Sunday, October 28, 2007

West Indian Girl - 4th and Wall

This was unexpected. I've written before about being surprised how popular, in terms of comments and email, my music reviews have been, but I definitely did not expect to have music recommended to me by promoters on the basis of my reviews. When, therefore, just such a person recommended this album to me, I was skeptical. However, I gave the promotional track a listen, and was interested enough to check out the whole album.

Electronica and rock have enjoyed tenuous relationships in the past. I'm not exactly a music historian though, so in order to avoid doing any research, I'll just say that a long creative thread runs at least from Emerson, Lake, and Palmer through Madonna's "Ray of Light." It is a genre I enjoy, and though I no longer fall asleep to the Future Sounds of London, the formation of sound and art through digital means still speaks to this 21st century soul.

If in my last review I was complaining about how often mimicry passes as artistry, this album stands as a lesson to aspiring artists. You can work in a given style, but you need your own twist. Putting a twist on an old style for the sake of the twist is obnoxious (like Jet pretending to be the Rolling Stones), but when you do it as part of a coherent vision, like West Indian Girl is doing, it becomes worthwhile. While listening, I was trying to make comparisons, but winding up with absurdities in the process. Folksy Pink Floyd. The Shins meet U2. Perhaps it is best I am paid to be a doctor, and not a music reviewer. But it is true that I have not heard anything exactly like this crew before.

"To Die in LA," opens this album with a distant flute sound, but rapidly picks up, adding drums and synth until the singers (in their first clear words on the track) voice the listeners' own thoughts with a chorus of "here it comes." I'm not certain the lyrics on this particular track are meaningful. They aren't particularly important, as in most trip-hop, but they do get the album off to a fast paced start with a few cool vagaries. Even if I was rocking with the album, I wasn't truly impressed until the track "Solar Eyes," where electronic beeps and an acoustic guitar trade off without jarring the listener. It sounds impossible, but they manage to do it. Throughout the album, with transitions like that, the confidence with which the disparate sounds were melded struck me. Also, I admit (though it is no surprise to anyone familiar with my defense of Keane's first album) that I like songs with a tune. That's why X&Y didn't really do anything for me. But the tracks here are all hummable.

It's not a perfect album. The band struggles with ending their songs, dragging the otherwise strong "Sofia" on at least a minute more than truly necessary. And the lazy, psychedelic "All my Friends" will never rank in my favorite track list. Of course, the Goa-trance meets folk marriage here (there I go again) is bound to have some distinctive offspring, some more palatable than others. Still, there is quite enough to enjoy here, and this one is going to be the soundtrack to my commute for a while yet.

Thursday, October 25, 2007

Just another call day, or good nurse, bad nurse II

Me imperturbe, standing at ease in nature,
Master of all or mistress of all, aplomb in the midst of irrational things

Eleven am. I walk into the hospital, change into scrubs, and within ten minutes I'm admitting my first patient of the day. By mid afternoon, I'm collecting signouts from the other teams, and by 6pm I am responsible for the medical care of some fifty patients overnight.

At about 9 pm Mrs. Stone really lost it. She was frustrated with the primary team's treatment of her husband, and utterly convinced that IV antibiotics were better than oral. So she and her husband decided that was a great time to page me, the night call resident, and demand IV antibiotics. I remained as calm as possible while explaining to her that the particular fluoroquinolone her husband was on had exactly the same bioavailability in either IV or oral form, and that a UTI was not, in this instance, life threatening, but she was having none of it. Her concern I could understand. Her manner I could not, and as her voice reached a level which was probably audible from several adjacent floors in the hospital, as she denounced my ability to have compassion, my intelligence, my understanding of medicine, and virtually every person connected with her husband's hospitalization, the charge nurse (blessings on her and her children) came in and interrupted by saying that visiting hours were over, and that if Mrs. Stone did not remember the way to the exit, the security guards would be more than happy to show her the way out.

Three am, and I am awakened from my one hour of sleep by a nurse who feels that this is a great time to pass on to the night float doctor the results of several perfectly normal, non-emergent tests performed over the course of the day. The sorts of test which will not, by any stretch of the imagination, change the management of the patient in the next three hours before the primary team comes back in.

Eleven am. I am now in the step-down unit, dealing with my patient who has developed mental status changes. I am very suspicious that these changes are due to the fact that he has bad COPD and has been off his oxygen. I need an ABG, quickly, to determine whether the oxygen I'm about to start is going to fix the problem, or whether I need to keep looking for a cause. The patient's nurse has decided that it is far more important to gossip about another doctor to one of the other nurses than to actually draw a lab that might help her patient. I try telling her nicely, but she will not be interrupted. So, exasperated, I draw the lab myself and make a note to write up an incident report.

Four pm. The bed manager finds out, and pages me about, the fact that one of my patients has been off telemetry monitoring for most of the day, because the nurses can't find the tele pack. They've only now decided this is worth passing on. Another twenty minutes of work. That will teach me to think of getting out of the hospital early post call.

Five pm, sign out complete, my patients passed off, my pager off, I drive home. And in just under twelve hours, I'll be right here, headed the other direction, starting all over again.

Sunday, October 21, 2007

Back to the ward

As the title suggests, I've gone back to the inpatient wards. It's a welcome change in ways, since I now feeling like a doctor again, making treatment decisions and actually taking care of patients. However that also means I'm on call, missing sleep, and since I had a month off essentially, I've lost a lot of the good habits I had. My first night back on call was rocky, and it was fortunate that we had a phenomenally light call, or I would have been completely hosed. Now I'm two days in, and getting back into stride.

Of course, that entails sacrifice. I had made plans to go to a play with a new friend of mine this afternoon, but as I was heading out the door, I got a page about one of my patients who was crashing. Two hours later he was safe in the MICU, but the play had already started. Still, that's the kind of medicine that excites me, making actual helpful changes in patient care, rather than the combination social worker-slave-clinician stuff that usually compromises a medicine intern's life.

In other news, Mrs. Roman got that surgery, oddly enough because someone told her exactly the story Judy mentioned in the comments.

Friday, October 05, 2007

Faith healing

Mrs. Roman needs her lung removed. It has become severely damaged, is chronically infected, does not aerate her blood, and is spilling bacteria into her good lung, causing life threatening pneumonia. However, she will not undergo the lung resection surgery because she believes God told her he will heal her. So she lays in her ICU bed, trusting that God (plus antibiotics) will cure abscess and empyema.

This is (to put it mildly) ill-advised. So much so that it makes me angry to think about it. Without realizing it, I have become the person I feared.

Back in medical school, we had a class on the "human context of medicine." It was our first year, we were still figuring out how to do the whole medical school thing, and for three hours every Thursday morning we sat in small groups and discussed the papers we had been required to write about a variety of topics. Death, end of life care, sexuality, culture, religion. Pretty much we talked about everything your mother told you was bad manners to discuss with strangers. The teacher for this class, who gave us weekly lectures on top of our discussion, was a militantly atheist Reform Jew, and one of his pet projects was to ensure we all kept our religious convictions out of our practice of medicine. At the time, I thought this impossible. I resented his depiction of a strictly empirical physician, admitting the presence of more than flesh and blood only when necessary to gain the trust of a patient. It was an odd, soulless compassion he taught.

But I realized today, standing next to Mrs. Roman's bed, that I have become more like that person than I knew. Through the next three years of medical school, and the first few months of internship, I have come to believe in the power of medicine. I've seen medicine heal the sick and make the lame walk. If we haven't made the blind see yet, we're working on it. More effective than any lecture or any crazy triple-board certified medical school teacher was merely living this life. And standing by that bedside, my first reaction was anger, or at least irritation, that this woman held to a ridiculous conviction that is going to kill her. I was angry that this pleasantly deluded woman didn't share my near-religious conviction in the power of medicine.

At the same time, I share her convictions, at least in part. I am a Christian, but I've never been the "let go and let God" type. I'm more a "praise the Lord and pass the ammunition" type. I figure that no matter what you think about the controversial questions in life, God has given us all a brain and hands, which we ought to put to good use. Because of faith, I allow that God could heal her. But I believe in medicine the way I believe in gravity: it just works. Of course, it works based on principles which are either impossibly serendipitous or intentionally designed, but then that truly is the religious question. Whatever the answer, it is not germane to Mrs. Roman's condition. She is waiting for a miracle, and if she does get better, that's what she'll call it, but I'm intensely skeptical of miracle claims. Remissions happen in many diseases, and we don't always have an explanation for them. It is only when they happen to religious people that they are called miracles.

So the focus on pathology and on biology has made me a skeptic and maybe a bit of an empiricist. Where that breaks down, and where I retain my faith and humanity, is in the big picture. Certainly, the only way Mrs. Roman is going to be cured is with cold steel. But if there is any point in curing her, it is more than molecular; she is more than a broken machine, and the only way to understand that is not found in Robbin's Pathology.

Wednesday, October 03, 2007

Said the Whale - Taking Abalonia

So I admit it, I first heard about these guys from Perhaps I shouldn't admit frequenting such places, but I figure if you haven't checked that site at least once, you aren't doing your part to be the "Great Satan" that Ahmadinejad sees in the world. Anyway, whatever I think about the color scheme and the content, Perez occasionally has good music taste, and this wasn't a disappointment.

The first song I heard from this album was "This Winter I Retire" which is the most distinctive track on the album. Check their Myspace page to get a taste here. I like upbeat songs with a minor feel, so musically I was predisposed to like it, though the lyrics are nothing spectacular. As I listened to the rest of the album, I was lured into just listening, and forgetting to be critical. But a few listens have me somewhat less enthralled. That first track is still distinctive, but the balance of the tracks are derivative sounding, with the most egregious being the second "Live Off Lamb" which James Mercer could probably sue for plagiarism over. The Shins, the Strokes, the alert listener can place all of them in this album. None of which says that this is a bad album. It's not. But it mostly sounds like B-sides of bands you already like.

In short, there's potential here, coming out particularly in "Plans for the Future" and the already mentioned lead off track. But the potential has yet to be realized, I feel.

Monday, October 01, 2007

Return to Psychiatry

If I thought ENT was a step back in time, psychiatry is worse. Don't get me wrong, I loved psychiatry as a med student, but here I'm not even supposed to talk to the patients. My whole experience is to "shadow" a psychiatrist, basically pretending I am a hole in the wall. So clinic was pretty boring this morning, with the only bright spot occurring when I stood behind the front desk looking out. On the back of the desk is a row of photos of people who have made credible death threats against staff in this psychiatry group, along with a short description of last known whereabouts and any other useful bits of information. One guy had the terse line "an FBI investigation is ongoing" beneath his description.

Next month, when I return to the wards, I don't think I'll complain too much about COPD exacerbation patients. At least none of them have ever tried to kill me.

This is a pretty informal rotation, so I ditched the clinic in the afternoon. I joined up with the Consult-Liaison team instead, and had a much better time. C/L psych is something I could enjoy, plus the specialists in it seem to be the sarcastic, screwball humor, polymath types that I enjoy so much in any specialty. We didn't have too many patients, so the attending launched into an impromptu discussion of paraphilias, which is apparently his research interest. Think Doctor George Huang from Law and Order: SVU, only an older white guy and you've got a pretty good idea what this doctor is like. Both entertaining and informative.

He reminded me, at first, why I thought psych was so cool, but after a while he began to remind me why I couldn't end up doing it. Psychiatry can be pretty creepy, and while some of the discussion was interesting, after a while, frank discussion of deviancy gets old, and then painful to discuss. I have been relieved before when a lecturer (usually a pulmonologist) ended a talk, but the end here was a very different sort of relief. That's more of an "awakening from sleep" relief. This was more a "coming out of a haunted house" relief. We'll see tomorrow what a full day in the haunted house is like.