The next word I say

Rivulets of now
gurgle into tanks of yore.
I stand and surmise:
nothing is more informative
than what we don't prepare for.

Dangers and dingers make
a finely textured catastrophe
or cancel out to a standstill:
listen! The next word I say

isn't a bad choice
to avoid oblivion. Your
warm room, your baby's bottle
are made possible in part
by what I write here.

She doesn't know why she's in the hospital?

I'm still thinking about an all-too-common hospital situation: doctor and patient don't agree on the reason why the doctors put the patient in the hospital. I'm giving a revised talk about it on Wednesday to my primary care colleagues. Comments welcome!

Why Yiddish Translations of Kids Books?

Hurting for translations? Come hear me talk tomorrow at 7pm, at Temple University Student Center (Philadelphia Center City, 13th and Montgomery) on why we publish Yiddish translations of kids' books. It's in English and free; books for sale!

Ask and you shall...what?

The USPSTF says every doctor should ask every patient about smoking. Guess I ask 90%. But the 95 year old? Really? The only thing I ask everyone is "How can I help you on this visit?"

Guess the typographics of SMS-blogging are not as transparent as I assumed. O for a stylus & clay tablet!

.."). I'm all for patient-centered care, and "male" is indeed too impersonal...but calling everyone "gentleman" is a touch unctuous, no?

When I was an intern every man in the hospital was a "male." Now they're all "gentlemen" ("This is a 56 year old gentleman with stage IIIA rectal cancer.

Three for three at Triptych

I had the good fortune tonight of hearing Yusef Komunyakaa, Hermine Pinson, and (who made the biggest impression on me) Aracelis Girmay. See the links at Triptych for information on these poets.

With regard to Girmay, I find myself in something of a spot, since she subscribes to an anti-Israeli orthodoxy ("apartheid" was a word she mentioned, in an introduction to a poem albeit not in a poem itself). She assumed that her audience was of the same belief, while I was squirming in my chair, distinctly uncomfortable and wondering if I should have taken off my yarmulke. But for her poetry! which busts every barrel hoop - I have to place my reservations with some poems over on one side, and my unfeigned joy with others at the center. Plus she was just so nice when she signed for me her new book, Teeth. You should buy it like I did. (She's a Watson fellow too, like I was; she sweetly signed her book: "Thank you for taking these into your home / to you, fellow traveler.")

A poem of hers:

FOR ESTEFANI LORA, THIRD GRADE, WHO MADE ME A CARD
for Estefani Lora, PS 132, Washington Heights

*
Elephant on an orange line, underneath a yellow circle
meaning sun.
6 green, vertical lines, with color all from the top
meaning flowers.

*
The first time I peel back the 5 squares of Scotch tape,
unfold the crooked-crease fold of art class paper,
I am in my living room.

It is June.
Inside of the card, there is one long word, & then
Estefani’s name:

Loisfoeribari

Estefani Lora

*
Loisfoeribari?

*
Loisfoeribari: The scientific, Latinate way of saying hibiscus.

*
Loisforeribari: A direction, as in: Are you going
North? South? East? West? Loisfoeribari?

*
I try, over & over, to read the word out loud.
Loisfoeribari. LoISFOeribari.
LoiSFOEribari. LoisFOERibARI.

*
What is this word?

I imagine using it in sentences like,

“Man, I have to go back to the house,
I forgot my Loisfoeribari.”

or

“There’s nothing better than rain, hot rain,
open windows with music, & a tall glass
of Loisfoeribari.”

or

“How are we getting to Pittsburgh?
Should we drive or take the Loisfoeribari?”

*
I have lived 4 minutes with this word not knowing
what it means.

*
It is the end of the year. I consider writing my student,
Estefani Lora, a letter that goes:

To The BRILLIANT Estefani Lora!

Hola, querida, I hope that you are well. I’ve just opened the card that you made me, and it is beautiful. I really love the way you filled the sky with birds. I believe that you are chula, chulita, and super fly! Yes, the card is beautiful. I only have one question for you. What does the word ‘Loisfoeribari’ mean?

*
I try the word again.
Loisfoeribari.
Loisfoeribari.
Loisfoeribari.

*
I try the word in Spanish.
Loisfoeribari
Lo-ees-fo-eh-dee-bah-dee
Lo-ees-fo-eh-dee-bah-dee

& then, slowly,

Lo is fo e ri bari
Lo is fo eribari

*
love is for everybody
love is for every every body love
love love everybody love
everybody love love
is love everybody
everybody is love
love love for love
for everybody
for love is everybody
love is forevery
love is forevery body
love love love for body
love body body is love
love is body every body is love
is every love
for every love is love
for love everybody love love
love love for everybody
loveisforeverybody

Cuss like an Israeli

With this handy article (in Hebrew).

Thanks to a helpful Louisville reader who probably will not lose sleep if he is not mentioned by name here.

Evidence-based medicine meets the Times

A great post by David H. Newman (an ER doc) on their Health blog, Believing in Treatments That Don't Work.

A problem, though: occasionally, instead of practice not following evidence, the evidence lags clinical practice (there are clinical problems which haven't been studied yet, or at least not in the population the clinician is seeing), and then it's very difficult for the doctor to know what to do. Then he or she has to integrate different kinds of clinical evidence.

Evidence-based medicine is everything, but it's not the only thing...

Life-saving duties and the "observant" doctor

In the Journal of Halacha and Contemporary Society (LVII - love the classy Roman numerals!), Howard J. Apfel, a pediatric cardiologist, rabbi, and teacher at the boys' high school of Yeshiva University, presents a thoughtful and detailed article entitled "Life-saving duties on Shabbat: switching call with a nonobservant Jew."

This being an Orthodox journal, there are a number of premises I don't agree with. The first(implied but present nonetheless) is that all Jews are either "observant" or "non-observant." In reality, while Jewish religious observance is a spectrum, what the author means here by "observance" is membership in the [ultra-?]Orthodox community, which has certain sociological criteria. Thus, while I'm an observant doctor, I am not an "observant" doctor for the purposes of this article.

The second premise is that contemporary halachic decision-making must be attendant on the gnomic public pronouncements of great ultra-Orthodox rabbis. We've talked about this.

But putting those premises aside, there's something else to talk about:

"[W]hile the non-observant doctor or soldier fully intends to save life, they are also deliberately doing the prohibited actions involved [on the Sabbath] for personal gain (for example to receive their pay, or to avoid being fired or prosecuted) as well."

I won't go into the details of the halachic argument, but I will point out that the understanding of motivations here is deficient. Doctors, soldiers, and other people walk around with multiple motivations, some of them primary, some of them secondary. Some of these motivations recede into the background and on occasion cannot even be recognized by the person so motivated. But in the majority of cases, people aren't motivated this way at all! No one thinks, "I need to put in these medication orders or I won't get paid"; "if I don't go check on the patient, I'll get fired"; "if I don't put in this IV, someone will sue me successfully."

Well, maybe some doctors do, but not the good ones.

The Rise of Yiddish Online

In Jewish Currents.

How could someone not know why they're in the hospital?

As it happens, I gave a talk on that topic today. It involves some ongoing research of mine. Have a look!

Miscellany (or: Dead animals; The Chinese Channel; MI and Racism)

I'm such a Mishnah nerd. Starting a new tractate gives me a rush. And I've never really learned Zevachim before. (Look, Zevachim 1:2 isn't paralleled in the Tosefta at all?!)

*

Verizon FIOS didn't mean much to me until Celeste figured out that we now have Chinese TV. 很不錯！

*

What are the factors associated with racial differences in myocardial infarction outcomes? They have more to do with baseline cardiac risk and hospital factors than with treatment received. So disparities - as we all thought, I guess? - are pretty far upstream. To put it crudely but not inaccurately: African-Americans are poorer, and their hearts are sicker, even before the first troponins are drawn.

Snackbag Poetry

Enemies run harum-scarum!
Today at last we have our Purim!
Tie the noose in several knots.
Joking: Excess. Drinking: Lots.

[Yiddish/Hebrew doggerel here.]

Things are looking up!

Just a couple of hours ago, while buying some Fritos, I heard the President of the United States say live on national TV, "There need to be more primary care physicians."

Sounds good to me!

Operator, can you please page the Surgeon General on call?

The name of neurosurgeon and health journalist Sanjay Gupta was leaked in early January as Barack Obama’s choice for Surgeon General. His selection has caused controversy, and the formal nomination seems to have been delayed by the search for a Secretary of Health and Human Services after the withdrawal of Tom Daschle. While we’re waiting for Gupta to be confirmed, we can ask: what exactly is the Surgeon General supposed to do, and in this administration whose watchword is change, can the office be more useful?

More in Clinical Correlations.

Doctoring while (not) intoxicated

It's easy to be high-minded about working Yom Kippur, but I just realized I'm working Purim - and I'm pissed.

Layers

Swimming up through layers
we see a cheese crumbled onto a
plate, a fat nut
gleaming in the center.
Suddenly in the black water
a large island.
Someone has already pinned
it with arrows.

Always takes a second
to figure out what I'm
looking at. No one says to their
lover: Honey, look what happened
to my body!

Today I pull up the scan
and everyone says Oh.
No one needs to point.

Does Massachusetts's health care reform work?

As Massachusetts’ Secretary of Health and Human Services, JudyAnn Bigby, MD, is charged with overseeing the health-care program which covers nearly all of the Commonwealth’s residents (nearly 98%) while costing more than anyone expected (about 800 million dollars in 2008). On February 4th, Dr. Bigby spoke at NYU’s Medicine Grand Rounds, where she summarized the approach and accomplishments of Title 58, the health care legislation passed in 2006. The program had several goals: improving access, reforming the insurance market, and (it was hoped) improving outcomes. Bigby gave clear and convincing evidence for the first two goals, while the jury is still out on the third.

More in Clinical Correlations.