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“Nice guy” music

Recently various folk (Hi,

[info]immlass

  and drelmo!) were talking about the “nice guy” phenomenon – that is, the icky guy who is only being nice to you because he thinks you’ll put out…

And then today I was listening to random CDs today and hit a few songs from George Michael’s “Faith”… like “I want your sex”:

****

“I swear I won’t tease you, Won’t tell you no lies; I don’t need no bible, Just look in my eyes
I’ve waited so long baby, Now that we’re friends; Every man’s got his patience, And here’s where mine ends

I want your sex, I want you, I want your sex

It’s playing on my mind, It’s dancing on my soul, It’s taken so much time, So why don’t you just let me go
I’d really like to try, Oh i’d really love to know,
When you tell me you’re gonna regret it, Then i tell you that i love you but you still say no!

****
You know, when I was fifteen or so and this song came out, I didn’t find myself thinking “yeah, Georgie, since when is friendship with me supposed to have a guaranteed physical payback? And, er, no, you don’t have a right to have sex with me just because you tell me you love me!” Although I’m pretty sure I was clear on those concepts even then, but I don’t think I ever listened to the words that closely.

Or how about this little treasure?

****
It’s late, Time for bed;
So I sit, and wait For that gin and tonic To go to your head

I know It’s a devious plan
But it’s the only way that I know To get those big bad car keys Out of your hand

You know That I remain a gentle man
But even so There’s only so much A gentleman can stand
Sleep with me Oh sleep with me tonight
****

Then switched over to classic jazz. And was in a sufficiently cynical frame of mind to note:

****
Gimme a kiss to build a dream on
And my imagination
Will thrive upon that kiss
Sweetheart, I ask no more than this
A Kiss to build a dream on

Give me a kiss before you leave me
and my imagination
will feed my hungry heart
Leave me one thing before we part
A kiss to build a dream on

When I’m alone with my fancies
I’ll be with you
Weaving romances
Making believe they’re true

*****

Um… so, is the above (sung by the immortal Louis Armstrong, I believe) sweet, or just creepy? …. I’m leaning toward creepy and more than a little pathetic…

Enough.  Time to go to sleep.

My weekend: sundries

Friday I had another informational interview about a possible job that would have me working for the same company as

[info]nicoleallee

– the work sounded like fun and they sounded interested in continuing forward to another interview, so I’m cautiously hopeful. 

Last week K came home and said “The Saturn has the check brakes light lit and there’s this nasty burning smell that wasn’t there before.”  This would be the second time in a month it’s been in the shop; it’s been averaging every couple months in the shop all year, at a few hundred bucks every time.  So when he asked me if I thought it was safe to drive it to the shop or better to call a towtruck, I suggested that we carpool that day, he take a taxi to the airport the next (he had an overnight to Ann Arbor), and then we spend the weekend buying a new car.

So Friday after my interview I sat down with the phone and an internet connection; called several area Toyota dealers and said “By this time tomorrow my husband will be driving a new Prius.  What I want you to do is tell me what cars you have on the lot, what their feature packages are, and what is the rock-bottom price you’re willing to sell it to me for. When my husband gets home tonight, I’m going to give him this list from all the dealers in town, we’ll pick the best deal, and we’ll go buy it tonight or tomorrow morning.  If yours is the best price, it’ll be the easiest sale you ever made.  If it isn’t, well, you didn’t waste too much time on me, just giving me the list”.

Several salesguys refused to take me seriously, simply saying that if I wanted to see their selection or talk prices, I had to come in person to their dealership.  One gave me a list of available cars, but just listed the MSRP price – although I’d already told him I had a better deal than that on my list.  One gave me a halfway-decent offer but it was on a black car – which gets hot, here in Houston.

One of the sales guys said “You know, I’m not allowed to determine the pricing.  Let me talk to my manager and we’ll call you back.”  The callback was from the manager, who directed me to a web page that explained how much of the MSRP is profit to the dealer – and then he offered me a deal that basically handed me back 75% of that profit.  And threw in a couple extra things that cost him labor but not cash. 

So that’s who we bought the car from, Friday night.  Total time on phone – maybe an hour (spread out over a couple hours, with gaps between calls).  Total time in dealership, filling out paperwork – an hour or less.  End deal, pretty good I think. 

Then I ordered myself a new camera (Canon digital Elph – I like having a little camera around to take shots of the cats and I ought to return the one I’ve borrowed) which should be arriving tomorrow. 

Saturday I slept in, worked out, acquired insurance for K’s new car, then lazed around until evening, then went to have dinner with friends.  There was wine and italian food and cards and conversation and much, much laughter.  Made me very aware of how lucky I am to have such good friends.

Today I worked out, had brunch with a friend, did all my clinic paperwork for the week, went and bought silly toys for my cats (I’m slowly redecorating my entire home in cat furniture…), worked a little on a handicraft project, and caught up a bit on email.

Have finally figured out ideas for K for Christmas.  I’m gonna make him a wallet of classical CDs for his car – should be able to pack a lot on a CD since the car stereo will read MP3.  And if I can find a nice one I’ll replace his ratty old bathrobe.  Any suggestions where I should go for that?  He also needs long-sleeve, button-up shirts, preferably not stripes or plaid or blatantly Hawaiian.  Any suggestions there?

Still need to write a holiday letter and put up associated holiday website.  Let me know if you want a paper snailmail card or just the weblink – probably will be new-years cards at this point.  Still need to do my annual charitable contributions both for myself and for Xmas gifts for my family.  Still need to set up the annual donation to my brother’s student loans.  Still need to find actual tangible gifts for the nephews and nieces on both sides, and for a few of my good friends here in town.  Still need to… aagh. 

So yeah, it was a good weekend.  Hope everyone has a good week.

Mac question

Anyone have a newer desktop Mac?

I have a G5 desktop and overall find it to be quite satisfactory.  But, it’s an astonishingly noisy machine.  The fan runs loudly, and constantly.

I understand part of the issue was that the G5s were the last ones with the old mac chips, before they went over to intel (which I guess runs cooler?)  I may have a chance to replace my desktop machine in the not-so-distant future and am wondering whether a newer Mac would be quieter, or whether I should go for a PC.  I like the Mac OS but maybe not quite enough to justify the constant white noise bombardment.

On other fronts, who makes the best laptops these days?  Who sells PC laptops that DON’T have Vista?

So THERE!

Vindication feels nice.

Some time ago I saw a young woman patient who’d been feeling crappy for about a year.  She’d seen several docs but hadn’t managed to get a diagnosis.  She described an amazing array of diffuse, hard-to-characterize symptoms, and my initial concern was that I was going to have a hard time finding anything on this one, too.  The situation was worsened by the fact that she had some clear ideas about possible diagnoses, which was coloring her description of the problem to me.   So to get a clear viewpoint, I first had to look past her bias.

After some initial testing turned up nothing, I suggested that I needed to see information about her symptoms in much, much more detail.  I asked her to keep a diary of her symptoms, her diet, her sleep, and her activities for two weeks.  When I received the diary, I went over it with a fine-tooth comb and had a flash of inspiration – her symptoms had a fairly clear diurnal variation, with one set of problems in the morning and a different set in the afternoon/evening.  And, the afternoon/evening symptoms seemed to vary depending on her behavior that morning, in particular with how much salt she ate.

I concluded she may have an adrenal problem causing increased cortisol and mineralocorticoid activity.  Sent her for some initial testing and sure enough, her morning cortisol was about twice normal.  So I sent her off to the endocrinologist to see what was going on.

Well, he was really rude to her.  He laughed in her face, basically, and told her that her cortisol lab was high because she’s a hysterical little girl who got excited over the test.  He told her he’d order a backup test (24-hour urine cortisol) to “prove” that she doesn’t have this problem, and sent her home.  She was pretty upset. 

But today the urine cortisol came back and … guess what!  It’s nearly three times higher than the upper limit of normal.  Of course, his first line of action is to tell her something must’ve been wrong with the test, and ask her to repeat it…  but meanwhile he’s also ordered the additional tests (the ones my little lab can’t do) that will be needed assuming the original test is valid.  Which it will be.  She’ll get the diagnosis and get the appropriate workup and treatment to take care of the problem.

Why did he laugh at her?  Well, the symptoms caused by high cortisol are eventually very destructive on the body.  Someone with high cortisol will develop obesity, a hump of fat on their upper back, a widened, moon-shaped face, severe acne, and hair growth in inappropriate places on the body.  My patient has gained weight, seen increased acne, and feels like she’s seen some changes in the shape of her face, but these issues are all still very early – she hasn’t gained enough to be obese, hasn’t got enough acne to be disfigured, etc.  So she doesn’t “look” like she has the problem.

And I say, what’s wrong with believing a patient who knows her body is behaving differently, doing a diligent workup, and finding the problem before it leaves her permanently altered? 

So I’m feeling pleased that the patient will get the care she needs, smug that I identified the diagnosis on the basis of some very subtle clues – clues that several other doctors failed to see – and, well, rather guilty that I’m actively pursuing jobs other than medicine. 

Woo-Hoo!

OK, so I figure that we should look for the positive in everything… and celebrate the positives we find, so we don’t get all squashed down by the negatives.

So I just opened the envelope with results from a recent physical exam.  And I’m happy to report… I have awesome cholesterol.  Like, really great.  My total is fine, but the really cool thing is the breakdown of “good” and “bad” cholesterol, which puts me in the best possible risk category.  Last time I was checked I had pretty good cholesterol.  I think the difference has to do with exercising daily instead of occasionally…

I also don’t have TB, which is always useful.

That’s all, I’m done bragging now.

Musings on scientific progress

For some time now I’ve been overwhelmed by the insoluble problem that is healthcare.  There’s so much that we COULD do to optimize peoples’ health.  But many of the things we do now are long-term therapies, which are costly.  The US is one of the wealthiest nations in the world, we spend over 15% of our GNP on healthcare, and we’re still failing to provide care to a frightening proportion of our population.  It seems impossible to do everything for everyone without bankrupting the nation – and the cost of care is an even bigger issue for the rest of the world, that doesn’t have our financial strength.

The “healthcare crisis” is driven by this disconnect between what we want done, and what we can (or choose to) pay for it.  For the last several decades, the system has been weakened by efforts to make the current system deliver more for less money.  From the POV of a healhcare provider, expectations for what we should do have steadily increased, while real wages have dropped and working hours have expanded.  That’s just a little piece of the overall complexity that is healthcare – I sure wouldn’t want anyone quoting this as an exhaustive summary of the healthcare crisis – but it is a piece that threatens to destroy the entire industry as talented providers abandon the profession in droves.

The knowledge-leaders and politicos discuss what will solve this dilemma.  Universal healthcare?  Healthcare rationing based on complicated cost-effectiveness models?  I’m increasingly convinced that none of it will work.  Our only hope, I suspect, is that some amazing revolutionary breakthroughs lead to astounding changes in what we can do with peoples’ bodies.  Permanent cures for common and expensive chronic diseases, for example, would free up enormous sums of money for treating other people and other problems.

What’s got me thinking of all this?  Two of the biggest news topics of the day:

1.  The presidential election:  After listening to various candidates talk about how they’d “fix” healthcare, I’m convinced none of their plans will do much good.  When it comes to fixing the healthcare crisis, the most important platform item may be how much the new president is willing to restore to the healthcare research infrastructure, which has been gutted after 2 terms of W’s administration.

2.  Stem cells from skin:  News items like this one make me feel so excited and hopeful for the future.  Could this be *it*? Could this be the technique that changes the world we live in? Or will it just turn out to be another disappointment, a fraud or a flawed result or an intriguing but ultimately not-very-useful footnote in the path of medical progress?

Rant du jour: Animal hospitals

This morning, I am working in a coffee shop.  Next to me is a couple women talking, one far more than the other.  Talker-woman has many opinions.  Actually her husband seems to have many opinions, and talker-woman’s goal in life is to share them all with her friend.

One of the opinions is about animal hospitals – T-W’s hubby feels it’s “wrong” to provide high-level medical therapies to animals, when some humans aren’t getting adequate medical care.  In particular he objected to a nearby facility with top-of-the-line cancer treatment equipment for animals.

It would be rude to approach talker-woman and explain why her husband is wrong.  So, I’ll write it here instead…

First, I seriously question whether the presence or absence of pet hospitals has any influence on a human’s ability to get care.  There’s no equipment shortage: we can manufacture as many machines as we want. And I postulate that the money for pet care is coming from a different budget than the money for human health services.  That is, the money people spend on pets is their discretionary or entertainment budget; in the absence of pets they would be spending that money on movies or music or restaurants, not on public health projects.

Second, medical care in the human sphere has benefited enormously from the veterinary field.  There’s far fewer restrictions about what a vet can do, so many therapies are tried first in animals, and then adopted by the human community if they prove successful.  For example, years ago I had a cat who had invasive cancer.  He was treated at a local vet school, where they tried an approach that was entirely new at the time* – they implanted a set of radioactive pellets into and around the cancer, which would expose the tumor to round-the-clock radiation while the cat went about his normal activities. This approach eventually proved so successful in the veterinary practice that it became standard of care for several human cancers. 

Finally, the entire argument rests on an assumption that human beings are somehow more important – or more deserving of care – than cats.  Frankly, I don’t buy that premise – I’ve very fond of my cats, who treat me better than many humans do**.  I also hold (adult) humans more responsible for taking care of themselves.  I feel very conflicted about The Ant and the Grasshopper; who is the villain in the story and what is the true moral?  In at least one variant of the story, the ant toils while the grasshopper sings, and then in the end the grasshopper eats the ant… Does a pack-a-day smoker (average cost in our area $90 – $120/month) have a right to complain that his blood pressure medicine costs $70/month? Far simpler to spend my limited resources on the care of children and pets, who’ve got no opportunity to provide for themselves. 

Anyway, I restrained myself from telling talker-woman that she could fix the health-care crisis if she’d go get a job and donate her entire salary to HHH, instead of spending her days in coffeeshops drinking $4 coffees and distracting those of us who work for a living… and she’s gone now so crisis is averted…

Hope y’all are having a lovely Friday.

***

*Why were we willing to try this untried approach in treating the cat’s cancer?  Well, being in hospital for weeks to treat his cancer would be torture for him, and he wouldn’t comprehend why it was necessary.  His cancer was not yet affecting his quality of life, so putting him to sleep immediately wasn’t needed.  Implanting the pellets meant he had a chance for a cure without putting him through hell.  For a human in those days, I’d have suggested in-hospital treatment, which a more assured chance of success – because the human would understand what was going on.  For the cat, I thought the experimental therapy was the kinder, best all-round option even though the odds of success were unknown.

** The old saw about catching flies with vinegar vs honey is true, at least for me.  If you’re nice to me, I’ll go way out of my way for you. If you’re nasty to me, I’ll still go out of my way… to make sure you don’t get what you want. I’ve had the new cats less than a month and already they’ve noticably modified their behavior to keep my happier, in return for which I’ve given them lots of snuggles and treats and love.  I’ve got patients, on the other hand, who haven’t figured it out after years of experience. 

Cat report

The big cat seems to have a thing for paper.  On at least one occasion she came up and nipped a corner off the page of the book I was reading; piles of articles or mail have a way of getting thoroughly mauled; newspapers are thoroughly exciting events.  Just now she rather efficiently shredded the paper bag in which I collect paper for recycling.  I see I’ll need to start collecting recyling in a non-paper container…

I had a quilt over my lap with the end dragging the floor.  Felt a little tugging and came to realize the little cat had pulled it around and over her to make her own private little cave.  Only one ear is showing.

Problem is, the big cat hasn’t quite gotten past her tendency to assume a moving lump under a quilt (say, feet?) is something to be pounced upon.  So a short discussion ensued…

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