Politics.
After seeing her doctor for a chronic cough, a woman had a workup including imaging (an X-ray and a CT). This revealed a concerning 1.5 cm nodule in the right upper lobe of the lung. Unfortunately, this workup was performed as her health insurance ran out, and she had to wait 6 months until she could get enrolled in the California Medicaid program, Medi-cal, and get an appointment with a pulmonologist, get seen, have her old images reviewed, and then get set up for a biopsy.
We, the pulmonologists at the public hospital, diagnosed her with cancer last week. Now we get a PET scan (3 wk turnaround), and then on to oncology or surgery (another 3 wks). But she knew she most probably had cancer 6 months ago.
This is what I deal with every day, and this is one of the good outcomes in our country's health insurance mess. She at least had insurance at one point and was able to get seen by a doctor who was concerned enough to order an X-ray. If she hadn't eked out that appointment on her dwindling insurance, she may have bounced around ERs getting prescriptions for Tessalon, until she had widely metastatic disease. It doesn't even scratch the surface of the absolute disaster our system is.
For wanting to change this, for wanting to make things at least a little better, for wanting to make sure our infant mortality is as good as Cuba's, we get a significant portion of the populace "erupting" at town halls. Our Constitution is under the greatest threat because our President believes that the richest country in the world should at least have a life expectancy as long as Jordan. And now there are people with guns at these events, and being put on national television thereafter. And their representatives just egg them on.
All the while these same folks were silent while the United States adopted an official policy of torture. They were silent when the US government was expanded with the largest non-military discretionary increases, which amounted to little more than corporate welfare for drug companies.
Sure, these nutballs are true believers. But they are true believers of misinformation and lies, planted by assholes on television and radio who will say any damn thing for viewership and market share. They are planted by cynical politicians who know they can get electoral headway as they will never be called on it. They are planted by the same people who have put "recission" and "preexisting condition" in the lingo.
It's enough to make me want to pull my hair out. Worse, it makes me think of what happens when the violent talk actually takes root. Lincoln, Gandhi, MLK, Rabin -- just a few clear-headed thinkers taken out by reactionaries. At this point in time, with the economy still in the shitter, with unsustainable rises in health care, with two wars still going on, I just don't know if we could get through that without this country falling apart. With it over a debate on helping people not go bankrupt when they are diagnosed with cancer, I wonder if we really should...
Monday, August 24, 2009
Tuesday, August 18, 2009
First post in a month
Sorry for being away so long, for the four people or so who read this blog.
A lot has happened:
1) I finished at the VA and now am in the beautiful Potrero Hill district at the world famous San Francisco General Hospital. I believe it is world famous for being the most urinated upon building in the Northern Hemisphere. It is the site of a homeless encampment so large that the UN has a permanent platoon of Cambodian soldiers deployed to it.
2) I did a week of sleep medicine. This was an interesting experience. Realty, and by proxy, hospital beds being in dire shortage in the UCSF system, the geniuses in sleep medicine have rented out a wing of a Best Western in Japantown. This hotel, being in Japantown, true to form has giant vending machines in the lobby that dispense Japanized souvenier toys and t-shirts. Regular rooms have giant anime figures painted on the walls. There is a lounge with giant televisions and game systems, and it hosts gaming tournaments.
The sleep medicine folks have geared out 8 rooms with night vision cameras, EEGs, sleep sensors, snore sensors, CPAP machines, intercoms, etc, and have another 2 for control rooms. Every night, the chronically tired and morbidly obese come to Japantown in order to diagnose sleep apnea, narcolepsy, bruxism, restless legs, and so forth. All the while, 14 year old boys point their Wii mats to the same hotel 5 times a day...
3) I took the national internal medicine boards. 240 questions, most of which were three paragraphs and started with "a 54 year old woman" and ended with me trying to remember the correct treatment for cryoglobulinemia. It sucked. It was shorter than I thought it would be. They just had to work harder to cram the annoyingness into a shorter time.
4) Hosted the parents, went to Sausalito, the Muir Woods, Muir Beach and its overlook, Monterey, and of course all over San Francisco and the East Bay.
5) I've eaten like a huge hog. Working in the Mission doesn't help. We've gone to shabu, sushi (and the dude from Mythbusters was at the next table), original Mission burritos, the most unbelievably good tortas, excellent Chinese food 5 blocks from our house, incredible banh mi in San Jose on the way to Monterey (we knew the way...), not to mention countless neighborhood sandwich and coffee places. I need to stop eating. It's wreaking havoc on my gastrointestinal system.
A lot has happened:
1) I finished at the VA and now am in the beautiful Potrero Hill district at the world famous San Francisco General Hospital. I believe it is world famous for being the most urinated upon building in the Northern Hemisphere. It is the site of a homeless encampment so large that the UN has a permanent platoon of Cambodian soldiers deployed to it.
2) I did a week of sleep medicine. This was an interesting experience. Realty, and by proxy, hospital beds being in dire shortage in the UCSF system, the geniuses in sleep medicine have rented out a wing of a Best Western in Japantown. This hotel, being in Japantown, true to form has giant vending machines in the lobby that dispense Japanized souvenier toys and t-shirts. Regular rooms have giant anime figures painted on the walls. There is a lounge with giant televisions and game systems, and it hosts gaming tournaments.
The sleep medicine folks have geared out 8 rooms with night vision cameras, EEGs, sleep sensors, snore sensors, CPAP machines, intercoms, etc, and have another 2 for control rooms. Every night, the chronically tired and morbidly obese come to Japantown in order to diagnose sleep apnea, narcolepsy, bruxism, restless legs, and so forth. All the while, 14 year old boys point their Wii mats to the same hotel 5 times a day...
3) I took the national internal medicine boards. 240 questions, most of which were three paragraphs and started with "a 54 year old woman" and ended with me trying to remember the correct treatment for cryoglobulinemia. It sucked. It was shorter than I thought it would be. They just had to work harder to cram the annoyingness into a shorter time.
4) Hosted the parents, went to Sausalito, the Muir Woods, Muir Beach and its overlook, Monterey, and of course all over San Francisco and the East Bay.
5) I've eaten like a huge hog. Working in the Mission doesn't help. We've gone to shabu, sushi (and the dude from Mythbusters was at the next table), original Mission burritos, the most unbelievably good tortas, excellent Chinese food 5 blocks from our house, incredible banh mi in San Jose on the way to Monterey (we knew the way...), not to mention countless neighborhood sandwich and coffee places. I need to stop eating. It's wreaking havoc on my gastrointestinal system.
Sunday, July 12, 2009
One and a half weeks in
It's a little weird to identify myself as the pulmonary fellow, after three years of being the medicine resident. It's a little weird to be on strictly first name basis with all the attendings. It's great, though, to be white-coat less (mine is still on order, perhaps a California IOU?) and tie-less. It's about 50/50 here, and I've made a decision to join the tie-less 50%. Which means that the Osler tie will get a much needed rest.
The VA is very laid back, and not the learning curve of the rotations at the main hospital (I'll start there in September). Which is not a bad thing considering the last bit of my residency, the move-out, the drive, and the move-in. I'm using the BART and MUNI to get to work, which unfortunately takes around 1.5 hrs there and back. Which is excusable now, as I am studying for the boards. But this could be irritating. The VA is the farthest out, though, and the other hospitals should be better.
Immediately, changes become obvious.
The old view from the MICU nurses' station:
The new view from the MICU nurses' station:
The old view from the parking lot:
The new view from the parking lot:
The VA is very laid back, and not the learning curve of the rotations at the main hospital (I'll start there in September). Which is not a bad thing considering the last bit of my residency, the move-out, the drive, and the move-in. I'm using the BART and MUNI to get to work, which unfortunately takes around 1.5 hrs there and back. Which is excusable now, as I am studying for the boards. But this could be irritating. The VA is the farthest out, though, and the other hospitals should be better.
Immediately, changes become obvious.
The old view from the MICU nurses' station:
The new view from the MICU nurses' station:
The old view from the parking lot:
The new view from the parking lot:
Thursday, July 2, 2009
July 1
Today was July 1, the worst day of the year to be sick. The new interns, residents, and fellows started today. I started at the VA, which apparently has the best view and the worst food in all of the Bay Area.
So far it seems like an easy rotation, though on BART/MUNI it takes me 1.5 hrs to get there. Right now, it's OK as I am studying for my boards and reading while riding, but that may get irritating.
Part of what strikes me about this whole thing is between today and yesterday we had around 9 hours of orientation. Next to none of this had to do with being a pulmonary fellow. Almost all of it had to do with "The ACGME/JCAHO/Regulatory Commission XYZ has required that we tell you about this random fact." Which I have now heard at least 3 or 4 times. It also took me 3 hours in line to get an ID, on a day which every single year they know they will be issuing 200+ IDs. The scary fact is I was lucky to get an ID; there were plenty of people behind me when I got my ID finally at 4:30 PM and they were threatening to close at 5 PM.
Tom Friedman wrote a book about how the world was becoming flat. While he meant this as the development of economic parity between the developing and developed world, I think he missed the boat. What's really going on is, with 9/11 as a catalyst, there is a great leveling of the bureaucratic nightmare between the developed and developing world.
My dear wife, as a semester abroad student in Israel, once attempted to get a deposit back in the days when you needed to put a deposit down on a phone. She showed up with a huge stack of papers and bills in order to do this. My dear uncle explained that the clerk was highly trained by the Israeli bureaucracy to rifle through a stack of paper and quickly identify the one paper which you did not have. True to form, in under a minute, the clerk identified she did not have her first month's bill and to this day we are still waiting for a check from Bezeq.
Such has become the experience in getting licensed in California, in getting a DEA number, in trying to start the process of registering a car, in getting a driver's license, in trying to get deposits back for things like E-Z Pass in Maryland, and so forth. Friends starting in Maryland or *gasp* for the federal government agency of the NIH have had it as bad or worse. Like any good third world nation, though, California's budget crisis has forced most state government to close at random times and on random days with the only apparent rationale being that the days they are closed happen to coincide with the only convenient days for you. I only got my license (today!) after basically cajoling my way through the lackey on the phone in order to talk to the muckety-muck. I applied for it in February, and was lucky. Last I heard they were still processing November applications. I also have a dire lack of protectsia in the new state which doesn't help things out.
Anyway, I expect by 2011 that we will need to be offering bribes in order to get simple tasks done. Mark my words and start hoarding $20 bills.
So far it seems like an easy rotation, though on BART/MUNI it takes me 1.5 hrs to get there. Right now, it's OK as I am studying for my boards and reading while riding, but that may get irritating.
Part of what strikes me about this whole thing is between today and yesterday we had around 9 hours of orientation. Next to none of this had to do with being a pulmonary fellow. Almost all of it had to do with "The ACGME/JCAHO/Regulatory Commission XYZ has required that we tell you about this random fact." Which I have now heard at least 3 or 4 times. It also took me 3 hours in line to get an ID, on a day which every single year they know they will be issuing 200+ IDs. The scary fact is I was lucky to get an ID; there were plenty of people behind me when I got my ID finally at 4:30 PM and they were threatening to close at 5 PM.
Tom Friedman wrote a book about how the world was becoming flat. While he meant this as the development of economic parity between the developing and developed world, I think he missed the boat. What's really going on is, with 9/11 as a catalyst, there is a great leveling of the bureaucratic nightmare between the developed and developing world.
My dear wife, as a semester abroad student in Israel, once attempted to get a deposit back in the days when you needed to put a deposit down on a phone. She showed up with a huge stack of papers and bills in order to do this. My dear uncle explained that the clerk was highly trained by the Israeli bureaucracy to rifle through a stack of paper and quickly identify the one paper which you did not have. True to form, in under a minute, the clerk identified she did not have her first month's bill and to this day we are still waiting for a check from Bezeq.
Such has become the experience in getting licensed in California, in getting a DEA number, in trying to start the process of registering a car, in getting a driver's license, in trying to get deposits back for things like E-Z Pass in Maryland, and so forth. Friends starting in Maryland or *gasp* for the federal government agency of the NIH have had it as bad or worse. Like any good third world nation, though, California's budget crisis has forced most state government to close at random times and on random days with the only apparent rationale being that the days they are closed happen to coincide with the only convenient days for you. I only got my license (today!) after basically cajoling my way through the lackey on the phone in order to talk to the muckety-muck. I applied for it in February, and was lucky. Last I heard they were still processing November applications. I also have a dire lack of protectsia in the new state which doesn't help things out.
Anyway, I expect by 2011 that we will need to be offering bribes in order to get simple tasks done. Mark my words and start hoarding $20 bills.
Tuesday, June 30, 2009
RIP Ali Akhbar Khan
Ali Akhbar Khan died last week. One of the luminaries of Hindustani music:
His father, Allaudin Khan, trained him, Ravi Shankar, and Nikhil Banerjee. I had the privilege of seeing him in concert a few times. He started a music college that some of my friends have attended in San Rafael; it has always been in the back of my mind to go out there for some lessons if time permits.
His father, Allaudin Khan, trained him, Ravi Shankar, and Nikhil Banerjee. I had the privilege of seeing him in concert a few times. He started a music college that some of my friends have attended in San Rafael; it has always been in the back of my mind to go out there for some lessons if time permits.
Wednesday, June 24, 2009
Cape Cod Kwassa Kwassa
Last year's Vampire Weekend CD was fantastic. One of the standout tracks is "Cape Cod Kwassa Kwassa". Bringing afro-pop back to indie rock:
The chorus starts "It feels so unnatural/Peter Gabriel." So who would you pick to cover the song? With the fantastic Hot Chip, the man himself:
Vampire Weekend, at its heart, only had the afrobeat thing on loan. So when Esau Mwamwaya, a Malawian musician, releases his side project, The Very Best (which features Ezra from Vampire Weekend on the very good "Warm Heart of Africa"), he takes the Kwassa Kwassa right back to Malawi.
The chorus starts "It feels so unnatural/Peter Gabriel." So who would you pick to cover the song? With the fantastic Hot Chip, the man himself:
Vampire Weekend, at its heart, only had the afrobeat thing on loan. So when Esau Mwamwaya, a Malawian musician, releases his side project, The Very Best (which features Ezra from Vampire Weekend on the very good "Warm Heart of Africa"), he takes the Kwassa Kwassa right back to Malawi.
Thursday, June 18, 2009
Day 4
Our stuff arrived yesterday, so there was no time to blog. What with 150 odd boxes and bunk beds and cribs to reassemble. Much thanks to granma and my wife who have led the way in blitzkrieg unpacking and organization. We are only about 30% through, I think, but it's been less than 24 hours. And, the main stuff needed for life is all done.
Here's the end of the voyage.
We woke up at around 7:30 AM in Reno. Lisa gave us a call slightly thereafter asking very politely to please please please please please try to move it so she wouldn't have to rent a car in Oakland when she got there. Well, neither of us felt like playing more baccarat, so we hopped in the car and started driving west. 202 miles to our destination.
We quickly were over the last state line:
There was lots of road work on the Donner Pass and the Donner Summit. We kind of got holed up in a bit of traffic, but it was at least nice to be able to enjoy the scenery. Snow on the peaks, giant trees, beautiful mountains and streams. I was a bit peckish, and Paul began to look a bit appetizing.
We breezed west, with a stop for gas in Sacramento. Then Davis, and the western fringes of the Bay Area. All too quickly, we were almost home.
A few turns and we pulled up in front of the new house.
This was the first time for me here. We rummaged through the crammed back of the car to find keys. We walked in at around 11:30 AM and appreciated the fine tartan carpet and the spiral staircase in person.
(the carpet is scheduled to be replaced)
Anyway, we rapidly unloaded the crammed minivan, and then got in the car. We were just pulling up to OAK when Lisa phoned that the plane was on the ground. Paul ran in to help with the bags, and then we were all reunited in sunny (well, overcast and cold) California.
The original plan was to head home but boneheaded me made a wrong turn and we ended up on the Bay Bridge.
So we marked Bay Bridge to Bay Bridge a little sooner than I had hoped (and I didn't really start at the Chesapeake Bay Bridge, because Paul's plane was late). We had lunch at the Embarcadero and then headed home to start laying out our new household.
I'll be posting updates from California in the future. Tune in!
Here's the end of the voyage.
We woke up at around 7:30 AM in Reno. Lisa gave us a call slightly thereafter asking very politely to please please please please please try to move it so she wouldn't have to rent a car in Oakland when she got there. Well, neither of us felt like playing more baccarat, so we hopped in the car and started driving west. 202 miles to our destination.
We quickly were over the last state line:
There was lots of road work on the Donner Pass and the Donner Summit. We kind of got holed up in a bit of traffic, but it was at least nice to be able to enjoy the scenery. Snow on the peaks, giant trees, beautiful mountains and streams. I was a bit peckish, and Paul began to look a bit appetizing.
We breezed west, with a stop for gas in Sacramento. Then Davis, and the western fringes of the Bay Area. All too quickly, we were almost home.
A few turns and we pulled up in front of the new house.
This was the first time for me here. We rummaged through the crammed back of the car to find keys. We walked in at around 11:30 AM and appreciated the fine tartan carpet and the spiral staircase in person.
(the carpet is scheduled to be replaced)Anyway, we rapidly unloaded the crammed minivan, and then got in the car. We were just pulling up to OAK when Lisa phoned that the plane was on the ground. Paul ran in to help with the bags, and then we were all reunited in sunny (well, overcast and cold) California.
The original plan was to head home but boneheaded me made a wrong turn and we ended up on the Bay Bridge.
So we marked Bay Bridge to Bay Bridge a little sooner than I had hoped (and I didn't really start at the Chesapeake Bay Bridge, because Paul's plane was late). We had lunch at the Embarcadero and then headed home to start laying out our new household.I'll be posting updates from California in the future. Tune in!
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