The Mathematics of Milk

Today I economized in a way that made me proud to be Grandpa's grandson. I walked into the Sunflower Market to the back of the store. The obligatory walk of consumption to buy milk. I asked the clerk if any reduced milk was available in the back. He said no but that if I found a jug with a sell-by date within the next two days, I could get it for 99 cents.

Like a man hunting geodes I stuck my skinny neck in the cold rows of dairy, squinting at dates on the top of milk jugs. I found one. I knew I would. I handed it to the clerk and he took a sharpie out of his pocket to write the reduced price on the jug.

"So, I can just walk in here and find a nearly-expired milk anytime," I asked with a grin.

"You bet, just make sure you are nice about it. Don't be like the old ladies who shove a jug at me and demand, '99 cents!' Just don't be annoying about it."

And with that I secured a way to purchase a gallon of milk for 99 cents. At two gallons a week that could save us 104 dollars a year. Multiply that by 30 and I've reduced our grocery bill by 3120 dollars over the next thirty years. Milk lasts longer than the date so we're safe. Now, onto the next money-saving idea...

I WIll Find You

A cloudy night. A semi-strong breeze. A dying moon. Perfect night for a jog. That's what Anna thought and she invited me along. I'm glad I went. We drove a mile east to the River Trail parking lot and parked in the darkest corner to begin our late night run.

We walked through the parking lot to the paved trail and began our run. The trail borders along the Rillito River. And if you know your Arizona, you know river is synonymous with wash, so we were basically running along a very wide wash, probably a hundred yards wide. The river cuts through the heart of Tucson. It's flanked the entire length by ranches, parks, and corrals so you really don't feel like you're in the city. But since you are in the city, the lights bounce off the clouds at night and light up your way like an eery Hogwart's night setting. It's great. And along the way you pass giant sentinel Eucalyptus trees. The Ghost Gums' branches literally float in the wind; giant dementors to scare you along the run.

And to perfect the ambiance, you're in the desert, which I'm convinced is the BEST spot on earth in the winter. It's not too cold, but nippy enough to wear warm clothes. The animals are still out - not hibernating. And the plants are still alive. There you go: mother nature in her happiest mood. Tonight we could hear the chorus of Coyotes howling along with us as we ran. They were in the wash. To liven up the run I did a goofy "Last of the Mohicans" dash through a part of the trail to show Anna my manliness. Sadly, a skinny runner man has little claim on James Fenimore Cooper's idea of masculinity. For that I would need fifty more pounds, a hatchet, and a lot of leather.

Luckily, our only hunting at the end of the run would be at Trader Joe's, our reward for the best run on earth.

Partners in Crime, Watch out J Edgar

How It Happened (A Primary Source)

We came around the corner of Harvest and Allen in the late afternoon. As second-graders we were just two nondescript Mormon boys having some after-school exploration through the neighborhood.

But let's provide some context. The neighborhood was what our parents called "blessed." At the time that meant nothing to me. But I did know I had a lot of friends. And if I walked down my street my arm could possibly tire out from the number of waves made to passing neighbors and cars. Waves were reciprocated earnestly. So waving in our neighborhood was as common as the warm sun. Nothing big here other than the fact that everyone knew everyone and was on good terms all around. This was to be a terribly important setting for what we were about to do.

Around the corner...I spotted a newspaper in the Kleiner's yard. Late in the day I thought they didn't need it. So I grabbed it. We kept walking and two houses down another newspaper lay in the driveway. So my partner in crime went and grabbed it. Two boys. Two newspapers. No. Big. Deal.

But here is the deal. If you throw your mind back to when you were a young boy in the prime of youth with only a pencil box in your desk at school to your name, you liked things, especially free things. And you were competitive. If your best bud had one, you wanted one. And if your best bud didn't have one, you never though about having one. We both had one newspaper. But I wanted another one.

And so, a few houses down, I grabbed another newspaper I saw (apparently our neighbors were not well-informed of what happened the day before in Mesa). Well, my buddy grabbed the equalizer at the next available driveway.

So, we got home with newspapers. Nothing big, but it was an easy booty. I bid my friend good evening and walked home to dinner with the family, passing the "Return with Honor" plaque on our front door.

The next day at school, my buddy and I started talking about resuming our collection. But newspapers were boring. And each one said the same thing. What else could we collect out there in our world? The answer came on the way home from school. Another one of our buddies was out of town. So we knew he must have had uncollected mail in his mail box. I told my buddy to watch out for anyone watching us, and I quickly opened the mailbox, which was stuffed. My heart skipped with joy as I plunged my hand in for the easiest "free" stuff in the world. We ran around a fence and sat down with my buddy's mail. At this point you might wonder where our consciences were vacationing. To this day, I never know why they were AWOL, so I cannot answer that question, I really was otherwise a good kid.

Back to the mail, one of the envelopes was a birthday card for our mutual friend. We opened it. I know, terrible. And we read it. And laughed at the words, though it was nothing special. But our hearts were racing. This was cool. It was fun. It was exciting. We looked down the street at an entire line of mailboxes, standing there on their posts like prisoners in front of a firing squad, unmoving and silent.

We moved on and at the next house opened the mailbox. Nothing. But at the following house the mailbox was again full of mail. I grabbed it all. This one was lucrative, veritable booty, if you will. It had a brand new shiny penny inside the envelope. The face of Honest Abe staring right at me. I was pumped up about this new scheme of ours. Funny birthday cards. Free pennies. Why hadn't we done this earlier?

We moved on down the line of waiting mailboxes. At this point you have to realize we were feeling no remorse. Not only were we pre-baptismal age, we simply had no idea about the significance or consequence of taking people's mail. That's another thing, we truly felt we were "taking" not "stealing." If it comes everyday, why would they miss one day's worth? With my hands full, my buddy grabbed the next box's contents.

By this point in the afternoon our hands were full. We crossed the street to my partner's home. On the side yard was a large vine with big, flat leaves. It crept up from the ground to the roof and spread across half the side wall. It was a perfect treasure spot. We cleared away leaves and branches and placed all our mail on the cool, shaded ground. No one ever walked at this spot except potato bugs.

What happened that night I cannot recall. I'm sure I was looking forward to more mail. Because we got more mail. And more mail. Day after day. How many days this happened I also cannot remember. I just have vague episodic memories that haunt me to this day. After one illegal excursion my partner and I sat atop the fence dividing his home from the neighbor. We had scored an actual box in someones mail, as it turned out, the box of my future church Bishop. We opened it up - a box of pills. We gleefully threw each pill into our neighbor's pool. That was fun! I remember they were red and white pills.

Another episode nearly ruined our fun. We had opened an envelope with two bank cards! One for each of us. We played with these cards in the downstairs of my buddy's house. His dad walked by while we had them out. He asked to see one. We didn't sweat it or skip a beat at all, we simply said we found them on the street. Now, looking back, I realize our "Sherman's March" through the neighborhoods of our youth was widespread. Because my buddy's dad had no idea who the person was named on the card. We might be talking a full square mile. My memory suggests more like a half-square mile.

After a few days we had loads of mail under the ivy. Our treasure was our fun. And no one suspected. I can't believe we were not caught. We always took mail during the day in full view of front windows and living rooms. But I think people started noticing. How else would Mom have been tipped off?

One afternoon we were coming around the street north of Harvest, which is my street. Our hands were full of mail. And there was Mom, walking with a purpose, to us. We both turned around to face away from her and quickly stuffed the mail up our shirts. Great minds think alike. Apparently, authoritative minds think alike, because Mom asked, "what is up your shirts?" I distinctly remember saying, "nothing." By now you realize my IQ equaled my age at the time, so you can understand the response.

I don't remember the long walk home with Mom. I don't remember what happened to my loyal partner when he went home. But I do remember that evening we were returning loads of mail. I can only imagine what our parents thought when we uncovered the ivy. What they saw must have made their hearts drop. But, in the 1980s and in a good neighborhood, we were cushioned against reprisals from the victims.

One evening soon after our capture was devastating. We had to sit through a half-hour lecture from our neighbor across the street who was...a mailman. He told us what could happen to us and where we could end up. I walked out the door feeling all eyes, including the birds, were trained on me. The worst part of the evening was that they were showing Crocodile Dundee II on TV. Mom would not let me watch, as part of my punishment. I learned my lesson. I loved Dundee.

About a week later my partner in crime and I were playing in my back yard. When it was time for him to go home we walked out to the front. And there, right in front of his house were two cop cars! We knew we were in trouble, possibly headed to where the mailman said we would be going if we ever stole mail again. So we ran into my backyard and spent the next hour crouched under a table. We were spooked. Way after dark we emerged, peeked over the fence, and saw the cops had left. Whew! Close call.

Not much happened after that. But the episode, referenced often at family reunions, brings a few laughs. It could have been worse. It should have been worse. But then again, we grew up in the best neighborhood on earth! So if you decide to steal your neighbor's mail, try it in Mesa, AZ. Just avoid the half-square mile around 1336 E Harvest because they're on alert!

Lives to Word By

When I was a freshman at Arizona State I lived with Bill, Jennifer, and Andrew Hall. My family had recently moved to Utah and I wanted to save for my mission to Brazil. So I took advantage of the Hall's goodwill and moved in. Plus I had a nice deal going with ASU (free school with a stipend).

The Halls are my second family, so I can't really say I grew any closer during my freshman year. I had lived over there for 18 years as is. Another year was nothing new. However, Bill quickly found out I was particular about two things: homework and sleep. If either my homework or sleep routine were violated, life was rough. When I wasn't slaving away on essays or counting my sheep, I was usually hanging with the Halls. We had a great year. It was a memorable year in history, the year of the twin towers attack, the D-backs World Series, the beginning of the Afghan war. It was a year of mission calls and friends starting to talk marriage. A lot of change. But I was able to note something I wasn't expecting: Jennifer's work ethic.

It's not that I did not know Jennifer worked hard, it's just that I didn't pay attention to it. Like a word you learn and suddenly begin hearing everywhere, as soon as I learned how hard Jennifer works, I noticed it everywhere. In a year of living in her home, I caught her sleeping a total of two-and-a-half times. The half time was when she was doing this pseudo-slide off the couch, downstairs. She reached the ground before she reached REM, so it counts as a half. She had just finished hooking up Andrew's CF treatment at 5:00 AM and I was leaving early to school to witness the rare event of Jennifer pausing for a break.

Jennifer works crazy hours. She is a professional caterer, working as many as four receptions a week. She teaches swimming lessons in her pool to all the kids and their kids in Mesa. She works actively in the church. She cooks homemade meals nightly. She is constantly running errands for family and friends. And she is never too busy for people. When a client comes over to discuss a reception, she will spend over half-an-hour just shooting the breeze and getting to know the person and their family. Her product at receptions and swimming lessons is more than time, it's love. And that's why people keep coming back for her swimming and catering.

I'm again staying with the Halls this month as I work at St. Joseph's hospital in Phoenix. I haven't seen Jennifer sleeping yet in two weeks. Though she once told me, "I'm going to bed," a phrase I never heard her speak before. This past weekend she pulled off something that would have made my legs fall off. She catered a reception Friday night for over 400 people. She directed a staff of ten, paid them all, sent them home, cleaned up, went home, and began packing for the next day's reception in Sedona, AZ. At around 12:45 am she began making her shopping list for her 7am trip to stores. I was tired and went to bed. Then next thing I heard was her footsteps upstairs at 5:30 am. She had an appointment with her running buddy. They are running a half-marathon in two weeks. After that she was off shopping. She came home, cut up veggies, made two sauces at the same time while listening to me jabber mindlessly, and finished packing her trailer. The amazing thing about those sauces was she had to quadruple the portions, doing the math for the different sauces in her head. By 10:30 she was off to Sedona. I stayed back to study, and re-attach my legs that had fallen off while helping at the previous night's reception.

At Sedona she had to improv as grills went out, the trailer didn't fit, and her cell phone stopped working. Once more unto the breach she went, and she came home victorious, early Sunday morning. When I talked to her Sunday evening, her voice was tired and hoarse, the effects of two straight days of giving directions beginning to show. I went to bed and today saw her in the afternoon. She was giving me an update on the day even though she was late for a service project for a girl she helps with cerebral palsy. Then her daughter called, who she stopped to help. Then she told me her dear friend had passed away this morning from a heart attack, her tired voice beginning to break as she began to cry. I couldn't help but think: God bless you Jennifer for all you do and are.

A while ago she once told me, "If I ever stop I'll break." We were running on the beach at Santa Monica at the time. She was talking about more than running. She was talking about life. Thanks Jennifer, for showing me that whatever we do, we give our best, because anything less is "to sacrifice the gift" (Prefontaine).

Because I'm proud to be an Arizonan

The state covers a lot of territory. But from Tombstone to Tempe and from Pine Top to Prescott we consistently celebrate one thing well: History. See below:


http://www.nytimes.com/2011/10/13/us/a-celebration-for-the-london-bridge-in-arizona.html

The Tucson Sunset

The Insider

If you walked into a store and an associate said, "Here, buy this, it's on sale today for real cheap. See, look out on the window where an ad is placed on this item," then I would listen.

If I walked into the same store and the associate said, "Come here, don't tell the manager this but I'm going to let you know of a sweet deal just for you today on this item. No one else knows about this," then I would be inclined to furrow my forehead and pretend like someone was calling my phone so I could leave.

My wife and I have learned that the special treatment, often under the table, heavily persuades us to not buy a product. We have walked away from apartments and car dealerships because of the sweet deal "just for us," when "no one else is supposed to know about it."

I really believe the most comfortable sell is the one open to everyone. And there has to be transparency in company hierarchy, from top to bottom. If not, it just feels like your buying into something that feels at best, vaguely slimy.

Four Years Reputation

We celebrated our fourth anniversary a couple weeks ago! Thanks to my oldest, most wisest sister, we dined at a classy joint. While I was contemplating how to make a dinner of chicken nuggets, mac and cheese, and cookies and ice cream romantic on our front porch, I contacted Whitney. Her input caused my plans to evaporate to the voice of reason. The voice consistently says, "She deserves finery." But for some odd reason which might be due to maleness, or just plain cheapness, I ignore the voice. As a side-note I wonder if the sound of the voice resembles those Sirens of old.

And in pursuit of finery, I embarked on an internet search of the classiest joints in Tucson. In the end, I relied on the quotation of an ESPN article I read that morning reporting Coach Mike Stoop's favorite restaurant in Tucson is Vivace. We've already dined at the table next to Lute Olsen, so I had to broaden our value-less bragging potential with the possibility of sitting near Stoops and Co. Plus, our anniversary was the night before the football season home opener. What coach in his right mind would not dine at his favorite place the night before a big game?

So we arrived and dined. It was fine. No football coach present, but I didn't notice, even after four years.

Oh Sweet Saturday

From espn.com:

"Kennedy (18-4) became the NL's first 18-game winner and has victories in his last three starts. He allowed one run on five hits in seven innings, struck out six and walked two.

"Arizona beat Lincecum at sold-out AT&T Park for the second time in just over a month after a win against the Freak here on Aug. 2. Lincecum allowed nine hits and five runs and struck out seven in five innings, his shortest start since also going five against San Diego on July 4."

can you hear the rumbling memories of 2001?!

The Nail in the Coffin

When I was seven I met a kid named Adam. He moved at 97 mph and never stopped. I always admired his energy, especially in high school track where he could run the 800m faster than I could dream. Nothing stopped him. Not even a nail shot through his head. One day out working construction with his brother, he was climbing up a ladder. The man above him was climbing with a nail gun. While the man was ascending, the gun bumped a ladder rung and discharged a nail down into Adam's head.

Adam climbed off the ladder and felt the top of his head. Nothing. Just a little scratch where the nail presumably ricocheted off. But just to be sure, they went to the ER and took a plain film of his head. And there, smack dab inside his temporal lobe floated the nail. I saw that plain film in Safford, AZ, where a technician showed me. Amazing picture. Amazing luck.

Surgeons removed the nail and Adam continued his life, racing around high school and track like his normal self. I've always remembered that story and thought how extremely lucky he was. In fact, he was the luckiest person I knew...until now.

Today in the reading room with the radiologists, we pulled up the images of a local Tucson man. He was pruning his garden when he dropped his shears. The sharp edge wedged into the ground, with the handles (blunt end) pointing to the sun. He bent down to pick them up and tripped right on top of them. Amazingly the handle penetrated under his eye ball and down into his face, all the way into his neck until it rested on his carotid artery. And there it rested, bumping with every beat of his heart.

Surgeons removed the shears and today he has made a full recovery. Sorry Adam, you've been trumped by an 87 year-old gardener.

Rene Le Fort, History, and Radiology

My two interests of radiology and history combined during a resident lecture today at lunch. The attending physician, Dr. C, described the research of French army surgeon Rene Le Fort. In the early 20th century, he outlined specific facial fractures. He interest in studying this macabre medicine was allegedly born upon his visit to Notre Dame cathedral.

There, he observed the buttress with the fly, supporting the posterior tower. Rather than use more cement for a sturdier tower, the great architect wanted to install stained glass. His solution was the flying buttress. Le Fort made note of these supports and wanted to find analogous support in the face. And so, with hundreds of cadavers, he used a system to

be able to predict lines of fractures based on direct and indirect stress or collision.

He used hammers, boots, and more, to literally smash the faces of these cadavers. He would then boil the heads for 24 hours so the meat would fall off the bone. He then would study the fracture lines. Another alternative w

as to soak the heads in a dye for 6 months, which would achieve the same purpose. Perhaps in the early 20th century it was costly to boil water for 24 straight hours.

Because of his observations and manuscripts, radiologists today report Le Fort fractures in their dictations. There are currently three Le Fort fractures, with the third being most severe as it consists of a complete separation of the face from the skull.

History and medicine.

Parking spots

We drove up and around and around the hospital parking garage. Talking and driving aimlessly we pulled right into the nearest spot to the hospital entrance. It was the greatest moment of the day...until we pulled into the nearest spot to the supermarket entrance later on. I told Anna both times we should walk home and just leave the car in those spots, to gloat.

Extra driving time is always worth it when you get that spot. The sad part about this day was we weren't even trying. It was too easy. Life is never that easy, but it was for us then.

I gazed deep into the eyes of the awaiting drivers when we pulled away from the spots so I could telepathically stress how important of an event this transfer of parking spots was. In reality, I was sulking for the loss. Don't ever take for granted good parking.

I was going to blog about my sweet day in neuroradiology. But for some reason parking lot karma trumped it.

Insight to Psych

Psychiatric refers to mental illness. Like the body, the mind gets sick. Actually, our health, mind and body, sits statically on a spectrum. Our bodies are assembled, built-up, fortified, remodeled, and broken down. Dust to dust. By 90, almost %50 of people will have some sort of dementia. Which makes me wonder, what are my chances? But over the last six weeks I've come to learn, it's not about chances. We get sick because we are human. And our minds get sick like our bodies. You can count on it.

The difference between having a down day and two straight weeks of down days might not seems like much, but it's enough to tag you with Major Depressive Disorder. The difference between you checking your locked door three straight times versus 30 straight times is the difference between "normal" and OCD. And the only thing keeping a drunkard on the streets from being petitioned into a psych unit is the fact that there's no loved one willing to sign the paper to get him forced treatment.

Those patients in psych units are not far removed from us on the outside. Yesterday they went to work. Tomorrow they'll go back. They are our co-workers. Our neighbors on the bus. They are not different. They have the same mind, the same neuro-chemical pathways susceptible to imbalances, and the same responses to medication.

But they are inpatient because they or a loved one thought they were more sick in mind than the rest of us. It's amazing to see the anti psychotics or mood stabilizers restore an individual back to coherence, back to the ability to carry out activities of daily living. Olanzapine works on the mind no different than hydrochlorothiazide on blood pressure. There is a physical receptor the medicines affect. It's not just theory to me anymore because I've witnessed it work.

It's strange to see fourteen people in a living unit on lock-down. We have them diagnosed and packaged. We feed. Me medicate. We often condescend. But if you sit and talk, you'll hear something familiar, and before long you'll be saying to yourself, "I think that way," or "I've done that." I just haven't thought or acted in such a way to be a threat to myself or others. But being idealistic, I believe ever threatening thought or action is actually a calling out for help. Whether conscious or not, it's a calling out for help. Why else are we here? And not being a humanist, I think we all cry out, looking up. Ride on!

Runner's World

For the first time this summer monsoon weather spent the night to hang out this morning. Thunder and lightning brought back a thousand memories of youthful shenanigans.

The best part was being able to soak it in. Drove Anna to the airport at 4:30 am under moderate rain and thunder. Then it started to get light. But the sun had to pound through two membranes of cloud, succeeding in only breaking the one closest to ground, so it remained eerily orange-grey.

I was a road hazard on the way home. My camera makes me ADHD, trying to get all the cool, momentary shots in time. Luckily the roads were mostly empty.

I arrived home, placed my body on the bed and told my head to go to sleep. But the window kept rattling, daring me to go out for a run. How could you not. One of running's secret pleasures is to go out under a drizzle, with the weather cool. The breeze gives a pretty good sideshow of swashing desert greenery accompanied by that ever-so-cool whistling through the leaves.

So I was out on the river trail, running and grinning. Pure sport. Take it anywhere, anytime. No lockout can touch it like other sports. And free adrenaline. Now I'm late getting to the hospital...typical

Shelby Cobra

This morning we awoke to a moderate breeze. The sky was clear but for a few floating vestiges of last night's monsoon.

The air was warmer than typical for the high desert. And there was calm...before the storm.

After we put on our Levi's, pulled up our socks and tied our shoes, we placed caps on our heads. nodded at each other, and headed out the door.

We got in our car and drove up Oracle Road to Mike Treece's home. This was one of Anna's birthday presents. A ride in Mike's Cobra. There exist only a few hundred originals in the world. The Cobra, manufactured for only three years in the sixties, can easily be worth over one million bucks. Mike built his from a kit.

The first thing he told me when he offered to give Anna a birthday ride was, "This thing has had problems. When it used to shift it literally jumped off the road, then fishtailed to the left."

The only time I like my cars fishtailing is when I decide they fishtail. That's besides the point. Mike knows his stuff, I hoped.

"As a matter of fact, yesterday the fuel line was leaking", he told us. He was going to take his wife out for her birthday. She never made it because they had to repair the line. After finding out about the leaky line, I made a mental note to locate the fire extinguisher in the car, which I'm sure Mike had.

After a brief tutorial on getting in the car and buckling up, Mike took Anna off on her birthday ride. She had a great time. But we all know the real reason I arranged this present. My turn came.

And what a sweet ride it was. I came to realize that car aficionados drive on another plane than the lay public. The road becomes their playground. They literally become oblivious to other cars, except when they say, "that guy thinks he's going fast." Besides that infrequent reference, they are in another world. Red lights become their friends. It gives them a chance to flex their motor muscle. Now, Mike says his Cobra is the fastest car in Tucson. Whether that's true or not, it was an adrenaline rush.

Life is fun when you can dip into another person's hobbies. People like to share their hobbies and it gives you a chance to learn something new. So, cheers to wife's birthdays! And for Mike's birthday I might get him a fire extinguisher.

A Shift

An addiction specialist lectured us today.

Some interesting trends and facts.

He says abusers of opioids are wising up to the damage they are causing to their livers by abusing Percocet and Vicodin. So they are turning to Oxycontin. So, if you abuse, oh be wise.

Also, a sobering fact. The most common cause of mental retardation in the United States is maternal alcohol use. Sad, but can be prevented with some attention by good homes.

What to do?

My attending asked us today whether or not it was society's place to judge whether a pregnant, psychotic patient should have a choice of conceiving a child when there is substantial risk to the well-being of the fetus.

Hmm....

Electro Convulsive Therapy

Friday was a knockout, literally. It was a comedy of errors too. Thursday afternoon I was reading the case of two rabid dogs in Michigan. About 130 people were treated with post-exposure medication, causing quite a ruckus. So Friday morning I headed out to find a dead battery in my car. I hopped on my bike, rolled up my pant legs, pulled my socks over them like a Scottish school boy, and pedaled up the hill towards Northwest Hospital.

Off to the side of the busy street, under a Palo Verde, stood a leaning dog who in my mind looked rabid. You know the dogs that kill in "Lady in the Water?" This is what it looked like. And he charged...

So there I am kicking the dog with my Scottish school boy leg while pedaling up hill trying to get to the hospital on time. Dr. Weigand, concerned, called for my whereabouts.

"I'm on my bike...should be....there....soon!"

And I was. And it was a fun day. After two weeks of non-procedural work I was given the crash course to electro convulsive therapy. As hands on as you can get in psychiatry. In a nutshell, this procedure is for those with major depressive disorder, schizophrenia, OCD, and bipolar mania who do not respond well to medication. It can also be used in the autistic spectrum of patients. It basically involves applying a surge of electricity to the brain of patients, inducing a real seizure.

It's a factory, filing patients through quickly. Nurses prep the patients in their gowns. Then we ask the patients how they're feeling, why they are here, what meds they are on, what concerns they have. Then the anesthesiologist puts them under. Following that, we apply gel to two pads for good conduction, and stick two paddles on opposite sides of the head. "In between the tragus of the ear and the eye, and one inch superior." After the paddles are applied, we hit the big yellow button, and a patient seizes, usually from 10 to 30 seconds. Of note, we use caffeine to lower the seizure threshold. Think about that before your next Pepsi, though you'd have to drink 12 Pepsis to equal the dose administered.

Included is a picture of the seizure of a man from whom I applied the paddles. It was a remarkable experience. I also walked away thinking it was under-utilized. We medicate so many but ECT has proven un-harmful and beneficial. One mom flies her son out for daily treatments, from California. California HMOs do not support ECT. So this mom pays $1500 per treatment and sleeps up at Star Pass Resort. She has some money for her autistic son, thankfully.

Twice in the morning were cultural references to "One Flew Over the Cuckoo's Nest." So I need to watch it.

An amazing morning of medicine in practice.

Mania and Fans of sports

In lecture today we discussed mania. We wrote a mnemonic to memorize the symptoms.

D - distractability

I - irritability

G -grandiosity

F -flight of ideas

A - risky activities

S -little sleep

T -tangentiality

Okay. First, if you listen to a group of sports fans (probably guys) talk about sports,they practice tangentiality in their conversation. One idea leads to another idea which leads to another idea. There is sometimes no connection or logic to the topics of conversation. Each fan is out to prove he knows what's going on in coach's' or players' heads right now even though all his information is from ESPN.com or SI.com. But you must articulate your chromosomal relationship with the gridiron, no matter how cliche you sound. I, Spencer, am tangential when I talk sports. But I'm not a manic fan. Or am I?

I do get distracted from life by sports. I do get irritable when I can't watch what I want or if my team loses. I suffer from grandiose feelings of superiority (my email is sunsfanyesiam). I do have flight-of-ideas. I can lose sleep for sports. But risky behavior? I think not. And I think to be a manic sports fan, I would have to engage in risky behavior. The photos below depict three recent sporting events where manic fans were present. One is of a riot in Vancouver after the Stanley Cup when the home team lost and fans proceeded to lay waste to their city. The other shows a manic fan trying to catch a baseball on a wobbly table. And the last, sadly, is of a Giants fan who was beat up in front of his children in the parking lot by Dodgers fans. This happened months ago, April 5th, to be exact. He is still in the hospital with permanent brain damage. There is real psychosis in sports. Think about that the next time you "boo" your opponent.

The Social Worker

A social worker in the hospital is a professional "Hey,- is-there-anything-I-can-do-for-you?" person.

And they do it.

If I could select my next door neighbor, it would be a social worker.

If I had to send our kid to be babysat by anyone and I knew they were a social worker, I would have less qualms than a palm tree to drop them off there.

I hope they make $100,000 a year. They deserve it.

The Team

On the psych ward there is a very even ratio of health-care professional to patient. On the geriatric floor I'm working there are 12 patients. Many of them are "train-wrecks," and require a lot of back effort and forward planning. Their stay on the floor averages out to anywhere between two weeks and a month.

To coordinate the effort to care for these 12, Team A - of which I'm a part- (mostly silent part) gathers every Monday, Wednesday and Friday morning at 9:15. Around the table are pharmacists, nurses, social workers, case managers, physicians, insurance agents, and students. Friday I counted 12 at the meeting. One health care worker for each patient.

Now let me take you back to Kum-Kundi-Yilli. Just north of this village, down a long, red dirt road sits a hospital. Green weeds and trees border the building and pools of water reflect all over the grounds. The entrance to the hospital is enclosed by a metal gate, like the kind you see around elementary schools. Outside are vans with people sitting. They are either bleeding or waiting for someone that is bleeding. Leading up to the hospital is a line of villagers doing the same thing. Inside the gate is a giant courtyard with concrete seats lining the walls. Each seat supports a patient. And off in the northeast corner of the courtyard is a little office. Inside the office is a well-groomed gentleman with glasses. He wears a tie and wields a pen. He's the physician. All his supplies lay scattered on the desk. He is also nurse, surgeon, primary care physician, pharmacist, and hospital administrator. The nurses are on strike, so today his job, theoretically, is to treat all the patients outside his office.

That's Kum-Kundi-Yilli, in northern Ghana, at least how it was when I visited for a month a few years ago. Our health care system is broken, I hear. But on the battle front I still see something good. I see American brothers and sisters working for the idea that life, any life, is worth saving. I don't know if it gets any more complicated that treating a majorly depressed man who comes in after his 8th suicide attempt. Yet the team works as if he were their own flesh and blood Grandpa.

I know comparing the Ghanaian health care system to ours is apples and oranges, but it's worth reflection that as Americans we budget ourselves into the red because we believe in the cure. Call it hubris. All I see, so far, is courage. But I'm biased, I work on Team A.

My challenge the next five weeks is to formulate my own opinion on the best way to reform health care. I'm a naive knave...

The Brain

Dealing with psych patients today was very memorable. I saw geriatric patients in wheel chairs sitting at the end of the hallway in the sun, like potted plants soaking up the light. They didn't move for hours. Perhaps they know something I don't.

I saw women yelling at anything that moves. I saw men doing things I thought only adolescent boys did.

I saw old, seasoned veterans of the earth acting out like children.

Yet despite all this obvious disorder from the norm, I kept thinking about two things I read this morning.

Half our genome goes to building the brain. And, there are more neurons than stars in the Milky Way. I think our Creator values the individual. The human brain holds more star power than the Galaxy.

So, why disorder among us? Their has to be a constellation that can be drawn from all the scatter-brains that populate the psychiatric wards. I'm not expecting to find it. But I bet someday we might know.

Back in...

The opening line to my textbook today read:
"Knowledge does not keep any better than fish."

And that's what I can testify to after day one of my fourth year, after a year off.

But oh, was it worth it.

Today was orientation in the psychiatric ward of the hospital. A pretty light day with my only patient interaction being with a 350 pound man who thirty minutes earlier threatened the life of himself and the attending physician across the room. I was unaware of these threats until a nurse saw me bump into him in the lock-down hallway on my way to the bathroom.

The rest of the blessed day was spent reading for tomorrow's activities.

In God We Trust

[P]roclaim liberty throughout all the land unto all the inhabitants thereof...

Leviticus 25:10

A Change

This is my last week as an official medical student "drop out." I'm dropping back in on July 5th. I'm excited. Anna comes home from the ICU and dazzles me with stories from the life in health care, constantly reigniting my desire to get back in the game.

Just for the sake of a personal accounting of my last year I want to catalog some of the fun I had, some of the things I did:

-Hikes with Anna all over Southern Arizona
-Campouts until 9 pm
-Pick up the guitar and learn the classical approach
-Play the piano any time I passed one
-Serve as a boy scout leader
-Play basketball
-Compete in road bike races
-Run a road race
-Work as a substitute teacher (One of the most fun things I did)
-Work with Jennifer as a punch boy in Mesa again
-Visit family in Thatcher, Lake Powell, and Salt Lake
-Read, read, and read (I'm a new fan of Newberry books)
-Publish in a radiology journal
-Eat good Anna dinner without having to pick up a medical book to study soon after
-Sunday walks with Anna
-Sleep in when Anna had days off (I feel guilty typing this)
-Write thoughts, figure out what I like to write
-Make sling shots and give them away to missionaries in the Tucson mission
-Go on exchanges with the Elders
-Go to Bookman's often
-Watch movies with Anna
-Drop off my brother at the MTC before he headed out to Cusco, Peru (a great highlight)
-Play tennis (watch out Rich!)
-Listen to NPR and Dan Patrick radio on many a morning (these two shows have a way of canceling out the flow of information in my head)
-Journal
-Look up family history
-Call family more often
-Learn about trees (there seemed to be a calming influence as I finally learned about these standing neighbors I pass everyday)

And there was more to bore. Oh! And I got to watch March Madness and the NBA Finals uninterrupted by study or hospital work. But trust me, I'm excited to join the human race again in the normal way of life.

But how normal it will be you can decide. Come back and check out the adventures of a fourth year medical student, which begin July 5th. My first clerkship (5 week assignment) is in psychiatry.

One Unfortunate Event

We drove home from Utah yesterday, into incredible wind. Gales, in fact. Also, much of the way down I-17, 89A and I-10 was under construction. At one place on the 89 between Lee's Ferry and Flagstaff we were forced to stop at a one-way section of road. The oncoming and outgoing traffic shared alternating turns of the one way stretch. We pulled right up into line to wait out turn. We rolled down the windows to get some fresh air. We were out in the middle of nowhere. The wind was blowing. Clouds were sailing their shadows across the hills. And the mood was calm. But then it stank like a mix of partially clean bathroom and partially messy bathroom. And there, upwind, on a solitary hill stood a port-a-john. The door was flapping open in the wind, sending the sweet smell of good stuff right into our car. We rolled up the windows and cranked up the A/C, in idle mind you! Gone are the last tracings of Grandpa's conservative influence on me and cars. Fear not though, I still drive 65 mph.

Anna is the most, most patient wife in the world.

The humble Noble

I attend a weekly neuro-oncology tumor conference. I can point out the brain on an MRI, and maybe a tumor or two, but beyond that I have no real expertise. But I like to listen, and watch. I am, after all, just a student.

Someday I want to participate in a meaningful way in one of these conferences. You know, House style. Wham! Bam! Slam!

That's the esprit de corp at this conference. You have the brightest of the brightest from disciplines such as radiology, pathology, neurosurgery and more, who discuss tough cases and create a management plan for patients. And they sometimes never have mercy on each other. The doctors seem young, vibrant, strong, and persuasive. You know your stuff if you wear this medical badge of courage. And if you're shot down with a whamable and slamable comment, you bite your tongue until it's your turn to strike.

These conferences are fun.

But...meaningful contribution. When am I going to make one? I would love to know it all. But today I saw something that reminded me of what medicine is all about and how I would hope to contribute. To establish context, the computer mouse and keyboard were malfunctioning, delaying the conference proceedings. So as each case was brought up on the computer, heads rolled and comments were made. "Why can't we fix this?" "This is unacceptable." "We can't go on this way."

But on we went, heads rolling. Off in the corner of the horseshoe arrangement of tables sat a retired surgeon. He had long, stringy white hair. He wore a long sleeve maroon shirt with khakis. And he had his black buckle briefcase that looked like it was from the seventies on the table, with a tooth-paste looking stain on it. He had two stacked cups that ten minutes before held his coffee, sitting in front of him. He attends these conferences, as some retired doctors do, for reasons unknown to me. I guess it's to keep up or to provide input.

As far as input goes, no one wanted to hear from him. I kid you not, when he would raise his hand to comment, the doctor as the lectern would look at his raised right hand and ignore him. No time for an old-timer who studied in the analog age with printed books and medical journals. But the old man stayed. After the third case, he got up and left. I was standing in the back and looked forward to taking his chair but thought I'd give it two minutes just to be sure he was gone.

Then, back in he walked - oh I forgot, he also had a cane - holding a mouse and keyboard he grabbed from a nearby vacant office. He weaved past the extended legs of the doctors right up to the lectern to replace the malfunctioning hardware. After the job was done, he walked back through the gauntlet of extended legs and sat down in his chair.

And the conference proceeded, in my mind, beautifully.

This retired doc got the job done, no matter how custodial it was. It was a simple event in the day but I want to remember this guy! Especially if I get in the habit of sitting back and rolling my head. Meaningful contribution.

The Fabulous World of Newberry

I like for people to tell me what is good. Trails to run, food to eat, movies to watch, and books to read. I like when they all have been critically reviewed and recommended. I'm not much of a cultural scout. And I've taken this preference to my book reading this last month.

I read three Newberry Honors in a month, and for not being a novel guy (pun perfectly intended) I can't get enough.

Newberry winners are fantastic authors. They write well. If I could ever write as well as them I would consider my skills to have maxed out. Think about it, their challenge is to engage the youth. You have to use words to make a kid stop, sit down, open a book, and read to completion. There is power in those words, especially if all the words you use for your boy scouts are "Shut-up!" or "sit-down." I want to learn a better method and I think those Newberry books have the answer.

The greatest of the latest:

The Bronze Bow

Lizzie Bright and the Buckminster Boy

Wednesday Wars (which didn't win but got runner up)

I'm going to miss these reads when I pick up the stethoscope again...

The Man Who Killed Santa Claus

This is taken from "The Story of My Life" by Benner Azro Hall:

"In December of 1932, the local newspaper was a weekly, called the Mesa-Journal Tribune. John McPhee was the editor and publisher of the paper. Well, that year, he and some of the business men came up with a brilliant idea to add some excitement to the Christmas celebration. On Friday, December 9, the Journal had front page headlines which announced, 'Santa Claus Coming in Airplane'. The article went on to say that he would fly over Mesa, do a few loops, then jump out in a parachute to land in the arms of the waiting crowd.

Well, that should be really exciting. At that time there was only one airplane available in Mesa, a two-wing biplane, flown by Mitchell McFadden. They found a stunt man someplace, who agreed to dress up like Santa and jump out of the plane.

Unfortunately, the stunt man was one who was fond of alcoholic beverages and he started celebrating too early. When they were ready to load him in the plane he was so drunk he couldn't stand up. So, John McPhee came up with another idea.

They put Santa's costume on a dummy, put a parachute on it, and loaded it in the plane. McFadden was instructed to fly over the crowd, do a few loops, then push Santa out of the plane, so he would land in a field, just outside of town. The police car would drive down Main Street, with another man dressed as Santa.

Well, all went well, with lots of excited children as the plane flew over, doing its stunt; but then tragedy struck the great town of Mesa.

When Mitch pushed the dummy out, the parachute didn't open. You can just imagine all the terrified children, gasping as Santa's body tumbled to the earth.

But, a few minutes later, all were relieved when the police car came driving down the street, with Santa in the back, waving and throwing bags of candy to the amazed children. The Christmas spirit was renewed in the town of Mesa, but Mr. McPhee had difficulty living down the reputation as 'The man who killed Santa'."

Sedona

Here's to spontaneity pointing at Sedona. Thanks Craiglist.

Space to Grow

When I feel something, I write. When I write, I learn about about what matters to me. I recently wrote about homosexuality. And through the post I learned that what matters most to me are my relationships with others.

I have met so many amazing people in my life I can call friends; I feel like the richest man on earth. Over the last few days I've burned bridges with my words. How I would risk friendships to preach something I was never called upon to preach is beyond me to answer. I don't know. But I know more about the personal regression that comes from highlighting the mote in my brother's eye.

My beams are many. Big enough to support the biggest cathedral of self-worship sometimes. I want nothing more to do with motes. I need to work on my cathedral.

We are all walking the same road of choices no matter who or where we are. My choice is not your choice, but since when did that make me better than you? What would separate us would not be our choices, but withholding love from each other. Thank you for allowing me space to learn this, space to grow.

Why we camp, can't, shouldn't...

I can see the pioneers of old looking down on us in wonder when we set off to go camp in the domesticated wildernesses of America.

"Sweet Joseph and Mary, why do they leave the comforts of their fluffy homes with all their magical devices and freezers with ice? If it were me I'd never take another step outside."

Or...they might just be looking down on us and smiling, thinking, "Oh, those darling folks. They do try, don't they?"
This sounds more likely what hushed down from the heavens as we trekked out into the Coronado National Forest this weekend.

In summary, we left with supplies for two days, plans for hours of hikes, and blankets so thick we couldn't see out that back of the car. We had knives, saws, matches, first-aid kits, and toilet paper. We were going to rough it on hot dogs, manly beans, and marshmallows, all over a roaring fire hot enough to singe my beard. We were going to gaze off a peak at the sunset and be back up with the sunrise, hunting down a black bear sighting. In the end, we hiked 45 minutes, saw the sunset, shivered back to the car, ate half a raw hot dog, cried into a can of cold beans and drove home. I was no Kit Carson. Anna was no Calamity Jane. But we couldn't have had a better time realizing we weren't born pioneers.

The camping trip started out promising. Our hands floated out the car window as we drove up the mountain. We watched the temperature drop from 106 in the valley to 70 by the time we reached Ski Valley. As we made it to our trail head we loaded up with supplies for a hike off into the forest. We planned for four hours. You know how long we made it.

Instead of hiking, we ended up on the ground with our backs against a fallen pine. The forest, four years past a fire, looked young, scarred, and fresh. Off to the left we could see forever with the sky islands opening up over Tucson. To the right we watched the sun descend into the Ponderosa. Smoke from fires on the border gave a purple/pinkish haze to the late afternoon. And we talked. And held hands. Who cares for four hour hikes when you have that?

Then we shivered. We stood up, dusted off, and headed back up the trail. We were passing through some meadows of green grass, ferns, and pine when we looked west though the trees and smokey haze to see a blood orange sun, setting. We ran to the edge of the mountain to see it set. The dramatic violin music from the new Jane Eyre movie was playing through my mind as we ran...until Anna tripped over a root and face-planted. Then it was all laughs for the rest of the sunset.

Then we hungered. We had learned upon entering the forest we could not have fires. So we bundled up in the car, opened our beans, and sat with a lighter heating up our hot dogs. If you've never done this, don't, it will infuse a butane-like aroma into your hot dog leaving your ready to pitch anything you might have eaten all week. At this point I couldn't tell if I should be laughing at Anna's recent face plant or the state of our dinner. We couldn't imagine a better trip, so we threw the rest of our hot dogs away, gathered all our stuff, and abandoned our two-day plans in the mountain for McDonald's in Tucson and a night in front of our TV watching The Man from Snowy River. Now there's a man and a woman of note!