Satisfied Customers (is BS)

More Satisfied Customers | WhiteCoat’s Call Room.

He nails it.  Here’s the best quote:

Treat a judge like this and you get thrown in jail for contempt of court.
Treat an employee this way and you get sued for harassment or sexual discrimination.
Treat an average person on the street like this and you get a fist in your mouth.

When people can come to your place of employment and treat you like a piece of toilet paper – yet your continued employment depends on pleasing “each one of them every time,” it’s time to think about whether to continue practicing medicine.

Feels Different

I was watching Anthony Bourdain’s No Reservations this afternoon, lounging in the sloth of a Monday afternoon, gorging my face with buttery microwave popcorn when I had a realization:  the show used to be quite different.

Growth, especially personal growth can be a good thing.  But when it is a transformation from the gritty blue-collar scribe of the kitchen into a poncy oenophiliac middle aged Midwest diversion the difference is jarring.

I noticed it when Tony stopped smoking.  As a nurse I thought, “Good for him.”  As a devoted viewer I thought, “What the fuck?”  Slowly but surely the rough New York features, born and bred over the hot stove began to morph into a gentler, more Botoxed version of himself.

Veneers?  Why yes.

Dying the hair?  Sure.

Tanning?  I detect a hint of it.

Exercise?  Almost undoubtedly.

Quips about excess intake of Lipitor?  Let’s just say Dr. Jarvik is happy with that.

Watching the older episode today brought it all back to focus.  One would be hard pressed to find a shot without a smoke or a beer in hand.  There was no gloating over the glories of a particular wine while adopting the pose of a wine lover, almost down to the pinkie finger splayed out from the glass.

And butt crack.

If the name of the show had changed to Anthony Bourdain, Plumber, it would not have been surprising with the amount of butt crack shown.  And have we seen it since?  Not really.

I won’t go so far as to call him a sell-out, although the wife does.  But the Tony of today is a more Disney-fied version.  It’s like they took CBGC’s and transplanted it to Main Street, Disneyland.  It’s jarring.  And it’s wrong.

I understand the lure of filthy lucre.  Money, especially after having none is a powerful thing.  I get it.  You slaved all those years behind a grill, behind a typewriter in order to make yourself a success.  Damn if you haven’t done one helluva’ job.  But the image you presented, the cocky chef turned food critic, the scribe of the kitchen, more apt to look down on fancy pants preparations and places then indulge in their pleasures, drinking and smoking your way across the globe all the while regaling us with the tales of your adventures.

But now?  It’s the same, but with  a more highly buffed and polished veneer.  It’s as if respectability has won out over street cred.

But I’ll still watch.  And I’ll bitch about it every week.  I’ll bitch that you look like a poncy freak sipping your wine as your wax rhapsodic over some sort of fancy food.  Granted you still seek out the street food vendor, but it’s more a desperate cry for help, as if to say, “I’m still cool.  I still matter.”

But really, it’s because I’m just a little but jealous.  I’m trying not to be a hater, but it sure comes out like I am one.

So Tony, less wine, more beer and liquor.  More meat, less fancy-pants foodie stuff.  In other words, go back to your roots!

Wound Vac on the Cheap

…negative pressure system dressings can be kept in place for days at a time, all while speeding up healing. Up until now, the $100 per day rental systems have been out of reach for the developing world, but MIT student Danielle Zurovcik recently developed a negative pressure pump that costs just $3 to build.

via $3 Healing Device Speeds Up Wound Treatment | Inhabitat – Green Design Will Save the World.

Wound vacs are, well, kind of fun.  There’s a sense of achievement that comes with being able to bridge wounds, fix the leaks and help the patient heal.  It’s nifty tech for sure.

Unfortunately, as the author points out, the gurus like KCI will never let this appear in the US.  Why let a cheap version out when you can charge $100/day?  It will be great however for under-developed regions like Haiti where the need is great and the availability is absent.

So, a sleep study, eh?


I dragged my tired snoring butt to the sleep lab yesterday for a sleep study.  It was an interesting experience to say the least  More on that in a minute though.

But why a sleep study?  You’re studly bike-riding dude, healthy, in the prime of your life, right?  Err, wrong.  I’ve been off the bike for more that 2 months due to a confluence of a nasty URI that set off my asthma, really crappy weather and the acquisition of a new car.  Healthy?  Right.  I could almost be one of my patients some days.  Prime of my life?  Getting there.

The biggest reason was that in spite of sleeping what seemed to be an adequate period of time, I was still sleepy.  I’d sleep for 8-10 hours, get up, putter around doing household-type stuff, sit down on the couch, turn on the tube and within a half-hour, be snoozing.  After meals became a constant effort to stave off the head-dropping and need to snooze.  But what really drove me was the near constant refrain from the wife, “Roll over and snore somewhere else!”  A nag she is truly not, more than anything she is straight up worried about me.  In that, I’m a lucky man.  Studies have shown that men whose wives push them to seek medical and preventive care tend to live longer, but I digress.

I talked to my PCP and he agreed that my symptoms sounded suspiciously like sleep apnea and did what all good PCPs do:  refer me out.  Off I went to the sleep medicine clinic where the doc there after asking me a ton of questions and subjecting me to a mind-numbing video that I struggled to stay awake for agreed as well that my symptoms sounded like sleep apnea.  Sleep study pending insurance approval on the way.

The closer I got, the more acutely aware of the issue I was.  Snorting myself awake from a nap?  Check.  Snoozing on the couch more than normal?  Check.  Fighting the urge to close my eyes for a second at stoplights on my way home?  Check.  Still I was worried more about a negative answer.  Sleep apnea I could deal with, not having it, not so much.

It’s not that I want to have sleep apnea.  I don’t want to be just like my Dad, or lug a CPAP machine with me everywhere I go, not to mention the extreme sexiness of wearing CPAP in bed with the wife.  Getting a negative answer meant that there was something else going on that would require more tests and trips to more doctors.

Since I work nights the sleep doc and I decided it might be advisable to do a day study for me, to better mimic my typical sleeping conditions.  I just knew that the night before the study I would get canceled or put on stand-by and have to try to stay awake at home instead of trying to stay awake at work.  Luckily we stayed busy so I worked.  And was totally fried at the end of the shift.  I would sleep.

I go to check in at “Patient Access’ (formerly known as Admitting…) and the lady looks at me quizzically, “Sleep study?  But it’s morning”

“It’s what I get for working nights, y’know?”  I reply.

I head up to the sleep lab area and I’m tired.  I just want to get this going so I can go to sleep.  As I was overlapping with the night studies there was a little wait as things got cleaned.  Luckily for the techs, I was able to shower and get the floor funk off of me.  Then came the process of getting me wired up.

Wired up?  I had more monitoring on me than an astronaut.  EEG leads, EKG leads, eye movement sensors, a snoring mike, bands that had sensors to see if I was breathing and the funky thing that stuck in my nose that would tell them I was still breathing, even when the chest straps said I wasn’t.  I felt almost like Pinhead.  But how was I going to sleep with all of this crap attached to me?  Uncomfortably.

It’s a weird and annoying issue that I have, if I don’t crash right away, I tend to stay awake longer than I need.  So between getting wired up and all the paperwork, I was nearly wide awake.  Couple that with being in a strange place, with strange noises and the myriad monitoring equipment I felt I would never fall asleep.  After some time, no thanks to Housekeeping as they kept banging shut the door of the room next to me, I drifted off.

I woke with a start as the tech came in and said, “OK, we’re going to put you on CPAP now.”  I looked at my watch, 12:40, I’d been asleep for maybe 2.5 hours, tops.  Maybe this was a “good” sign.  Falling back asleep with a hose blowing air into my nose was not the worst way to rest as it took some getting used to, but eventually I did.

Then the air shut off.  After you’ve been sleeping with air blowing in your nose, a disruption like that wakes you abruptly.  It’s like suffocating, made al the worse by the odd situation.  The tech came in to tell me it was 5pm and the study of over.  4 hours had gone by and I didn’t even realize it.  A little disconcerting.  Getting me unhooked a much simpler, just pull.  A little karmic retribution for all the patients I have taken tele leads off of was inflicted as he pulled the EKG leads off, taking hair with them.  Unhooked, cleaned up and ready to go I pressed the tech for a least a glimmer of understanding to what I did during the study.

He says, “Well, I can’t tell you anything.  Y’know how it is.”  A pause, “But you’ll live until you get your CPAP…”

And live I did.  When you’re waiting for answers, even a couple of days seems interminable.  I just want to know.  Even though everything seemed to point to the obvious fact that I have sleep apnea, I needed to hear from the guy in the white coat.  So I waited.  Patiently waited.  Then the magic phone call.  SUre enough, like we though, sleep apnea.  My AHI?  38.3/hour.  That’s 38 awakenings an hour.  The typical minimum for treatment of sleep apnea is 5.  That puts me in the “severe” category.  Any wonder why I’ve felt like shit for as long as I have.  I used to chalk it up to the effects of working nights, but now I realize this has been going on for a long time.

Now that I have a diagnosis, treatment can start.  CPAP it is.  According to the wife there is nothing sexier than sliding into bed with a guy wearing a CPAP mask.  In the immortal words of Fat Bastard, “I’m dead sexy!”  Not.

I’ll be honest, it’s taking a little bit of getting used to.  Today was the first time I wore the mask for the entire time I was asleep.  It’s still too early to tell a difference, although I did feel little more awake when I got up.  The truer test will be down the road after I’ve been wearing it for weeks/months to see if there is a measurable change to my life.  I hoping there is.

Killing the B.A.?

“We think the students need to have a grounding in the arts and sciences, but they also probably need some training in a specific area.”

via Jobs: The Economy, Killing Liberal Arts Education? –

My first degree was a simple humanities degree.  A Bachelor of Arts in Social Sciences – kind of sounds like I should have been a Social Worker.  I tell people it was a lot of history and literature with a dollop of politics and religion thrown in for good measure.  I read a lot and consequently wrote a lot.

“Among liberal-arts proponents, the concern is that students who specialize in specific careers will lack critical thinking skills and the ability to write, analyze, and synthesize information. While business education tends to prepare students to work well in teams or give presentations, it often falls short in teaching students to do in-depth research or to write critically outside of the traditional business communiqués of memos or PowerPoints.”

I came away with the ability to think, not just regurgitate facts.  Take the essence of a idea and expound on it to create a synthesis of information and present it in understandable form.  And the realization that my career path involved a lot of  “Do you want fries with that?”

My first job out of college though hired me because of this ability.  I worked for Korean Air Cargo and was the very epitome of “needing training” some on-the-job aspects.  But here’s the kicker:  I already knew the job having done it while in school.  Thus I became their go to guy for “How do you say this?”

I think a foundation in the liberal arts is essential, one needs to know how to read and write, formulate an argument, reconcile multiple viewpoints and perspectives and be an informed member of society.  Unfortunately with the demonization of intelligence that has run rampant through American society, what with reality TV, celebutantes and Gen Y, we’re quickly devolving into the society forecasted in Idiocracy, full of mouth-breathing knuckle-draggers.  Luckily not all of us are running that route.

The push however for job-oriented training in lieu of actual knowledge makes this too clear.  By not knowing our past, we’re condemned to repeat it.  And if your college education does not contain any mention of the past or a brief glossed over macro view, but merely the training for a career, we’ve already lost.

Updates, sort of.

A loyal reader pointed out to me that my blogroll has some stuff that is dead/invite only (I’m looking at you Nurse K!).

So I got to looking, then pruning, then adjusting, then comparing to what’s on my gReader and finally fixing the issue.  I think everyone listed is at least semi-regularly posting and if nothing more, their archives are available.