The Red Button

I don't post all that frequently (yes yes, durr, that's obvious), so perhaps as a result of that, I try to make 'em count when I do. My rant about arguing with the Billing department at my old job related to a guy we were about to release on a blood thinner (the practice didn't want to pay for INR checks, because the guy was behind on his bill) got linked by the AAPA's Twitter presence, for example, and I liked how my own subjective view of a larger problem got some small and fleeting light shone on it. Swear words and all, btw, so good for AAPA on that one especially.

I'm presently in the midst of a kerfuffle with a family member about childhood immunizations. And I feel kind of bad, because this person is a pretty amazing parent, all in all, and the young kids involved are great kids. Their shots are all up-to-date as far as I know, and I miss those kids like crazy whenever I don't see them for a while.

But tonight this family member said something on Facebook about "wondering if (they) could trust the pharmaceutical companies and doctors" and about "finding the other side of the coin," when it comes to measles. To be fair, I was the one who brought up measles, quoting some statistics about how deadly a disease it used to be, as a way of showing that the 90-some percent immunization rate we have now is, y'know, generally a very good thing.

That's when Family Member trotted out an unsubstantiated claim that there have been "a lot of" recent sudden-death reactions from shots, among babies and little kids. And that's when I sort of lost it.

I get little clinical updates in my email inbox all the time. From my employer, from SEMPA, and from the various clinical resources I subscribe to and use online all the time. If there were a rash of deaths, linked to anything, I'd be hearing about it. Plus, as I said in response over Facebook, if there really was a problem that seemed to be linked to a vaccine, those big bad Pharmaceutical Companies would be pissing themselves over potential lawsuits, and pulling vials off the market so fast there would be little vial-shaped Looney Tunes-style clouds of smoke whenever we opened a box of the product. If you call them weaselly and profit-motivated (which by the way I wouldn't argue against), then you have to accept all the consequences of that, and see them through logically.

Along those same lines, when Family Member said that there were supposedly more deaths per year from reactions than there are from measles, I laid a logical smackdown: the whole reason measles deaths are so damn rare nowadays is because of the immunizations. You can't compare the post-innoculation mortality numbers from measles to the number of hypothetical, unproven deaths from the injection, without also factoring in the number of deaths that would happen if there were not immunizations. Apples to apples, please.

And so, thinking about how to explain this to a layperson, a good parent, a concerned citizen, and an intelligent person who just isn't used to thinking about this problem as the public health issue it actually is, I came up with the following scenario. Try it sometime on your vaccine-averse friends and family, and see how you do:

Imagine you are standing in a room. In front of you, on a console, there are two buttons, one red and one blue.

If you press the red button, ten little kids will die.

If you press the blue button, one hundred thousand little kids will die.

Put it like this, it's horrible and it's sad and it should never happen, but the right thing to do is pretty damned clear, right? You press the red button. You press the crap out of it, then you press it again to be sure the blue button won't somehow get pressed by mistake. And that's, in a sense, sort of how public health questions are/ should be/ need to be approached. It's a way of thinking that, thankfully, most people don't really need to engage in; we get to enjoy the illusion that these sorts of choices are only hypothetical, and beyond the reach of modern science and public policy. For people who really do work in Public Health, I imagine this discussion is even more maddening than it is for me, a humble Urgent Care Bear.

But wait, excuse me, I left out one very important part:

If you press neither button, a timer will count down from 30 seconds to zero, and then the blue button will be pressed anyway.

This, I think, is a pretty decent analogy for what a lot of immunization-averse parents are doing. The timer has a much, much longer countdown, but the basic idea is the same. Parents who want the best for their kids, don't know whom to trust, and can't possibly have all the facts they really would like to have in order to be 100.00% sure will often simply retreat from the conundrum, throwing up their hands in frustration.

And as a result, they don't press the red button, while not exactly pressing the blue button either. Which helps explain why, as a result, herd immunity has been declining slightly but measurably, and some medical practices are actually starting to refuse to see kids whose parents refuse to immunize.

Tick tock, guys, you need to make a choice. And again, the better one, or at least the less-horrible one, is to press the red button. That's obvious to just about anyone.

Ahh, but if that's true, then what's the problem? How does Jenny McCarthy (who for me, by the way, is most famous for being naked in Playboy when I was in my early 20s) get so much traction with her anti-vaccination propaganda? Why does my otherwise kind-hearted, smart family member treat the sketchy, anecdotal evidence as if it were as legitimate and relevant as the actual data?

As a parent, I understand this one far better than I understand it as a medical practitioner, and as a practitioner I understand it pretty well. It involves a subtle but important change to the first part of the rules:

If you press the red button, ten little kids will die. One of them might be your kid.

If you press the blue button, one hundred thousand little kids will die.

I honestly don't know what I would do. I know logically that saving 9,990 kids is a good and noble thing, and something I'd be proud to do. I know I'd probably sacrifice my own life to do it, if I had to, and that it would be "a good death," as Crazy Horse, the Klingons, and Batman would say. That's what I'd consider heroic, under most circumstances.

But to take the beautiful, amazing little kid that makes my days so rich, the one that adds so much that's good to what I've contributed to the world (and easily makes up for all the stupid stuff I've ever said or done out of fear or ignorance), and potentially just snuff out all the incredible, wonderful life she has ahead of her? Fuck you, buddy, this just stopped being interesting.

And that, of course, is how the argument works. How dare you even think about causing my kid harm!, people say, choosing not to acknowledge that crossing the street or driving to the park is far more dangerous.

But that's parenthood. We're programmed by Nature to be fierce protectors of our offspring. This is why I don't look down on people who have doubts about immunization, and I don't think people are necessarily being stupid when they don't immunize. (Yes, they are being stupid, actually, but it's stupid in a way, and because of something, that I empathize with.) People are being selfish, is what it is, and I empathize with that as well.

It's to our credit, in a weird way, that in the world we have made over time, we haven't had to make these kinds of decisions. We've done okay, as a society, because we don't need to make Sophie's Choice on any sort of a regular basis. We don't routinely give birth to four kids but only get to raise two of them past the age of 3 years old, anymore. We don't tend to die in childbirth all that often. We don't have any real first-hand experience, anymore, with polio or smallpox. So it's understandable that we're so very bad at thinking this way.

But all it would take is a couple of generations beyond the present argument, and I suspect we'd regain the kind of clarity we would need. I really hope it doesn't come to that. And in the meantime, as I've said in the past, if your kid isn't immunized, that's a shame, because now my kid can't play with yours, and you aren't welcome in my house. If we're going to decide as a society not to slide backward, I figure it has to start somewhere.

I am pushing the red button.

Hi.

There may be a few new visitors thanks to my essay over at Life With Levi, about co-sleeping with the toddler. So this is as good a time as any to re-introduce myself and the blog, and maybe explain why it gets updated so infrequently.

For several years, this was a story about an Arts-educated guy, finally admitting that while not going to med school as a 22-year-old douche was probably the right decision, it was nonetheless time to buckle down and get serious about joining the profession as a 30-something guy. Then, it was a story about the long and sometimes painful process of doing just that. In the last few years, with graduation and employment, it was a much-less-updated story about moving into the world of practice as a PA. The first job out of school was... not awesome. And it seems like more and more ER and other med-bloggers are closing down their blogs all the time. It's an odd situation for people who want to share ideas and observations, since so much tension still exists about HIPAA and whether it's possible to even be a medical person and a blogger (I think it certainly is, and there are steps you take that are not so difficult really, but even people who are cautious find themselves in more trouble than it's worth).

So at the moment, it's a very slow and gradual story, about how to put it all together. I'm a second-career medical practitioner, a stay-at-home dad, I still have that liberal arts point of view, and it's always nice to see new people around here. How are ya?

Fun facts

It's been... A while.

I couldn't talk much about my previous job because for a while there, I was just so darn new at it. Then, I couldn't talk about it because I hated it. Fnally, I couldn't talk about it because I signed a document saying I wouldn't say anything bad about them for a year.

Year's up - well, more than that, really - and honestly, meh. It was not a good situation, but everybody's had that feeling they're in the wrong place and should maybe be thinking about leaving. I was actually pretty lucky, because I suspect someone there must have realized, oh crap, we hired this guy and it's not what we advertised, and he's stubborn enough to sufer through it.

So I'm not mad. I'm not even frustrated anymore (which may have been the point of the one-year noncompete and nondisclosure, naturally). They gave me a big check in exchange for being cool about things, and I spent half a year doing nothing but taking care of my kid. Most people I know would be all over that, and indeed I am.

My new job, I can't talk much about because the group has a very intelligent policy about social media. But as I understand it, I am free to just make up unrelated and random crap as much as I want. I will maintain the same paranoia about patient info I've always had, and assume that of the twelve people who ever see anything I write here, two are related to the person I'm talking about. I'm also starting to think that every patient in every story from now on should be one of the characters from Yo Gabba Gabba, but that could just be where my head's at these days.

Working part-time iiiiiiis awesooooooommme!

More in the next little while.

Yes. Like that.

Mark Evanier is a writer, one I've been vaguely aware of for a very long time, but couldn't have told you what the heck he wrote. I assumed he did a year of Marvel's Fantastic Four, or maybe one of those horrible early-90s X-books where everyone had too many cargo pockets on their spandex suits. It turns out he actually was a TV guy as well as a comics guy; he story-edited "Welcome Back Kotter," scripted a bunch of Sid and Marty Krofft shows, and his biggest and most famous comic writing is for Groo the Wanderer, a book I have never ever read.

Anyhow, dude's got a blog, and he explains here how he approaches writers' block. It's a good read. It resonates with me because I am right the hell THERE with Dorothy Parker, who famously said she loved "having written," but wasn't keen on the actual work of, y'know, writing.

Evanier is not especially sympathetic to that point of view, but that's cool. He's right. Totally right. And he has made a perfectly cool career doing something he loves and is good at, for 41 years and counting.

On the other hand, while I have written a fair amount of crap, most of it stayed in the drawer, and nobody will associate me with the MacLean Stevenson Show or Pink Lady and Jeff. I feel pretty okay saying that the small amount of creative output I've released into the wild is better than some - just some, mind you - of the stuff Evanier got paid pretty decent money to do.

What I can't decide is how to feel about that.

Fear not

Posts about "I'm really sorry I haven't posted" are lame. Someday, looking back, it will be a blip for you, too, thinking about the first half of 2010.

But I do intend to get around to some medical stuff in the near future. Maybe when the baby's napping, I can make a point to come by and tell some stories.

For the few who actually follow this thing, please know that I appreciate you, and still think I have a story here worth jotting down, for whomever winds up following a similar Viking-ish path later on.

Hey wait

Two broken computers, one new baby, no posts for a while.

But wait! There's more!

It's all turning around now. My TouchBook is back up, after a fun excursion into OS upgrading, and I have a new laptop coming in a week or two.

So hang in there. I'll talk about my job and stuff.

Hi, everyone, what's up?

This comment came in earlier:

Feb needs to get to blogging...November 2 was a long time ago. I thought there was some resolution to keep this thing more updated???

Hey, that was a 2009 resolution, as I remember. (Or maybe a 2008.) Anyway, I have a good excuse:


I need to come up with a good Web nickname for this little peanut. She arrived on Christmas Day. (Yes, it's true the blog was already getting moldy at that point, but give a sleep-deprived new dad a break, eh?)

Work continues to be a nice hike up the learning curve. All that stuff I thought to myself, whoa, that's complicated. I can memorize some bullet points, but I'm going to need to work with this concept a few times before it really makes sense to me... well, I'm working with it. And much of it is sinking in pretty well.

The one thing I can say for sure about hospital medicine: we treat sick people. Back in the ER, the big challenge is one of volume: you have all these folks in the waiting room, and you need to find and treat the sick ones, while being nice enough to the not-sick ones that things run smoothly. It's a challenge to send somebody home, not knowing for sure, really, that nothing too terribly bad is going to happen. And it's a different kind of challenge to see a parade of people who honestly are not in dire need of medical attention after all - partly because that experience can confuse the issue and get in the way of helping those who really are in dire need.

On the other hand, it's been very interesting for me, picking things up at the step AFTER I'd become sort of accustomed to handing off the patient. "Hey, this guy's actually sick. We should admit him." Okay, well, much as I realized after EMT training that "somebody should call 911" had become "holy crap, now I am 911, kind of," now I'm one of those people to whom the ED admits patients. And in fact that's the bulk of my job -- admitting new patients.

I can talk more about the nuts and bolts of that later, if people care to hear it. Meantime, I just wrapped up Uncharted 2 with the baby asleep in my arms for the last couple of hours of the game. She's fitting into the household well so far.

Feb gets political!

So, how long did I get to do my job practicing hospital medicine before I had to argue with someone about finances?

Nine days. And what's weird was, I wasn't fighting with the party I assumed I would be.

We discharged a guy from the hospital last week, and because he'd had an unexpected event happen (I'm being intentionally vague about the specifics, but it's in that category of "maybe you can predict who's at higher risk, but you never know for sure if or when it'll get you"), he had to be discharged on a medication that was new for him. It greatly lowers the chances of future badness, but the med itself isn't exactly a glass of warm milk. You need to watch people carefully at first, test some blood, make sure the level is right. If it's wrong, things can go very bad indeed. This requires careful follow-up with the primary provider.

So I'm calling Scheduling to make sure this guy can a) get the appropriate blood test in a few days, and b) get in to see his regular doctor pretty soon. The scheduler says, "huh, that's odd" and "I'm sorry, but I'll have to have you speak with so-and-so." Then I find myself on the phone with someone who says the patient can't be allowed to schedule these future appointments, because he owes our practice group over $2000. I'm speaking not to some insurance company, but to our collections person.

Turns out, the guy had tried to schedule an appointment a few weeks back, and was told he couldn't, unless he paid some portion of his outstanding bill. Again trying to be as polite as I could, I wondered out loud if maybe this unexpected nasty thing that caused him to be hospitalized for three days maybe could have been avoided if he'd, oh, maybe seen his doctor a few weeks ago. The collections person was not impressed. Fair enough.

But this person's heart was not made of stone, and when I mentioned that the patient, sent out into the world blindly with no assistance beyond me wishing real hard for their med level to be correct, could potentially die, they did relent, and allow for one visit, for both the blood test and the primary care check-in. But no more!

From now on, when I discuss how messed up health care is in our country, I will tell this story. It's personal, it makes me crazy, and I can see several sides of it, all of which are totally and utterly, for lack of a better word, fucked. In my mind, it all boils down to a few key things:

1) Sure, this dude smoked, drank, and ate cheeseburgers; in short, acted like most Americans do. Sure, if he'd been jogging, avoiding high fructose corn syrup, cigarettes, and other vices; if he'd been eating bran muffins and celery sticks instead, he'd be better off now. But we play the hands we're dealt, and the guy in front of me is this guy, with this history. I have to treat him, not the version of him I would prefer to see.

2) According to what I could tell, he has insurance. I know a former Blue Cross claims agent who pointed out that lots of people have "80/20" plans, where the insurance only covers 80% of anything. That fits with the amount between $2000 and $3000. And of course, that bill is about to go up, from this recent hospitalization.

3) We're a private clinic group, so my own salary quite literally depends on the collections person doing their job, and doing it well. This person is, and I have no ilusions about this, on my side. God knows how many situations like this I'll encounter in my first year. If, hypothetically, my bleeding heart insisted on enough people in this situation being given care anyway, and if enough of them were unable to pay, then eventually we'd collapse and be able to help nobody at all.

4) And yet, when it all comes right down to it, I am not willing or prepared to say "screw this guy." I won't let him go out and die, or (worse for the system) get sicker and rack up more costs, just because he can't get in to see somebody. There are free clinics, but not enough, and anyway he earns too much at his job to qualify. There are a handful of sliding-scale clinics, but they have a waiting list that's months long, and he needs to be seen in a week. The walk-in urgent care centers don't do the ongoing primary care stuff, and the ER can do any test you want but it's ten times the cost so that's no solution.

And while it makes good sense in several different ways for my respected colleague the collections manager to aggressively defend the solvency of our business, how much would we have to pay his family in the event something bad happened and someone made a convincing argument that we could have done something to prevent it? (Ahh, but you can't reliably measure potential costs, and health care is all about potential expenses vs potential savings. Ask anyone who works in primary care why they don't make more money, and that's essentially the answer.)

So, for me, that's what the debate about a public option boils down to: somebody has to be willing to look that guy in the eyes and say "no." No, you can't get treated. No, you don't deserve a slice of these limited, expensive resources. No, the situation you are in, when stacked up against the situation others are in, and compared to what we have to work with, does not warrant you having this test, this visit, this intervention. And by the way, no, there is no reliable, consistent safety net we can allow you to fall into, so that at least there is a minimum standard you can count on. Have a nice day.

Because here's the thing: we say no to people all the time. We ration health care in the United States. We just like to pretend that we don't. And it doesn't go to the sickest first. In my opinion, getting anywhere near that truth freaks people out.

Well, the next person I encounter who doesn't believe in reform, or thinks a public option is Communist, is going to hear this story. And then I'm going to tell them I'm not willing to be that person who says "no, there's nothing, now get out." And then I'm going to ask point-blank if they would be willing.

My entire life, in 2970 characters (with spaces)

When I was writing my CASPA essay, the challenge was to shorten it enough to meet the requirements, but include enough detail that the elephant in the room -- how come you're applying to grad school at the age of 35? -- was sufficiently addressed. In a way, that made me one of the lucky ones, because the biggest problem PA school applicants have is identifying the specific goal of their own essay.

I know this because I've had the opportunity to assist a few newbies with their essays. There seem to be two major traps people can fall into: either they overestimate the uniqueness of their situation, or they completely fail to recognize it. For example, "I experienced how the serious illness of a loved one affected me and my family" is certainly a story worth telling, but in that stack of PA school applications, perhaps as many as 1/4 or 1/3 of them will tell a story along those lines. Likewise, a kid who barely graduated high school but buckled down and aced an accelerated EMT course because he was so intent on being part of the ski patrol will, not realizing that's a powerful story in its own right, focus instead on his time volunteering at the front desk of a clinic.

While it was stressful and challenging, I also had a pretty good time getting my essay together. I had just finished the post-bacc in Vermont, after leaving the stability of my previous career, and the essay was a good opportunity to tie it all together. I got (and actually used) some feedback from my good friend Jeff, whom I've known since we were both 13. He's the professional writer; I'm just a dude who knows a couple of things, including who to ask for help.

Here is what I put together. It was part of a package that got me interviews at every school I applied to.

I am not by nature a spiritual person, yet I understand what people mean when they say they have been 'called.' My parents gave me a sharp curiosity and respect for intellect, but at the same time my family prizes 'street smarts' over intelligence. I went to work after high school, finishing my BA degree ten years later. It would be another five years before I would discover my calling and return to school to pursue medicine. Like many future PA's, I have been a 'non-traditional' student my entire academic life.

In the years I worked in offices, I helped people buy houses, and gain access to higher education. I worked to become a trustworthy, effective advocate and a solid part of every team I was on, including those I led. Ultimately, although I was on a comfortable path, I came to the decision that the rest of my working days should be spent doing something I not only appreciated in an abstract way, but truly respected, and furthermore which uses my talents. Exploring those ideas led me to the county hospital.

Volunteering at the (Name of Hospital) Emergency Department revealed that medicine was that kind of work. Soon, I was certified as an EMT, and hired part-time as a clinical assistant in that same ED. That's when I learned medicine is something I could do well, and love doing for the next 25 years. My calling wasn't a dramatic or a transcendent moment; it was simply recognition of something that made sense.

There were days when I'd finish a workday at the office, walk to the hospital, and work another eight hours. Usually, I felt less tired after taking care of patients than I had been earlier, after eight hours at a desk. Once, during the day, I referred to customers as 'patients.' Clearly, my mindset was changing. Meanwhile, the staff of the ED, particularly the PA's, not only answered questions but encouraged me to take steps toward joining them.

I know now that medicine is an excellent arena for the skills I developed in college, and at work in my previous fields. I am a natural problem-solver and detective, recognizing and connecting the most important pieces of an emerging puzzle. I'm a communicator with a knack for explaining complex issues in simple ways, as well as asking the right questions. I thrive in conditions that are fluid, even chaotic. I have the passion of an idealist, and the work ethic of a realist. And of course, having spent more than two years working in a busy ED, I am aware of the day-to-day realities of patient care.

It's this last point that drew me to the PA route specifically. I have varied interests, including research, teaching, and medical writing. The focus of my practice will always be my patients, but I am drawn to the PA paradigm, where the expression of that focus is allowed, even encouraged, to evolve over time. When I consider what I would like to do, and the way I would like to do it, PA is closer to a perfect fit than most people ever find. I'm grateful to have made these discoveries, and excited about what's next.

I'm not saying this is a perfect essay, but it accomplishes several goals, and it hangs together in a way that is crucial to making this part of the application more than background noise. I may have mentioned it the other day, but it's my opinion that a bad essay can work against you even more than a good essay can work for you. Once interview day rolls around, of course, the essay matters much less (although interestingly enough a good essay can stack the deck in your favor during that moment when you're about to walk into the room and the interviewer is reminding him- or herself about who you are).

Today is PA Day, and the beginning of PA Week. Best of luck to everyone working on a CASPA application, and to all those out there in the trenches. I'll be joining you very soon.

Getting Personal

Next week is PA Week. I won't actually be at work October 6th through 12th, but I'm showing my spirit. As a touch of advocacy, a little public awareness, and also to give back to the pre-PA n00bs (whose ranks I only just left), I'm doing a little somethin-somethin I said I'd do, oh, over three years ago.

Some background: there's a discussion out on Teh Boardz about personal statements. This is the time of year when the not-really-very-early birds are submitting to CASPA. Long-time readers will remember when I was stressing about distilling my whole life down to 2970 characters, with spaces. A cursory search seems to show that it's now 500 words, so ha! to the new ones; mine was 518. I guess I just like small words.

Anyway, I contributed to a recent PA Forum discussion with some advice, and thought it fits the overall theme here. Especially if I finally post my own long-ago essay, like I once said I would. That seems like the kind of thing I can easily tease out into a few posts.

First, here's the wisdom I dropped on today's youth:

I believe that good personal statements won't tip the balance and turn a mediocre application into an interview, but bad ones can help admissions people weed out apps that are on the fence. Mine was awesome, but only because it told the story of who I was and how I came to be an applicant. That's really the goal, no more, no less. And it's amazing how many people mess it up.

On the other hand, get 1400 on the GRE and all the essay has to do is be written in English, and make some manner of sense.

(I then gave some specific advice about the essay which started off the thread, and brought it back around to the generalities.)

...I know what you're saying, but (and this advice is for everyone) you need to write for someone who has been looking at essays non-stop for two hours. Give that person a break, and stop trying to impress them. For this essay, you show facility by creating clarity. To quote Metallica, Nothing Else Matters.

Yeah, I brought Metallica into it. I'm insouciant online. That's a GRE word.

THIS WEEK: My essay, and the various forms of butt kicked by it

Progress.

Hey, what's up?

Me? Not much. I'm most of the way through Batman: Arkham Asylum. I'm in 1968 in Beatles: Rock Band, and kind of conflicted about playing more because I know what happens at the end. We've been to some weddings. The wife is six months pregnant. And I get to start my job in a little more than a week.

Yes, the long and grueling credentialing process has moved enough that it's safe to send me to orientation soon. And since I'll be spending a week at the Mayo for a conference, there's even some cushion. The upshot is, the slothful unpaid vacation will be coming to a close.

Medical training vs common sense

I'm a patient again. Much like what happened sometime in 2007, a random tiny scratch to the surface of my skin blew up into a cellulitis over my right jaw and temple that has me looking half as round-headed as Charlie Brown. I had a perfectly normal yearly checkup on Friday, and by Sunday night was febrile and wracked with chills.

Being relatively smart, I went to Urgent Care Sunday afternoon, so I was already downing antibiotics, and I was sure that this infection was unrelated to a minor surgical thing I had done to my right cheek earlier in the day on Friday. Nonetheless, I thought it courteous to let the Derm Surgery people know I was blowing up, and taking antibiotics. Naturally enough, they wanted to see me again today.

It was a silly visit, all in all, but I kept reflecting that if I were the provider rather than the patient, I'd want that patient to come in. The surgeon nodded, listened, looked, and agreed that I was doing all I could, or should. Then I mentioned that maybe I'd start warm compresses a few times a day, just to help the lymphatics drain. And he said something I think is incidentally hilarious:

"Well, that's just symptomatic relief."

I mean, we just got done talking about my regimen of two antibiotics. It's not like I gave any indication that a hot washrag is my idea of a cure. Also, he knows I'm a PA.

So I said "well, yeah," when inwardly what I meant was "no shit, it's just that my awareness that there are bacteria isn't what's making my face hurt, and while I wait for them to die I'd like to control the symptoms." Symptoms are by definition those things that are bugging the patient. Relieving them seems like it might be worthwhile.

I know what he meant -- controlling symptoms is not the same thing as treating a condition, and things that make you feel better don't necessarily make you better. But it's clearly such a reflexive thing for this guy to say, and he must have said it so many times, it just struck me as funny.

We're funnier when we're not trying

Actual exchange between my wife and me, early in the AM when we both had been asleep...

Teslagrl: Hey. Hey, wake up.

Feb: Huh?

T: You were making weird noises.

F: Oh. Sorry...

T: Goodnight.

F: ...I was dreaming about watching The Disney Channel.

T: Well, you were making noises.

F: Were they noises that sounded like Nick Jonas?

T: If Nick Jonas had a seizure, maybe.

The Coolest %@$#ing Thing I Have Ever Seen (on YouTube)

Imagine you're a 15-year-old kid from Santa Cruz. Now imagine you're a Green Day fan (not so tough for me, as I love me some Green Day). Imagine also that like a lot of 15-year-olds, you spend some time in the basement or garage with your guitar.

Okay, now imagine that you're pretty good. So good, in fact, that when you go to the concert at the hockey arena, you don't feel you're bragging when you hold up a sign saying "I CAN PLAY JESUS OF SUBURBIA" (which, for the uninitiated, is a lengthy song-suite from a kickass album, kind of like the kind the Who used to make).

Now's the fun part: because this is Green Day, and because they're awesome, there's this thing that sometimes happens at their shows...

RP episode 7: "Crazy Love" (Crazy, weird, radioactive, vaguely insulting love)

I'm trying something a little different for this episode. I'm still behind by four, and in the interests of speeding things up, plus making watching the show less of a task, I've adopted a format designed to keep it snappy while still touching on the most important points. It's less of a book this way, although even worse for people who might not have given the show their full attention. This week, "Boris has a shark in his basement." He also (SPOILER!) totally has cancer, or something.

The "A" Plot in one paragraph:

Jill's friend Katie (who got a call from Boris as soon as the shark arrived, remember?) is in town, for discussions about a research project which would be funded by Boris. She reveals that Jill, being a Hamptons native, has a string of summer-only flings. She also counsels Jill to be cut-throat and kind of evil about Hank... or does she?

The "B" Plot in one paragraph:

Divya's fiancee Raj is introduced; he's a floppy-haired hotelier, a nice enough guy, and I'm getting a serious "just friends" vibe off Divya. Faced with the hot-blooded, overwhelming "Lambada: the Forbidden Dance"-ness of this week's PDBs, Divya wonders what kind of relationship she's about to become locked into. This thread ends on a nicely unresolved note; is she craving a more passionate, less Old Country relationship with Raj, and frustrated because of how close it is? Or by how far away? In other words, when she kissed him with such passion, was it a test... and did they pass? He must be a good bloke, right? Who takes a freakin' bus to and from the Hamptons?

The "C" Plot in one paragraph:

Crazy, rich, Latin lover stereotypes have weird problems. Say what you want about American health care, but when we agree to secretly insert a GPS tracking device into somebody's breast implants without their knowledge or consent, we don't use plutonium-powered ones. Divya is really snotty about these particular PDBs, and ambivalent about her fiancee as a result of hanging around them. Evan hounds them for payment, and uncovers the truth; he's just as stupid about investing as she is stupid about him, so these DBs are less P than most.

PDBs of the Week:

Italian/ Argentinian/ Generic Exotic People Sofia and Javier; I had been hoping they would not in fact be redeemed by the end, and remain DBs. I was, for the most part, not disappointed. Credit is due to the writers for letting their characters remain horrible people throughout the entire episode, without much comment.

Obnoxius product placement moment:

"Wow, that's a good martini! When you showed me the bottle and declaimed the name of the brand, it made it more special."

Medical Moments:

* Opening on a stress test for Boris. Dude's treadmill is out on the patio. Nice. So, when's his colonoscopy? Sweeps?

- Roadside, after a Vespa goes off the road, Hank stil irrigates with nowhere near enough fluid.

- "I was going to cal 911, but then Divya told me about you..." say what, now? Didn't you get here thanks to a giant lawsuit arising from somebody thinking you were a dumbass who was doing too much?

* At Boris', Hank could be using enough irrigation for once, since the scene fades in on him using a 40ml syringe... but that pool table is wrecked if he's using the proper amount, with no towels down.

* When did they do a CT scan? I mean, cool. They did a CT scan. Okey-doke.

- The jewelry shouldn't even be in the same room as the MRI; never mind if it's powered on or not. It's still an enormous magnet. Physics fail. Oh, and same deal with the, uh, foreign object.

Divyaliciousness:

This episode sees Divya using the performance of medical duties as an excuse to postpone dealing with Raj, and the thorny nature of her personal life. This is something that plenty of real-life medical people might do, but so far it's not something we've seen on this show. So there's nothing to gague it against. I think here, it makes her look emotionally immature, rather than conflicted; and unprofessional, rather than distracted.

What's My Problem This Week:

Even before watching, I was thinking about the issues I've raised so far, and it sounds like actor Mark Feuerstein has been wondering something along the same lines. (It's a good interview at that link; read the whole thing. I'm referring to the very last question and answer.) In a nutshell, my issue is that Hank is such a nice guy, and everybody loves Hank. Always. Anybody who doesn't love Hank is either shown to be wrong and given the chance to change their opinion, or is a bad guy. But Hank, meanwhile, hasn't come to be in this situation because he's awesome; he's in this situation because things in Manhattan got utterly bollixed up. But since coming to the Hamptons, he's been nothing but wonderful.

As last episode showed, it's not like Hank is always even right; it's just that the show, centering as it does on him, is charitable to a fault about Hank's missteps. And a show about a perfect character is boring.

So it's nice to see a little erosion of his calm; what if Jill is only into him as an MSG? Then again, by the patented end-of-show tender moment, he's such a stand-up guy about not knowing his plans for Labor Day and beyond... he basically does the heavy lifting for Jill, allowing her to dump him with a minimum of fuss. "Gee, I'm sorry breaking up with me is so trying for you. Perhaps if I made some cocoa?"

Best line: "right now, I feel like I'm living on a Bond villain's property..."