First things first

You know how they say that printer toner is the most expensive fluid on the planet? An ounce of it costs more than gasoline or pretty much anything else you can think of. But a few days ago I discovered something even pricier.

In order to combat an allergy-induced, contact-lens-wearing-exacerbated infection in my eyes (I’ve been walking around with itchy and mostly red eyes for the past few weeks), my optometrist prescribed some combination steroid/antibiotic eyedrops for me. A 5ml bottle of this stuff costs $125. And that’s with insurance.

Thanks, everyone, for your kind words about Doug (posted here and sent to me privately). I do appreciate it.

It’s interesting to see the public remembrances of him that are appearing everywhere. The crossword-puzzle folks have been especially prolific in that regard. (Not really a surprise there: they are numerous and love words, and Doug was a pillar of that community. His friend Will Shortz (NPR’s Puzzle Master) wrote this tribute on the New York Times. Doug was a longtime resident of the Philadelphia area and passionate about early American history. It makes sense, then, that the Philadelphia Inquirer and PhillyHistory.org remember him, too.

I knew about his love of crossword puzzles and his interest in history. But there were other aspects of him that don’t appear in those writeups: the time he offered to lend me money from his own pocket so I could make my rent payment when our dot-com startup funding dried up and the staff went without paychecks for months (as one of the company founders, he had put his own paycheck on hold even earlier, to keep money around for everyone else as long as possible). The times we disagreed about webpage layouts (I sought editorial consistency, whereas he often resorted to “we can’t do that in HTML”). And the time he stole Stephen Sondheim’s copy of the New York Times.

Lots of good stories and memories to hold on to.

Yesterday I did one of those things that truly sucks to do but at the same time is truly important to do: I went to visit a dying friend. Doug was diagnosed with stage IV pancreatic cancer about half a year ago, underwent (unsuccessful) treatment over the winter, and last week moved to a hospice home.

I was there for about an hour, and it was simultaneously lovely and heartbreaking to see him. His body was clearly failing him and he was in much pain, and though he didn’t talk much his eyes twinkled occasionally as it was clear he was hearing and enjoying the conversation around him. Doug and I had worked at the same dot-com startup (which he co-founded) a little over a decade ago, and I remember him most for his intellectual curiosity, his love of words (he wrote crossword puzzles for The New York Times), and his love of theater, especially Stephen Sondheim. In fact, Doug was responsible for my proper introduction to that music. One day at work he was horrified to discover that I didn’t know much about Sondheim and set out to rectify that immediately: we spent the next hour listening to Pacific Overtures in his office. The last time (before yesterday) that I saw Doug in person, in fact, was in the spring of 2003, when he organized a group of people to see a professional production of Pacific Overtures at the Arden theater in Philadelphia.

I left the hospice yesterday with a heavy heart, fairly certain I would not see him again. And feeling a bit sad and bewildered by the randomness with which these sorts of things happen to people. Over dinner last night I explained to my seven-year-old daughter that I had gone to visit a friend who was dying and told her about him. “Is he a nice person?” she asked. “Oh yes, very nice,” I told her.

This afternoon the message went out: Doug is gone. I read the post and started crying, and my daughter started crying too when I told her what happened. “Why are you crying?” I asked, since she’d never met him. “Because he was a nice man and I miss him,” she replied.

You know what? He was a nice man. And a lot of people will miss him.

May the Fourth be with you!

“Within this world of instant and absolute communication, unbounded by limits of time or space, we suffer from unprecedented alienation. We have never been more detached from one another, or lonelier. In a world consumed by ever more novel modes of socializing, we have less and less actual society. We live in an accelerating contradiction: the more connected we become, the lonelier we are. We were promised a global village; instead we inhabit the drab cul-de-sacs and endless freeways of a vast suburb of information.”

What do you think?

This is the Cloisonné Jacket from the fall 2010 issue of Interweave Knits. I’m actually knitting it in the yarn called for in the pattern, Berocco’s Ultra Alpaca, and so far it’s going all right.

I had consulted with a friend about how to convert this knit-flat pattern into one knit in the round and had worked out all the fiddly details. But once I started the two-color section, I didn’t like the bulk created by carrying both colors through the middle part (which would later be cut, folded under, and sewed down). Figuring that the pattern was written flat for a reason, I decided to follow it as written.

(via Bits and Pieces)

Written by “An Anonymous Doctor” and originally published as this post on Whatever.

Reprinted with permission.

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Where Is The Physician Outrage?

Right. Here.

I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics.

I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins.

I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as “rape”. If I insert ANY object into ANY orifice without informed consent, it is rape. And coercion of any kind negates consent, informed or otherwise.

In all of the discussion and all of the outrage and all of the Doonesbury comics, I find it interesting that we physicians are relatively silent.

After all, it’s our hands that will supposedly be used to insert medical equipment (tools of HEALING, for the sake of all that is good and holy) into the vaginas of coerced women.

Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.

It’s time for a little old-fashioned civil disobedience.

Here are a few steps we can take as physicians to protect our patients from legislation such as this.

1) Just don’t comply. No matter how much our autonomy as physicians has been eroded, we still have control of what our hands do and do not do with a transvaginal ultrasound wand. If this legislation is completely ignored by the people who are supposed to implement it, it will soon be worth less than the paper it is written on.

2) Reinforce patient autonomy. It does not matter what a politician says. A woman is in charge of determining what does and what does not go into her body. If she WANTS a transvaginal ultrasound, fine. If it’s medically indicated, fine… have that discussion with her. We have informed consent for a reason. If she has to be forced to get a transvaginal ultrasound through coercion or overly impassioned argument or implied threats of withdrawal of care, that is NOT FINE.

Our position is to recommend medically-indicated tests and treatments that have a favorable benefit-to-harm ratio… and it is up to the patient to decide what she will and will not allow. Period. Politicians do not have any role in this process. NO ONE has a role in this process but the patient and her physician. If anyone tries to get in the way of that, it is our duty to run interference.

3) If you are forced to document a non-indicated transvaginal ultrasound because of this legislation, document that the patient refused the procedure or that it was not medically indicated. (Because both of those are true.) Hell, document that you attempted but the patient kicked you in the nose, if you have to.

4) If you are forced to enter an image of the ultrasound itself into the patient chart, ultrasound the bedsheets and enter that picture with a comment of “poor acoustic window”. If you’re really gutsy, enter a comment of “poor acoustic window…plus, I’m not a rapist.” (I was going to propose repeatedly entering a single identical image in affected patient’s charts nationwide, as a recognizable visual protest…but I don’t have an ultrasound image that I own to the point that I could offer it for that purpose.)

5) Do anything else you can think of to protect your patients and the integrity of the medical profession. IN THAT ORDER. We already know how vulnerable patients can be; we invisibly protect them on a daily basis from all kinds of dangers inside and outside of the hospital. Their safety is our responsibility, and we practically kill ourselves to ensure it at all costs. But it’s also our responsibility to guard the practice of medicine from people who would hijack our tools of healing for their own political or monetary gain.

In recent years, we have been abject failures in this responsibility, and untold numbers of people have gleefully taken advantage of that. Silently allowing a politician to manipulate our medical decision-making for the purposes of an ideological goal erodes any tiny scrap of trust we might have left.

It comes down to this: When the community has failed a patient by voting an ideologue into office…When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient’s…When the legislative system has failed the patient by allowing the legislation to be considered… When the government has failed the patient by allowing something like this to be signed into law… We as physicians cannot and must not fail our patients by ducking our heads and meekly doing as we’re told.

Because we are their last line of defense.

When I first saw the Cable Luxe Tunic pattern a few years ago, I knew right away that I wanted to make one. But I had plenty of other projects on my plate, and it was only a few months ago that I found myself ready to make it. Fortunately, by then the pattern was free (hooray!). Armed with 40%-off coupons, I went to my local Joann and bought some Wool-Ease yarn. Usually I shun acrylics, but this yarn actually isn’t bad. It’s also the one called for in the pattern, and after looking at the Ravelry pages of completed projects, one that lots of people had used with great success.

I cast on some time in November and finished a couple of days ago. (Details are on Ravelry here.) There were a few mistakes (of the gnash-my-teeth-while-ripping-out-because-DAMN-IT-this-thing-is-going-to-be-PERFECT), but this pattern wasn’t very difficult-—especially after I’d written a row-by-row list of which cables crossed when (and how). (Keeping track of two different cable patterns—one over 8 rows and one over 12—in my head was beyond me!) Once I got into the groove of it, it even became “mindless knitting” of the sort I could easily do while watching a DVD or hanging out with friends.

I followed the pattern exactly as written with one exception: I added about 3″ to the length of the body, so it would not ride up above my waist in the back as I moved around. Right now, it hits at mid-hip, which is just right for tunic-not-dress length. The sweater flares out a bit at the base, which makes it not clingy at all.

I actually wouldn’t mind knitting this again some time. If I did, I’d make a few more changes:

• I’d plot out how to knit the whole thing in the round. As it is now, it was done in one piece, but I did have to sew up the sleeve seams and the side seams. If I could avoid that seaming altogether, I’d be very happy indeed.
• Another possibility: converting this into a cardigan. That would mean eliminating the awesome center cable in the front (though I’d still have one in the back), though, and I’m not sure I want to do that.
• I’d add a tiny bit more space in the armpits. Right now, they are pretty snug up against me. They’re fine when I’m wearing a close-fitting t-shirt underneath, but anything more voluminous would be uncomfortably tight.

Here’s an amazing time-lapse video of Yosemite. The nighttime shots are especially stunning.

I need to go out west again.