Forgive the blatant self-promotion, but someone googled elizabeth taylor with tapeworm. I, of course, got the Number One slot.
I just have to link to my post on this one: Liz & Larry Live!.
Hadn’t read it for a while. Kinda humorous.
Just writing. No thoughts as I type. We’ll see where ADHD takes us.
Basketball season started tonight. I detest basketball. It isn’t the game, per se, it’s the players. Just a bunch of highly focused egomaniacs. Too much money and too little brains. I remember a comic 20 or 30 years ago that did a bit about alternative careers if sports or acting was not available (read, "income greatly disproportional to effort). He was an impersonator-type guy – did Kirk Douglas saying, “You want fries with that?”
So LA is probably going to get Joe Torre. That’s a good thing. They’ll get Don Mattingly in the deal. One manager for 4 years or so, then another for 10 of more. You’re welcome. It’d be nice if Marino Rivera went, too. Stocking the left coast with some good Yankee talent. Somebody somewhere is turning in their grave as the Bronx Bombers start to shift talent to the Brooklyn Dodgers. Somebody somewhere is also paying off an old debt. Muscle memory kicks in a bit because I lived by SF for so long. We used to sit in the stands at Candlestick and taunt Tommy Lasorda. We hated LA. But SF sucks. And I warmed up to LA when they warmed up to Pat O’Reilly. NY and LA seem to have this symbiosis that I can accept.
Enough sports.
I was drifting around the net and found something called The Ultimate Final. A lot of the other stuff on the page was hit or miss, but this bit was humorous …
Instructions
Read each question carefully. Answer all questions. Time limit: 4 hours. Begin immediately.
History. Describe the history of the papacy from its origins to the present day, concentrating especially but not exclusively, on it social, political, economic, religious, and philosophical impact on Europe, Asia, America and Africa. Be brief, concise, and specific.
Medicine. You have been provided with a razor blade, a piece of gauze, and a bottle of Scotch. Remove your appendix. Do not suture until your work has been inspected. You have fifteen minutes.
Public Speaking. 2500 riot-crazed aborigines are storming the classroom. Calm them. You may use any ancient language except Latin or Greek.
Biology. Create life. Estimate the differences in subsequent human culture if the form of life had developed 50 million years earlier, with special attention to its probable effect on the English parliamentary system. Prove your thesis.
Music. Write a piano concerto. Orchestrate and perform it with flute and drum. You will find a piano under your seat.
Psychology. Based on your knowledge of their works evaluate the emotional stability, degree of adjustment and repressed frustrations of each of the following: Alexander of Aphrodites, Ramses II, Gregory of Nicea, Hammurabi. Support your evaluation with quotations from each man's work, making appropriate references. It is not necessary to translate.
Sociology. Estimate the sociological problems which might accompany the end of the world. Construct an experiment to test your theory.
Engineering. The disassembled parts of a high-powered rifle have been placed on your desk. You will also find an instruction manual, printed in Swahili. In ten minutes a hungry Bengal tiger will be admitted to the room. Take whatever action you feel appropriate. Be prepared to justify your decision.
Economics. Develop a realistic plan for refinancing the national debt. Trace the possible effects of your plan in the following areas. Cubism, the Donatist controversy, the wave theory of light. Outline a method for preventing these effects. Criticize this method from all possible points of view. Point out the deficiencies in your point of view, as demonstrated in your answer to the last question.
Political Science. There is a red telephone on the desk beside you. Start World War III. Report at length on it socio-political effects, if any.
Epistemology. Take a position for or against truth. Prove the validity of your position.
Physics. Explain the nature of matter. Include in your answer an evaluation of the impact of the development of mathematics on science.
Astronomy. Define the universe. Give three examples.
General Knowledge. Describe in detail. Be objective and specific
There’s another line on the site that I am going to use sometimes: The more you run over a dead cat, the flatter it gets. Words to live by. It’s followed (in the Corporate America section) with, There is always one more imbecile than you counted on. Man, ain’t that a statement we’ve all proven out countless times.
One final bit from the Laws of Combat, but could just as well be in the Corporate America section: If the enemy is in range, so are you.
So I’ve been trying in some ways, marginally so, without much diligence, perspective, or commitment, to put things into perspective in my life. It’s tiring, even debilitating, to go from one fire to the next. There must be some respite out there. Planning, anticipating, avoiding the easy problems would change so much. Ah, fuck it. It’s tough being us, eh?
I need to stop writing now because I feel a bad flip coming. Look out, fire in the hole!!!
I just spent two hours correcting java script for Snap-whatever - button on the sidebar bottom. I'm pretty cranky. I don't know how to program. Guess I can add "programmer" to my physician's license. I did get my end result - when you hover over links, you get a pic of the destination or the latest entries in the RSS feed. If it annoys me, it'll be gone. I think it is cool so far. Stupid thing would not work inside posts, but everywhere else. Pathetic.
I think it's about time to act out. No more "politically correct" this or "can't we all just get along" that.
Let's get it on, eh? This is most definately NSWF. Meet Reginold ...
I enjoy tracking my hits from time to time. I don’t seek traffic in any manner, and I just started exchanging links (one so far, maybe a second out there). I just write what is on my mind. Sometimes it is a fleeting thought or emotion, other times more considered.
“If you write it, they will come” is not a motivation for me. I just enjoy having my space on the net and playing. It’s like a sandbox for a wifi-equipped deranged child. I do enjoy seeing return readers. I think it is amazing that people would read something I wrote, and then purposefully return. I think it may be rooted in the “train wreck syndrome.” “I just know this guy is going to go to supernova someday. Even though I am sitting here in [insert wherever the hell you are], I just know it will be spectacular when it happens. It will hit the AP wires.” When my book comes out in the 18-24 months it’ll take to finish and pre-pub, you dedicated readers can e me – I’ll send you a personalized and autographed copy. It’ll make for a great flat surface to prop up your bedside lamp to a better height. Your eyes will thank me as they are able to read real writing without all the strain from before.
Anyway, I was checking my hits – not the numbers, but the sources. I read something on another blog about listing the Google Number Ones you have. So I have done that below, along with the top fives.
Number Ones.
I did several posts on a spam call I got. The number came back as 864-223-1911. What troubled me was that the Caller ID read a residence. I reversed it and found a street address and a couple’s name. WTF? I was being solicited to buy Verizon cellular service, and the caller was spoofing their origin! I posted, and got all sorts of hits. I’ve posted a few times now. Go over to Mine Shafts or lower to the Cloud of Coal Dust and check out the posts. Actually, the comments are more interesting and informative than what I wrote.
Seems one of my medical posts got a hit when someone googled, correct spelling for guaiac-negative. “Guaiac” refers to a fetal smear test when they look for occult blood. Tell me it wasn’t a doc checking the net to make sure he spelt it correctly. Please. I figured out “subpoena” and “res ipsa loquitur” because it was part of my job. It just isn’t my problem that the word derives from “Guaiacum,” being a genus of shrubs and trees native to the Americas.
Sometimes I am amazed at the seemingly generic words or phrases that rank me so high. How can I own the Google top spot for unsafe things? Should Ralph Nader or Concerned Citizens for Safer Sex Toys (CoC-Saf-T) be there?
If you look at my posts on “prison girls” you’ll see the mug shots and beauty comps I did. Several of them (or their new concerned mates or coworkers!) google the names frequently. Got this recently: "Abigail Fields", robbery Hey, Abby! Write me!
Top Fives.
I am no longer going to use the designation “Dr. Clyde” in my medical posts. I’m gonna switch (maybe) to “IDr. Clyde.” I am not a real doc – I just play one on the internet! Really! It’s disturbing when people google enlarged left ventricle and read my stuff. If that puppy is bigger than it should be, stop searching the net! Get a real doc! I’m fucking serious!
Sometimes the hits make no sense to me: lewis ling in squirrels. Who is Lewis Ling and what is he doing inside a squirrel and why does someone search the net to confirm or deny his presence in said rodent? Shudder.
Gotta love coming up big on 1969 Woodstock bumper sticker slogan. I am a part of Americana, eh?
Now, why why why do I rank on "nearer thy god to thee" lyrics? My site is rated NC-17. Yes, I am a Christian, but not a very good one, and certainly not a source for old-time lyrics. Makes me glad my dad is dead. I think he would kick my ass if he saw this ranking.
This is a somewhat narrower search, seeking only blogger hits: "Beware of Darkness" Harrison blogspot. My post included some video and the lyrics, so I am content with this ranking. Good hit.
Speaking as a doc, I am concerned when someone googles big piece shit from anus. Did you just wake up from a coma and are re-learning life? You know, the “who are you” to your spouse and kids, and “what’s that box with the little people in it? A TV? What’s that?” and “I think I may be sick. Something just came out of ass!” kind.
This hit is truly disappointing. That 1959 cookbook I reviewed was bad enough, but it seems people still want to know about dressings for jello molds. C’mon, people! You know what jell-o is made from? You don’t “mold” the stuff – you run from it. You don’t put dressing on it, you go through aversion therapy to ensure you don’t relapse next time the urge to even walk down the same grocery aisle comes.
Alright, who wants to know about the dwarfs live inside mt.shasta? I knew they lived somewhere. The clowns are in Sarasota, Florida. Carnival people live here in NEPA. Now we know where the dwarves are. I feel safe.
All for now.
I read a book once that was co-written by Peter Straub and Stephen King, The Talisman. I was curious to read it because I was, at the time, a big Stephen King fan. The first book of his that I read was Cujo, and I remember being immersed. By the time I got to Salem’s Lot I was unable to either stop reading or be alone. I remember Wife No.1 left bed to go the bathroom; I sat in the hallway outside the closed door. It was humiliating even then.
I read Danse Macabre, wherein he wrote of the genre of horror writing, and paid particular attention to his affinity for Peter Straub’s Ghost. (I subsequently read On Writing, A Memoir to the Craft, and gained a lot of appreciation for his talents – an appreciation that had waned when the kid in some book spoke with the reflections of an octogenarian. My new-found appreciation wasn’t enough to have me read any of his subsequent books, I stopped somewhere around Pet Sematary and The Talisman.)
I bought Ghost and dove right now, full of anticipation. The first several pages built into the first few dozen. I am all, “WTF? Where is this going? Doesn’t make sense.” Then something clicked. I never went back to re-read the opening portions to understand why I was so adrift. Maybe it was just his writing style, and I am much more adept now at discerning styles and meaning within than I was 20-some years ago. But when the tumblers fell into place, I was mesmerized from that point forward. Salem’s Lot was good, Stevie, but the premise of vampires is harder to dwell within than ghosts. Ghost is the singularly most frightening book I have ever read.
So when the joint book, The Talisman, came out, I was eager to read it. On balance, my recollection is that I enjoyed it. I recall at the time, however, that allocating the writing between Straub and King was not very difficult. Two people writing apart did not make for a cohesive whole.
It was that thought which prompted this post in my mind.
Two people can sit in a room, each creating a single story, but if they write on different pieces of paper, the story will never be one. In the end, they go their separate ways, each continuing to write, each prolific in their own way.
In the end, two stories can never be combined into one.
A favorite word of mine through the years has been, “non-sequitur.” I suspect the hyphen is not correct because it is taken directly from Latin (so “non” is a word rather than a prefix) meaning, “it does not follow.”
Although it is a favorite word (or two-word combination) of mine, I cannot ever remember uttering it in context. Seems to me to be not quite fitting of coal trash to have such a robust lexicon. When I think of such things, I recall leaving the courthouse one day (I had a hearing of some kind in a neighboring county). I walked past a group of lawyers that did not give me, a lawyer from away, even a nod. One was saying to the group, “… not sure, I mean, he couldn’t even propound an appropriate inquiry!” Wasn’t a reference to my courtroom work (I’m a good propounderistarianer), but I thought as I walked by, “… douchebag. They don't give out nickels for big words anymore.”
I use my share of long words, but as one of my graduate students wrote on a course eval, “You use a lot of big words, but you use them all correctly. It’s refreshing.” And, to me, therein lies the issue. Words communicate. The simpler the word, the more likely your message will be communicated. Sometimes longer words are needed – just be sure to know what they mean before you use them.
Little shit drives me nuts: “We are doing this to insure we get it right the first time.” Insure, as to financially underwrite? “That” is limiting; “which” is not. But, to me, misuse at this level is just lazy, and it’s OK to be lazy. We all are in some areas of our lives including, big time, me. However, when people go out of their way to use words they do not understand just to use a big word, then you know they are not trying to communicate, but to impress.
“Impress: to press (a thing) into or on something.” Isn’t that what Charmin is for?
Could we say, in light of the above, that one who uses big words for the very sake of their length and that flushing sound one hears typically from behind a closed interior door in a residential environment is, empirically, the antithesis of a non sequitur? Methinks, without measureable trepidation of the prospect of contradiction, that such is an accurate manner in which to describe the state of affairs. In short, if you do not know the difference between “didactic” and “pedantic” then do not use either.
Naw, not being a dick, just tired of pseudo-intellectuals.
Alright, enough pompous bullshit. Soapbox to the right; me to the left.
Here’s a good story: “In 1386, the tribunal of Falaise sentenced a sow to be mangled and maimed in the head and forelegs, and then to be hanged, for having torn the face and arms of a child and thus caused its death. … As if to make the travesty of justice complete, the sow was dressed in man's clothes and executed on the public square near the city-hall at an expense to the state of ten sous and ten deniers, besides a pair of gloves to the hangman.” – E.P. Evans, The Criminal Prosecution and Capital Punishment of Animals, 1906 This site is full of good stories.
Good rule from my twin: if it wasn’t food a hundred years ago, it isn’t food now.
This sounds good:
Autumn Roasted Vegetable Salad
Ingredients
1 (8 oz.) yam, peeled and diced to 1-inch
1 (6 oz.) granny smith apple, peeled, cored and diced to 1-inch
1 (6 oz.) red onion, diced to 1-inch
2 tbsp. olive oil, split
salt and pepper to taste
2 tsp. balsamic vinegar
1 tsp. Dijon mustard
1/2 cup sliced California Ripe Olives
2 cups mixed baby greens
1/4 cup of chopped toasted cashews
Directions
In a large mixing bowl, toss yam, apple and red onion with 1 tablespoon of oil. Season with salt and pepper and scatter on one or two roasting pans in an even layer. Bake in a 450˚F oven for 20 minutes until golden. Remove from heat and allow to cool for 10 minutes. While cooling, whisk remaining oil, vinegar and mustard into mixing bowl. Toss in California Ripe Olives, baby greens and cooled vegetables. Top with cashews and serve. Serves 4. Courtesy of The California Olive Industry.
If you get off on articles that begin, “Almost one billion people throughout tropical and sub-tropical latitudes are infected with hookworms. In the countries affected, hookworm infection is often the major contributor to irondeficiency anemia, a direct consequence of the parasite’s bloodfeeding activities” then you can read the rest here - The bandit, a New DNA Transposon from a Hookworm - Possible Horizontal Genetic Transfer between Host and Parasite. The article is focused on DNA analysis. I can’t bring myself to show a pic of the things, but go for it if you like.
I started reading some articles on why lethal injection is “inhumane,” and then got sidetracked to other issues. Data from Amnesty International: In 2006, 91 per cent of all known executions took place in six countries: China, Iran, Pakistan, Iraq, Sudan and the USA. Based on public reports available, Amnesty International estimated that at least 1,010 people were executed in China during the year, although these figures are only the tip of the iceberg. Credible sources suggest that between 7,500 to 8,000 people were executed in 2006. The official statistics remain a state secret, making monitoring and analysis problematic.
Iran executed 177 people, Pakistan 82, and Iraq and Sudan each at least 65. There were 53 executions in 12 states in the USA.
Um, we set the internal toaster oven to "bake" for 53 people and you’re on our case? Shoo, fly, go away! Shoo!! Seems to me you’ve got more than enough work to do with China. Better go pout at the UN, eh? Further, if the 7:1 to 8:1 holds for China, you gotta know, brother, that is also good for Iran and the Sudan.
And don’t you just the love the opening crack – “91 per cent” in six countries. They are using a base of 1,591 executions. Wouldn’t “88 per cent in five countries” sound better? Narrow the culprits to just FIVE! Ah, but that would leave the US off the list.
How’s this for another twist? In point 11 not quite half way down: China reports executing about the same number of people in 2006 that the United States has executed for the past 30 years. That is Amnesty’s data, but not the way they want us to view it.
Here’s another set of data, different source, same year: China, at least 5,000 (approximately 8,000 according to Liu Renwen, Professor of the Chinese Academy of Social Sciences); Iran, at least 215; Pakistan, 82; Iraq, at least 65; Sudan, at least 65; and United States, 53.
China’s number essential the same – a guess as to the total. Iran creeps up over 20%, and joins Iraq and the Sudan with the qualifier, “at least.” Seems the US role is shrinking by the article.
Want an observation? Where is Russia in all this? Ah, they have a moratorium on the death penalty. Why? Last paragraph of the link – Russia committed itself to scrapping the death penalty in 1997, when it signed a protocol to the European Convention on Human Rights. Money. Follow the money. It is routed in trade with the EU. Remember Russia in the 1990's? They were in economic freefall.
Butt hay, who needs the death penalty when you can murder your undesirables? But, Clyde! How can you say that! It, it, it’s so cold! Blow me – here’s the data:
Russia murders per 100,000 population: 201 (#5 on the hit parade)
US murders per 100,000 population: 42 (#24)
Weighted average for the world: 100
Gee, maybe there’s something to the theory.
Where did I get started on this tangent? Oh yeah, the “inhumane” nature of lethal injection. Here’s the scientific article saying it’s bad. Read it all, then come back and read this:
I grabbed this at random from Dead Man Eating:
SOUTH DAKOTA LAST MEAL
ELIJAH PAGE
July 11, 2007
Last Meal: Page had a final meal request of steak with A-1 sauce, jalapeno poppers with cream sauce, onion rings, and a salad with cherry tomatoes, ham chunks, shredded cheese, bacon bits, and blue cheese and ranch dressing. He wanted lemon iced tea and coffee to drink and ice cream for dessert.
The skinny: Page, 25, was executed for the torturing and killing a 19-year-old man following a robbery.
It was South Dakota's first execution in 60 years.
More skinny: Page and two other young men were convicted of killing a 19-year old "friend," near the town of Spearfish in the rural west of South Dakota.
The victim was kidnapped at gunpoint, then tortured for almost 3 hours before his death. He was forced to drink acid, repeatedly kicked and beaten, stabbed in the head and torso, and forced to remove his clothing in an icy creek.
His body was not found until a month later.
Upon his arrest in Texas, Page admitted his involvement in the murder. Page later pled guilty, received a death sentence, and waived appeals.
Accomplice Briley Piper, age 19, also pled guilty and was sentenced to death. Accomplice Darrell Hoadley, age 20, is serving a sentence of life without parole.
Last words and such: Asked if he had any last words, Page replied, "No." Asked if he understood the question Page responded, "Yes, no last words."
I really hope he enjoyed his jalapeño poppers. I wish I knew what flavor ice cream he asked for.
I also hope the execution procedure was a complete fuck-up, totally in line with the scientific article linked above.
Yes, the death penalty is retributive. Ain’t got nothing to do with general deterrence. It does, however, help the recidivism rate, eh?
I am somewhat reluctant to even write this post, let alone publish it. I found an article, the “Top 87 Bad Predictions about the Future”. I enjoyed reading it, but let’s retitle it, “Top 85 …”
It’s a good list except for the two political cracks. George the Elder “no new taxes” completely blows off the fact that the dems in Congress blatantly and publicly lied to set him up. They said the increases in taxes would be offset by decreases in spending, and the margin would dollar-for-dollar reduce the deficit. It was a political trade in the best interests of the country. Geo the Elder bit – then the dems bailed and crucified him. Not only did they not reduce spending, they increased it. A-holes top to bottom. The other crack is about Iraq and WMDs. Everyone thought – including Clinton – that they were there. We all had evidence they were there (just ask the Kurds), the UN required proof of destruction, and Iraq refused entry to sites to allow us to prove out their words – yeah, the Iraqi government lied plenty of times before, so they had no veracity on this topic. So this statement by Franks is on par with the rest of the list – space travel, light bulbs, television? I really detest political and social agendas buried in otherwise worthy reading. Childish of them. Degrades their work.
I’ll press ahead anyway because I am … um … me. Screw ‘em. Ain’t no lib with a sign that reads, “Bush lied and people died” gonna take away my fun. How’s this for a sign, “I have my head stuck so far up my ass that I can fart out my ears.” What a copy? Establish your lib credentials to me and I will have the sign made and shipped to you.
Onward.
«I see no good reasons why the views given in this volume should shock the religious sensibilities of anyone.» Charles Darwin, in the foreword to his book, The Origin of Species, 1869. Actually, I agree with him. It was not his work, but the abuse of it that has caused such turmoil. His work speaks only of evolution, not a word about creation. He can write all he wanted to about apes-to-men, but there was no fossil record of it and he admitted the same. He did say it existed, but just hadn’t been found. That was his scientific mistake. He should never speculate. Not good science. He found evidence of intra-species evolution and should have limited his speculation. Oh well.
«They couldn't hit an elephant at this dist-» Last words of Gen. John Sedgwick, spoken as he looked out over the parapet at enemy lines during the Battle of Spotsylvania on May 9, 1864, then promptly took a fatal shot. Here’s the full story: His corps was probing skirmish lines ahead of the left flank of Confederate defenses and he was directing artillery placements. Confederate sharpshooters were about 1,000 yards away and their shots caused members of his staff and artillerymen to duck for cover. Sedgwick strode around in the open and was quoted as saying, "What? Men dodging this way for single bullets? What will you do when they open fire along the whole line? I am ashamed of you. They couldn't hit an elephant at this distance." Although ashamed, his men continued to flinch and he repeated, "I'm ashamed of you, dodging that way. They couldn't hit an elephant at this distance." Just seconds later he fell forward with a bullet hole below his left eye. – Bet that left a mark, eh, John?
«... good enough for our transatlantic friends ... but unworthy of the attention of practical or scientific men.» British Parliamentary Committee, referring to Edison's light bulb, 1878. Ironic that the symbol for having an idea is now a light bulb above a head.
«There is no reason anyone would want a computer in their home.» Ken Olson, president, chairman and founder of Digital Equipment Corp. (DEC), maker of big business mainframe computers, arguing against the PC in 1977. This caught my attention because I graduated high school that year. About six years later I bought my first home computer. I wonder if the statement is given more weight than he meant. It could have just been some marketing territory thing, a put-down of an upstart competitor.
«Lee DeForest has said in many newspapers and over his signature that it would be possible to transmit the human voice across the Atlantic before many years. Based on these absurd and deliberately misleading statements, the misguided public ... has been persuaded to purchase stock in his company ...» a U.S. District Attorney, prosecuting American inventor Lee DeForest for selling stock fraudulently through the mail for his Radio Telephone Company in 1913. What amazes me is when people think outside their profession. I understand the drill – for some trial work, I had to prepare to go (and did) toe-to-toe with docs and other professionals, attacking them in their field of expertise. But here, raising money to conduct scientific inquiry does not seem to rise to the level of a crime. It could have all been in the delivery – “I guaranty this can happen. Your returns on these investments will be no less than six-fold.” Those statements would be worthy of indictment, but would not make good fodder for a bad-quotations list.
«Space travel is utter bilge.» Richard Van Der Riet Woolley, upon assuming the post of Astronomer Royal in 1956. ”Bilge” is such a great word. American Heritage provides the following: “1. The rounded portion of a ship's hull, forming a transition between the bottom and the sides. The lowest inner part of a ship's hull. 2. Bilge water. 3. [Slang] Stupid talk or writing; nonsense. 4. The bulging part of a barrel or cask.” I am singularly unsatisfied with this list of definitions. The slang doesn’t seem to have a basis in the rest. Here’s the etymology: c. 1513, "lowest internal part of a ship," also "the foulness which collects there," variant of bulge "ship's hull." Ah, that makes sense. It is “stupid talk” as in “foul words.” So I wanted to see when the guy died (December 24, 1986) to get a lift out of what he saw in his lifetime, and I found the complete quote: "It's utter bilge. I don't think anybody will ever put up enough money to do such a thing . . . What good would it do us? If we spent the same amount of money on preparing first-class astronomical equipment we would learn much more about the universe . . . It is all rather rot." Ah, while there is a history in the guy (in 1936, reviewing P.E. Cleator's "Rockets in Space", he also said, "The whole procedure [of shooting rockets into space]...presents difficulties of so fundamental a nature, that we are forced to dismiss the notion as essentially impracticable, in spite of the author's insistent appeal to put aside prejudice and to recollect the supposed impossibility of heavier-than-air flight before it was actually accomplished"), the “bilge” quote seems to be taken out of context. I am becoming less enamored with this “list” as I go.
«A rocket will never be able to leave the Earth's atmosphere.» New York Times, 1936. Back on track. Nothing like the stupidity of the NYT on display to brighten my spirits. Commercial: “I read the NYT because it gives me a view of the news not available anywhere else.” Yes, but the problem with the “view” is that the sources are specious, the writing usually opinion appearing off the op-ed pages, and they have this kiss-my-ass attitude about anyone that differs with their world view. While I don’t mind, as a general statement, a KMA attitude, I do mind when it is them because, well, they are them. Know what I mean? They can kiss my ass.
«Atomic energy might be as good as our present-day explosives, but it is unlikely to produce anything very much more dangerous.» Winston Churchill, British Prime Minister, 1939. Fundamental problem: A politician speaking not of politics, but of science. Shudder.
«A man has been arrested in New York for attempting to extort funds from ignorant and superstitious people by exhibiting a device which he says will convey the human voice any distance over metallic wires so that it will be heard by the listener at the other end. He calls this instrument a telephone. Well-informed people know that it is impossible to transmit the human voice over wires.» News item in a New York newspaper, 1868. Is this the NYT incognito?
«Rail travel at high speed is not possible, because passengers, unable to breathe, would die of asphyxia.» Dr Dionysius Larder (1793-1859), professor of Natural Philosophy and Astronomy, University College London. [I had to correct the spelling of his first name from the source post.] It seems the comment was related to an assessment of a plan to have the government fund the construction of a broader gauge railroad track. An informative bit: “Brunel himself suggested that the opinions of other engineers should be sought and he was unlucky enough to be saddled with a Dr Dionysius Lardner who displayed a remarkable talent for drawing incorrect conclusions from observed data. Lardner attributed the poor performance of the company's best engine to the excessive air resistance of the wide locomotives and concluded that the broad gauge was inherently inferior. However, Brunel and Gooch found that it was back pressure due to misalignment of the blast pipe orifice and not air resistance which was the cause. After some hasty modifications to the engine they were able to haul nearly three times the load on but one third of the fuel used in Lardner's tests.” So, the statement was an extension of his (albeit incorrect) conclusion based upon observed data. Not as egregious as presented.
«The idea that cavalry will be replaced by these iron coaches is absurd. It is little short of treasonous.» Comment of Aide-de-camp to Field Marshal Haig, at tank demonstration, 1916. But, sir, when you hit the tank with a bullet, it goes “tink!” as opposed to the “ooooff!” you get from a horse or rider!
«Fooling around with alternating current is just a waste of time. Nobody will use it, ever.» Thomas Edison, American inventor, 1889 (Edison often ridiculed the arguments of competitor George Westinghouse for AC power). There are many quotes by Edison that I have read over the years of this ilk. The boy seems to have been a singularly disagreeable fellow. I suspect he was widely disliked by all but his fellow megalomaniacs of the time.
Alright, I’m done. But I did learn something … on balance, the article wasn’t fair. Oh well. Good thing I don’t pay for column inches.
I really like being a doctor, but in a lot of ways it makes me feel dirty, so I am going to take come time off from the practice. Why does it make me feel dirty? Well, first it just does. All that pus and oozing and white trash with mouth sores, but beyond the tossing and turning to nightmares about talking to these people in a small room and smelling them, it came home to me this morning when I checked my site meter. Somebody from Madrid searched “anal” and got me. They didn’t just “get me” – I got the number one spot. Just, yuk. I figure if I leave the incoming case studies as unread e’s, it’ll be like cryogenic storage or something and nobody will die. They can talk to Uncle Walt’s head over there in Vault MM. I do have that “alien in the butt” case to resolve, though. I already opened that e, so it’ll be like two-week expired tofu in another couple of days.
I read on some blog that Paris says that she that is going to be cryo’d so that she can come back to blow some future guy in whatever passes for the front seat of a car. I think someone needs to tell her that people have, like, looked into the future and, like, everything gets cured but face lines and age spots. I mean, like, everything! No more big butts, that c-word … censored … no … commercial … no … ca-ca-canber – cancer! That’s it. That gets cured, too. But, like, it’s really bad because everybody gets cured of all these horrible diseases and, like, conditions but all that means is that they live to be old people. And, like, since face lines and spots couldn’t be cured, the old people look like old people. So what happens is that, like, beautiful people, like Paris is right now – just so awesome, pristine, like a Greek goddess – are, like, these big prizes. They get stuff all the time. People just love them. It’s like everybody is an illegal working for granddaddy’s hotels or something. So, like, my point is that if she waits, if Paris waits to get cyro’d and she’s got these lines and spots, too, then she’ll wake up as the hotel staff, and the only blowjobs she’ll be giving will be to other hotel staff in, like, hotel rooms that somebody else slept in the night before. That can’t happen! Not to Paris! Somebody needs to tell her. She has to cyro right now while she is still so beautiful and pretty. And what would be really fun, and somebody needs to tell her this, too, is that she should get all of her best friends cryo’d at the same time. They could wake up, like, a billion years from now, and start out a new life with the coke she stashed in her jeans, and then she could take her friend’s hand and go find a car. Somebody please tell her! Please!
I’ve mentioned it before, but I enjoy reading the posts on totally unauthorized. I wish she would add me to her blogroll – I mean, like, have I got to beg? I am not beneath that by any measure, but it would be nice to be asked to grovel. btw, I like to be kicked but not spit at. Spitting is gross, generally. Well … OK, I better stop.
I play houseboy today. Laundry, dishes, maybe I can get one of the minions to vacuum. My daughter is real good about helping. Does it without being asked. Penn State plays Ohio State tonight. All the ESPN guys say Ohio State will trample them. It is to laugh. Or cry. It’s OK, though, I have alcohol somewhere.
I detest the news in any form. The TV is never on when I am alone in the room. I stay away from news sites. Here’s another example of why: Apple is stupid. Always was. It sat back and held its source code from developers while Microsoft did the exact opposite. The result was an industry replete with Microsoft applications, and cute little programs for Apple. Apple can be innovative, but so can an idiot savant locked in a padded room. So here is Apple saying no cash and limit of two iPhones to deter resellers. Deter? I got the phone in my hands. I am going to resell it. Doesn’t matter to me if it is on a card or with cash. So I leave the money in the bank and give you a debit card. WTF? How does your system deter resellers? Unless, of course, this is an illegal alien thing. The market where people are hacking iPhones and reselling them is not concentrated in the illegal alien population. Dumb. And look here to see the future: Nextel is unlocking its phones. It’s another losing battle, Apple, of which you find yourself on the wrong end (again). Got a product? Sell it for more than it cost you to bring to market. End of story. Stop the social engineering. You suck at it.
It has been raining for a few days. Reminds me of living in California, but without the illegals on every street corner hawking hacked iPhones. Supposed to stop raining around 11:00AM. Whatever.
I like rain. Closes me in. I am a quiet person when I’m alone, and I am alone often. I used to flip whenever I was in the company of anyone so that they could be entertained. I broke that habit over the past couple of years. So I am much more quiet all the time, except for work things. They expect vibrancy, so I fulfill their expectations. The majority of my work, however, is at home. I get my phone calls, my dozen or two of e’s each day, but the majority of what I do is creating words and data. I hope this phase doesn’t end soon. I like being alone. I rarely go out of the house. I drove to the store two days ago, I think it was. Few groceries. I never go to restaurants anymore except when I am on the road. Quiet times for me. I like it. A lot.
We start this session in the office with a little pissed off attitude. “Why?” you ask. “Let me tell you,” I respond.
I get these case studies and I have real patients with real problems (dicks falling off, aliens in butts (that one is coming soon), etc.), albeit all in my virtual medical practice. I get it – I’m not a “real” doctor, I just play one on the internet. But still, that guy’s dick was going to fall off, that cold butt would be numb by now if I didn’t prescribe a hot shower and a good spanking.
Well, I open this file, jot out my diagnosis, give the guy a script for weed and speed, go to the drug store to fill it, come home, and get toasted and hyped. As while I am scratching the fricking thousands of gnats off of the wallpaper, and also gathering the carcasses to top my brownies that are baking (protein supplement), I decided on a lark to check the “real” answer written by “real” docs – as if they actually know what the hell they are talking about. What I did find? You won’t believe it! I am so pissed! They added more data! A-holes.
I have watched precisely one Hercule Periot episode. One. I am an old Columbo fan. Have seen about every one a dozen times. My hero. So I was curious about this Periot guy. I never liked men that act as he does. Character or not, he makes me want to act out. So the show goes on – the crime, the investigation, the big finale – and what happens? As he is explaining how he “solved” the murder, he added data! He added data! You don’t add information when you give your solution. It’s like a rule. That was 15 or 20 years ago. I am still pissed about it. I can be real anal about some things.
So when I felt like reading the junior varsity’s diagnosis of this guy and saw that they added data I almost quit practicing medicine again. But I have a responsibility to my patients, and I took the Hippopotamus Oath sometime or another, so here I am.
Let’s look at some pics. Here’s the one they shows us in the background.
The guy (presumably, could be a chick), has a problem immediately apparent. See it? The dude’s must be shaped like a grotesque pear! Very thin on top. Can see right through him. Then with his heart in the middle, you can see his butt pushing right up to it! See his cheeks? That’s really gross. Heart looks kinda big, too. Is having a big heart a bad thing? They always say it’s ok, but this one may be swollen because it’s chaffed or something from rubbing up against his butt cheeks.
Note: “Relocate butt.”
His bones look kinda thin, too. Note: “Prescribe calcium supplement.”
And now, the pic they were hiding from us (I won’t treat you, my team of residents, in the same despicable manner as Dr. Periot treated me).
Ut oh! Another misfile? Looks like Joe Camel all dolled up to make himself feel pretty got his booty caught on a night-surveillance camera. Thought no one would be looking, eh, Josephine? You know, pal, there is one rule in this world: When you want to look pretty, and you’ve got a pump-action yogurt chucker sitting atop a mud flap all stuck inside your tummy-tucker pantyhose, you stay inside with the doors locked and windows blocked. It’s like a rule. OK?
I can’t believe it’s another misfile. Let’s look closer. Yep, misfile. Joe Camel. Let’s go to the patient …
BACKGROUND. A 27-year-old man presents to the emergency department with a 3-day history of worsening epigastric pain and nonbilious vomiting (Oh, this sounds bad. I better put on one of this ear things with the cold silver front that the “real” docs lick and then put on a woman’s breast. Note: “Put morgue on alert – incoming.”). His bowel movements were normal until the day of presentation (“until”), when they turned black and sticky (I’m gonna puke.). He denies having any hematemesis (so would I. What kind of pervert to do think I am? Hema-what? WTF is that?), fever, chills, or any other associated symptoms, as well as any history of prior surgeries or medical problems. He has taken no medications recently except for Pepto-Bismol, which made the pain worse (did you check the expiration date? That stuff tastes like shit on a good day; can you imagine after the half-life has expired?). He does not smoke tobacco but consumes 4 beers each day (that’s almost 1,500 beers a year! What was that word up there … oh yeah, “epigastric.” Means, “beer coming out the wazoo”). He denies any illicit drug use (why? He’s thoroughly liquid. This boy spends almost a $1,000 a year on beer! No wonder his ass is so big).
On physical examination, his oral temperature (oh, c’mon, have some balls – stick it up his ass. Oh yeah, you’d have to work your arm up to the elbow just to find the entry point. Oh, dry heaves coming!)is 98.6°F (37.0°C). His pulse has a regular rhythm with a rate of 88 bpm. His blood pressure is 198/88 mm Hg. He is noted to be in mild distress secondary to his epigastric discomfort (hurts having all that beer coming out your wazoo, doesn’t it?). The examination of his head and neck, including a check for icteric sclerae (is that like code for head lice?), is normal. His lungs are clear to auscultation with normal respiratory effort (sure, and remember the homeless guy that they crammed something down his throat to make him gag? Not this guy – he’s got insurance!). A 1/6 soft systolic ejection murmur is detected (“Systolic.” I;ve heard that word before. It’s a medical term of some kind.). His S1 and S2 heart sounds are normal. His abdomen is soft (“fat”) but tender to deep palpation in the epigastric region (the “wazoo” region). The rectal exam (oh no! Going in! Better tie a rope around your waist. Gas mask!) reveals normal tone and black, guaiac-negative stool (I really do not like the sound of “gualac-negative.” It’s like, “we did a scrotum check, and it came back ‘testicular-negative.’ We’re sorry, sir, you have no balls.”). The peripheral arterial pulses in the lower extremities are palpable but diminished when compared to the pulses in the upper extremities (that’s normal, ain’t it? Nearer thy god to thee?).
The laboratory analysis, including a complete blood count and a basic metabolic panel, is normal; however, his serum amylase and lipase levels are elevated, at 240 U/L (normal range, 30-110 U/L) and 2118 U/L (normal range, 46-218 U/L), respectively (Hey, Joe, you got the extension for the morgue? 221? Thanks.). The patient is diagnosed with alcohol-induced pancreatitis (surprise, surprise) and treated in the ED with bowel rest, intravenous fluids, antiemetics, and generous doses of intravenous opiate analgesics (gotta love ERs. Here’s some opium, a generous amount. Who’s leg you gotta hump to get this script?). The patient is to be admitted to the hospital for continued bowel rest and intravenous fluid therapy for complete resolution of his pancreatitis; however, despite having his pain eased, the patient is noted to have a persistently elevated systolic blood pressure in the 190-199 range (she’s gonna blow!) and a diastolic blood pressure in the 90-109 range. When further queried for his past medical history (because we think you lied the first time) and a thorough review of systems, the patient does not recall ever having had his blood pressure checked, although he does report that he frequently experiences cramping in his legs (sure you don’t smoke?) and sometimes feels as if his feet are “cold.” (Got socks?)
A posteroanterior chest radiograph is obtained (Image 1). (Hollow guy, big butt.)
What is the most likely cause of this patient’s hypertension, and what further testing should be performed? (Beer. Put him a treadmill until he drops like a stone, then call the morgue. Should take no more than 7 minutes.)
HINT. The next step should be to check the blood pressure in the lower extremities.
ANSWER. Aortic coarctation: The patient’s hypertension and murmur are likely caused by a previously undiagnosed coarctation of the aorta (Beer-induced heart malfunction. Would have been better off smoking. At least his butt would be a normal size.). The chest radiograph demonstrates an enlarged collateral intercostal arterial circulation that has caused notching of the inferior-posterior rib margins, which is supportive of the diagnosis (JV clowns. The “notching” is because his ass has rubbed his heart. The resulting chaffing has enlarged the cardiac organ to such a degree that it is now affecting his ribs.). Magnetic resonance angiography (MRA) confirms the presence of a postductal aortic coarctation (Image 2). (Joe Camel in a dress.)
(You can read more … I’m done.)
Coarctation of the aorta is a congenital condition that results in narrowing of a segment of the aorta. It was first described by Giovanni Morgagni in 1760. Historically, coarctation of the aorta was classified as preductal (before the origin of the ductus arteriosus) or juxtaductal (distal to the origin of the ductus arteriosus). More recently, the latter designation has been abandoned for the term postductal. The postductal form is the most common type of coarctation of the aorta. Coarctation of the aorta constitutes approximately 6-8% of all congenital heart diseases in infants. It is most frequently associated with other forms of congenital heart disease, such as ventricular septal defects, patent ductus arteriosus, bicuspid aortic valves, and aortic stenoses; however, it may also appear as an isolated condition. It is more common in males than in females; in patients with ovarian agenesis (Turner syndrome), it is particularly common.
Patients diagnosed with coarctation of the aorta in infancy usually have a combination of other heart anomalies that can lead to overt congestive heart failure. Those patients presenting beyond infancy, such as in this case, often have vague symptoms that may include headaches, a propensity to nose bleeds, leg cramps, and cold feet. Hypertension is usually present and leads to further in-depth testing. The hallmark physical sign of postductal coarctation is that blood pressure in the arms is at least 20 mm Hg higher than it is in the lower extremities (normally blood pressure in the lower extremities is slightly higher than in the upper extremities). A systolic or continuous murmur in the infrascapular or infraclavicular area also may suggest the presence of this anomaly. Additional murmurs may indicate the presence of associated anomalies, such as ventricular septal defects, patent ductus arteriosus, or aortic stenoses.
Chest radiography may demonstrate cardiomegaly and rib notching from the compensatory collateral intercostal arterial dilatation. The classic “figure 3” sign seen on chest radiographs occurs in at least one third of patients, and results from prestenotic dilatation of the ascending aorta followed by indentation of the aorta at the coarctation site and poststenotic dilatation of the descending aorta. The “reverse 3” or “E” sign can also be observed on barium swallow studies, resulting from matched compression of the esophagus by the dilated segments of the aorta. Signs of left ventricular hypertrophy are also often seen on electrocardiograms (ECGs). An echocardiogram is usually performed to detect any associated cardiac anomalies. MRA and cardiac catheterization may be necessary to confirm the exact location and the presence of collaterals. A gradient of more than 20% across the stenosis during cardiac catheterization indicates a severe coarctation and requires urgent intervention.
Treatment of aortic coarctation is usually surgical. Antihypertensive medication must be used with caution, as its use may lead to inadequate perfusion of the lower body and renal impairment. The best treatment strategy is admission for early repair. If left untreated, 90% of patients with aortic coarctation die by the age of 50 years, usually from hypertensive complications. Historically, surgical resection of the involved aortic segment has been the treatment of choice, and it has a high success rate. More recently, balloon dilatation and placement of endovascular stents are gaining popularity and becoming accepted forms of primary therapy, especially for patients who may be unsuitable candidates for surgery. Postoperative complications may be acute or delayed and include persistent hypertension, recoarctation, and aortic aneurysms, among others.
This patient had an echocardiogram that failed to reveal any associated cardiac defects. He was referred for surgical intervention and underwent successful resection of the coarcted aortic segment after resolution of his associated pancreatitis, the initial reason for his presentation and admission.
i added something cool, well, cool to me, to the site. i tried once before to add an audio to the postings, but was stumped on a couple of tries. could get it to the sidebar, but not the posts. then i was on daily cup of tech and saw his "listen now" button. i followed the feed and found odigo dot com. not only free, but it automatically (and successfully) updated my template.
still trying to figure out some things. a couple of the articles below say "too short so not processed." not sure why. also, if i did it over again, i would have set blogger to display all of my articles before i signed up, not just the 13 i keep on a page. that would have given to me an initial conversion of a lot of stuff - then i would have set it back to 13. not sure if i can get it to do articles on demand. maybe i can edit and republish?
but still, free and easy. i love hearing the audio say, "peckerhead," "you are a peckerhead," "you are nothing but a peckerhead." i get joy out of small things.
however, i have yet to post since installing it, so we will see if it does it automatically. i may fall instantly out of love in a few seconds. i guess if you are hearing this, peckerhead, peckerhead, peckerhead, then i am still in love.
ah, the joys of a late fall romance!
If you’ve never come across Shane MacGowan, you’re missing something huge – not unlike stumbling into the then-unknown American continent on your westward way from Europe to Asia for riches in silks and baubles. You would disembark your ship all awed at the beautiful land, arms stretched to frame your view, and then you would take an arrow in the chest. And from the coastal wood line your dying ears would discern a snicker or two. That snicker would be Shane, who would then absently walk in another direction. Your death was just to see the look of shock on your face: “Bet he won’t see this coming!” [ZING! THWAP!] (snicker) “Hee, hee, hee. What say we get a drink? Which way?”
Shane’s an incredible songwriter. His lyrics run the gambit from drinking songs to sober love songs. He’s got this stage presence now that is heavily influenced by his constant consumption of whiskey. His teeth were never good. But how can you criticize a guy whose first band was named the “Nipple Erectors”? (The record label said no - so they changed it to the "Nips." I learned that from an interview he gave. The next band of his, "The Pogues," was a name of which I never knew the origin, but just stumbled on this, " ... took his band’s name from the Irish phrase 'póg mo thóin' (meaning 'kiss my arse')." I was going to source that find, but I googled it and found several sources. Pick the one you like.)
He’s worth googling and checking out his youtube videos.
Just a sidenote ... I spent some good time wandering the net for material. I have some interview/documentary video at the house. I've listened to Shane and followed his travails loosely for a few years. It is real easy to point and laugh in this world. I find that the clowns that write about his drunken exploits usually do not have the intellectual depth to wrote a coherent sentence, let alone write lyrics or compose music. Everyone has a talent; everyone has a shameful side. Enjoy Shane for his talents.
The videos I selected begin around 1983 with Dirty Old Town. The same song is the last video – 20-some years later. No, didn’t age well. I’ll do a quick intro on the other videos. All the lyrics are at the end.
This song is beautiful - Haunted. Sinead O'Connor actually looks like a normal person. Her voice can be so pretty. I wish she wasn’t so into performance art in the rest of her stuff.
Shane did not write this song. Christy Moore is an old Irish favorite. I like Shane’s presence – walks on, walks off. Gotta love him. Spancil Hill. Quick story – song is based on a poem a 23 year-old guy wrote a little before 1873. He came to America and never saved enough to have his wife come over from Ireland. He was sickly, and wrote the poem knowing he would die soon. He did in 1873.
It’s Christmas Eve in the drunk tank. Beautiful line. Fairytale of New York with Kirsty MacColl.
Live performance. Get drunk and sing along. A Pair of Brown Eyes.
This is the later performance of Dirty Old Town, performed on the Henry Rollins Show. Yeah, his politics suck, but he’s drunk all the time, so I’ll cut him a break.
”Dirty Old Town”
I met my love by the gas works wall
Dreamed a dream by the old canal
I Kissed my girl by the factory wall
Dirty old town
Dirty old town
Clouds are drifting across the moon
Cats are prowling on their beat
Spring's a girl from the streets at night
Dirty old town
Dirty old town
I Heard a siren from the docks
Saw a train set the night on fire
I Smelled the spring on the smoky wind
Dirty old town
Dirty old town
I'm gonna make me a big sharp axe
Shining steel tempered in the fire
I'll chop you down like an old dead tree
Dirty old town
Dirty old town
I met my love by the gas works wall
Dreamed a dream by the old canal
I kissed my girl by the factory wall
Dirty old town
Dirty old town
Dirty old town
Dirty old town
“Haunted”
Do you remember that sunny day
Somewhere in London
In the middle of nowhere
Didn't have nothing to do that day
Didn't want to do nothing anyway
You got a way of walking
You got a way of talking
And there's something about you
And now I know I never ever
Want to be without you
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
of your precious love
of your precious love
The first time I saw you
Standing in the street
You were so cool you could have
Put out Vietnam
All the girls say "Whats he like?"
I said "He's kind of shy
But that's the kind of girl I am,
He's my kind of guy"
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
of your precious love
of your precious love
I'll build my world around you
I'll bless the day that I found you
I'll stay beside you and I'll never leave
Or tell you all those lies you'd never believe
Uh huh huh
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
of your precious love
of your precious love
You got a way of walking
You got a way of talking
And there's something about you
That's the kind of girl I am,
He's my kind of guy
And now I know I never ever
Want to be without you
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
I want to be haunted by the ghost
And now I know I never ever
Want to be without you
Haunted... Haunted... Haunted...
“Spancil Hill”
Last night as I lay dreaming of pleasant days gone by
My mind being bent on rambling to Ireland I did fly
I stepped on board a vision and I followed with the wind
And I shortly came to anchor at the cross of Spancil Hill
It being the 23rd June the day before the fair
When lreland's sons and daughters in crowds assembled there
The young and the old, the brave and the bold their journey to fulfill
There were jovial conversations at the fair of Spancil Hill
I went to see my neighbors to hear what they might say
The old ones were all dead and gone and the young one's turning grey
I met with the tailor Quigley, he's a bould as ever still
Sure he used to make my britches when I lived in Spancil Hill
I paid a flying visit to my first and only love
She's as white as any lily and as gentle as a dove
She threw her arms around me saying "Johnny, I love you still"
Oh she's Ned the farmers daughter and the flower of Spancil Hill
I dreamt I held and kissed her as in the days of yore
She said, "Johnny you're only joking like many's the time before"
The cock he crew in the morning he crew both loud and shrill
And I awoke in California, many miles from Spancil Hill.
“Fairytale of New York”
It was Christmas Eve babe
In the drunk tank
An old man said to me, won't see another one
And then he sang a song
The Rare Old Mountain Dew
I turned my face away
And dreamed about you
Got on a lucky one
Came in eighteen to one
I've got a feeling
This year's for me and you
So happy Christmas
I love you baby
I can see a better time
When all our dreams come true
They've got cars big as bars
They've got rivers of gold
But the wind goes right through you
It's no place for the old
When you first took my hand
On a cold Christmas Eve
You promised me
Broadway was waiting for me
You were handsome
You were pretty
Queen of New York City
When the band finished playing
They howled out for more
Sinatra was swinging,
All the drunks they were singing
We kissed on a corner
Then danced through the night
The boys of the NYPD choir
Were singing "Galway Bay"
And the bells were ringing out
For Christmas day
You're a bum
You're a punk
You're an old slut on junk
Lying there almost dead on a drip in that bed
You scumbag, you maggot
You cheap lousy faggot
Happy Christmas your arse
I pray God it's our last
I could have been someone
Well so could anyone
You took my dreams from me
When I first found you
I kept them with me babe
I put them with my own
Can't make it all alone
I've built my dreams around you
“A Pair of Brown Eyes”
One summer evening drunk to hell
I stood there nearly lifeless
An old man in the corner sang
Where the water lilies grow
And on the jukebox Johnny sang
About a thing called love
And it's how are you kid and what's your name
And how would you bloody know?
In blood and death 'neath a screaming sky
I lay down on the ground
And the arms and legs of other men
Were scattered all around
Some cursed, some prayed, some prayed then cursed
Then prayed and bled some more
And the only thing that I could see
Was a pair of brown eyes that was looking at me
But when we got back, labeled parts one to three
There was no pair of brown eyes waiting for me
And a rovin' a rovin' a rovin' I'll go
For a pair of brown eyes
I looked at him he looked at me
All I could do was hate him
While Ray and Philomena sang
Of my elusive dream
I saw the streams, the rolling hills
Where his brown eyes were waiting
And I thought about a pair of brown eyes
That waited once for me
So drunk to hell I left the place
Sometimes crawling sometimes walking
A hungry sound came across the breeze
So I gave the walls a talking
And I heard the sounds of long ago
From the old canal
And the wind was whistling in the trees
Where the birds were gently laughing
And a rovin' a rovin' a rovin' I'll go
For a pair of brown eyes
OH YEAH, BABY! The doctor be IN! No intro. Straight to the pic – this just came in moments ago. Here you go:
(Hand raised – bouncing in seat.) Pick me! PICK ME! I got it! I KNOW THIS ONE! Know that with no more data! This boy done got the scratch! He been doin’ some ho’s and shit! Been banging and shit with the nasty girls! See where that is, way up along the top part? WTF wrong with this man? He ain’t using no rubber! He be just banging and banging and banging! Dumb motherf—ker. Serve him right. I hope his dick falls off. Stupid motherf—ker out there making it nasty for the rest of us.
Let’s see what this man has to say for himself …
BACKGROUND. (“Background” shit – this man doing ho’s with no rubber. Get the f-ck outta here. Alright, alright. I’ll shut up. Let the man say his piece, lying motherf—ker.) A 52-year-old man (52! You should know better, stupid motherf—ker. Where you head at, besides buried in some ho’s twat?) with no clinically significant medical history presents to the emergency department with a chief complaint of a “rash” on his penis (A rash? A RASH?!? You dumb motherf—ker, that be the scratch and you know it! You trying to get free medical or sumptin? F—cking lying piece of sh—t you be.). The patient states that the rash first appeared 1 week before presentation. He denies any dysuria, urethral discharge, pruritus or pain in the area of the lesion. This is the first time he has had such a rash (lying piece of shit, you be lying like a motherf—king rug). He admits to having had several recent sexual partners(ho,ho,ho, motherf—ker wit no rubber).
On physical examination, his vital signs are normal (you check for a brain?). The patient has a well-demarcated, ulcerated lesion (always is) on the ventral aspect of his penis (see Image). The lesion is not tender to palpation (never is). No other lesions are noted (better hope not, mofo, else that dick be falling off!), and no discharge is observed from the urethra (just wait.). The findings of his testicular examination are unremarkable (“Hey baby, whachu doin after work? Maybe you and me go steppin’ out. I gots some blow with your name on it.” "Not with that dick you ain't steppin' out wit nobody like me."), with the exception of bilateral prominent inguinal lymphadenopathy (that means sumptin be big down there that ain’t aposta be big, like Swollen Nut Syndrome. This stupid motherf—ker be sick!). The remaining physical findings, including the cardiac and abdominal findings, are unremarkable.
What is the diagnosis, and what empiric treatment is necessary? (The boy gots the scratch. Give him some penicillin and a handful of rubbers. Better check him for The Drip and Crabs. I hopes he’s gots them all. Serve him right. Dumb motherf—ker.)
(I’ll just let the answer run. I don’t care nuttin for this jackass.)
ANSWER. Primary syphilis: Syphilis, an infectious disease caused by the spirochete Treponema pallidum, is usually transmitted by means of sexual contact; the usual route of transmission is the skin or mucous membranes of an uninfected sexual partner coming in contact with the mucosal ulcerations (eg, in the genital area, mouth, or anus) of an infected partner.
In the United States, the rate of primary and secondary syphilis declined by 89% from 1990 to 2000; however, in November 2005, the Centers for Disease Control and Prevention (CDC) reported that the number of primary and secondary cases of syphilis had been increasing, from 2.6 cases per 100,000 population in 2002 to 4.7 cases per 100,000 population in 2004 (an increase of 87%). This rise was partially attributed to increased rates of infection among men who have sex with men, who in 2004 represented 64% (up from 5% in 1999) of all cases of primary and secondary syphilis in the United States.2
Primary syphilis manifests as a nonpainful ulcer (chancre) at the site of infection. The lesion is usually on the genital area, but it may also occur on the lips, tongue, cervix, or anus of the infected person. This lesion usually develops within 3-4 weeks after infection, but it may occur as long as 3 months after. The primary lesion spontaneously heals in 3-7 weeks, and it may go unnoticed, especially if it is on the cervix or anus; therefore, infected individuals may not realize that they have an infection. Unilateral or bilateral regional painless lymphadenopathy is also a characteristic finding of primary syphilis.
Secondary syphilis is the next phase of the disease, developing 4-10 weeks after the primary lesion appears. This phase is marked by nonspecific systemic complaints, such as fever, headache, fatigue, and lymphadenopathy. A characteristic rash that consists of round, discrete, nonpruritic macules on the trunk and proximal extremities and penny-sized, reddish-brown sores, appears on the palms, soles, scalp, and face in this phase. These sores may coalesce to form highly infectious lesions called condylomata lata. Symptomatic secondary syphilis also spontaneously resolves, and the disease then enters a latent period where few if any symptoms are seen; the latent phase is divided into “early” and “late” periods. Symptoms may recur in the early latent stage (during the first 2 years of infection). The disease then goes into the late latent phase, when patients remain asymptomatic and noninfectious.
About one third of patients with primary syphilis develop a form of the disease called tertiary syphilis, which is a chronic inflammatory process that progresses over years and decades and results in varied symptoms and physical findings, including mental illness, blindness, heart problems, and eventual death. Cardiovascular syphilis can cause devastating damage to the heart, including aortic endarteritis with medial necrosis and aneurysm formation. Gummatous syphilis manifests as coalescent granulomatous lesions affecting the bones, joints, skin, or almost any part of the body. Finally, symptomatic neurosyphilis can lead to meningitis, brain parenchymal infection, endarteritis, or stroke.
Standard treatment for primary syphilis or for syphilitic infection <1 year after exposure is benzathine penicillin G 2.4 million U given by intramuscular (IM) injection. Alternate regimens for patients allergic to penicillin are a 2-week course of doxycycline 100 mg given orally (PO) twice daily (BID) for 14 days, tetracycline 500 mg PO 4 times daily (QID) for 14 days, or ceftriaxone 1 g given IM or intravenously (IV) once a day for 8-10 days. A recent study also demonstrated efficacy with azithromycin 2 g PO as a single dose; however, the authors suggested caution in applying this finding to patients in the United States, because the trial was conducted in a geographically limited area outside of the US, and because macrolide resistance has already been demonstrated in the US.1
If the patient was infected for >1 year at the time of presentation, benzathine penicillin G (2.4 million U IM once a week for 3 consecutive weeks), or doxycycline for 4 weeks is recommended. Neurosyphilis requires treatment with aqueous crystalline penicillin G 2-4 million U IV every 4 hours for 10-14 days. Patients with neurosyphilis should also be followed up every 6 months for 3-4 years for cerebrospinal fluid (CSF) and serologic testing.
Given this patient’s allergy to penicillin and current social situation, he was treated with azithromycin 2 g PO instead of a 14-day course of doxycycline. The ulcerative lesion was swabbed and sent for darkfield microscopy. Rapid plasma reagin (RPR) and Venereal Disease Research Laboratories (VDRL) serum studies were also ordered. A urine sample was sent for Neisseria gonorrhoeae and Chlamydia polymerase chain reaction (PCR), and the patient was counseled about concomitant sexually transmitted diseases (STDs), including HIV. He was referred for HIV testing and given a fast-track follow-up appointment for the laboratory results.
I went through my old e’s and found that I have almost 20 of these case studies. So I have some catch up to do. I sure hope none of my patients died in the interim. That would be bad. I think.
Today we have, “Altered Mental Status in a Homeless Man.” Let’s start, as we always do, with the photographic evidence.
This here thing-a-ma-bob with the squiggly lines is called an “electrocardiogram.” It’s called that because of a little known story. It's a good story. Let me tell it to you.
It seems that a clerk in a Western Union office in Cheyenne, Wyoming, in or about 1884, was sending a telegraph message.
. .- - | -- .
.. | .- -- | ... . .-. .. --- ..- ...
. .- - | -- .
(If you're out of pratice with Morse Code - you have to do one line at a time.)
A bandit rushed! He was a particularly cruel bandit with yellow teeth and small feet. He told the clerk to give him all the money – he said, “Give me all the money!” The clerk said he didn’t have any money, except the few bits people paid for telegrams to be sent. “Well then,” said the bandit, “send one of them there electric telegrams and tell somebody to bring money here! Now!” The clerk agreed:
--. --- - | ... --- -- . | .-- .... .- -.-. -.- | .--- --- -... | .... . .-. .
... -- . .-.. .-.. ... | .-.. .. -.- . | .... --- .-. ... . | -.-. ..- --
-.-. --- .-- .--. --- -.- . | .. ... | .- | ...- . .-. -... | - --- | - .... .. ... | --. ..- -.—
... . -. -.. | - .... . | ... .... . .-. .. ..-. ..-. | --..-- | | .--. .-.. . .- ... .
- .... .. ... | --. ..- -.-- | -- .- -.- . ... | -- -.-- | .- ... ... | - .-- .. - -.-. .... | ..--.. | | | .... ..- .-. .-. -.-- | ..--.. |
“You be typing a lot, little man,” said the bandit.
“I am telling them to bring a lot of money. That takes extra words,” said the clerk.
“Oh,” said the bandit.
Soon the sheriff could be seen in the distance with his posse and the bandit knew he had been duped.
“Why, I oughta send YOU as a telegram!” he spit through his cracked lips with breath that smelled like he had sex with his horse in lieu of breakfast.
Then the bad bandit smiled a terrible smile. He tied the clerk to his chair – arms, legs, and neck – and gagged him with a dirty oil rag. He took out his Bowie knife and CUT the clerk’s shirt open with a flourish. He did a pirouette and clasped his hands together as his pants got tight across the middle section. He paused for a moment. His eyes glossed over. He looked at the clerk intently. "You married? Involved?" Drool leaked out of his mouth.
With a snap of his head, his eyes cleared. “You got a needle and thread?” he asked the clerk. The clerk nodded towards the cabinet on the far side of the wall. “Thanks,” said the bandit.
The bandit rummaged through the cabinet and found what he needed. He went to the desk, took the telegram button thingey that you hit to make that tap-tap-tap sound, and then sat in front of the clerk.
“This is gonna hurt. Sorry,” said the bandit. He threaded his needle. The clerk’s eye was wide open (he lost the other in a terrible accident that the family refers to simply as, “The Baking Soda Incident,” then they all lower there heads and they shift uncomfortably in their seats). With the swiftness of a mule on crack chasing the candy delivery cart, the bandit disconnected the wires from the telegram button thingey, tied them a few inches apart on the thread, made an incision with his Bowie knife just below the clerk’s rib cage, and reached up in there with the needle in hand.
He sewed the wires to the clerk’s beating heart in mere seconds, then used a blanket stitch to close the wound.
“Now, I want you stay in this chair for a few days. Drink lots of fluids, and come see me if it isn’t healing properly, OK?” said the bandit.
With his eye as round as a dollar coin and face as pale as a bucket of chalk dust, the clerk, through his gagged mouth said, “Hhm-uh.”
The bandit stood still, tilted his head, and listened intently. “Can you hear it? Can you?” he said.
“Hrmph vtoph,” the clerk seemed to say.
“You. You’re an electrical-heart-telegram! I made a fun—”
Before the bandit could finish his sentence, ”Zing” came a .50 caliber slug into the back of his head. The sheriff had saved the day! Unfortunately, the posse opened fire at the same time, and the clerk took no less than three pounds of lead from his belt up.
A little over 50 miles away in Laramie, Wyoming, a clerk was hunched over his desk. He was transcribing the dots and dashes he was receiving from Cheyenne.
“What the fuck is that?” his boss said over his shoulder.
“Can’t make sense of it, sir. Sometimes I think it says … wait … it just stopped.”
“Must’ve been rats chewing the line. Throw it away.”
“Yes, sir.”
The story spread to the universities on the east coast. Collectively, they thought it was rather amusing, but may also hold scientific value. So they got some government money and perfected the technique on prisoners.
The name of the procedure was changed to reflect the Latin base more illustrative of the seriousness with which they viewed themselves – electro-cardio-gram, or “ECG,” for short.
OK. Where was I? Oh, yeah, this guy’s ECG:
Notice how the lines kinda go up, and then down, with flat spots in between. Might be important. Note, “Lots of flat spots on the telegram thingey.”
See those little rises? Those are called “P waves.” You can calculate the Atrial rate from the distance between them. Them big spikes are called “R waves,” and have something to do with Ventricular rate. I have no skills with which to apply such knowledge, but I am pretty sure it has something to do with his heart.
Note, “Patient has a heart.”
OK, enough with the pictures. Let’s go interview the guy!
BACKGROUND. A 38-year-old man is brought by ambulance to the emergency department. The patient was found lying near the stoop of an apartment building (he was asleep? Why are you bothering the dude? Let him relax?). The paramedics were unable to obtain any history from the patient en route because the patient has an altered mental status (maybe because his “altered mental status” was REM sleep?!?).
On arrival, the patient’s vital signs are an oral temperature of 95.72°F (35.4°C) (a little cool), a blood pressure of 88/40 mm Hg (relaxed), a heart rate of 38 bpm (very relaxed), and a respiratory rate of 24 breaths/min (deep sleep, ok?). His oxygen saturation could not be obtained. The patient appears to be a homeless, disheveled man and looks older than his chronologic age, with a faint smell of alcohol on his breath (so he had a beers, found a nice doorway, and went to sleep. You people running low on patients or high on residents? Can’t you just let the poor man sleep?). He can be aroused but does not follow simple commands (neither do you, numbnuts, until your first cup of coffee. Did you give him a cup of coffee?). He has intact gag and corneal reflexes (“gag reflexes” WTF did you people do? You crammed something down his throat, he gags, you write “normal” on the chart? WTF?). His pupils are equal and reactive to light. No obvious signs of head trauma are noted, and the examination of his oropharynx is unremarkable (so … nothing wrong with the guy? I reiterate – why did you drag his ass in here? He was sleeping!!). The results of his cardiac examination are significant for marked bradycardia (smoker, lived outside – got a problem with that?). A lung examination reveals rhonchi in the right lower lung field. The patient’s skin is cold, and his blood glucose level is 104 mg/dL.
An electrocardiogram (ECG) was performed before the physical examination (see Image).
What is the diagnosis and treatment? (Drunk, asleep, no coffee.)
HINT. The patient’s rectal temperature is 87.7°F (31°C). (Here we go with the rectal again. You drag this guy out of bed, cram something down his throat to make him gag, and now you stick something up his ass to check his temperature?!? What is wrong with you people?!? But, hey, we have something here. Several degrees lower. Think, Dr. Clyde, think. Seems familiar. Think. New Hampshire. Snow bank. 1981. Drunk. I GOT IT! He has “Cold Ass.” Used to get it all the time when I got drunk and slept in doorways. What’s the problem here? Just give him a cup of coffee and maybe a hot shower.)
ANSWER. Hypothermia secondary to alcohol use and environmental exposure: The patient’s ECG demonstrates the classic abnormalities associated with hypothermia, the most evident being profound sinus bradycardia. … (We’re done here. Cold Ass. Drunk and asleep. Move on.)
(Only because I like you people, I’ll leave the rest of the text intact. Remember – Cold Ass.). In addition, all leads show classic Osborn waves (J waves seen at the junction of the QRS complex and the ST segment). As always, the ECG must be interpreted within the clinical context; in this case, the apparent elevations of the ST segment should not be misinterpreted as evidence of myocardial injury. Other common ECG findings associated with hypothermia that are not seen on this tracing include atrial and ventricular dysrhythmias, as well as prolongation of the PR, QRS, and QT intervals.
This case features the most common etiology of hypothermia (ie, environmental exposure or accidental hypothermia). Other conditions often coexist, such as infection, metabolic abnormalities (eg, hypoglycemia), drug or alcohol overdose, and endocrine problems (eg, hypothyroidism); on occasion, any one or a combination of these conditions may also be the etiology.
In general, the life-threatening cardiovascular complications of hypothermia are cardiogenic shock and malignant dysrhythmias. Typically, rewarming the patient is sufficient to restore normal myocardial contractility and cardiac rhythm. For patients in shock who do not respond to resuscitation with warmed intravenous fluid and other passive and active rewarming techniques, low-dose dopamine is the recommended agent because of its inotropic and peripheral vasoconstrictive effects. Atrial dysrhythmias are generally associated with a slow ventricular response; therefore, treatment with digoxin or calcium channel blockers is not warranted. Bretylium has long been recommended for the treatment and prevention of ventricular dysrhythmias, though little evidence supports this practice. The use of amiodarone has increased in recent years as a result of shortages in the world supply of bretylium. For refractory bradydysrhythmia, external noninvasive pacing is recommended in favor of transvenous pacing because insertion of pacing wires into a hypothermic ventricle can potentially cause a fatal dysrhythmia.
Hypothermia is often diagnosed before an ECG is performed; however, the ECG can provide important clues to the diagnosis and yields critical information regarding the overall severity of the patient’s condition, from an electrophysiologic standpoint.
I went to Woodstock this weekend. Is it a pilgrimage for hippies, like Mecca for Christian-haters, er, Muslims? (You see, I always get confused when books fundamental to a religion reads, “Now when you meet the unbelievers, smite their necks until you overcome them fully...” (Qur’an 47:4).)(Continued digression – what is wrong with you people? “Smite”? “Smite” them? That’s a little extreme, ain’t it? And just because we are “unbelievers” in your version of the afterlife? Can’t we – can’t we al – [I can never get this phrase out without bursting out laughing][focus, Clyde][breath deep, stretch toes (it works!)][OK] Can’t we all just get along?)(Full Disclosure: I had a Muslim guy make some crack to me Saturday morning when I was pumping my own gas. Seems it was a semi-full service gas station. The Muslim guys running it were wandering around helping people pump their gas. I was mid-pump before he got there. He walks up to me and says, “Ah, typical American! You think you can do everything!” I said with a smile, “Not everything, but I can pump gas.” He did this good natured laugh and walked away. I looked at the back of his turban thinking, “WTF was that?”). 
Whew, man, where was I? Woodstock! Oh, yeah. I went to Woodstock, NY, this weekend. It was, um, interesting. Screaming liberals caught in a 40-year time warp. I am so incredibly happy for them that we are fighting a war in Iraq – it gives them the perfect parallel for Johnson and Vietnam (well, let’s be fair, they still think it was Nixon, but that’s absurd to anyone who wasn’t tripping their brains out constantly from 1963 through 1973 … oh yeah! Nevermind – Nixon’s war. Got it.)
Everywhere you look you see condemnation of President Bush and the war: Store fronts, telephone poles, car bumpers. Surprisingly, there completely lacked any innovation slogans. The most common, which also made appearances on yard signs, read simply, “Impeach.” OK. Whatever. Free country, free speech (thanks to President Bush’s appointment of conservatives to SCOTUS). Isn’t “impeach” a transitive verb? It needs an object, right? I understand sentences in a continuum where the subject can be understood to avoid redundancy, but I never saw an object-understood sentence. I also did not see any of the bumper stickers popular with liberals down here: “I support the troops. Bring them home.” (Ah, you support them as long as they don’t have to do what they are trained to do. Yeah, OK. Whatever.) So in Woodstock, they support neither the war nor the military. Funny how some things don’t change.
So what does Woodstock look like? Here’s the “Corner Cupboard.” The red cans out front read, “Butts.” I think they are port-a-potties. See the paper-laden telephone poles? The white paper facing the road reads, “Lost dog today.” Funny. The sign outdates itself in less than 24 hours. There’s foresight! “Ah, Flower, you need to tell them when you lost the dog, so they know how long ago.” “Um, yeah, I guess you’re right, Moonbeam. What day is it?” “Today.” “OK, I’ll put that.”
So I got up at 630 or 700 this morning. The place was putting out coffee at 900. 900? You run this place and you sleep in? People staying there are, like, tourists. Tourists get up and, well, tour. Coffee is a staple. Tourists get cranky without coffee, and me in particular having to wait until 900. Had to walk three blocks to find the first open place. Here’s where I eventually had coffee this morning. Yeah, this pic was taken in 1969. That’s Bob Dylan in the doorway. Same place, still there. They keep the coffee pots in the walk-in freezer. Still can’t figure that out. Maybe it has something to do with making iced coffee. How do you make iced coffee if the pot is warm? Makes sense on some stoned-out-for-decades basis, I guess.
This picture of the waterfalls is from 1900 or thereabouts. Same falls, still there. Nothing changes in Woodstock, it seems, except the inventory of the consumables: Weed, acid, mushrooms, coffee, guitar strings, hair dye. The things that stay the same include waterfalls, coffee shops, late risers, glossy eyes, mindless stares, clothes now threadbare, publicly accessible port-a-potties. Even the people are the same people that have been there since 1969. You see, when you come into town from the NYS Thruway on Route 212, the road bends to the left and becomes Tinker Street. OK, no problem. But when you go back there’s like this other road that you don’t see when you come in. So if you travel back down Tinker, the 212 thing is, like, other there, but then in front of you is this road. It, um, well, it’s freaky, cuz, like, if you go out that road then, like, it isn’t 212. I don’t know what it is, but it isn’t that 212 thing. So, I think we’d better turn around. Now, if you walk, it’s cool. The 212 thing comes up, and, hey, there’s “Not Fade Way”! Let’s go in! Maybe the new Janis shirt came in, or some new Jimi stuff. Then, like, before we know it, we’re on 212. But in a car, it just doesn’t work that way. Must be Bush's fault. So, well, may as well find a place to live, eh?
Doubt me? Compare these pics. See the guy in the BW, the one sitting up front? Same dude in color, just now he’s wearing a dress. Looks like the place he got to live is town square. Nice TV.
Woodstock, NY. Remarkable town.
Posts
All Comments
