Firefight at the Old Folk's Home

Monday morning came peacefully. I could hear the birds, only, breaking silence. It was cool, with a wispy cloud screen overhead. Such serenity really can only be found on El Rancho. And that's where I was for the day, spending time with Grandma while Susan accompanied Grandpa into Tucson for his heart procedure.

With a backpack full of books and twenty dollars on the kitchen table from Grandpa for lunch in town, Grandma and I were set. But you can always get more books, so in the morning Grandma wanted to visit the public library. She held my arm and introduced me to all the librarians. One lady gave Grandma a letter she left in her previously returned book. Then this lady showed us to Grandma's favorite aisle of books. We browsed, me silently and Grandma out-loud, naming each and every author and title on that aisle.

After she selected four books we left, setting off the scanner, which is okay because everyone knows Grandma never has her card but she's good for the books.

Then we went for some basic groceries. Grandma held my hand, claiming it needed "warming" as we strolled the aisles. We grabbed milk, yogurt, and fruit. And we were having a great time. I kept wondering why I don't come out to spend more time with Grandma. She makes me feel like a million bucks, all the time. And she's always smiling. And she has great stories, like the time she was called as Relief Society President, "When I hated relief society."

After the grocery store we went to the drive-thru at Wendy's. I was beginning to concern myself with the fact we spent the morning walking around town and Grandma was not drinking. So we loaded up on liquids and headed home. I knew also I needed to keep Grandma near a bathroom. Intake and output, probably the two most important geriatric priorities of the day, in my mind.

Back at the Ranch we spread out lunch on the table. I had to remind Grandma to eat and drink and she got a little impatient with me so I asked if I could take the trash out and burn it. Grandma endorsed the idea enthusiastically, so I left for five minutes to take the trash out behind the wood pile, throw it in the metal trash bin, and set it aflame. This is always my favorite chore at Grandma's house.

After five minutes of watching the flames I went back inside, and there was no Grandma at the table. But there was a half-eaten sandwich and an empty glass of water. Success! I found Grandma in the back bedroom talking to her cats. I asked if she wanted to finish lunch with me and we returned to the kitchen. I had just sat down when I smelled smoke. I jumped up, rushed to the kitchen window, and saw flames creeping down to Grandpa's garage, where he had two cars parked and two dune buggy's, as well as enough gas to blow us to Tucson.

I think I said something like, "Oh, crap. Oh no," with my voice wavering. In a split-second decision I decided not to tell Grandma and I ran outside with my cup of water from lunch. I ran to the flames approaching the garage and felt an overwhelming depression as I saw three more lines of flames, one heading into the woodpile, another across the barbed wire and south of the property, and a third heading east into the wash. I could NOT believe this was happening to me. My mind was racing and I could not think, so I looked in the garage and found the most plastic and flammable tarp you can imagine and raced back to line #1 (garage line) to flap it out. You can guess what happened to the tarp. So I started using my feet, but my scrubs started to catch aflame, so I ran back to the house, thinking maybe I should call the fire department. But that far out, who would come? And are they a volunteer crew? Pro Bono might not be bueno today.

I saw the house hose. It was five feet long, a good hundred-fifty too short. But in one of many tender mercies of the day, there were two buckets right by the door. I cranked the faucet and filled both buckets and ran back to the fires. I had to prioritize. I was about to lose a huge mesquite and wood pile. I was also about to lose ground on everything south and east. But I knew I had to finish line #1 (garage). And I did. Thankfully, the garage, and dune buggy survived by two feet. I ran back to the house and saw Grandma walking out with her slow, shuffling walk.

"Oh my," she said in surprise at all the smoke in her yard. I wasn't sure how she was going to react. Luckily, she looked down and saw the hose running so she grabbed it and started watering the flowers by the door. I ran up to Grandma and placed my buckets on the ground in front of her.

"Okay Grandma, everything's okay, the trash fire got out of control but I've got it under control." That was a complete lie. But I needed to keep Grandma in control.

"Oh, okay," was her response.

"Grandma, you fill the buckets up, I'll run and take care of the fire, and come back for you to fill them up again, okay?"

This was our plan. I ran back to the spreading lines and began to gain some control. I eventually put out the mesquite tree and line near the wood pile, which I came within five inches of losing. Every time I ran back to Grandma, she was there waiting with hose. She filled buckets and watered flowers while I fought the fire.

The third line on the south was difficult because I had to negotiate a barbed wire fence. At this point I was wondering when the neighbors were going to arrive. That's a testament to their confidence in Grandpa and his controlled burns I guess, because they never came. I eventually put out the third line and fourth line which was spreading down into the wash.

And there was Grandma, faithfully filling buckets in 90 degree weather, wearing sweats, a sweater, and a wool cap. I made a mental note to make sure she drink a few cups of water when this was all over. I eventually filled up a wagon with water and gave Grandma a big hug, thanking her for saving the day. I was close to losing control but Grandma saved precious time having the hose ready. After I made sure the four lines were out I went back to Grandma and told her to get some rest inside.

"No, I'll just sit right here and wait. By the way, this will be our little secret."

I felt like crying, but didn't want to be the first firefighter in the world to do that, especially on my first one, so I gave Grandma another hug. She stood up and we stood staring at the smoke and ashes, side-by-side. I put my arm around her, sharing the moment of victory and wiped the sweat off my forehead and the tears out of my eyes. But I think the tears were more for having an AWESOME grandma than for avoiding near tragedy.

I spent the next hour spot-checking, putting out flames that would pop out of a yucca or piece of wood on the ground. The wind picked up, reminding me that while Grandma saved the day, it was divine assistance that made the difference.

Funny how family has been talking about getting the grandparents off the ranch and into a safer, more comfortable living environment. I guess it's not time yet.

What John Wesley Powell Felt Like?

I cannot imagine walking real estate not previously traversed by norte americano humano sapiano, but to feel, to really feel what it would be like to do so seems exciting. My imagination leapt outside it's weedy and rusty playground and fired me up Monday morning.

Anna and I went for a hike in the Tortolito mountains. The trails, recently opened, cross through a minor mountain range north of Tucson. The range, lower in elevation and a little distant from the more popular Catalinas, is probably overlooked by locals and visitors. But thanks to Marriott, the modern day bank-roller for studs like John Powell, we could ride the coattails of the rich right into some high desert that was more virgin than I'd ever seen. Because his kingdom built a Ritz-Carlton right at the foot of the mountains and supplied funds for trail--really good trail--building.

The range also houses a perennial stream, a stream that runs ALL YEAR LONG. You're more likely to get eaten by a shark than jump over a perennial stream out here in the desert.

In the mountains, wildlife is there. The plant variety is enormous-- not to mention the quantity--and the trash is none. With 65 degree weather, a slight breeze as a companion, and no clouds, we forged through the Aspen Loop trail. The area was home to ranging Hohokam Indians from 500 AD through 1300 AD. I would've stooped in search of arrowheads but I didn't want to hold up Anna. My goal in life is to get Anna to like arrowheads. The last time I mentioned them she said she didn't need any bottled water :)

So, we hiked. And my imagination was going. And I felt like I would want to be a modern-day Powell, laying out new maps for a growing and blessed nation. I just don't think I could do it with one arm...

More Tucson Thoughts

-A few Saturdays ago I rode home from the hospital and passed 9 yard sales, in 4 miles. It's an exercise in discipline for me not to brake, spin my bike around, and hit the pedal back to the tables of possible treasures. This makes me feel adolescent because I stand up to pedal faster, leaving my backpack flapping from shoulder to shoulder, rapid-fire. But I didn't stop...I think because my mind caught hold of a thought and held onto it like angel food cake.

How many other countries have yard sales embedded as a social norm? I can strike off Israel, Brasil, Ghana, France, Mexico, and Egypt because I've been there over weekends, never seeing yard sales.

-Over the past couple years a few physicians disclosed their salaries to me. They also disclose offers they've received to relocate. One physician was offered seven figures to pick up and move from Phoenix to a practice in New York. But the physicians don't move for money. And they all commonly say the same thing: "Enough is enough. You get to a point where you are comfortable and you don't need more." Just seeing how much Peyton Manning signed for ($96 million for five years) made me wonder why you rarely hear athletes say, "enough is enough." They are always bartering for more.

-I finish my neurology clerkship today. In one lecture we learned about treatment for Alzheimer's. The current treatments do not cure, but prolong the inevitable--a form of mental life support. If it were me being treated, would I want to prolong the inevitable? My knee-jerk reaction is to answer, "no." This probably has to do with imagining the strain I would put on loved ones. However, rarely do I see loved ones less angelic than when they are caring for their Alzheimer's loved one. No judgements here, just observations.

-I read this in my textbook: "Essential tremor often responds briefly but dramatically to ethanol consumption, which may be a useful diagnostic feature." I always find it interesting when medicine and The Word of Wisdom intersect in a most perpendicular way.

-Racism. If someone criticizes the church for withholding Priesthood from those of African descent, and it's a criticism based purely on race--with no subjective bias against the church--then they should always be willing to discuss, at the same time, how America withheld the right to vote from those of African descent until the 15th Amendment. And if they truly have no church bias, they won't object to the comparison, for sake of discussion.

Eat Your Spinach

Mom always told us to eat our spinach. It will make us strong. We believed. We ate. And we walked away from the dinner table to gather our capes and plastic swords to battle the bad guys down the hallway. Good thing only my sisters lived at the end of the hallway because I ate a lot of spinach. Dad always said I would grow hair on my chest if I ate sardines.

"Now these will put hair on your chest," he said. I can still remember his smile as he bit the heads off at the dinner table, making my sisters run back down to the end of their hallways where I would later confront them with my spinach-bolstered bravery...er...knavery--with no hair on my chest.

Okay, so this blog entry has a point. Spinach. I love you Mom, but maybe moms have been known to be wrong about a few things--propagating healthy rumors that are nothing more substantial than rumor.

Knuckle cracking. Known as "KC" in the literature. Has Mom ever told you it will give you arthritis? Well I finally came across an elegant (elegant in every sense of the word) study by a physician who found KC does not cause arthritis.

For fifty years he diligently knuckle cracked his left hand at least twice a day. Yes, 50. He refrained from cracking his right hand during this time, and any crack on the right was unintentional. How he did this for fifty years amazes me because I always feel unbalanced if I crack only one side of any part of my body. But he cracked unilaterally, and diligently. And then he imaged his hands and compared the two, finding no evidence of arthritis in either hand, in fact, both hands showed similar joint space findings.

You can check out his paper here:

1. Unger DL

. Does knuckle cracking lead to arthritis of the fingers? Arthritis Rheum 1998;41:949–50.

I finally learned the physiology of knuckle cracking this week. We have ligaments over our joints to provide stability. In between the ligaments is a synovial film, or fluid layer. When we apply pressure to the joint we separate the ligament layers and create a negative pressure within the synovial film layer where air quickly rushes in. The air rushing in is the "pop" we hear. And we can't pop it again right away because it's already full of air. The air must be reabsorbed out of the synovial film space before we can pop it again.

So thanks to Unger at least I can stop worrying about arthritis in my neck, back, knees, fingers, and toes, because the best thing at the end of the day is a little KC!

Cottonwood

The first change I noticed was the direction--I was driving away from downtown and my usual route to the hospital. Into the foothills of the west, on a road called Sweetwater, I drove. Wishing I was biking instead of driving to the Cottonwood clinic, I was otherwise stress-free this morning. I listened to NPR on the radio recapping last night's Oscar Awards ceremony. After an eight mile drive on a route Anna and I frequently road bike, I saw a sign indicating Cottonwood's entrance. I turned right and after a few small curves and turns I arrived at a gate with a keypad and speaker. I pushed the "push to talk" button and waited a couple seconds before a pleasant-sounding lady asked my business. I told her my business, a medical student on a rotation assigned to follow Dr. Onate. She opened the gate, instructing me to park and walk into the first building on the left.

I parked, gathered my pencils and notebook, clipped my ID onto my shirt, checked for outstanding nose hairs in the rear-view mirror and got out of the car. It was a breezy morning and every tree in the clinic was dancing. I love that. I walked into the first building on the left and announced who I was. I was given another ID by the receptionist and also told where to find Dr. Onate's office.

"Follow the path past the Lodge, the tennis courts, the pool on the right, and the garden. Onate's clinic is the last long building on the far end of the campus."

"Great," I said.

I walked outside and headed east down the path. The grounds are well-kept at Cottonwood. The walkways are straight-edged and cut through gravel landscape. Every five feet is a tree of some variety. After fifty feet of walking I passed saguaro, rosewood, texas rangers, pine, queen palms, ocotillo, oak, mesquite, and mountain laurels--which happened to be in bloom with their intoxicating grape-smelling flowers. It was the kind of landscape you find at a Sedona or Scottsdale resort.

The campus buildings are constructed of rough-hewn stone, the color of sand. The windows, doors and rooftops are a light blue. The buildings blend with the background mountains and sky. Walking east I passed various staff, starting their day. There was no rush in their walk, at least not the rush you see in the hospital halls of University Medical Center.

I passed the Lodge, tennis courts, pool, and gardens and found the last building on the lot. I walked into the middle door into the reception area. Inside I saw three teenagers sitting--or rather laying sideways across plush armchairs--reading magazines and chatting.

I walked up to the reception desk and introduced myself. The receptionist was the first person I saw on campus who looked really busy. Normal busy for a Monday she told me. She said Dr. Onate was waiting for a medical student and that I must be the one. I was. She led me to his office. Inside Onate was sitting, chatting with a fellow psychiatrist. He smiled and extended his hand, which I shook.

Onate was wearing a dark, Quick-silver button down, untucked, with dark corduroys and black shoes. His skin was bronze and he had a badger-streaked goatee. He was short and well-built. He did not look like a physician. Then again, most psychiatrists don't look like physicians in my book. But Onate had something western about him. I later found out he grew up in Clifton, Eastern Arizona. That explained his mannerisms and look. You can tell if someone is from the copper country.

Onate, like most psychiatrists, enjoys his work. He walked me around the campus, showing me the various buildings and their purpose. We passed through some in-patient units and he stopped occasionally to speak with counselors or nurses about specific patients. Evidently it was a busy weekend. Patients were sneaking benzodiazepines, "cheeking" pills, pretending to use the bathroom to put on hairspray, staying out late at night at the lodge, and upsetting roommates. Nothing unteenager-like there, I supposed.

After the tour we returned to Onate's office. He gave me a seat and I sat. I looked out his window at the blowing queen palms and pines with the clouds passing quickly by under the blue sky. I mentioned he had a better view than any I had seen during medical school. He agreed his location was prime. I wanted to tell him I'd wager his job was probably better than any I'd seen also, but I held that comment in my head and told it to go away. Maybe at the end of my rotation I'd tell him my thoughts on his job.

He showed me his schedule of the day. We were to see three patients and then he had a meeting after lunch. "I'm usually out of here by two," Onate said. That thought I held in my head about his job being the best in medicine almost slipped down to my tongue and out my mouth, but I again held it back. I'd wait and see patients with him first.

We walked out the office together, down the hall to the reception area. We passed your typical office pictures on the wall: An eagle with the word "Dignity" on the top, mountains with the word "Respect" on top, and two ducks necking with the word "Love" on top (they were doing some sort of hugging with their necks, I never really knew what "necking" referred to so I'll just think that's what it means). Onate called for patient 1 and a skinny, young blond guy popped out of the chair he was lounging in. We three walked back to Onate's office.

After introducing patient 1 to me and asking his permission for me to sit in, we all sat down and began the session. Patient 1 wore a blue hoodie, skinny jeans, and converses. He hair was gelled mildly, teepee style. He had aviator sunglasses hanging from the neck of his hoodie. He sat back in the chair and clasped his hands together.

Onate asked how he was doing.

Every day is a struggle, patient 1 said.

Onate: You have the past, the present and the future.

Patient 1: My life is shit, all I do is remember my past. It haunts me, you know what I mean, and all the debt, and survivor's guilt, and pain. It comes back to haunt me and my head does a three-sixty, you know what I mean? Then I think about the future and what's going to happen and my anxiety goes up and I feel like I'm surrounded. He says this while drawing an imaginary circle around himself. And I'm trying to get out, he says, imitating the breast stroke in the air.

Onate: Well, that's why here we are just trying to get you to focus on the present.

Patient 1's story came together a little for me. He's from New York. At his rocky bottom he was living on the street, trying to find a way to his next Heroin fix. His last one was July 4. Out with a bang, he said, smiling at me. I smiled back and looked down at my shoes. Onate said he looked a lot better this week. He was able to talk more--provide more insight into his "present." He was leaving Sunday and wanted to get things ready before his discharge. I wanted to ask patient 1 his plans once out of here. Would he go back to New York? What would he do after his next relapse? Would he end up on the street again? After this session I didn't feel much hope for patient 1. He seemed fragile and unsure. And he was leaving Sunday. After a discussion about his medications, Onate told him thanks and patient 1 got up and left. Onate charted. I looked out the window in wonder of what it would be like to be a patient here.

We gathered patient 2 from the reception area just like patient 1.

Onate: How are you doing?

Patient 2: I've been having more paranoia and acid flashbacks, I presume. I would say flashbacks because it's quite natural to have, coming off drugs.

Onate: Have you tried Seroquel?

Patient 2: It causes me to go crazy, and I'm not exaggerating, it actually makes me crazy. I don't think I'm psychotic, to be honest, and I think that comes from the Seroquel.

Patient 2 is a skinny 17-year-old who has already suffered a heart attack from cocaine use at 15. He's from London. His chart says he studies Fundamental Art. Reviewing his chart before we met patient 2, Onate asked if I knew what Fundamental Art was. Who knows, I said. I wondered if patient 2 knew.

I learned from patient 2 Cottonwood has a liaison set up in London where it's "well-represented." He was targeting two treatment centers: Cottonwood and one in South Africa. Mode of therapy won him over to Cottonwood. Tell me how this sounds to a struggling kid:

Adapted from the Cottonwood brochure:
Cottonwood's compassionate team created an individual plan in which the patient always comes first...a plan that includes these treatment modalities:
Group Therapy
Individual Therapy
Trauma Therapy
EMDR
12-Step Meetings
Equine Assisted Counseling
Expressive Arts Groups
Yoga
Challenge Course
Rocks and Ropes
Psychoeducational Lectures
recreation Therapy
Tai Chi

Sounds like Sedona or Scottsdale for a couple's weekend get-away. And why not? Wouldn't the patient benefit that much more from equine therapy than a stable couple looking for some fun on their stability like a cherry on top?

Patient 2's issue today, other than paranoia, is depression

Patient 2: I don't know, I might be depressed, actually, when does depression start? I might be but I should just give it time. Can I not have something for emergencies, like a benzo--it calms my body.

Now that's Fundamental Art

Onate: You're in a drug treatment facility.

Patient 2: I'm aware of that, he says without sounding britishly snobby (which I didn't think was possible)

Onate: We try and stay away from addictive drugs. Are you open to something else?

Patient 2: Yeah, it won't help, but I'm open to it.

Onate and him agree to start an anti-depressant, a selective serotonin re uptake inhibitor. These are good drugs. Serotonin helps with sleep and a sense of feeling rested and focused. It helps to recognize thoughts for what they are, rational or irrational. I like the choice for patient 2.

I felt some anxiety when patient 2 was complaining about not getting benzos. I imagine he put down a few ten thousand dollars for his month here. As his physician I would feel tempted to make sure he was pleased with his stay--to ensure a good "customer feedback" form was in order. To make sure patient 2 returned home to London and had nothing but good things to say about Tucson. I told Onate after this visit with 2 my thoughts about treating to please and he said no, it wasn't a challenge. Onate asked if I found 2 depressed. I thought not--too talkative, too forward-looking, too engaging. I knew depression to be a black hole for everyone around and 2 didn't leave me feeling drained as some deep depressive patients have.

Patient 3 was talkative. She had long, blond California hair and she wore tight sweats and a hoodie. She could have come straight out of your typical high school pep rally.

Patient 3: I still feel out of body doctor. I feel like my dreams are very, very...I don't feel like I'm sleeping. I dream I'm on a horse with Hulk Hulgan. What is that? I want to change my dosage from night to morning.

Onate: Okay, we don't like to make many changes to your drug regimen. You're very talkative today so let's slow down. We have time.

After some discussion it was agreed to increase 3's Lamictal from 25mg to 50mg. The max dose is 200.

Patient 3: And can I have my razor back?

Onate: You're switching subjects, again.

Patient 3: It's my birthday coming up on the 10th.

Onate: Oh, that's good, he says, smiling

Patient 3: Maybe I'll get a tofu cake, with some recyclable candles. When she says this she smiles, and I think her side profile looks like Joaquim Phoenix, stoned, in Walk the Line. That lazy smile thing going on where the eyes kind of drift aimlessly.

Cottonwood probably hosts many birthdays. The average length-of-stay is 30 days. Some stay 45. And adolescents stay 90. Patients see a psychiatrist once a week and a personal counselor daily. The days are filled up with therapy from the list above. And the final week is "family week." This is what it sounds like, therapy with the family. Another expensive proposition. But Cottonwood, as I'm learning, spares no expense.

After seeing three patients, it was noon. Onate walked me to the cafeteria and we stood in line for food. The cafeteria looked like it belonged in a nice Marriott. The head chef served us--the menu today was top sirloin or fish stir fry. A hot meal, gourmet, cost five dollars. The salad-bar was 4 dollars. The cafeteria served patient and practitioner alike. The patients never sat at the same tables as the staff. But bread was broken together under the same roof. I liked that. I liked the top sirloin.

I spent lunch sitting at a corner table with 5 physicians. Two windows behind me poured the sunlight onto my table. I struck up a conversation with a physician who came out here to work from New York. He is here to stay. We talked a little about religion. He mentioned how one needs to break his heart to find happiness. I couldn't help but ask if he had read The Book of Mormon. He had not. But we both agreed our path to happiness involves focusing less on self and more on others. Any religion that can do this is a good one. I agreed, to a point only. I hope to talk to him about authority next time we share lunch at the same table. He is a good man. And like most staff at Cottonwood, he smiles a lot.

After lunch I was released. I strolled through the campus thinking how nice it would be to bring Anna on a date here. If every treatment center possessed these resources up in the hills where the dove sings every morning, the world would not be so telestial. But we are by design in a telestial world so the stay for patients at Cottonwood is, appropriately, temporary. Pretty soon every patient has to step back out into the unknown future and start that breaststroke, blindly, through the air, trying to find safety.

Maybe Romney Ain't So Bad...

A Presidential Candidate

I have pretty much made up my mind to run for President.
What the country wants is a candidate who cannot be injured
by investigation of his past history, so that the enemies of the
party will be unable to rake up anything against him that
nobody ever heard of before. If you know the worst about
a candidate, to begin with, every attempt to spring things
on him will be checkmated. Now I am going to enter the
field with an open record. I am going to own up in advance
to all the wickedness I have done, and if any Congressional
committee is disposed to prowl around my biography in the
hope of discovering any dark and deadly deed that I have
secreted, why—let it prowl.
In the first place, I admit that I treed a rheumatic grand­
father of mine in the winter of 1850. He was old and inexpert
in climbing trees, but with the heartless brutality that is char­acteristic
of me I ran him out the front door in his night­
of shirt at the point of a shotgun, and caused him to bowl up a
maple tree, where he remained all night, while I emptied shot
into his legs. I did this because he snored. I will do it again if I
ever have another grandfather. I am as inhuman now as I was
in 1850. I candidly acknowledge that I ran away at the battle
of Gettysburg. My friends have tried to smooth over this fact
by asserting that I did so for the purpose of imitating Wash­ington,
who went into the woods at Valley Forge for the
purpose of saying his prayers. It was a miserable subterfuge.
I struck out in a straight line for the Tropic of Cancer because
I was scared. I wanted my country saved, but I preferred to
have somebody else save it. I entertain that preference yet. If
the bubble reputation can be obtained only at the cannon’s
mouth, I am willing to go there for it, provided the cannon
is empty. If it is loaded my immortal and inflexible purpose
is to get over the fence and go home. My invariable practice
in war has been to bring out of every fight two­thirds more
men than when I went in. This seems to me to be Napoleonic
in its grandeur.
My financial views are of the most decided character, but
they are not likely, perhaps, to increase my popularity with
the advocates of inflation. I do not insist upon the special
supremacy of rag money or hard money. The great funda­
mental principle of my life is to take any kind I can get.
The rumor that I buried a dead aunt under my grapevine
was correct. The vine needed fertilizing, my aunt had to
be buried, and I dedicated her to this high purpose. Does
that unfit me for the Presidency? The Constitution of our
country does not say so. No other citizen was ever considered
unworthy of this office because he enriched his grapevines
with his dead relatives. Why should I be selected as the first
victim of an absurd prejudice?
I admit also that I am not a friend of the poor man. I regard
the poor man, in his present condition, as so much wasted
raw material. Cut up and properly canned, he might be
made useful to fatten the natives of the cannibal islands and
to improve our export trade with that region. I shall recom­
mend legislation upon the subject in my first message. My
campaign cry will be: “Desiccate the poor workingman; stuff
him into sausages.”
These are about the worst parts of my record. On them I
come before the country. If my country don’t want me, I will
go back again. But I recommend myself as a safe man—a man
who starts from the basis of total depravity and proposes to
be fiendish to the last.
Mark Twain
[1879]

NBA...Jane Eyre...Moms...Absolutes

Okay, if you enjoy the above as I do then sit back down on your chair to collect yourself and stop looking around for the nearest person to share this spectacle with. I love athletes who work from their core. Blake echoes Rafael Nadal on the court. He's not quite the consistent tiger Nadal is, but close. If you need some more bum-from-the-chair-raising highlights, google last weekend's Australian Open final highlights between the Tiger and Djokovic. Tennis has surpassed the glory of Sampras and Agassi.

But if you need to study, like I do tonight, I need to recommend the soundtrack to the recently released Jane Eyre movie adaptation. It is the right stuff.

For other thoughts, I had a lecture today about medicare reimbursement. For an emergency physician to stop a nosebleed he will apply and bill for a "nasal tampon." This minor procedure nets him $80. So if moms earned more than a nickel for every nosebleed they stopped, they for sure would be millionaires.

Also, I love absolutes, but sharing my thoughts tonight on two absolutes will have to wait until another post because it doesn't fit into the mood of tonight's words...

Life...is...good.