Monday, January 26, 2009
I've also read a couple of blog posts recently by academics lamenting the unprepared minds they are expected to reach. One professor discusses in length the number of students who don't seem to understand that 800 BC came before 450 BC. There has been much talk about how even the best students view coursework and classes as mere obstacles to be overcome with the least amount of work.
All of which leads me to ABBA. Yes, the 70s Swedish pop group. I was discussing these ideas with my wife, and commented on the fact that in many universities, general history courses are often no longer required. Students don't have to know who Napoleon was in order to get degrees. I dramatized by say that one can go all the way through one's high school and college career without even hearing the word "Waterloo".
Now I challenge anyone over the age of 40. Can you hear the word Waterloo without the hearing somewhere in the back of your mind ABBA singing? Even if you are or were a die hard rocker or country fan, ABBA still seeped in and stayed there, because that's watch catchy song hooks do.
The interesting thing about this is that the ABBA song is not about the battle, but about a girl falling in love. But to get the song, you have to know the phrase "to meet one's Waterloo" meaning to come to a permanent, decisive surrender. The girl has surrendered to love, she has met her Waterloo. Of course the phrase is meaningless if you know nothing about Napoleon and the Napoleonic wars. The phrase itself has slowly slid from the language over the last thirty years as fewer and fewer people understood the referent. Today it unlikely that any band would write a song that assumed that the listened would know what happened to Napoleon at Waterloo.
So this is where we are. We live in a culture in which ABBA songs are to intellectually rigorous for the mass market. God help us.
And since we are talking about music, here's a video. Don't hit play unless you want ABBA to be stuck in your head all day.
Saturday, January 17, 2009
Thursday, January 15, 2009
So there is this law that says that we medical folk can't divulge patient's medical information without a good reason. We also can't act on it for any reason other than to treat or aid the treatment of the patient. The rules are so strict that if I saw my mother's name on the surgery schedule, I couldn't go and see her after surgery unless I also got the information from a non-hospital source. HIPAA can cause some problems for bloggers, as the best stories involve patient information. I feel that on this blog I am abiding by these rules in the following ways.
I, of course, never use patient names. I don't use my name or the name of my hospital. I don't even explicitly name the city where my hospital is located, although it probably isn't difficult to figure out. However given my other interests, as seen on my other blogs, anyone who knows me would recognize me here. I am the only scrub in my town, who works the weekend shift, with my set of interests. I have a limited set of patients, so it theoretically may be possible to figure out which patient I am talking about. I doubt anyone will actually go to the trouble to figure out which town I work in, then who I am, and therefore which hospital I work at, and then connect my patients with a blog post. It could be done, but only by someone who has access to my hospital's records, and who knows me. Still I protect myself further by lying. When I say "this weekend", I mean, "sometime in the last 19 years". I can and will change the nature of a patient's injuries, disease or treatment in ways that don't change the core of the story. If I can, I might even change the patient's gender. In other words, this isn't the patient you're looking for. Go away.
I made passing reference to the something that made a case suck over here, but I thought that the causes of surgery sucking could be further expanded upon. Note that some of this list is subjective. It is also viewed from the scrub staff's point of view, rather than the surgeon's, patient's, anesthesia's or circulator's point of view. I suppose that ophthalmologists actually like eye surgery. Some circulators like long cases because they get to sit. Anesthesia has a completely different set of priorities from the rest of us. They seem to think that just because the patient’s blood pressure stays in the 50s it is a bad case. There are even some scrubs who might some theses cases.
First and foremost, harvests suck. Nothing sucks worse.
Second, eyes suck, but not as much as harvests. Retina and vitreous surgery sucks more than other eyes.
Third, any case with certain doctors suck, because the doctor is an asshat. Luckily, this is actually a small set of surgeons.
Any case involving more that one surgical specialty sucks. The suck factor goes up exponentially. A case with two specialties sucks 4 times as much as a similar case with 1. Three specialties sucks 27 times as much. Four specialties sucks 256 times as much. If we get to five specialties, just put a central line in me and hook it to wall suction.
Any case which departs from its script sucks. Some departures suck more than others. This includes, for example, the unscheduled opening of an endoscopic case. Note that just because we don’t know what we are doing going in doesn’t mean that there isn’t a script. For example, an exploratory laparotomy for bowel obstruction has departed from the script if we find a huge diaphragmatic hernia. It hasn’t if we find a tumor or adhesions.
Dead bowel sucks. Smells too. That’s why it sucks.
Any case scheduled to last more that 150% of what a normal version of that case would last sucks. First it's going to last twice as long as it's scheduled for, and second the surgeon knows something, and it's not good.
Any case scheduled for longer than two hours sucks. (Corollary, heart scrubs are crazy.)
Any case that requires re-draping sucks.
Any case with broken bones in more than one limb sucks.
Any case in which the circulator has to leave the room for anesthesia more than twice sucks. The circulator is there to get me things, not them.
Aneurisms suck. All of them.
Holding retractors on vaginal cases sucks.
Interesting cases suck. After 19 years, if I haven’t seen it, I probably don’t won’t to. OK there’s one exception. Years ago, when I was a baby scrub, a case down the hall was a removal of a cyst. When the surgeon cut into the area an insect stuck its head out of the wound. The patient had been in the tropics recently. I didn’t see that case, but I’ve always wanted to see another one. Otherwise interesting is out.
So there it is, an incomplete list of ways that cases can suck. I leave out that there are certain case and doctor combinations that suck and that certain staff have people that they can't get along with, which sucks. I, of course, can get along with anyone.
Saturday, January 10, 2009
I've never had a day like yesterday before. It certainly wasn't the worst day of my life, but it was far from the best. It was mainly a long series of weird, mostly minor frustrations.
The day started when I rolled over, looked at my alarm clock and noticed it was 7:15. My shift starts at 6:45. I live an hour from work. This math doesn't work well. I jump up, run through the house, grab the phone to call work. No dial tone. I get my phone service, along with my internet, from the cable company, so I pull up my browser and connect to Google. I have internet, but not phone. I find the antique, princess phone that we keep for power outages, and hook it up. No dial tone. So I quickly get dressed, and start to work. planning on stopping at a convenience store to phone work. I don't see a phone at the first store on my way. The competition doesn't have one either, and it's the last store before I leave town. I turn around to got to QuikTrip, which I know has a phone. As I pass the first store, I notice a pay phone I overlooked before and pull in. No dial tone on the pay phone. I go into the store, and ask if there is a general failure of the phone system. They have dial tone in the store, and I make my call.
An hour later I pull into the hospital. As soon as I hit the front desk, my boss tells me "Call your mother." Never a good sign. I call her. There is a minor family crisis embedded within a major crisis. I can't do anything about the major crisis, but I can fix the minor crisis. What's more I'm the only one who can do anything, and it needs to be solved immediately. I check my OR, and see that another scrub is opening and is going to be running the mayo. I'm only there to hold retractors, so I ditch my room, find a phone and solve the minor crisis with a few phone calls. I also call the cable company and get them to send a tech to my house to fix the phone. My wife will be surprised.
My first case is a big complicated case with two surgeons, each in a different specialty. One of my rules is that the suckiness of a case increases exponentially with the number of specialties in the case. Two types of surgeons means the case sucks four times as much as a comparable case with one type of surgeon. This is a long case, so the suck factor is way high. Add on that the scrub running the mayo is in over his head, and I had an unpleasant couple of hours. (On a side note, if a surgeon asks for an instrument by name, get that instrument and no other. It really will make your life easier.) The rest of the day wasn't too bad, and the evening charge nurse took pity on me and let me leave early.
As I pull into my driveway, I notice what appears to be a small dog lying in the yard, next to the drive way. It doesn't move as I pull in. I walk over to it, and it is a small dog, with a lot of Jack Russell terrier in it. I nudge it with my foot. The whole body moves in one piece. Dead. I thought dogs crawled under bushes to die. When I go in, I find out that we have to go to Wally world, and the dog must be disposed of before we leave, so as to not disturb the sensibilities of the children. My wife doesn't volunteer. While I try to wrestle the dog into a trash bag without actually touching it, a long expected cold front arrived and dropped the temperature by about fifteen degrees in five minutes. Nice touch that.
After the trip to Wally world, I notice Lord Ratbane's litter box. There is cat stool with blood in it in the box. Although the cat seems to be acting fine, there is a vet trip in his near future.
I gave up and went to bed.
Today was a nice day.
Monday, January 5, 2009
First I needed a list of medieval authors. I started at the obvious place: Wikipedia. I entered the first medieval author that came to mind, Bede. I noted that the article is in several categories that will be fruitful to explore later, but see that in the "See also" section there is an article "English historians in the Middle Ages." It contains several lists, which I swipe. That article points to a second article, "List of English chronicles", which I also swipe. After collating the lists together and alphabetizing, I have a list about 100 medieval authors and texts, more than enough to start with.
First up on the list is Adam of Usk, a late 14th and early 15th century cleric, who spent some time around important people. He wrote a chronicle about the stuff he saw. I never heard of him or his chronicle before today. After reading his Wikipedia article, I'm off to find out what I can about English translations. A quick Google search finds me this blog entry, from which I find out that there was a nineteenth century translation and a late twentieth century translation. Next stop, the Library of Congress. Their catalog reveals 4 editions dated 1904, 1980, 1990 and 1997. The middle two are reprints of the 1904 edition, which I discover is the second edition. The 1997 is a new translation. I grab the pertinent information and move on. Swinging back by Google I find that Googlebooks has a preview of the 1997 edition. The preview includes the discussion of the manuscript tradition. It seems that Adam's chronicle survives in a single manuscript. The bulk of the manuscript is in the British Library (Add MS 10104), but at some point the final quire became separated from the manuscript. It wasn't rediscovered until 1885, after the first translation was published. The second edition included the text and translation of the lost quire. This explains why the reprints are of the second edition. Next stop is Worldcat, where I find the publication information for the first edition. I don't find any other English editions. I do find an Italian edition, though, which I ignore. For good measure, I check Bookfinder, but don't find any other editions. I am done with Adam. Repeat 10-20 times a day for ten years, and I might finish this project.
Adam of Usk, fl. 1400. English chronicler.
Thompson, Edward Maunde, Sir, ed. and trans.; Chronicon Adæ de Usk: A.D. 1377-1421 (London: J. Murray, 1876) (N.B. Adam's Chronicle survives in a single copy. The final quire of that copy became separated from the main manuscript at some point. It was not rediscovered until 1885. Thompson's second edition includes this fragment. The second edition, or the Given-Wilson edition are preferred over this edition.)
Thompson, Edward Maunde, Sir, ed. and trans.; Chronicon Adæ de Usk, A. D. 1377-1421, 2nd ed. (London: H. Frowde, 1904) Reprinted: Chronicon Adae de Usk, A.D. 1377-1421 (New York: AMS Press, ): and The Chronicle of Adam of Usk, A.D. 1377-1421 (Felinfach, Lampeter, Dyfed: Llanerch Enterprises, 1990) (with abridged introduction).
Given-Wilson, Chris., ed. and trans.; The Chronicle of Adam Usk, 1377-1421 (Oxford: Clarendon Press; New York: Oxford University Press, 1997)
Thursday, January 1, 2009
His Lordship is spending his period of adjustment to his new surroundings by hiding under and behind things. It took some physical persuading, but he will no longer be hiding behind the dishwasher. That way is closed.
The daughters had been making noise for several months about wanting a cat. The wife wanted a Maine Coon, mainly because she wanted a big cat. Well, we got a big cat. This cat is only three and half months old and is as large as some of the adult cats in our neignborhood. He is going to be monster. It is good thing for the neighborhood cats that he is going to be an indoor cat, because in 5 months he will be able to eat the current top cat for breakfast. (The current top cat is a mid-sized grey persian.)
Important safety note, BTW, if you hhave a low grade allergy to cats, it is best to not let the cat use its very sharp kitten claws to inject you in multiple places with its dander. Thank God (and McNeil Healthcare) for Benadryl.
2008 was not a bad year for me. We ended the year in our best financial condition in a while, which is kind of strange to say, given the times. But the reality is, if you haven't been an idiot with your mortgage, and you feel some security in your job, the times are not that bad. Prices went up a bit, but the bursting of the oil bubble has helped there. Since I'm in a recession proof industry, I feel pretty good about my job. Meanwhile I'm nearly a decade into paying my mortgage, which means that my pay has risen, but my housing costs haven't. We don't do credit cards, and whenever possible we pay cash for our cars. (We buy used.) I got caught flatfooted when my previous car died, which meant I had to take out a loan on the current car. That got paid off this year. If the current car lasts another year, I won't get caught flatfooted again. All in all, I could not care less what the credit markets are doing.
I've also developed a plan to get me out of my safe industry. I'm, quite frankly, tired of scrubbing. My plan involves going back to school and entering a fairly competitive job market, and may involve a future relocation, but also would move me into a field where the pay tops out at about double the realistic top-out in my current job.
In politics, my guy didn't win, but then my guy didn't materialize at all. The guy I disliked the least thought he could sit on the front porch and run for president. The guy I held my nose and voted for anyway lost. Oh well. Hopefully this is 1976.
I didn't loose any weight, in fact I gained some. I might actually have to make New Year's resolution about this one. Or not.
I don't do resolutions, per se. But some goals for the new year are:
1. Read more American history.
2. Read more "period" literature.
3. Fill some of the gaps in my reading of the Western Canon.
4. Redevelop some of my lost language skills. (Latin, French)
5. Develop some new language skills (Old English)
6. Write more.
7. Play a musical instrument regularly.
8. Walk more
9. Do more birding and other nature study.
10. Get into the library science program.
11. See and hear more music.
12. Develop a better understanding of architectural history in general and the architectural history of Oklahoma in particular.
13. Continue reading in art history, especially medieval art,
14. Visit more museums and other cultural/historic sites.
15. Widen my reading into new areas.
16. Create world peace.
17. Cure cancer.
All this while continuing my current interests and responsibilities. There is not enough time, to do it all, but I can try.