Eighteen hundred miles and four days later, I made it back to Denver. I hope I cleared the cobwebs a bit. I needed to skip town for a few days and press a shutter button, regardless of the result. My digital images await my editor’s eye, and I just got back the proof scans of my film images. I shot all of those with the Hasselblad Superwide. I’ll post a selection of images later in the week after I’ve had time to do some culling and captioning.
I’m still learning how to get the best from the Superwide. I have to keep reminding myself that its best use is to get close to whatever I’m shooting, and put its wide, distortion-free field and immense depth of focus to work to tell the photograph’s story. The temptation with such a specialist camera is to make the camera itself the story – here’s a cool “wide angle” shot taken from half a mile away wow that’s really sharp isn’t that interesting….not.
To recap my itinerary, I started on Wednesday afternoon in Denver, and drove west to Grand Junction, Colorado, on the other side of the Front Range. GJ is not far from Utah; it’s a favorite starting point for staging into southeastern Utah’s system of parks and public-access spaces. It’s a 250-mile drive, but with frequent stops it took me 6 hours to get there. No matter; the point was to get out and look at stuff, and maybe make a picture or two.
Thursday morning I drove to St George, Utah, through some of the most beautiful country in North America. I stopped, among other places, at Bryce Canyon, which I mentioned in my last post. The images I made – stay tuned – don’t really do it justice. That, in fact, is why I don’t consider myself a “landscape” photographer, in the tradition of Ansel Adams and others; anything I might shoot in that genre has already been done, and better, than I could do it. Simple documentation of locales doesn’t interest me much. But that said, there was a lot of cool “landscape-y” stuff along the route to St. George, so I gave in to temptation. I’ll post a selection of Bryce images soon.
Friday morning I left for the final outbound leg, to Gallup, NM. This southeasterly route shallowly cuts off the northeast corner of Arizona. The best part came along US Highway 89/89A, which I picked up at Fredonia, AZ, and followed in a meandering southeasterly direction, skirting Grand Canyon National Park to the north and east. I was tempted, but I’ve already been to the south rim of the Grand Canyon, and didn’t feel much like arriving at mid-day or early afternoon, to deal with harsh light and hordes of tourists. Besides, I was still reeling from Bryce, and not sure I wanted to look at some old ditch in the desert after beholding the wonders in Utah.
The route goes through the Navajo and Paiute reservations, and is a stark and beautiful desert landscape. Then, as US 89 veers due south towards Flagstaff, AZ, one traverses the Cococino National Forest, again a place of surpassing beauty. Then it’s on to I-40E near Winona, AZ, and there’s not much to look at until you get to Gallup. I was sorely tempted by the Petrified Forest and the Meteor Crater, but I arrived too late in the day for those attractions. Something for next time.
Saturday was my day to drive home; I was road-sick by this point, and the novelty of driving had worn off pretty thoroughly. My plan was to head towards Durango, CO, a part of my newly-adopted home state I’d not yet seen. US 491 took me north through Navajo and Ute nations lands, and Shiprock, NM, where it crosses US 64 at right angles. Then it was on to Farmington, NM and north to Durango. I didn’t find this leg of the trip compelling; it felt like a segment to get through quickly. Only when I got into CO and the terrain began to climb again did I really enjoy the view. Note to self for future trips.
There are numerous wildfires burning throughout the West, and I frequently encountered haze and the piney smell of burning wood, like a distant campfire. The Durango-to-Denver final homeward hop took me through at least four national forests, and I wound up having to alter my route slightly because of a road closure on US 280, due to fire. I finally made my way via Leadville, CO, through Breckinridge, to I-70 westbound and home. Saturday’s drive was something like 10 hours, which I’d have broken up if I’d planned better, and surrendered less to whim.
A note about what worked, and what didn’t. The American Southwest worked, overtime. My love for the region has been firmly cemented; the mix of desert, mountain, and forest is just enchanting. If I can convince my wife, I’d like to retire there. If they still have any water left.
The Fuji X-Pro1 with the Leica 35/2 Summicron ASPH worked – even though a 35 on its APS sensor is more like a 50, a bit too wide for my taste. That’s what feet are for, to move oneself backward away from the subject. Not bad for a 6-year-old camera, which might as well be from the Pleistocene, given the half-life of digital cameras. I wouldn’t say that the Leica lenses are better than the native Fuji lenses; they are different, in a pleasing way. Less bitingly sharp, with maybe better micro-contrast.
The Superwide worked, and will work even better once i’ve figured out how to get the best from it. It’s lightweight, simple, and oh, my, that lens. Get closer…. I was asked several times about the “video” camera I was using; when I mentioned “film” you might have thought I was holding a moon rock or the tibia of St Paul or something. I make a habit of looking, and mine was the only film camera I saw in my four days of travel. I saw no evidence of the current film resurgence, beyond the trunk of my car.
Which performed admirably; but Subaru’s in-car navigation decidedly sucked. This is evidently true of every OEM nav/entertainment system; at my last service visit the manager admitted as much. She told me that all the carmakers want to “own the customer experience”, whatever the f*^k that means. What they “own” is a steaming pile of flyspecked dung. My 2016 Outback’s systems are NOT Android- or Apple CarKit-compatible, but new models will be after 2019. I’m hoping for a firmware upgrade that will allow me belated entry to the 21st century.
Software, whether nav, entertainment, weather, traffic, is clearly not their core competency. Hell, it’s not even a peripheral competency. About all the Subaru’s mapping is good for is following one’s route, assuming the display doesn’t freeze up, as happened a couple of times. The system was frequently confused about routes and road closures, or wouldn’t timely update. Trying to enter a simple address or find a destination via its sluggish interface invoked a hell-scape of touchscreen buttons and sub-menus – compared to the brainless simplicity of searching for a destination in Apple or Google Maps. Of course, I’d never try to work a complex menu while driving; but data entry is disabled even for one’s shotgun passenger as long as the transmission is not in “park” I’ll never buy another car that locks me into an OEM nav/entertainment system. (That this is a first-world problem of the highest order, I freely stipulate.)
Google and Apple Maps worked, mostly, but they rely on an internet connection (cell-phone service) to update properly. Thanks to Verizon, which also worked, coverage loss didn’t happen very often. We recently switched to Verizon after 15 years with AT&T, and the coverage has been overall much better than, though not always as fast as, AT&T’s. I’m old enough to remember when you’d call AAA for a paper-map “TripTik”, or use a printed Rand McNally Road Atlas, in order to get from A to B. I’d say that satellite-based navigation is the best thing to happen for the traveler since they figured out how to measure longitude.
Mike’s Camera in Denver also works. I dropped my film off yesterday morning, a Sunday. They uploaded proof scans this morning, just after opening. Flawless. I’ll look at the negatives themselves to check for issues. As for film, the jury is still out on Cinestill 50D; Ektar 100 is my preferred emulsion for this sort of photography. I’ll have more to say, maybe, after I’ve gone over the negatives and scans.
Pictures to follow.
So far my impromptu jaunt through the Southwest has presented me with one amazing scenic vista after another. It’s overwhelming and awe-inspiring. Knowing when to stop shooting is the problem out here; at some point one becomes beauty-soaked; you just have to put away the camera and say, “enough”, and look around and take in the splendor before you.
That said, fear of the photographic-cliché landscape has thus far not prevented my shooting seven rolls of 120 film with the Superwide (that’s 12 shots per roll); and a couple hundred digital images with my aging-but-competent Fuji X-Pro1. As an experiment, I’m using my Leica 35mm f/2.0 Summicron with the Fuji, via an adapter. We’ll see how that turns out. It’s equivalent to a 50mm “normal” lens on the cropped-sensor Fuji, so a bit less wide than I normally like to shoot. So I just stand back a little farther. It’ll be interesting to compare the look of Fuji’s own lenses with the Leica on this sensor. Fuji’s lenses are superb, so the Leica will have a job to match them.
Yesterday and today have been a treat. Almost on a whim, en route from Grand Junction, CO to St. George, UT I decided to stop at Bryce Canyon, in southern Utah. It was fairly late in the day, which turned out to be the ideal time to visit. I’ll post images after I’ve gotten home and sorted through them. Suffice to say, Bryce might be the most beautiful natural “attraction” I’ve seen, second only to the Grand Canyon. And I’m not certain about that. There was hardly anyone there, which added immensely to the experience. (I met a couple from Iowa who told me that Arches National Park was a madhouse.)
I crashed in St. George last night, and departed – after a leisurely breakfast buffet of cold, rubbery eggs and acceptably flaccid bacon (I like my bacon thus) – for Flagstaff, AZ. My intention was to stay there tonight, but it’s close to the Grand Canyon and it’s Friday night, so “cheap”-ish hotels are in short supply. Instead, I’ll go on to Gallup, NM, then back to Denver tomorrow via Durango, CO. Nearly that entire route is lined by national forests, so it should be beautiful.
Today’s trip has taken me along US Highway 89 and 89A, which traverses a stretch of desert containing Paiute and Navaho reservations, as well as some remarkable scenery. I probably stopped at every “scenic overlook” along the route. The desert Southwest defies description; it’s a lunar-scape painted in pastel, warm colors. Of course, I wasn’t going to get Bryce-lucky again with the timing. It’s usually true that, when one visits anywhere, it’s at the wrong time of day for photographs; today, I went through at mid-day, with a scalding sun nearly directly overhead, broiling a sky already hazy from wildfires in the region. Nevertheless, I managed to expend some film.
I am big on geotagging my photos. One of my digital cameras – not in use this trip – has a GPS receiver I can put in the flash shoe. It tags the image “metadata” with the location of the shot, which I can then map in my image-management software, Adobe Lightroom. There is no GPS capability for the X-Pro1, nor for any of the Fuji X-series cameras. As for film cameras, forget it. I’m still trying to figure out the best way to conveniently record locations for film images. For now I make an iPhone image, which is automatically geotagged, in each area I shoot film photos, and I match them up later in Lightroom. It’s cumbersome – just like film photography in general in the digital age.
I’m wondering if a better method would be to use a standalone GPS receiver that can record and export a GPX “track log” file containing waypoints marked at every place I’ve made an image. I could then make sure my non-GPS digital cameras are time-synced with the GPS receiver, and I could manually record in my shoot log the time I make a film image. Once I ingest the photographs, I can also import the GPX file, and Lightroom will automatically match them up by time, and tag the images accordingly. I’d still have to manually enter the time for each film image. Accurate, but still cumbersome. That’s analog for you.
Time to hit the road for Gallup, which is about three hours down the road. More to come.
Our group schedules vacation time in the fall for the following year. I had grabbed this week, with no firm intention of how to use it. My wife is tied down at work with her usual month-end madness; thus I found myself at loose ends.
Road trip! I have been feeling restless and antsy, wanting to get out and make some pictures. So I pointed the car west on I 70, destination Grand Junction, CO. Beyond that, I’m not sure.
Stopped for lunch at Idaho Springs, and saw the sign for this barbecue place. Sliced-brisket sandwich, with spicy coleslaw and mac & cheese sides. Shiner Bock on draft to go along with it. If you ever find yourself in a Idaho Springs, give Smokin’ Yards barbecue a shot.
I’m going mostly analog on this trip, so pictures will have to wait until I get back and get them processed and scanned. But I will be posting a few digital shots along the way. Hopefully I can find something worthwhile to photograph.
This is what happens to dessert.
This is the photo that should have accompanied the last text.
Sake. After lots of bourbon ,rye, and sushi at Izakaya Den in Denver.
Date night with the missus. That’s a Foxhattan on the left, a John Daly on the right.
It’s summertime, and thus time for my favorite microbe to make an appearance.
Luckily, you can’t get primary amoebic meningoencephalitis from drinking the water; you have to get it way up in your nose. Usually it lives in warm, stagnant, fresh-water ponds; you can’t throw a rock in south Louisiana without hitting one of those. I’m amazed there aren’t ten cases a week down there. But this is the first I’ve heard of it being found in a municipal water supply.
Get it into your nasal cavity, and it ascends the olfactory (smell) nerves that penetrate the bony plate at the base of your skull, leading directly to the front part of your brain. Once there, it proceeds to eat brain tissue, forming abscesses. The disease is fatal in a high proportion of cases. Like 95% fatal. There have only been something like 3 or 4 survivors of documented cases of PAM.
Best chance – not that it’s much of a chance – for successful treatment is for the ER doc to suspect the diagnosis promptly, and begin the appropriate antimicrobial treatment. We’re not talking about wheedling a Z-Pak from the urgent-care center; the drugs that kill this beast are some toxic s&^t. Unfortunately, by the time most victims get to the ER, and someone figures out what’s going on, it’s too late. (Honestly, it was probably too late the moment you snuffed in that big snort of pond-water.) Better break out those nose-clips.
It’s morbidly-cool stuff like this that almost had me becoming an infectious-diseases doctor. I’d have wanted to go somewhere to study and treat the really bad stuff. Like those larval worms that make your man-sack swell to gigantic proportions by clogging your lymphatics. Or the various and sundry, sometimes yards-long, worms that might take up residence in your intestines.
People don’t realize just how overmatched we are by the microbial hordes. We are so hugely out-numbered and out-gunned it’s almost comically futile.
Last night I packed up one of my old cameras, a Rolleiflex twin-lens reflex camera of 1950’s vintage, to send to a technician for servicing. The camera had been serviced, but not very expertly, about eight years ago, and could use a re-do. It needs a good CLA, or Clean, Lube, and Adjust; and the film-winding crank is stiff and squeaky, which should never be the case in a mechanical jewel like a Rolleiflex.
Cameras of this age are generally all-mechanical works of functional art, made by craftsmen. They are mostly metal, with a few plastic components. Those get brittle with age; lubricants – of which there can be ten different types in a single camera – dry out and gum things up, unless they are periodically removed with solvent and replaced judiciously. Mechanical, spring-actuated shutters get out of adjustment and result in over-or underexposure. Other parts just stop working with age. The Rolleiflex, for instance, has a selenium-cell light meter. Selenium cells by their nature cease function after a certain number of years, and haven’t been manufactured for some time. As far as I know, there is no modern replacement for that old tech that can be installed into the camera and calibrated to work. Luckily, the light meter is non-critical; the camera works fine without it, and I can use a handheld meter, or simply guess at the exposure. I’ve gotten reasonably good at that over the years.
I have probably half a dozen older cameras, none of which is in current production. In most cases, like the Rolleiflex, the companies that made them no longer exist. As you can imagine, this can make sourcing parts a dicey proposition. The better technicians keep a stock of parts salvaged from unrepairable cameras, or bought from the manufacturers while they were still available, and hoarded against future need. In some cases, simple parts can be fabricated new; this could be a great place to put a 3D printer to use.
But the larger problem is that nearly every technician I’ve interacted with is at least middle-aged, like me, if not older. They and I will likely be retiring at around the same age, and there can’t be many people clamoring to learn their craft and carry on the tradition. If vintage cameras are slowly – or rapidly – disappearing, who’d want to bother learning how to repair them?
For instance, a few years back I sent a Crown Graphic camera to a gentleman based in Nevada, who had been a service technician for the Graflex company. He’d bought out Graflex’s stock of parts when that company ceased to exist. He went into business for himself servicing the Speed Graphic and Crown Graphic cameras that company made. These are the old-fashioned, boxy “press” cameras of film-noir fame; you’d know one if you saw one. They were ubiquitous until the 60’s, when smaller, more convenient cameras displaced them. The fellow was advanced in years, and had been in poor health, when I sent my camera to him a decade ago. He died in 2014, and I know of no one else living with his fund of knowledge and skill in repairing Graflex cameras.
I think I’ll be able to source film for as long as I want to shoot it; film has made a comeback over the last few years, and the big film companies have figured out how to make it profitably at much lower production volumes than during their heyday. Heck, Kodak alone has recently resurrected two films, one a beloved high-speed B&W emulsion, the other a color-transparency film. Processing is a concern for color film. But as long as someone is shooting it, I should be able to get it developed, albeit at an ever-increasing price. Black-and-white processing doesn’t worry me at all; it’s brain-dead simple, and the chemicals required are abundant and easy to acquire. You can develop B&W film in coffee, believe it or not.
I think what will finally drive me to all-digital photography will be when I can no longer get a broken camera repaired because there’s no one trained to do the work. I suspect this will happen even before I make it to that Darkroom In The Sky, and my camera closet will then become a museum. Carpe diem et imagonem photographicam, I might say.
Drug prohibition, like alcohol Prohibition before it, has been a spectacular and catastrophic failure.
My turn in the on-call barrel again today. I’m on the 7 am-7 pm day shift, first call. It’s now nearly 8 pm and I’m still working, which is often the case. Our practice’s custom is to finish the cases we start, except in exceptional circumstances.
There’s no general agreement or “rule” on how we handle these cases that crop up near shift-change time. This case was posted for 6 pm, which everyone knows is tongue-in-cheek. A Saturday evening case near OR-staff shift change simply is not going to start on time. If I have reasonable confidence that a case will end by 7pm, or shortly after, I’ll do it. This one was less certain, so I decided just to suck it up. At this point, my evening is spoken for, so another hour or so in the OR won’t make or break it.
Anything later than that, or certain to last for hours on end, and I’d have asked the incoming person if s/he wouldn’t mind coming in a bit early. I did that very thing for a partner a few weeks ago, and was glad to do it. Common sense – and common courtesy – should prevail whenever possible.
Plus, there are some cases you don’t want to turn over to someone else after you’ve started them, because it can be hard to get into the “flow” of a case if you haven’t handled it from the start. That’s not a big deal for the “simple” stuff; a good bit of what we do could be handled by a docile chimpanzee.
This case is kinda in-between simple and not simple. The patient is a middle-aged woman with an intestinal obstruction due to a section of large bowel twisting upon itself, thereby interrupting its own blood supply. When bowel becomes ischemic from lack of blood flow, its walls can begin to break down and leak bacterial toxins into the bloodstream, causing sepsis. This syndrome of overwhelming infection, and end-organ complications, can rapidly kill. Things have not yet gotten to that point, thankfully. She’s been stable for me, but I think she might be in for a rough few days.
I started the day with an early back operation, lasting until around noon. Uneventful. Had a few loose ends to tidy up on our Acute Pain service, which I’m also covering this weekend, so I didn’t get to spend much of the afternoon at home before this case was booked. That’s how it goes. You never know what’s gonna come in across the transom. Therein lies both the challenge and the terror.
I do it all over again tomorrow morning. I’m third-call, day shift. Hoping to sleep in a bit, maybe have my coffee in my pajamas, on the porch. There, I’ve jinxed myself.
Well, after yesterday’s whinge-fest of a blog post, I’m happy to report I encountered no road-ragers during my commutes today. And I worked with a couple of exceptionally pleasant surgeons, and the OR staff were as nice as always. The patients, however, tested my patience.
“Don’t eat or drink for x hours before surgery” includes fruit smoothies and popcorn, which were the forbidden pre-operative foods of choice, respectively, for two of my patients today. Some days I just want to pull out my hair. Yes, we told you not to eat or drink (miscreants frequently claim they weren’t told this. Bulls**t. It’s like saying you went to Mass but no one told you to kneel.) No, we weren’t kidding. (We don’t tell jokes.) The average American can go without food for a few hours without shriveling to dust. Your belly won’t bloat, nor will flies crawl over your dessicated lips, if you forego the chicken and waffles before your bunionectomy.
It seems that when we want some patients to think (common sense), they are often not up to the task. But if we simply want them to do, rather than think, suddenly everyone’s a Rhodes Scholar, heading to the Internet to consult with some shaman somewhere. Still others seem to believe it’s their duty to disobey anything they are told by an “authority” figure, even if it’s for their own good. People, pre-op instructions are decidedly not the place to work out your issues with authority.
If you’re having surgery, and your surgeon or another person in the know instructs you not to eat or drink for x hours prior — DON’T EAT OR DRINK!! We aren’t kidding. Don’t eat a fruit smoothie because “my blood sugar was low!”. That’s why God made apple juice, which most people can drink safely up to 4 hours before most surgeries. I don’t care about your low blood sugar; that might be uncomfortable (suck it up, you’ll live), but it won’t kill you like lungs full of smoothie just might. And I can only imagine what tiny popcorn particles marinated in stomach acid could do to lung tissue. Stomach acid is made to digest meat; lungs are meat; and small particles are just about the ideal way to ensure that acid gets to every part of the lungs.
The ironic thing is that more-recent evidence has demonstrated the benefits of drinking carbohydrate-containing liquids, like sports drinks, up to shortly before surgery. We are starting to advocate this step for more types of surgeries. But I’d say the single greatest obstacle to doing so more widely is our well-founded fear that we can’t trust patients not to abuse the license, because so many people can’t or won’t follow simple instructions.
End of rant. Thank you for your attention.
I might just need an attitude adjustment. I have been a grumpy SOB lately. Herewith, an exploration of my current neurotransmitter imbalance.
I brought two patients to PACU (Post Anesthesia Care Unit, or “recovery room”) yesterday, each of whom was having a transient issue that might require swift intervention upon PACU arrival. The necessary equipment is always available at all PACU patient bays. In times past, this equipment was kept deployed, connected, and ready for use within seconds. That’s as it should be; PACU’s are critical-care units, and bad things can happen in a hurry.
However, in each case I had to wait, temporizing as best I could, while the PACU nurse fiddled with peel-apart packaging to free the equipment; or tried vainly to dislodge the gear from plastic storage bags that wanted to grip it, while other loose components fell from bag to floor, and rolled under the stretcher, out of reach; or struggled to get suction or oxygen tubing freed from its bound coil, and connected to its wall outlet. Time wasted for no reason, because some higher authority decided, on poor or no evidence, that having this essential non-sterile gear opened and ready to go poses some putative infection risk. The PACU nurses’ management has forbidden them to open these items until they are needed. Happily, things turned out well for my two patients yesterday, despite the institutional and regulatory hurdles we had to clear. But why should needless struggle have added to the stress of the situation?
Physicians are trained in a scientific tradition that nevertheless takes into account the innate variability of the “biological units” we call patients, and the unknowability of many things we have to leave instead to art, or judgment. Within these limitations, we do our best to follow the evidence. But we all feel at times that “evidence”, especially the incomplete or inaccurate variety, is used as a cudgel to put us in our places, or to advance the ambitions of certain groups of allied professionals, rather than to advance the cause of patient care – or at least to prompt further search for the right answers. Gulliver bound by Lilliputians, if you must have a literary metaphor; or insects biting at one’s ankles.
Physicians have historically sat atop the money and prestige heap within the healthcare industry – a collective status I freely admit has not been merited in all cases by the individual ability or character of my predecessors and colleagues. Medical-school admissions and subsequent training tend to select for driven individualists with strong egos who don’t always play well with others – an obvious downside to the upside of a world-leading level of training and capability among the US physician workforce. Though the culture is changing, you can’t have the one entirely without the other. Most physicians cherish the story, often true, that they succeeded by dint of demonstrated competence and grueling labor, and apportion respect only to those who have earned similar stripes.
Unfortunately some of my colleagues have approached their careers with a sense of entitlement, rather than the required servant heart. Resentment and jealousy have followed – understandable reactions when others see people they judge as no more virtuous or harder-working than themselves getting paid much better, and enjoying much more deference. To that I can only respond that I can’t help what life choices others have made (the opportunity cost of a decade forgone during training come to mind here), or the behavior of those who came before me. I have to do the best I can each day.
The ability and willingness to shoulder responsibility is the final differentiator. Someone has to make the hard decisions, and live or die by them. When you look around during a medical shit-storm and find that everyone else is looking at you, then it’s likely you’re the doctor in the room. If you want to trade places with me, you can have my paycheck and perks, such as they are. But the marketplace has rewarded my willingness and ability to make such decisions at a value determined by their relative scarcity. I make no apology for that. But I’ve never claimed to be a more-worthy human being based solely on my degree; I leave that judgment to my family, friends, and posterity.
Today I did a couple of cases at another of our facilities, a place I enjoy going because the staff there are friendly and helpful, and the surgeons pleasant and capable. I’d like to think they reciprocate the courtesy and respect I accord them. However, there’s someone there – let’s call him/her Clipboard – who I absolutely know will be on my ass if I wear my LSU or Alabama cloth scrub cap. I’m not special; Clipboard is on everyone’s ass about something, all the time. (Just ask them, as I did today.) Someone up the Lilliputian food chain decided that disposable paper bonnets pose less infection risk for patients; cloth caps are verboten. Like your parents used to say, “because I said so.”
The evidence for this claim is sketchy at best, and recently refuted by the only controlled, peer-reviewed study that’s looked at the matter. They are certainly hotter and more uncomfortable to wear, because they are hermetically sealed against sweat evaporation. But hospitals, with the government and payers (increasingly one and the same) bearing down on them over infection rates, often seem more concerned about doing something than about doing something effective. And, if I’m being candid, biting the ankles of people you’ve long felt have disdained you (real or imagined) can be soul-satisfying to a certain sort of person.
Today I wasn’t in the mood to be hassled, so I sweated quietly under my blue paper bonnet, and Clipboard didn’t trouble me. Except to drop off my mandatory safety-instruction packet while I was in the OR holding open someone’s airway during surgery. I kid you not. I had to sign for it with my right hand while lifting a chin with my left. Had I politely asked, or pointedly told, Clipboard to get the f&^% outta my face, I’d have been labeled a Disruptive Physician, with potentially severe career implications. The packet is the same as last year’s, and the one before that; its delivery no doubt gave someone in Legal the frisson of satisfaction that only comes from having Covered One’s Ass. I’d say that this vignette neatly encapsulates the state of modern medical practice.
And still the Lilliputians weren’t done with me. I got a mass email from my own group’s administration asking us to moderate our use of an expensive anesthetic drug at one of our facilities. It seems our use of the drug is the highest among all of this hospital chain’s facilities in our region. Big budget line items attract attention, but ideally they should also provoke inquiry and analysis. The question should become, is our use of the drug appropriate? Or, what is the cost of the problems we’ve avoided by using a more-expensive, but much more effective, drug? No one can, or is, tracking that.
This hospital’s pharmacy can produce in minutes a report detailing exactly what drugs I’ve used, on which patients, since I started working there. How about identify the individual anesthesiologists who are “excessive” utilizers, and email them directly for corrective education – or maybe even plumb their reasoning for using the drug? Instead, I get an anodyne form email, no doubt at the hospital’s behest, that educates no one, informs no one, leads to no conversation or process improvement. It’s an item that Clipboard would have checked off his/her list of to-do’s, while sucking a drop of blood from an ankle vein.
And the day started with not one but two incidents of road rage directed at me en route to work. I’ll spare you the details; but you’d think in a state where people are consuming a lot of legal weed, people would be more chill. But Denver drivers are the most aggressive and rude I’ve encountered anyplace I’ve lived.
So yeah, I’m grumpy.
Crawfish, Colorado style. A slightly different slant on a south Louisiana staple, but delicious. Amazing to see how crawfish and beer get people talking to each other, no matter what the time zone or altitude.
The occasion is the college graduation of Chandler Young, the daughter of David and Sylvia, who I’ve known since I was slender; and who are the proximate cause of our move to Colorado.
Chandler, like her older sister Taylor, is a young woman who exemplifies what I’ve loved about having a daughter of my own: confidence, smarts, and a common decency that reflects the influence of the many people who have loved her.
Congratulations, Chandler. The world is yours to conquer.
I put my last labor epidural in place just after midnight, and made a comfort adjustment to another put in by a colleague earlier in the day. I retired to the call room for my usual fitful, restless sleep. I tossed this way and that until 0640, having been left undisturbed by the nursing staff, God bless ‘em. The overheated room and unfamiliar bed were disturbance enough!
Aaron relieved me for the day at 0650. Those ten minutes are a kindness. Thanks Aaron!
One of my patients delivered just before I got up. Mother and baby are both well. We don’t usually get called when a delivery happens, unless there are problems we can fix. At that point, it’s a three-way effort between mother, obstetrical nurse, and obstetrician. The soon-to-be-new citizen has a say also, of course. The OB nurse turns off the epidural pump a few minutes after the baby is born, and removes the epidural catheter shortly thereafter. Worst part about that is removing the tape from Mom’s back that secures the catheter in place. I warn all of my laboring patients that they will curse my name during tape removal. If a little tape is good, more is better; I’d use duct tape if they’d let me, rather than have to replace an epidural at oh-dark-thirty because it wasn’t properly taped in place.
Always feels good to get in the car for home after a call shift. The drives gives time to decompress and reflect — an internal after-action report. There were no disasters to ponder on this ride, just the donut shop to find. It’s right on the way home, and not to be resisted on a beautiful Saturday morning.
As I feared it might, my 8-to-12-hour shift on the OB deck has turned into a 24. Making the best of it, though my current state of boredom beggars description.
I even went to the car, retrieved the Superwide, and shot some mostly execrable photographs around the hospital. After checking with the OB nurses to make sure nothing evil was stirring, of course. There are some columns along the patient pick-up/drop-off driveway with interesting late-day light playing on them. And from my call room, albeit through filthy, sealed windows (call rooms always bring to mind a third-world prison cell), there is some lovely, gleaming HVAC stuff out on the gravel roof: pipes, ductwork, rust stains, and the like. Eye candy for the bored photographer otherwise bereft of time, or inspiration.
It’s a breezy, warm, dry day in Denver, with a beautiful blue sky. A good night to be drinking wine on my balcony while we watch the joggers, cyclists, and dog-walkers go by on their way to the park.
I was a last-minute substitute on the OB deck today. The regularly-scheduled anesthesiologist was pulled away with several others for a liver transplant, so I got the nod. Not a huge deal, but I was sorta mentally ready for that balcony, and that wine.
I was originally scheduled today to do a couple of spine cases at one of our hospitals where I normally spend very little time, though it’s technically within my call “pod” region here. I got a text at 11 pm last night that re-shuffled today’s OR personnel in order to cover a specialized case that was added. So I was pulled back to the OB suite I usually cover, at a different hospital, to free up someone for the add-on. This was a relief for several reasons.
First, the substitute place is much closer to home. The nursing staff and obstetricians I work with are really chill and pleasant people, and I like the work itself. I know where everything is, so every case doesn’t seem like a burglary, with me rifling through drawers to find drugs and supplies.
But mainly it’s because, at the other place, I’m pretty sure I’d have been getting my balls broken by the nursing staff over something or other from the moment I set foot on the OR floor. It’s just how they seem to roll there.
Under pressure from government and 3rd-party payers, hospitals are focusing intensely on trying to further reduce the incidence of perioperative infections, which stubbornly persist in the single digits despite everything we’ve tried. Infections are costly, both in dollars and in lives, and reducing them is a worthy goal. But it’s become a point of contention between nursing, administration, and medical staff. A cynic or paranoid would suspect there are elements of a power struggle involved. But I’m Polly-Effing-Anna, so I’d never think such a thing.
Here’s a for-instance. They don’t like cloth scrub caps, because they’ve convinced themselves (based upon no evidence, and contrary to the little good evidence that does exist) that cloth surgical caps are more likely to be associated with infections. Never mind that a recent, well-conducted study debunked this notion pretty thoroughly. I can be assured that if I wear my favorite LSU cloth scrub cap, I’m going to get grief for grief’s sake from some functionary.
They also insist that we wear long-sleeved scrub “jackets” over our scrubs to cover our arms while in the OR, because they’re convinced themselves and the administration that all of the skin flakes cascading off of everyone’s bare arms are the cause of infections – again, an evidence-light assertion, but a convenient cudgel to wield against the medical staff. Nonetheless, because I’m perhaps the consummate Team Player, I told them I’d be happy to wear a jacket, but not to bring me one that’s two sizes too small. I also suggested, perhaps bitingly, that before implementing such a policy, they might have made sure to provide the means for compliance – like, say, stocking an adequate supply of jackets sized for those of us who aren’t wraiths.
Sadly, there’s a lot of this kind of low-grade aggravation besetting the practice of medicine, like a cloud of mosquitoes constantly biting the tender flesh around one’s ankles. It strikes many of us docs as pointless gamesmanship and dominance-seeking behavior, especially galling because there’s generally no scientific basis for any of it. I suppose every job has similar annoyances. Sucking it up and trying to keep my tongue in check is all I guess I can do.
I’ve not been a recent country-music fan, with the watery, overproduced Nash Vegas quasi-pop that now befouls the genre. But I grew up listening to old-skool C&W in the car with Dad: the likes of Lefty Frizzel, Faron Young, Jim Reeves, Charley Pride, and – of course – Merle Haggard. So when I heard Merle’s plaintive baritone atop the twang of a Telecaster, memories flooded back. Mama Tried became the song I can’t get out of my head.
Now I’m hooked. Merle led me to the Bakersfield Sound. I’d heard the term before, but didn’t know what it meant. It was developed in the 1950’s, by Buck Owens and a few others, from the music the Okies brought with them to California during the Depression, as they fled the Dust Bowl for work out West. Haggard and a handful of colleagues chipped in to help put it on the map. It’s a stripped-down, clean sound that was expressly a reaction to the over-orchestrated stuff that Nashville was putting out. Just a clear voice like Merle’s or Buck’s, with a soft drum keeping time, a Telecaster for punctuation, and maybe an acoustic guitar providing a rhythm line. Quintessentially American.
I’ve also revisited a few of Dad’s favorites, among those I mentioned above. And I found one or two I’d never heard of before – like Gary Stewart, with his high, almost falsetto, vibrato, King of the Honkeytonks. My wife, who as far as I know does not read this blog, would be happy to know he was born in Letcher County, Kentucky.
I have something like 40 songs on a Spotify playlist, which have been in continuous rotation in the car for a week or so. I give it another few weeks, then I’ll be on to the next thing. But those sweet Telecaster licks from Mama Tried will be harder to expunge.