Blog break

It is entirely too busy here.

Ice Dancing

Dr. Michael Hebert: "I was just covering for the weekend. 'Just covering' means doing a lot of dancing on thin ice."

Room 441 looked easy. DNR was written loudly on the chart, telling me that the patient and family recognized that the end was near and were requesting that no resuscitation measures be taken...

I went in, and found myself surrounded by anxious family members. My stomach told me this would not be as easy as I had hoped. Yes, the family had consented to abandon all medical intervention except comfort measures, but they were not entirely comfortable with their decision.

The patient's middle-aged daughter was at the bedside, and I could tell that the eye of this storm of anxiety quietly spun around her. She had many questions.

She was probing me. Every doctor has this experience from time to time. A patient or family member is not entirely satisfied with another doctor's opinion, so she probes another doctor to see if he agrees. Each question and statement she made seemed a test to see if I would answer the same way my partner did. Did I agree with the diagnosis? The prognosis?

I strapped on my skates. Carefully I spiraled around every question, throwing in triple loops and double axels of knowledge to keep my answers sounding credible. This lady was very sick, and she would not last long. I tried to assure the daughter that the decision to limit treatment to comfort care was indeed the right one, even though ten minutes ago I did not even know this patient existed...

A powerful post. Highly recommended!

Art Buchwald says no to dialysis

On "This Week with George Stephanopoulos:"

STEPHANOPOULOS: Our voice this week, Art Buchwald. The Pulitzer Prize winner is best known for his razor-sharp columns published in more than 300 newspapers. And now, Buchwald is scripting his final days. Refusing dialysis, the 80-year-old author has decided it's time to die. From a bed in his Washington hospice, he tells us why.

(BEGIN VIDEOTAPE)

BUCHWALD: It was a tough decision, because you're affecting other people. You know, yourself, you're affecting your family. But I made it. I was relieved. It was over. The decision was made. The only part of it that I don't understand, and nobody else understands, is why I'm still here.

But, you know, it's a no-no. You're not supposed to talk about death. You're not to talk about where you're going. Yet everybody that's listening to this show knows they're going to go. And so it shouldn't be a secret. It shouldn't be banned. It should be a good thing. At least, you know, the way you go, I can't predict that. But you don't have to make it a terrible thing.

I'm having the best time of my life. Wouldn't you, to be sitting here, and everybody thinks you're a wonderful person? And you can't take it all, because first of all, you know, you start to feel like John Glenn. The big question that keeps coming up all the time with anybody -- an interviewer talks to me -- is: Do I believe in God?

The answer is: I believe in God, but I'm not too certain that the people that are telling me, 'It's God's will' are the ones I want to listen to. I've found a way that not a lot of people have to make other people laugh. And I'm proud. I hope I can be remembered for that. Because everybody wants to be remembered for something when they go...

Van Gogh's crisis

In the Telegraph: an extract from Martin Gayford's forthcoming book, The Yellow House. Gauguin and Van Gogh shared a yellow house in Arles. Van Gogh suffered bizarre symptoms (reviewed here). Gauguin was overwhelmed. Van Gogh asked: are you planning to leave? Yes, said Gauguin.

...Later in the evening, around 10.30pm to 11pm, he took the razor with which he sometimes shaved his beard and cut off his own left ear - or perhaps just the lower part of it (accounts differ). In this process, his auricular artery was severed, which caused blood to spurt and spray...
After he had staunched the gore pumping from his head with the linen which he had bought so proudly for the Yellow House, he put the little amputated fragment of himself - having first washed it carefully, according to Gauguin - in an envelope of newspaper (perhaps that morning's L'Intransigeant).

Then he put on a hat, pulled right down on the injured side of his head - Gauguin recalled that it was a beret, perhaps Gauguin's own, left lying around after his abrupt departure. Vincent went out across Place Lamartine once more, through the gateway in the town wall, turned left and then took the second turning on the left, and walked to the brothel at No 1, Rue Bout d'Arles. There he asked the man on the door if he could see a girl named Rachel, and delivered his grisly package...

Gauguin described what happened when Vincent was taken to the hospital:

"His state is worse, he wants to sleep with the patients, chases the nurses, and washes himself in the coal bucket. That is to say, he continues the biblical mortifications..."

Extracted from 'The Yellow House' by Martin Gayford to be published by Fig Tree on April 6 at £18.99. Copyright © Martin Gayford 2006. www.penguin.co.uk

More on the debate about Van Gogh's diagnosis: here.

Quiz

1. What did Shrinkette spill on her computer keyboard this week, rendering it inoperable?

A. Chateau de Beaucastel Châteauneuf du Pape, 2001

B. "Cosmic Elixir" (dewdrops collected from the leaves of 12 endangered plants)

C. Infusion of virginal tea leaves harvested from the shady side of the Himalayas during a full moon (-via the C.O.)

D. tap water

2. Which blog fodder went unposted, due to a soaked keyboard?

A. Why I've sworn off vanilla lattes.

B. "The truth about work." Do we secretly love meetings?

C. Snow in Eugene. Thursday's commute looked like this. (Great photos by L. A. Price.) Snow excites us here. We hardly ever see it. (The snow melted quickly, though. There's enough for one snowball in my yard today.)

D. Rejection at a Paris sex club. "...there is a strict door policy. 'If someone isn't sexy enough, we turn them away,' she said. 'But we turn them away with love.'" (TimesSelect, unfortunately.)

E. Simple exercises can boost our cleverness 40% in one week.(...Oh, really?) -via Mindhacks.

F. "Black.White"

G. A Hasidic Jewish reggae star.

H. All of the above.

Deja vu

I was halfway through a post about my recent experiences on call. Then I realized: it's almost identical to this post, and this.

You see the rhythm of my life.

Better.

Thank you for the kind wishes! The eye drops are doing their job.

This isn't my first eye injury. The windows to my soul are frequently smudged and scratched by diverse foreign matter: dust, sand, cinders (in London!), cigarette ashes (in Chicago). Eye shadow (two hours before my wedding! My groom brought me to the ER, and I sat there, cringing, in my wedding gown.) Cat's paws, baby's fingers...

It's amazing that I still have vision.

My ophthalmologist was more than an hour late for my appointment. Clearly, he had overbooked. (Yes, I thought of this post while I waited.) But when I saw him, all I could say was, "I am so very glad to see you!" I couldn't imagine complaining about the wait, or even mentioning it. At what point would I have spoken up, or walked out? Ninety minutes? Two hours? I didn't have a chance to find out.

As he peered at my (anesthetized) eye with his slit lamp, I thought: how I wish we had something like this for psychiatry! If only we had a device that would help us look around inside patients' minds. They could sit at my "psychiatric slit lamp," and I could explore...

And when people said, "Oh, no, a psychiatrist! I have to watch what I say," I'd reassure them: "No, please, relax. I can't analyze you properly until you sit at my special device, my psychiatric slit lamp." Where can I get one? Let's ask the Flapdoodle...

Anyway, I can now see my blog. I see that there is nothing new on my blog. And I see that my e-mail inbox is overflowing. So I should probably start there, and try to think of some replies.

But again, some e-mailers seek advice. I can't give advice here! (See disclaimer in sidebar.) My answer is always the same: please talk to your doctor!