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!