said, reassuringly.  “I’ll be right back.”   Then I ran away as the internist asked where I was going.

I ran to the OR.  There was no chance that I was going to be able to intubate this guy, of this I was sure.  Besides the fact that the man was huge, panic-stricken, and had an airway that was swollen almost completely shut–I sucked at intubation.  Just ask my last three code patients.  Except you can’t, because they’re dead.  The only hope was to grab an emergency tracheostomy tray so that when the guy was unconscious from hypoxia and not quite dead, I might be able to do an emergency trach.  About one chance in a million, give or take.  Still better odds than me successfully intubating the guy awake in that ER.

I slid around the corner into the OR and stopped dead in my tracks.  Usually, the OR would be dark and empty on a Sunday afternoon.  But the lights were on.  I ran into the anesthesia office and saw two huge shoes on the desk.  Tiny Ted was asleep in the chair.  Ted was the Chief and only CRNA at the hospital.  Actually, he was the entire anesthesia department, functionally speaking.  A grizzled bear of a man in his late forties, Tiny Ted was pretty much the only person interested in actually administering anesthesia to our patients.  The anesthesiologists in the department specialized in explaining why our patients couldn’t have surgery.  If you really wanted to operate on someone, you got Ted.  He was good natured, always wanted to work, and was supremely capable.   “Ted!” I yelled at him, shaking him awake.  “What are you doing here?”  “Stocking the drawers, getting ready for tomorrow,” Ted said, coming awake.  “And staying away from my wife.  Why?  You look like you’re about to piss in your pants, Geller.  What’s up?”  I explained about the patient with Ludwig’s angina.  “Nasty,” he commented, rubbing his stubbled chins.  “Let me guess, Geller–you came here to grab a tray so you can do a slash trach down in the ER?”  I nodded sheepishly.  “Why don’t you just shoot him in the head?  Be more humane, less messy.  Less likely to kill him, too.  I heard about your last trach, Geller.”  {see “Equinimity“} He let me squirm for a minute before slapping me hard on the back.  “Get your patient up here and set up a room for a trach.  I’ll give you a hand.”  “Thanks, Ted,” I said, relieved.  “Where are you going?” I asked.  “Get some coke,” he said, leaving.  “You’re thirsty?” I asked.  “Not that kind of coke, Geller.”  Oh, I thought.  Maybe I caught Ted at a bad time.

With the help of two orderlies, I got the patient lying semi-reclined on an operating room table.    I had set up my instruments and a scalpel, which the patient was staring at fixedly.  He was also breathing about forty times a minute and his stridor was even higher pitched than before.  He looked about twice the size of Ted, and Tiny Ted was a rather big man.  That’s why we called him Tiny Ted.  Also, I noticed at this point, the patient had the interesting anatomic feature of having no visible neck.  His head apparently sat directly upon his chest.  Great.  “This here,” Ted said, interrupting my rising sense of panic, “is the entire stock of cocaine in this institution.”  He held up an impressively large vial labelled 4% Tincture of Cocaine.  “Can we talk about that later, after this?” I asked him.  I really needed Ted’s help.  “This is what’s going to happen,” Ted continued, ignoring my comment.  “I am going to take one shot at intubating our friend here.  Exactly one shot, period, amigo.  If I can’t tube him, it’s your turn.”  He stared at me.  The patient stared at me.

I nodded solemnly.  “And then he’ll die a horrible, bloody death,” I thought to myself.

“And then he’ll die a horrible, bloody death,” I heard out loud.  I thought somehow my thoughts had become audible.  But no, it was just Tiny Ted saying what we were both thinking at that point.  The patient appeared somewhat more distressed at this.  “Don’t worry,” Ted said brightly to him, “you’re going to do fine.”

“Probably not,” I thought.  “Just kidding,” Ted said.  “But I’ve got cocaine.  You ever do coke?” he asked the patient.  The patient barely managed to shake his head, being pretty much fully occupied with struggling to draw his last breaths through an airway about the width of a swizzle stick.  “You’re going to be fine,” Ted said again.  Tiny Ted, the master of mixed messages.

At this point, I took up my position over the patient with a #10 scapel in (trembling) hand.  Ted lowered the head of the OR table as the patient’s eyes, now big as saucers, never left mine.  Ted began a complex ritual of spraying cocaine into the patient.  This was accompanied by a soothing Hindu prayer chant, intermixed with an off-key rendition of Tupac’s “God Bless the Dead.”  (Actually, I made that last part up as a shameless, subliminal pitch for my first novel.  He actually was tunelessly singing “White Lines (Don’t Do It)” by Grandmaster Melle Mel.)  After something intravenous, Ted began a process of inserting a series of cocaine soaked cotton tipped applicators deeper and deeper into the patient’s nose.  Eventually he had about four sticking out of each nostril.  The patient seemed happier.

“Here goes nothin’,” Tiny Ted announced as he dramatically took endotracheal tube in hand and waved it over the patient’s face.  The patient had his eyes closed.  Seemed like a good idea, so I closed mine and silently promised God all sorts of stuff if He didn’t make me cut open this man’s throat.  A chocolate ice cream sundae, if the occasion arose.  And other stuff, too. Like learning to intubate better.

“Done,” Ted announced.  I opened my eyes.  There was a tube sticking out of the patient’s nose.  The stridor had stopped, replaced by the sound of easy, ventilator-assisted breathing. Ted was busy pushing enough muscle relaxant through the IV to put down an elephant for a month.  “This should keep him from pulling the tube out until I get of here.  After that, he’s your problem, Geller.”  I nodded and put away my scapel.  I could have hugged him, but it would’ve been awkward.

“Thanks, Ted.”

“No problem, Geller.”

 

 

Anesthesia isn’t Easy-1

The Michael Jackson Edition

A doctor’s formative years are often telling.  If during the first year of medical school you fall in love with gross anatomy, you really have no choice but to pursue a career in surgery. After spending a year exploring the new and fascinating territory that is your personal cadaver, dissecting along tissue planes formed or nerves stretched as an embryo, some of us just can’t see putting it all aside.  Very soon, one realizes that the only physicians that need to know much about anatomy are surgeons and gynecologists.  Everyone else is pretty much practicing applied pharmacology.  Doesn’t matter where the iliopsoas muscle lives or if it’s your hypogastric plexus that’s pathetically paretic–write the script and see if the patient is better in a couple of weeks. If you love anatomy, if you pine for those early mornings smelling the formaldehyde perfume of your best dead friend, you’re going to be a surgeon.images

Similarly, anesthesiologists are practicing practical physiologists.  In the physiology lab, the subject (woof!) is attached to an array of monitors as the recently pubescent physician infuses various pharmacologic agents or inhaled mixtures of oxygen plus whatever.  Agent X goes in the vein, the heart rate goes up and the blood pressure goes down.  Reverse the effect with agent Y.  See what happens when you add a dash of inhaled agent Z.  At the end of the lab, give the happy subject a treat.  Seven years later, anesthesiologists are expertly doing the same thing to people.  Except for the treats.

During the formative years of every physician, but anesthesiologists in particular, one learns a great deal of respect for people physiology.  People are predictable, but not perfectly so.  We are men, or women, or children–not machines.  Herein lies the challenge.  Almost every time you give the patient your dependable drug, he responds as expected.  Almost every time.  It’s that “almost” that challenges every anesthesiologist.  The occasional patient that responds not quite as expected, a little too emphatically or a bit reluctantly.  Adjustments are titrated on the fly.  The rare, but really exciting, individual that displays a completely inappropriate response, such as anaphylaxis.  It is for this reason, this subtlety, that anesthesiologists are carefully trained, not born.  Like the practice of surgery, it is not a skill that can be mastered by reading the textbook, even if you’re really smart.  The really smart/experienced anesthesiologists know this especially well.  Then throw in the fact that the patient is having the trauma of surgery that the anesthesiologist must compensate for.  Some surgical procedures are more easily compensated for than others.  Some surgeons are more easily compensated for (see earlier blog post Never Say Oops in the OR“).

The practice of anesthesiology, however, suffers from one towering challenge above all; a challenge unique among all physicians.  Anesthesiologists must be perfect.  It’s a problem.  No other physician is held to such a high standard.  If you come to your surgeon with a tumor blocking your bowel, rest assured that he or she is going to do everything in his/her power to extirpate the neoplasm and restore your comfortable continuing existence.  But there will be pain.  And a scar or two.  Perhaps you’ll have some hiccup in your ability to digest really deep dish pizza from now on, but you’re happy to be alive.  Same with every other field of medicine–except anesthesia.  The practice of an anesthesiologist is to take a perfectly mentating person and put him into a profound coma.  But just for a while, then magically reverse that comatose state and restore the patient immediately to complete normalcy, preferably without any trace of the experience, not even nausea or a missing molar.  No fair if the patient is just about the same as before he had the life-saving procedure; say, he can remember almost everybody from his high school graduating class but has a slight problem coming up with the name of that girl he married.  Not good enough.  The patient must awaken happy, comfortable–normal.  Best case scenario, the patient emerges from anesthesia by completing the punch line to the joke he was reciting at the time of anesthetic induction three hours ago.  Extra points for an exceptionally satisfying dream during the procedure.  Nothing less than a perfect return to the pre-anesthetized state is acceptable.

As one can imagine, this can, at times, be a bit of a challenge.  Consider the inconvenient fact that nobody who’s normal lays down on an operating table.  Patients are sick, many very ill, some with years of undiagnosed/uncared-for illnesses now being subjected to the significant stress of an operation.  The most stressful thing this patient experienced in the previous ten years may have been lifting the television remote control.  Occasionally, the patient is horribly, critically ill.  Doesn’t matter–the anesthetic must be perfect, and certainly not the cause of even the sickest patient’s demise.  The surgery is allowed to kill him, but not the anesthetic.

So if you’ve ever had an operation, and you didn’t spend the entire time screaming, and you woke up pretty much thinking like your self thought before that whole operation thing: Thank your anesthesiologist.  Send him a card.  Or actually pay the bill.  Whatever.  Just don’t try it at home.

Dog’s Got an Attitude

Bob Barker, the Tibetan Terrier who sublets from us, is giving me a bit of an attitude.  My fault, actually.  I left the Times out on the coffee table where he can see it from his side of the couch.  Unfortunately, the Sunday Magazine was on top, the one from last weekend with the cover story about the lawyer suing in NY Supreme Court to grant “personhood” to NY chimpanzees.  No way the dog was going to let that go unremarked upon.  Turns out, worst luck of all, that two of the chimps in question actually live in our little town here on Long Island, at the University.  What are the chances?  So, of course, this initiates a very uncomfortable discussion, which leads to raised voices, considerable barking–you know where this is headed.photo

I can’t claim that I didn’t see this coming, mind you.  The dog has a pretty high opinion of himself.  Not at all like our last dog, Mack (may he rest in peace).  Mack was a Wheaton Terrier, a terribly bright but completely psychotic houseguest that had the unfortunate habit of launching himself through screen doors if anything moved within 500 yards of our property.  Pretty high strung.  If you’ve ever met a Wheaton, you know what I’m referring to.  When excited (which is constantly), they have this amazing ability to jump straight up in the air to approximately eye level.  Rather unnerving in a forty pound animal with teeth. In twelve years of living with us, the dog never slept.  Wheatons do  become somewhat more mellow with age; which is to say, they settle down about two weeks after they’re dead.

Bob is not nearly as excitable.  Being a Tibetan Terrier, he is much more spiritual than most dogs.  He is always going on about the fact that Tibetan Terriers are not really terriers at all, but were misclassified by some English dog slaver that kidnapped his forebears from their homeland in Tibet, where they were originally bred (he always says “formed,” a la the training of a Jesuit priest) by the Dali Lama himself.  You know how most dogs (every other dog, really) can’t wait to be let outside in the morning so they can run around and relieve themselves?  Not Bob Barker.  This dog must be aroused from slumber each morning and enticed to take the morning air.  Upon finally sauntering outside, he assumes a Yoga pose on the porch, stretching and turning his muzzle to the sun, eyes closed and doing some kind of deep breathing exercise for about twenty minutes.  He may or may not empty his bladder, depending upon the scents he detects swirling in the morning drafts and his overall karma.  When called, he tilts his head and stares at me, but he doesn’t return, instead exhibiting a look of disdain for a moment before trotting off again to roll about in a patch of sunshine.  He is a very strange dog.

Which would be okay.  I wouldn’t begrudge the dog his nearly burning down the house with his incense burning every night, or finding him just staring into the refrigerator at 3 am, then leaving the fridge door open after finally deciding to steal the last beer I’ve hidden all the way in the back behind the milk.  I mean, he lives here.  I get it.  But some consideration is to be expected.  Maybe not taking-out-the-garbage type consideration, but I can’t tell you how many times I’ve watched the dog come back from a walk and just saunter right past the empty trash cans without even considering bringing them back.  Don’t tell me he doesn’t know where they belong, the dog is obsessed with those cans when they’re full.

Some quid pro quo is necessary.  If our pets are going to be granted “personhood” status ( http://www.nytimes.com/2014/04/27/magazine/the-rights-of-man-and-beast.html ), I expect a little more responsibility on their part.  This isn’t Neanderthal cave living, where just barking a couple of times whenever a saber tooth tiger was in the area was enough to earn your place by the fire and a few leftover bones.  Inappropriate barking at the mailman is not going to cut it anymore.  Don’t give me that crap about instincts, either.  Get over it.  Time to start doing the dishes on a more consistent basis, not just licking the food off the plates after they’re already in the dishwasher.  It’s a dishwasher, idiot–welcome to the 21st century.  And if you’re going to be making brown spots all over the lawn, the least you could do is try peeing on the dandelions every once in a while.  Don’t tell me that takes much effort.  And don’t give me that “can’t see colors” excuse–that got old after you insisted on turning off The Wizard of Oz once they got to Oz just so you could watch the WWF.  What kind of Buddhist watches professional wrestling, anyway?

Oh, and spelling out “union” with your chew toys?  Not amusing.

 

A Hard Place To Live–Part Two

The new Chairman of Surgery had only been in town for a few weeks when he asked me to accompany him for a drive to visit a friend in Westchester.  The new Chairman had just moved to New York after a distinguished, meteoric career at a famous medical center in the South.  Not the south side of New York.  I mean the South; where people are friendly and the pace is peaceful and life is grand.  He was, shall we say, new to New York.1-new-york-city-1270751697

The new Chairman had a research buddy in Westchester that he wanted to visit and it was a beautiful, sunny Sunday.  He thought we should drive his BMW the couple of hours it should take and I could help navigate and I’d surely be interested in the research project they were to discuss.  I had to explain that I had never been to Westchester and that my sense of direction is limited to up and down, and that only on a good day.  He was undaunted.

We started off confidently, driving down the Long Island Expressway at a good clip, discussing the new Chairman’s grand plans for the department.  As we began to navigate the sinuous and subtle exchanges of the various parkways and expressways of the city proper, our conversation lagged as we quickly realized that we didn’t know exactly where we were going.  This was confirmed when we passed under a large sign reading “New Jersey.”  Westchester, we were quite sure, was still in New York. Unfortunately, we were now on the rather intimidating approach to the George Washington Bridge and it appeared that our fate lay in crossing the Hudson River despite our reluctance.  As we paused at the toll booth, the new Chairman expressed to the toll worker that we really were going to Westchester.

“But you’re going the wrong way,” the toll booth attendant informed us.  We acknowledged this helpful bit of information and inquired how we could avoid crossing the bridge.  “You can’t,” she said.  “What you need to do is take the first exit after the bridge, get off the expressway, make a left and cross under to the other side, then get back on the expressway and come back over the bridge.  That’ll be sixteen dollars.”  The new Chairman thanked her for her helpful advice and got change for his twenty.  Now certain of our path, he did exactly as she recommended.  As he crossed under the bridge, however, a police officer standing just past the left turn waved him over and told he to stop the car.  The new Chairman pulled over and rolled down the window.

“Is there a problem, officer?” the new Chairman asked politely.

“License and registration,” the officer replied.

“I’m sorry?” the new Chairman asked.

“You will be if you don’t give me your license and registration in the next two seconds,” the officer replied.  The new Chairman looked at me.  I shrugged.  He gave the police officer his license and registration.  The officer disappeared to his cruiser.

“What’s going on?” the new Chairman asked.

“Haven’t a clue,” I answered.  “I’m sure we’ll find out, though.”  So we sat and waited to find out.  We sat for a half hour.  At last, the officer reappeared at the window.  He began throwing traffic tickets through the window at the new Chairman.

“Illegal left hand turn, obstructing traffic, expired license,” the cop rattled off, throwing the new Chairman’s license and registration back into the car. “Absent front license plate, failure to use turn signal,” the officer droned on as he continued to fling tickets into the car.

“Hold it, hold it,” the new Chairman spluttered, flabbergasted.  He reached down on the floor to retrieve his driver’s license.  “My license isn’t expired.  I just renewed it before I moved here three weeks ago.  Look,” he held up the license for the officer and indicated the back of the license where the renewal was documented.

The cop took the license and looked at the indicated sticker for a moment, then tossed it back in the car.  “They don’t pay me to look on the back.  Tell it to the judge.”

“Now hold it–” the new Chairman began.

The officer clamped his hand on the new Chairman’s forearm which was resting on the door sill, still holding the dollar bills he had gotten in change from the toll lady.  “And if you say one more word, asshole, I’m gonna arrest you for trying to bribe a police officer.”  He nodded at the four dollars in the new Chairman’s hand.

“You’r not serious,” the new Chairman said.  He turned to me.  “He’s not serious, is he?”

“I think he is,” I advised.  “I think you should stop talking now.”

The officer agreed.  Finally, we were allowed to resume our journey to Westchester.

“This place,” the new Chairman said as we drove on, “is a very hard place to live.”

I had to agree.