Happy 100 to Me!

This is post 100. I toyed with retrospectives, lists, and major announcements, but it was taking too long. Instead,as brevity is the soul of wit, I've decided to keep this to 100 words. Thanks to all of my readers -- I mostly write for me, but it's nice to know you're out there. Thanks to those I've met blogging: you've proven to the skeptics that you can have a "community" on-line, though I wish we could meet in person more often. Stay tuned, I'm working on some new stuff. I hope you'll be with me for the next 100 posts.

OK, People...Calm the F*** Down

As I mentioned, I am on back-up call this week. That means I need to be nearby and sober. So I've been getting up early and getting things done around the house. To pass the time, I've been listening to news and talk radio (and catching up on the Dan and Jimmi show). I want to make a few comments about the recent events that seem to have both sides of the aisle in a tizzy.

VA Tech
In case you haven't been following the Iraq war, suicide bombing works. If someone wants to kill someone else, and is willing to trade their life to do it, it is damn hard to stop them. Especially if you want to maintain some semblance of a free society. So:
1) There is no proof, nor will there ever be, that stricter gun laws could have stopped THIS tragedy.
2) There is also no proof (Mr. Limbaugh) that less restrictive gun laws would have resulted in a student having a gun and shooting the killer, thus saving lives. Nor would a less politically correct culture have stopped it.
From a medical perspective, I consider it akin to treating high blood pressure. I will never be able to prove to you that taking medicines will keep YOU from having a stroke or heart attack. But I can prove that, in a large population over time, those who take medicines have fewer of both. Similarly, I think the overall data sugget that gun control is a wise way to decrease the number of people who die in violent shootings. So I'm for it, even though I doubt it would have prevented this one. As data come out, it appears a better mental health care system wouldn't hurt, either.

"Partial Birth Abortion"
This is not the end of the world, nor is it the end of "a woman's right to choose" -- a phrase even I think we should chuck. There is no right to choose -- there is a right to privacy that has been interpreted into the Constitution.
First, the Court just said that the law, as written, is not unconstitutional. Justice Kennedy clearly left open the possibility that a challenge to its application would be considered. Honestly, I'll be shocked if it gets that far. The defendant will either be a Doctor who did what s/he thought was best for the patient, or a mother who just had an abortion. I don't see a jury convicting either in this country.
Second, I'm not sure it so terrible for us to be in an officially vague middle ground. The judicial branch is designed to protect minorities and the weak. Roe v. Wade defends the rights of the woman. Since I don't know when ensoulment/individuality occurs, I err on the side of the woman. But I'm also willing to consider the possibility that a potentially viable fetus should be given a chance, and might deserve the protection of the courts as well. If people would stop screaming and start talking, we might be able to get to a place where abortion is, as President Clinton hoped, "legal and rare".
And, third, we could put the money the "Prolifers" and "Pro-choicers" use browbeating each other into the adoption and foster care systems, giving the children a real chance.

BTW - I realize the above ruins any chance I had of running for office as a Democrat. So I'll just have to settle for running Phillip's campaign someday.

Mr. Gonzales
You've seen my prediction on this.
To the Democrats -- this was not an assault on freedom. The President had the authority to fire these folks, and he did so. He just didn't want it to appear political, which it was. So he covered it up, and got caught. Get rid of Gonazles, and let it go.
To the Republicans -- Join the angry mob. I think Sen. Coburn calling for Gonzales' head says it all. From the clips I've seen of his testmony, I'm embarrassed to have him as attorney general. He looked clueless.
Mr. President -- make it go away.

What did scare the hell out of me yesterday was the shooting at the hospital in Tijuana. I was actually thinking about this possibility as I drove home Monday listening to the news about VA Tech. To have it happen so soon was startling.

I don't worry much about terrorists specifically targeting a hospital -- I don't think they'll engender much sympathy specifically targeting the weak, the sick, and the people trying to help them. I say "specifically targeting" because these groups are obviously a large portion of civilian "collateral damage".

But we do treat many victims of attempted murder and domestic violence. Clearly, someone out there would prefer I not succeed in my healing endeavors. While the Emergency Room of a county hospital often has police milling around, the ward floors and community hospitals rarely do. And entrance is wide open, without a metal detector in site. Lest you think nothing bad would happen in a hospital, most have a "Code Pink" protocol. Unlike the familiar "Code Blue", in which we charge in with ventilators and defibrillators, the "Code Pink" requires we try to crash the hospital until we find the person who STOLE A BABY. If people would come in to steal a child, it's not much of a stretch to think they might shoot the mother and her doctor. Especially if they were mentally unstable or on drugs. Not that THAT ever happens.

Sleep well. I may not.

Vacation

I finished a two week run at the UCSD hospital in La Jolla on April 8. I'm sure I'll get around to venting about it, but let's just say I was glad to have some vacation plans for the following (now past) week. They turned out great, even before they started.

I met someone on Sunday night, and we had a good time. He left Monday morning, in time for me to make my flight. My old roommate and a good friend who lives in LA picked me up at Midway airpot and took me to "Nookies" for dinner. Mmmm...Chicago steak sandwich and onion rings.

Then we did what is for the moment my favorite thing in the world -- Musical Monday at SideTrack. If you haven't been, they play clips from musicals, movies, and shows all night long on all their screens. The whole bar pretty much sings along. Julie Andrews, Madonna, The Rocky Horror Picture Show, The Best Little Whore House in Texas, West Side Story, Little Shop of Horrors -- you name it. We requested something from The Little Mermaid near the end of the night, and they played "Poor Unfortunate Souls". It got the whole bar going again, so we, of course, felt like the bomb. Except my striaght ex-roommate, who didn't know many of the songs -- but he plans to study up by watching muscials with his girlfriend. Which should have the added benefit of making him seem more sensitive/romantic and getting him more/better sex.

Tuesday, we sat in the bleachers at Wrigley Field for the Cubs/Astros games, which was really the point of the whole trip. The blistering cold was missing (it was mostly sunny, not very windy, and comfortable in a light jacket) but we got the rest of the experience. High-fives with other fans, lots of beer, a dog, and a pretzel. Yelling at the ump. Yelling at the Astros. Yelling at each other -- I'm not kidding. If things were calm for more than 5 minutes, someone on our side (left field) would start yelling "Right field sucks". They yelled back. It was hysterical, especially given that the seats aren't assigned.

The only bad part was the homophobic slurs flying. As we picked up souvenir cups at the end of the game, someone said, "Hey, you're not going to throw those out on the field are you?"

"No," I said. "My friend wants to take some back to her friends in LA".

"Good", he said. "I'm glad you're not one of those queers who throws cups on the field."

I considered saying, "No, I'm just the kind of queer who sleeps with men." But, I thought better of it. My friend from LA points out that, for the most part, it's something they say without meaning anything specific about homosexuals. By and large, I think she's right -- but I still don't like it. And I'm not thrilled I didn't say something, but I haven't really faced that stuff much since I've been out. So, I tried to distract myself from gay issues by thinking about what Cubs jersey I should get. The answer was obvious:


I also picked up a nickname. Someone was waving the above poster. I dared my friend to go meet the guy, which she did. Apparently, he thinks #12 (Alfonso Soriano) is smooth but fierce, so he was trying to get the name to stick. We decided it would never stick for Soriano, but it was too good a name to let go. So I got it.




Wednesday, we were supposed to go to another Cubs game, but it got snowed out. Yes, snowed out -- in April in Chicago (hadn't happened since 1995). During Musical Monday, they played a bunch of numbers from "Wicked", and we had talked about seeing it. So we called the theatre and were told that there were 12 tickets left for the matinee, but they couldn't sell them over the phone. By the time we trucked down there, there were three left. Unbelievably, they were together, so we sprung for them at $85 bucks a pop. It seemed steep, until they turned out to be 8 rows behind the orchestra in the middle section -- by far the best theatre seats I've ever had.

The show was amazing -- funny, great plot/commentary, well-acted, and with good music sung incredibly well. If you get the chance, go. If not, get the soundtrack.


After the show, we strolled downtown. Our first stop was in the Chicago Cultural Center, which has stairways done with beautiful mosaics, as seen above. My friends felt they were almost as gorgeous as her ass. Then we walked over to Milleunium Park. It was beautiful, even in the snow. This is our "tourist" picture, using our cameras in the reflective "Bean".

I flew back on Thursday, just in time to have dinner at Ruth's Chris. Steak drown in butter. Hard to beat.

Friday I got my haircut, primped, and headed off to Phoenix for a softball tournament. I had dinner with some of my teammates Friday night and played softball in PERFECT weather all day Saturday. Saturday night, one of the guys on our team bought us all dinner at Stockyards, which was great. Sunday, we played two more games -- losing the second one ended the tournament for us. In the end, we went 3 and 3, with two of our losses being by one run -- not too shabby. I did OK - solid in the field, but I wish I had hit better.


With the softball over, the only thing left to do was head to Phoenix Pride, which happened to be the same weekend. Fortunately, I had some great guides -- Jimmi and his boyfriend Kevin. Jimmi is the co-host of the Dan and Jimmi Variety Show Podcast, on which I was a guest to discuss gay health issues. I met Dan in SF, but had never met Jimmi face to face. He's a great guy, and we had a blast. He and Kevin picked me up for lunch and drinks, and then we hit Pride with their friend Joe, and then the bars.

They only left me when it was pretty clear I would have other company for the night. That didn't go as well as I had hoped, but it wasn't the end of the world either.

I drove back from Phoenix Monday morning, and made it in under 5 hours, which was my goal. I wish I had dallied a bit more, because my pager started going off as soon as I got back. Seems many of my colleagues were at conferences, two of the people working had family emergencies, and the guy on back-up had messed up his scheduling and planned something. So they needed me to be on pager call. I haven't had to go in yet, but it did put a dent in my day trip, wine, casino plans. Alas. So I've been trying to make lemonade -- I finally bought plants for my apartment, have been to the gym everyday, and am hoping the hottest guy in the world will call me back (more on this later).

Hope your week was somewhere near as good.

I'm pretty hot about some of the politics flying around today. They'll be more on that tomorrow or Friday, but I wanted to get in something light about life. It's fun, and it usually gets more hits. I'm sure I'd reach a new record with the story of the hottest boy in the world; but I wouldn't want him to read it and get scared off. You'll just have to wait until it's going well -- or not at all.

PS -- there appears to be something wrong with the pictures tonight. I'll try again tomorrow.

The New Attorney General

www.nndb.com

Given how long it took me to get the last post done, I've decided to give a little less background on this one. By now, I'm sure you have your own opinion on the firing of the US Attorneys. I think it's a glaring example of the fact that you can fire someone for no reason much more easily than you can fire someone for a bad reason (and sometimes even a good one).

My assessment is that President Bush had the authority to fire these US Attorneys, but he, or his staff, did not want it to look political, so they covered things up. In politics, it's always the cover-up that brings you down. Unless your last name is Clinton.

I'm more interested in making a couple of predictions. First, as you may have guessed from the title, I believe Attorney General Gonzales' days are numbered. Even a spectacular performance before Congress today probably won't save him for the long term. In fact, some have argued that the only reason he still has the job is that the President has no desire to send a nominee through a Democrat controlled Congress.

So here's my prediction (which my Dad thought was really slick) -- Attorney General Tom Ridge.

www.iflipflop.com

Why? I'll give you 5 reasons:

1) He's already been through a Senate confirmation as the first Homeland Security Secretary.
2) He's a former Congressman, so he may get some votes on old favors and friendship.
3) At the time he was in Congress, he was the only former enlisted man ("grunt" was his term) there. (There were many other veterans among the Congressmen/women, but they had been officers.) Voting against him, therefore, can probably be spun as unpatriotic. Plus, he might take what will likely be a messy job out of a sense of duty.
4) He was a Bush favorite -- in fact, some speculated that he took the Homeland Security post with the understanding that he would be given the VP nod if Cheney couldn't/didn't run in 2004.
5) As far as I know, he's just working in the private sector.

It also wouldn't surprise me if President Bush made a point of offering it to a Democrat in an attempt to take back control of the Senate. Maybe even an Independent Democrat, i.e., Attorney General Lieberman. I don't think anyone will fall for this.

www.boston.com

As unattractive as the job will look by then, they may just have to give it to the first person who will take it. I hear there are 8 excellent attorneys with high level government experience recently out of work.

Walter Reed and the VA

I know I promised this a long time ago, and I apologize. But have your parents in town, spend two painful weeks at work, go on vacation, and suddenly you'll notice that a month has gone by. I have a bunch of other things to write about, so I wanted to get this done, and I apologize for the text heavy format. Before I get into my analysis of this issue, I want to do recognize some people and some biases.

Shout-outs:
1) Everyone who is eligible for treatment at the VA or military hospitals . Thanks for your sacrifice.
2) Defense Secretary Robert Gates. He made heads roll over this in a way previously foreign to President Bush's administration. Rummy would still be giving cyclic arguments to the press about the unknown unknowns. If Gates had cleaned up Abu Ghraib, we might have a little more respect on the international scene.
3) The Press. Nice job keeping at this story. I wish you had been this dogged about pursuing stories on WMD and Nigerian Uranium, instead of being an a bullhorn for the administration. Welcome back to the game.

Biases:
1) I worked at the Atlanta VA as a student, and the San Francisco VA as a resident. I loved it.
2) I'm not sure if my observations at VAs attached to medical schools apply to other VA hospitals.
3) I was offered a job at Tripler Army Hospital in Hawaii. They needed civilian docs because many of their specialists were deployed. I turned it down, but only because I didn't want to move to Hawaii.
4) I'm a doctor, so I may not give the MDs as much blame as we deserve.

Let's do Walter Reed first. It was terrible, and it should NEVER have happened. There are two specific points about it that I want to discuss.

First, the worst of it appears to have been related to outpatient care. Not a big surprise. If you've tried to do anything medical from home, you know that "pre-authorizations" are a pain. Once you're in the hospital, I can do almost anything I want, and they have to pay for it as "acute care". If they want to fight it, they have to try to do it after the fact, and convince a bunch of doctors that I should have known it was unnecessary when I did it. Once you're discharged from the hospital, it gets harder again. Insurance companies (and MediCare/Cal) make it easier to get a hospital day covered than help or therapy at home or in a nursing facility, even though the latter is much, much cheaper.

Second, it seems that there was a problem getting paperwork done. This problem is not unique to the military, though we should make a special effort there. I can barely get through health care paperwork, so I don't have high hopes for my patients who aren't lawyers. When there are people paid to help with this stuff, they are often clock punchers. Even some of those who started as idealists get burnt out. (See below) That said, I have met a few amazing social workers and case managers.

On to the VA. In large cities, the VA Hospital is usually associated with a major medical school (SFVAMC and UCSF, Atlanta VA and Emory). The attending physicians are usually university faculty, and the house staff are high quality trainees. So, with regard to the doctors, the medical care is about what you'd get at a university hospital. The staff is hit or miss -- some are great, some have jobs way over their heads; but you can usually get more money elsewhere, so most people are there because they want to be. Honestly, the VA was always my favorite place to work -- the patients are the best, and you feel like you are doing someting worthwhile.

Most of the limitations of the VA system derive from the fact that it is basically a rationed system. They have a budget from the government, a certain number of patients, and they do the best they can. They group some therapies to certain hospitals by region -- the SFVAMC did the heart bypasses for veterans as far away as Reno, NV. Since we only had one or two surgeons, they often had to wait. It didn't matter if they were a General or a Private, they went in order of wait or illness. There are ways for sicker patients with imminent problems to speed through the system -- but they need to get into the system first. The big problem becomes getting that first appointment with a primary care doctor.

One answer will be to add more primary care doctors -- but there are budget limitations. The other answer involves changes in our focus on preventative health, as a system and on a personal level. I don't mean to sound harsh, but too many veterans never see a doctor until there is a crisis. If we could get these men and women into the system before things go bad, we'd have them hooked in when the problems arise.

Notice, by the way, that the problems at the VA and Walter Reed are common to any rationed, managed health care system. If I had my choice, I'd go to the VA over Kaiser in a heart beat. Financially speaking, both the VA and Medicare run at a significantly lower administrative overhead cost than other managed health systems.

These problems also reflect the poor planning of President Bush and his staff. The Iraq war adds daily to the roll of soldiers who will need treatment at these facilities, but there seems to be no strategy for this "surge". Like the ground/civil war in Iraq, it will probably be a mess left for the next commander-in-chief to fix. I hope he or she is up to the challenge.

Posts Script: I finished this post on the day of the tragic massacre at Virginia Tech. My condolences to the family and friends of all the victims. The coming discussions of violence, the second amendment, etc., are important; but they can bring back the people who lost their lives.