Your Brain is Green
Of all the brain types, yours has the most balance. You are able to see all sides to most problems and are a good problem solver. You need time to work out your thoughts, but you don't get stuck in bad thinking patterns. You tend to spend a lot of time thinking about the future, philosophy, and relationships (both personal and intellectual).

Saturday, November 27, 2010

Kay, Lamb, Cronin, and Howatch

Sounds like either a legal firm or an advertising agency !

Well, this is really about four authors I'm currently reading [or re-reading, as the case may be], and the similarities between some of them.

Harold Lamb is a big favorite of mine, although his is not a common name in literature these days. He began in the era of pulp fiction, back in the '20s and '30s, writing for Adventure magazine, with his tales of Central Asia, especially those about Klit the Zaporovian Cossack, set in the beginning of the 17th century, and progressed to non-fiction, in particular chronicling the Mongol invasions of the 13th century and their impact on the countries they conquered. March of the Barbarians was one of the first books I read --oh, I guess I was 10 or so --from my father's library, and its influence was immense. Not only did Lamb recount the history, he wrote with great insight of all the cultures of the area, and how so much history is dependent on population migrations. Reading his books [he also wrote a history of the Crusades, and fictionalized biographies of numerous individuals of the period that interested him, such as Sulieman the Magnificent, Omar Khayyam, and Tamerlane, as well as Genghis Khan] was like reading novels. His pulp stories, often of novella length, are now available for Kindle; and I just splurged [mea culpa, mea maxima culpa] $40 for a second-hand first edition of "The Earth Shakers", which is a combination of "March of the Barbarians" and "Tamerlane". His biographies of Genghis Khan and Tamerlane are also available in audiobook form [read by Charlton Griffin] from I'm sorry he's mostly out of print these days; I think he'd have quite a following if reprinted.

When talking about exotic places and times, I've got to admit that, for a long time, I avoided reading anything by Guy Gavriel Kay, because, in general, I'm not a fan of the fantasy genre. Well-written, and plotted SF I enjoyed throughout my childhood because my Dad was also a fan, and I got to read his copies of Astounding/Analog Science Fiction magazine when he'd finished [one of the most memorable stories was a serial called "Dune", for example, which has become a classic] but by my teens, and the Apollo missions, technology seemed to have caught up, more or less, with the imaginations of SF writers [except that no one predicted the PC] and I no longer found the genre so interesting. Fantasy often was a bit too twee for me.

However, the customer reviews on for Kay's latest, "Under Heaven" were good, and I like Simon Vance as a narrator, so I thought I'd chance it, and now I'm a fervent fan of his. It helps, of course, that the story takes place in an analogue of China and Mongolia several hundred years before the rise of the Mongols, an area and time that already interested me. I just downloaded the two books of the Sarantine Mosaic for my Kindle, and have "The Lions of Al-Rassam" on order [why Amazon, when it begins to Kindlize an author, don't do Kindle editions of ALL his major books, I don't understand, especially if they are a series]. Kay seems to have started out writing much more fantasy into his novels at the outset of his career, and with each book there is less of it, which is fine by me. I'm not sure yet whether I'll attempt "Tigana" or the Fionavar Tapestry novels. When I read the word "magic", I get a little uneasy [although I did like Marion Zimmer Bradley's "Mists of Avalon" and "The Firebrand" very much. The sequels and prequels to "Mist" were ghastly, IMO].

And this brings me to Susan Howatch's "historical novels": "Wheel of Fortune", "Penmarric", "Cashelmara", "The Rich are Different", and "Sins of the Fathers", in which she retells actual periods of history by placing the main players [renamed, of course], in other periods. Kay creates analogues --alternate universes, if you will, while Howatch shows how history can be "transferred" to another period as fiction. Both are interesting ideas, and are well done, and rather different than standard historical fiction. Very satisfying.

A.J. Cronin is a different kettle of fish entirely. The only real points of similarity are that, like Lamb, he is largely forgotten these days, and like Howatch, he fictionalized real events in several of his novels, most notably in "The Stars Look Down". However, I find his characters to be honestly written, and persuasive. I've known persons like the protagonists of "The Judas Tree", and "Hatter's Castle". His delineations of the working class -- Cronin was an unabashed social activist --at the beginning of the 20th century ring true. The Second World War and the Welfare State largely ended that kind of subculture. Indeed, "The Citadel" was supposed to have been a big influence in starting the NHS. Cronin manages to say a lot with relatively few words. Recently a number of his books have been made available on Audible, but I think they were recorded in the early days of audiobook production. The quality of the recording of "The Citadel" is abysmal -- the narrator sounds like he's at the bottom of a well -- but "The Stars Look Down" is well narrated [but one does hear pages turning and the occasional throat-clearing], and so is "The Judas Tree". It can be a little difficult at times to understand the dialect in "Stars", the narrator is accurate almost to the point of incomprehensibility [unless you're from Yorkshire, I guess] but I prefer that to having the reader give everyone a BBC accent. I think Cronin, who, like Lamb, wound up in Hollywood writing screenplays, should be re-discovered. He's still got a lot to say.

Hope this provides a bit of thought for those "I haven't got anything to read" moments. It might also excuse the thin blogging, recently.

Wednesday, November 03, 2010

Vindicated, Unfortunately!

I wrote this on November 8th, 2008. Alas, the midterms have turned out as I predicted. Quite a few other things have come to pass as I expected as well.

Just give me a gaudy turban and a crystal ball....

Now, what will happen in 2012? I'll let you know as soon as my demons inform me, but before I start with the pentacles and incantations, I want to let the election dust settle a bit

Friday, October 15, 2010

The Franchising of Jamie Fraser

Once upon a time, there was a book called Outlander. It spawned Dragonfly in Amber, and Voyager, and so on, until, in the fullness of time, there are seven books in the series, with an 8th in the works. Somewhere along the line, the author, Diana Gabaldon, began writing a number of novels and short stories featuring an 18th century nobleman, Lord John Grey, who is a career military man and diplomat, homosexual, and given to solving mysteries. These books are spin-offs of the Outlander saga -- he first figures in DIA as a 16 year old, and he reappears occasionally in the later books, becoming a major character in the most recent, An Echo in the Bone. Although she occasionally writes something contemporary, Gabaldon, most of the time, sticks with the universe she began to create in Outlander. Each book has some characters die or disappear, each book introduces new ones, so that the cast of characters has become quite large in the two decades that "Gabaldonia" is in existence.

Diana Gabaldon is a lush writer, lavish in description [all carefully researched], and full of small details. In fact, it is this that gives credibility to an otherwise fantastic conception: that time travel exists, and that a British nurse, at the end of WWII, can be transported to Scotland just before the Rising of 1745.

She has been immensely successful: about 17 million books in print so far, with a large fan following, several internet groups who discuss her books endlessly, and she herself is involved with a Compuserve writers' forum and not infrequently meets her fans at publicity events, where she talks and signs books. I've corresponded with her, and got an mention in the Acknowledgments in "Echo" for help with information concerning how to do a breech delivery. She seems a very nice person.

She is also a very intelligent one, and a good businesswoman. Her background is not history, but marine biology, and prior to writing Outlander, was a university lecturer. It's obvious she's good at multitasking; when she was still in academia, as well as raising three children, she had worked for Disney, writing comics, and was beginning her first novel.

Now Ms. Gabaldon seems to have been searching for new horizons with her tale of Jamie Fraser and Claire Randall. There's a new CD called "Outlander: the Musical" and a graphic novel, which is supposed to be the first part of Outlander told from a different viewpoint. What comes next? A Hollywood company has an option on Outlander, for a film, but it's all very vague at this time, and it has been hinted that perhaps a TV miniseries might at some point be considered. What's next? A line of men's colognes and/or women's perfumes named for Jamie and Claire?

The big initial problem Outlander had was of classification. It's not a book one can describe in 30 seconds or less. It is a historical novel with overtones of fantasy [the time travel aspect]. It's an adventure story -- there's plenty of action, and in fact, a not inconsiderable number of men find the saga interesting. And it definitely has a major love story, with explicit scenes that would qualify for an X rating. By default, although it radically departs from the standard formula for the genre, it was usually found on "Romance" shelves in bookstores, despite Ms. Gabaldon's crusade to move it. "Simply call it fiction", she has said. In many ways, it is similar in genre to Clavell's "Shogun" [Blackthorne discovers an unknown civilization, not through time travel, but through journeying to a virtually unknown destination, 17th century Japan, and is transformed by it].

No one would claim Outlander to be high class literature. Yet the decision to turn Outlander into a musical, and then into a graphic novel do not seem to help it achieve recognition that it is anything more than an upwardly mobile bodice ripper. Both the musical and the graphic novel will bring in scads more readers, undoubtedly. But will it also cheapen the original product and turn what should be a serious novelistic ouvre into fluff?

I think it will. I will frankly admit that I can't listen to the CD musical. I've tried, but find it saccharine and sentimental, but I'm not a big musical fan anyway. Just think about Anna Karenina as a musical, or, a better comparison, James Clavell's Shogun as a musical with Dutch sailors in chorus lines or humming samurai in the background while Blackthorne and Mariko sing a love duet. Sort of puts you off your breakfast, doesn't it?

The graphic novel is worse. It absolutely bastardizes the original work, reducing it almost to parody. An 800-odd page book is reduced to 184 pages [actually a bit less as the chapters are divided by title pages]. No one in the book resembles my mental image as based on the written descriptions in the novel itself, and there is enough variation in the artist's renderings that at times one can't even recognize a character who was in a different panel on the same page. In more than one drawing, Jamie looks as if he has mumps. Claire is reduced to a caricature [and is almost a twin of Jamie's sister] Murtagh bears a marked resemblance to the actor Sean Bean. But, to be fair, since I have no experience with graphic novels, it might be that the art work is above average in this book. If so, then the artistic level of graphic novels as a whole must be pretty abysmal.

In order to make fans feel that they are getting full value, a completely extraneous storyline, with a new character, is introduced, for what purpose I really can't tell. The backstory of Claire's particular circumstances, and even why she came to the stone circle through which she traveled back in time, is left out. This must make it a bit difficult for those who haven't read Outlander first. There is so little text that I think, were I asked to make an outline, chapter by chapter, of the original novel, I'd have more text than we have in the graphic version, and most of it is verbatim quotes of snatches of dialogue from the book. This is a book, in short, for the functionally illiterate, who would never dream of actually sitting down and reading a big, thick book. I was always sure it would sell very well -- and the NY Times has had it as #1 for two weeks now. In order to "hook" more readers into buying the other books, Amazon has been selling Outlander for $0.00 for about the same time, undoubtedly hoping that the graphic novel readers would decide they wanted to go for the hard-core stuff after reading the "trailer" that is the graphic novel.

So, as a business decision, the graphic novel seems a good idea. Certainly most of the fans are cooing over it. [So far Amazon hasn't posted any comments by anyone who hasn't already read some of the series, so it is difficult to gauge how the non-Gabaldonophiles are reacting.] Ditto the musical. Both will spread the story of Jamie and Claire to a larger audience. But what will it do to Ms. Gabaldon's literary reputation?

Wednesday, September 22, 2010

The English Defence League

Reading this article, I was reminded of those wonderful books by Leo Rosten, "The Education of H*Y*M*A*N K*A*P*L*A*N" and "The Return of H*Y*M*A*N K*A*P*L*A*N", which are hilarious tales of a WASP teacher in an evening "Americanization school" in the 1930s, which were filled with immigrants from just about everywhere, who were all avid to become "real" Americans. These classes were much more than English lessons, they were about civics and culture too, and immigrants flocked to them, usually after a working day that could be 12 hours long.

Mr. Parkhill ["Mr. Pockhill"] is not at all apologetic for his cultural origins. Neither are his students, for theirs. They don't perceive learning a new culture to denigrate their old one, just that they WANT to be able to live "as Americans" in the wider American culture. They want to show their gratefulness for the opportunity to escape poverty by embracing new values in addition to their old ones. At home, the Italians undoubtedly still "eat Italian" while the Eastern European Jews keep kosher; Madame Olga Trasha goes to a Russian Orthodox church, but not one of this group would dream of trying to demand that all restaurants be kosher, or Italian, or all churches Russian Orthodox.

Yet what we see, over and over again, is that Muslim immigration demands that the host country conform to their requirements, and there is no feeling of being beholden to the host country at all for improved health, work, social conditions. They see no reason why non-Muslims cannot comply with their religious and cultural outlooks. They have provoked the backlash that has created the EDL, and while I deplore any violence, I have to side with those, in Britain and the US who think immigrants should adapt to the host country, or return to where they came, and I'm not apologetic, either.

Wednesday, September 08, 2010

Chelm, Israel

The newest idiocy of the religious parties:

Every year, the date for changing clocks back and forth in the autumn and spring is determined by the Orthodox/ultra-Orthodox parties in the Knesset to suit what they perceive as important religious realities. The date for the autumn change, to "winter" time, is set for just before Yom Kippur, in the quaint belief that it makes for a shorter fast.

Of course, it doesn't. The fast is 25 hours long no matter what time you're on. But on daylight saving, or "summer" time as it is called here, one can sleep through a bit more of the fast following the prayers in the evening, and before they begin again the next morning. In fact, because Tel Aviv and Miami are on roughly the same latitude, the difference between summer and winter time only changes Shabbat and holiday times by about an hour during the year, unlike the UK, for example, which because it is so far north, can bring Shabbat in at 3 p.m. in the winter and not end until 11 p.m. in the summer.

This year the High Holidays come unusually early. Yom Kippur begins on the evening of the 17th of September, so the clocks are due to go back a day or two before. There has been a loud outcry from the general public [including quite a few religious]. It's still summer, really. The temperature is hovering in the high 80s, the sky is cloudless, and will be for a couple of months yet. Besides, nearly all the countries which use a daylight savings system wait until the end of October to change back, and that causes a lot of problems with companies which need to be in frequent communication with firms overseas. But no, the religious element in the Knesset is standing firm!

Dalia Itzik, an MK, demanded that the head of the haredi bloc, Eli Yishai [Shas] come up with an "innovative solution" to the problem. After some thought, he thought he'd found a way out. Israel will still move to winter time just before Yom Kippur, but then return to summer time until the end of October, to remain in sync with the rest of the world! In other words, make an already unpalatable situation even more complicated, not to mention ridiculous.

Words fail me. As of this writing, his ingenious plan has been rejected, and we're due to spend about 6 weeks on different time from everyone else.

I haven't posted a lot recently; the cruise to Norway, and pressures of work, and family, have been pretty stiff, but I hope to remedy that soon.

Here's wishing everyone who reads Antigonos' Annals a healthy, happy, prosperous New Year.

גמר חטימה טובה לשנה של בריות ,פרנסה,ואושר

A Distinction without a Difference

Angelo Lopez
The Tri-City Voice
Sep 8, 2010

To Jews, what Christians find objectionable in Muslims and what Muslims find objectionable in Christians is much of a sameness. Both are proselytizing religions which deeply resent the other's proselytization. But then, it is said, isn't it, that that which you dislike in others is that part of yourself with which you are uncomfortable. From the sidelines, as Jews are, in this fight, it is amusing how both sides don't realize this.

Wednesday, July 14, 2010

Bob Gorrell
Creators Syndicate Inc.
Jul 14, 2010

No comment. I don't think it's necessary.

Wednesday, June 30, 2010

Tuesday, June 29, 2010

How Sweet It Is....!

At Your Cervix has a post up about doctors who care, reeely care about their patients and take lots of time with them, the so-called "Dr. Wonderfuls" that Barb, on Navelgazing Midwife often goes on about. These are doctors who, according to the econiums on the blogs, try NOT to practice medicine, but behave [the highest compliment!] "like midwives". These are doctors who pay much more attention to their patients' requests than stupid things like evidence-based medicine, so that they take all kinds of risks just to make the patient happy. It all works out very well until the patients begin sueing when there's a bad outcome. Dr. Biter, on the West Coast, has managed to gain an almost fanatical coterie of women who think he's the Cat's Pyjamas, but in only 12 years of practice he has also been named in six lawsuits. One has to wonder why.

But this isn't about "Drs. Wonderful", or "Dr. Grouchy" or any other kind of doctor. It's about communication, or the lack thereof, and time, and patient expectations, and reality.

I'm the last one to deny that most doctors don't have "bedside manners" worth a damn. At Your Cervix has already finished one year of her CNM course [MA, I believe] and until now it's all been about communication. I keep waiting for her to get to midwifery -- I suppose it will show up at some point. Doctors never take courses in how to talk to patients, and to be honest, frank discussions are usually not viable for several reasons. The patient has to trust the doctor, yet he wants the doctor to be somewhat distant and objective, before he can open up and ask "What was that you just said? Can you repeat it in English?" or "Why are you advising this treatment and not that treatment?" because the patient fears the doctor will be annoyed with him for doubting his [the doctor's] pronouncements. [And the doctor, all too often, is. He wants to stay on his pedestal as much as the patient wants him to remain there]. So there is a very fine line in the interaction between patient and doctor. Add to this the fact that in OB the patient is a woman, and the doctor is very often a man, and having a baby is not only emotional but related to sex, and the line can be very fine indeed. One man's compliment can be another man's sexual harassment -- this is the reason all intelligent male doctors will have a female attendant in the room if an internal exam is likely. Females, be they nurses, midwives, or even female physicians, are perceived by the female patient as being less threatening. Those of us in the business know that the most obnoxious doctors [at least as far as their staff colleagues are concerned] can be women, who often need to prove they are tougher than the men, incidentally.

So patients can feel intimidated even when there's no overt intimidation going on, and insensitive doctors can think the patient is entirely satisfied with her treatment unless she signals that she is. The signalling is often misinterpreted as hostility. Trust, and communication, again.

But, the nurses and the midwives, one hears, "listen to me when the doctor doesn't". It depends on what the patient's talking about. It isn't the doctor's job to instruct the patient how to use her glucometer; it is a waste of time to do so, but it is a task the nurse is educated to do. The patient then perceives the nurse as being more interested, more supportive. On a ship, it would be a waste of time for the Captain to shovel coal in the boiler room; he delegates that to the appropriate people. The same thing applies here. The nurse can't determine what the insulin dose should be for a gestational diabetic; the doctor does that, and the nurse shows the patient how to administer it. It's called division of labor.

Now, about time, and reality. Ideally, I would have a half hour with each new patient, to open their pregnancy follow-up card, take a history, chat about the progress of the pregnancy, ask if there are questions, etc. At Your Cervix is interested in bringing the delights [!?] of unmedicated "natural" childbirth to low-income women. Do poor, uninsured women take private midwives? No, they don't. They go to clinics run by teaching hospitals. If a CNM sees a woman, she is a staff midwife, who doesn't pick and choose her patient caseload, she works in a clinic X days a week, or in L&D for X shifts a week. Right away, the one-on-one patient/midwife relationship is compromised. Ms. Hernandez will probably see a number of different midwives through her pregnancy and labor and, because the clinic is almost always crowded, will have only a brief time to speak with one. When doctors are accused of giving their pregnant patients short shrift, the patient doesn't usually know how many patients the doctor has to see within a given time: in my clinic, in a 5 hour stretch, a doctor usually has to see between 40 and 75 women. No time for cozy chats, is there? It's not uncommon for me to be supervising two women having NSTs [fetal monitoring], be teaching a woman about gestational diabetes, and have half a dozen women waiting in the hallway for their BP/weight/urine tests before going in to the doctor. It's a madhouse. And, oh yeah, the phone keeps ringing [usually with asinine questions like "I forgot my pill today but he didn't come inside. Can I get pregnant?" or "I'm 6 weeks pregnant but I'm bleeding and having cramps. I don't have a babysitter. Do I really need to see a doctor?"] The phone queries take more time than anything else.

Whether a woman gives birth in hospital or home, if she retains a private midwife, of course she gets a great deal more attention. She's paying for it [or in some cases, her insurer is]. Most CNMs who don't work in hospital work with a medical group, and depending on how much overhead there is, and how much profit her medical partners want to make, her caseload can be extensive. It often presents a dilemma. Whereas a doctor can relinquish on-the-spot care to the L&D nurses and only get to the hospital when the patient is nearing delivery, or will briefly pop in from time to time, thus being able to manage his office hours as well, the CNM is expected to accompany her patient, acting more as a doula than as a doctor, especially in early labor. Meanwhile, her clinics for her antenatal patients must be cancelled and all the patients rescheduled. The patients really love this, believe me. [Or the practice has several midwives, who cover for each other, which patients, used to seeing a particular midwife, also dislike]

Homebirth midwives make a big point of describing the huge amounts of attention they give their patients. Well, that's because of the infinitesimal number of patients they deliver. Two deliveries a week, 100 a year, is a really heavy caseload for a midwife delivering babies at home, and a midwife with a caseload like that is a physical wreck pretty soon, from exhaustion. Two deliveries a month is more like it, and while sometimes she might have a busy month, with four or five deliveries, she is also likely to go several months without a delivery. Most homebirth midwives can't make a living from this, no matter what they charge, and also work as instructors or doulas [or their partners support them].

So the bottom line is that although a midwife ought to be [1] a CNM, [2] carry a reasonable caseload which allows at least half an hour for each patient, [3] be linked to a major medical facility or have medical back-up which is sympathetic to the idea of promoting the midwife's ideology for birth, [4] has an income commensurate with her education and committment -- the chances are that it's all a long way off. Noticed any flying pigs in the neighborhood recently?

In the present, you do what you can. When I have an obviously distressed patient, I shoo everyone out and close the door, even occasionally lock it [but that doesn't stop patients banging on it anyway] and try to disconnect the phone [but the switchboard operators get antsy with the secretaries because they can't put "emergency" calls through] and give some quality time to the patient. But as the saying goes, until you've walked a mile in a man's shoes, don't judge him -- wait until you're in practice, At Your Cervix, before you make judgements on how patients are treated by their Health Care Providers. BTW, hope the day you begin your new career isn't far off.

Susan Howatch

In general, I give books with female authors and sensuous pictures on the cover a pass – Danielle Steel, for example, doesn't interest me in the least. So I have often passed over the audiobooks of Susan Howatch available on, but when I read the reviews of "Glamorous Powers", I was intrigued, and the audio sample was very well read. It was fantastic. In quick order I ordered the first and third books of the first "Starbridge" trilogy ("Powers" being the second) and devoured them. I also listened to "The Rich are Different", and "Sins of the Fathers", which belong to an earlier, "historical romance" phase. I don't really think that's a good description, but I don't know what else to call the Caesar/Cleopatra/Antony/Augustus story, set in the 1920s to 1950s, with Paul van Zale/Caesar an investment banker. Sounds awful, doesn't it? In the hands of another writer, it might be, but Howatch carries it off magnificently. I'm currently waiting for three more of her books in this genre: "Cashelmara", "Penmarric", and "Wheel of Fortune", which, I understand, are based on Plantagenet history, transplanted to the 19th century.

The "Starbridge" novels, consisting of two trilogies, the first in the 30s and 40s, and the second ending in the 60s (I believe) are followed by a third trilogy, the "St. Benet" trilogy, which carries the story into the 90s. At the heart of all the books are Jonathan Darrow and his son, Nicholas. Both clergymen in the Church of England's "High Church" end of the spectrum, both are unusually psychically sensitive and involved in spiritual counselling and healing. The first two trilogies are mostly concerned with clergymen in various states of nervous and spiritual breakdown; the third set of books has more of an emphasis on those secular persons who Nicholas attempts to heal. In my opinion, while interesting, it is the weakest set of the books, and I personally gravitate more toward Nicholas' mentor and assistant, Lewis Hall (the great-nephew, incidentally, of Nicholas' father's mentor), who is an older, rather curmudgeonly man which a sex drive which gives him problems (since he's divorced, and C of E clergymen are expected to be either married or celibate). It's not that Nicholas is a nonentity, but he's a pale shadow of his father, who is a very charismatic and forceful personality. There is a strong psychological component in the discussions of spiritual direction, but the language, most of the time, is religious rather than psychological, and I'd be happier if the "healing" was in the name of God (which, actually, it is, most of the time) rather than Jesus, who, for me, is a false god. I don't really have a problem with the idea that "demonic forces" are synonomous with neuroses. The implication is that, if there IS spiritual healing which happens in the name of a false god, then [1] either the real God is doing it regardless of the religious orientation of either the patient or the healer, or [2] it would have happened without any recourse to any divinity whatsoever. Once or twice in the books there are scenes in which phrases and actions associated with exorcism are invoked ("Depart, Satan!" or "In the Name of Jesus Christ, leave this person!") with a cross being flourished, and one of the "villains" cannot speak Jesus' name (why wouldn't she, probably with an expletive attached? Plenty of wicked and highly neurotic people do call on Jesus all the time, without ill effect [or beneficial effect, for that matter]. The whole concept that there is something unique about Christian healing (what happens if a Christian is prayed for by a group of Hindus?) makes me uncomfortable. As anyone who reads this blog regularly knows, Christianity makes me uneasy in a lot of ways. I'd be interested in knowing what clergymen think of Howatch's books.

In any case, I highly recommend her work.

Tuesday, June 15, 2010

So Far, So Dull

Joe Heller
Green Bay Press-Gazette
Jun 15, 2010

Remind me, just how long is it until Labor Day when the REAL football begins?

Friday, June 04, 2010


It's nice when you find another blogger who independently comes to much the same conclusions you have. And nice, too, when the comments, in general, support one's own thinking. I don't agree 100% with either Shrinkwrapped, or the commenters to his post, but in the main we're thinking along the same lines.

The View from Editorial Cartoonists

Scott Stantis
Chicago Tribune
Jun 4, 2010

Nate Beeler
Washington Examiner
Jun 4, 2010

Chan Lowe
Jun 4, 2010

Wednesday, June 02, 2010

A Psychoanalyst Notes

A must-read blog post from Shrinkwrapped.

Randy Bish
Pittsburgh Tribune-Review
Jun 2, 2010


Usually, after attending to personal needs and putting on my glasses, my first stop of the morning is my computer. I check my email and the numerous lists and forums to which I belong, then check the Haaretz and Jerusalem Post English sites, The New York Times and the Washington Post.

The past couple of days, to keep my blood pressure more or less normal, I've avoided them. I don't know which upsets me more, the real implications of the Gaza flotilla, or Israel's response to it.

As is so often the case, the flotilla is merely a symptom of a much larger and more serious underlying condition, and for this one has to study history. It's not an accident that the Turks are funding the enterprise, and that should be worrying a lot of folks in Europe and the US.

Equally worrying is the degree to which Western countries are being hoodwinked in relation to the true situation in Gaza and the true aims of both Hamas and the so-called PA "government".

And lastly, just how dangerous it is for Israel to believe its own mythology.

The flotilla itself was created to be a provocation, not a solution, because the problem it ostensibly is addressing -- the lack of "humanitarian goods" in Gaza -- is a false one. The Jerusalem Post today has an article showing that the goods found on the boat have already been supplied by Israel for some time and there is no need for them to be brought specially now. Nor was there any reason for the ships not to have complied with Israel's demand that the flotilla dock at Ashdod for inspection. Israel announced prior to the sailing that it would transfer all humanitarian aid to Gaza. No, the organizers wanted to be martyred for a fake cause -- and Israel gave them what they wanted. Silly Israel.

What is going on now in the Middle East began around the time of the Crusades, although it can be argued that the real beginning began when Shi'a Islam split from Sunni Islam. During the Crusader period there was a virtual civil war between the two Islamic factions (which was one reason the Crusaders managed to succeed in the First Crusade). The Caliph in Baghdad was Shi'a; so was the Caliph in Cairo. The Sunnis, who had been ascendant, and were the majority, were, for a time, swept aside by the Shi'ite "heretics". But that had been reversed by the time the Ottoman Empire was established. But the Shi'ites have long memories, and a big chip on their shoulders.

It is important to remember that the Iranians, Syrians, and Turks are Muslims but not Arabs. Traditionally these countries, together [sometimes] with Iraq and Lebanon, have formed a distinct axis which is ethnically very different from Saudi Arabia, Egypt, Jordan, and the Gulf States. In the 1920s Kemal Ataturk forced Turkey, then the "Sick Man of Europe" to modernize, and become a secular state. But the West has largely rejected Turkey's overtures as inadequate, and there is an Islamic backlash growing. Iran has been all to eager to "assist" Turkey to find its true Islamic "self" because, together with Syria/Lebanon, that forms a bloc which [1] isolates Iraq, which is also a target for the nascent Iranian hegemony and renewed "Caliphate", and [2] can split the Islamic world in two. Iran's ultimate goal is to be the most powerful state in the Middle East. If Iran can site its missiles in Turkey, after Turkey expells NATO and the US bases there, it cripples the West's ability to control Afghanistan, or any other region nearby, and threatens Europe directly.

Hamas has come to make common cause with Hezbollah, as well as Al Qaeda, and therefore is allowing itself to be influenced and supported by Iran, possibly directly although I don't think that right now there is any real proof. So Iran's sinister finger must be sought when looking behind the scenes. Iran encourages Turkey, who funds the Gaza flotilla, to help Hamas. The fate of the Gazans is almost irrelevant. And anything which embarrasses the Israelis is just icing on the cake.

The timing is also interesting because Obama is hosting this "Jewish American Heritage Month" right now, because he desperately needs the Jewish vote in the US this November. Bibi is drumming up support for his policies in the States and is somewhat preoccupied. Whoever planned the Israeli response to the flotilla (assuming anyone actually did) was acting without guidance from the PM, and the Turkish organizers are not loath to embarrass Obama as well. In the Muslim world he is regarded as weak and ineffectual; a bit of a joke really.

For a long time, Israelis have patted themselves on the back and felt that they are very clever; certainly they are a lot cleverer than stupid Arabs. Unfortunately this in itself is a dangerous trap. Arabs are not very intelligent about certain things, but very shrewd indeed about some things, and not all Jews are intelligent at all. Arabs are very adept at telling others what they wish to hear, and do not scruple to lie. It's all part of the game, and of their culture. And they are believed by the gullible. I was told just the other day that Israel faked the Karin A incident, when a boat carrying 80 tons of arms tried to dock at Gaza and was seized by the Israeli Navy. Palestinians moan about how Israel "doesn't want peace" but use schoolbooks whose maps show Palestine from the Jordan to the Mediterranean and use the Arabic version of Sesame Street to extoll child martyrs and a Micky Mouse figure talks about murdering Jews. That's all right. They complain about security fences and borders keeping them out of Israel, but no Israeli dares go to Palestinian territory for fear of being lynched. They want free and unlimited access to Israeli territory but they claim to want their own sovereign state and don't want Jews in it. Borders work both ways, habibi.

The question remains what to do about future flotillas, because the Hamas folks are planning them. The first thing is that there must be no doubt that Israel will not allow them to dock at Gaza, but that it is made absolutely clear that all aid will be transshipped to Gaza after inspection at an Israeli port if the ships come in peacefully. If they do not, the aid will be confiscated or returned to its country of origin. Netanyahu should hold a prime time news conference with as much of the international media as possible and this message must be spread as widely and reiterated as often as possible. Foreign journalists, and UN observers, if it can be arranged, should be on Israeli navy ships. Live filming and broadcasting should begin from the first hailing of any flotilla vessel until it is escorted into port. If networks choose to put foreign correspondents on Palestinian ships but not on Israeli ships, the credentials of correspondents working in Israel should be revoked. [I also think the major news networks should have a correspondent resident in Shderot permanently, btw] If there is a live TV feed, it will be obvious who is attacking whom and with what. Israel has got to realize that the world wants to believe the worst of the Jews at all times. Film released after the event will be called "fake".

During the Second World War, the acronym SNAFU was common. It stands for "Situation Normal, All F**ked Up". It is still applicable.

Friday, May 28, 2010

Victor Harville
Stephens Media Group
May 28, 2010

Think I'd better buy a ticket NOW.

Thursday, May 20, 2010

Sunday, May 16, 2010

Another Brilliant Idea that Comes a Cropper

Douglas MacGregor
The News-Press
May 16, 2010

Someone should explain to the geniuses that came up with this idea that secretions from scalp sebaceous glands COAT hairs with oil and sweat; the hair doesn't "soak up" oil. If it did, simple shampooing wouldn't clear it away. All using hair will do is coat the coast with hairy balls of oil, rather than just balls of oil, which is quite bad enough.

Tuesday, April 06, 2010

Obama Admits That, Against Ahmadinejad, He's Clueless

Two articles, one in the Jerusalem Post, and one in Haaretz, came to my attention today, and I find them very alarming, and not just for the threat to my life and country. Ahmadinejad is threatening the entire West, just as I've been predicting for a long time, using Israel as a hostage.

And Obama is too bloody stupid to realize it; and he has wasted a year during which he could have done something about it. Every day, in every way, it is becoming apparent that he is completely unfit for the immensely serious task of being President. He has achieved very little, and is ready to compromise his principles [just look what has happened to the health care reform bill -- and what will happen to it by 2014 when it's supposed to take effect] Now, he's telling Americans that they must accept that a maniac will have a nuclear arsenal. Makes "Munich" and Chamberlain look puny.

And, btw, I find his attempt to co-op Passover revolting. And frankly I find any US rabbis who pander to his distorted idea of what Pesach means equally revolting. The meaning of Pesach isn't universal; it is specific to Klal Israel. Considering how Obama is trying to stop us building in our own capital, how can he say "Next Year in Jerusalem", let alone "Next Year in Rebuilt Jerusalem" which is what Israeli Jews say at their Seder. It is as meaningful as all those "Moroccans for a day" Israeli Ashkenazi politicians who try to profit from Mimouna.

Sunday, April 04, 2010

Gee Whiz, It's Another iThingy!

Nate Beeler
Washington Examiner
Apr 4, 2010

For the moment, I can't see what possible use I would have for an iPad -- but of course, that could change...

Sunday, February 28, 2010

You Read It Here First

Several years ago, I predicted this (I wrote about an "unconfirmed report from Iran that they had missiles that could hit London") but on at least one list to which I belong I was accused of "warmongering", of course because I am an Israeli, and therefore, "biased".

"Buy Iranian oil at $500 per barrel, or we take out Vienna".

But personally, I think The Clown of Teheran wants a Shi'ite hegemony over the Middle East. The Shi'ites have a long, long grudge against Sunni Islam. Turning Syria into an Iranian proxy is only the first step in Achmadinejad's plan, just as Hitler "only" wanted the Ruhr, and the rights of the Sudeten Germans in Czechoslovakia "guaranteed".

But of course, being Israeli, I'm biased. There's nothing to fear from Achmadinejad, just as there was nothing to fear from Hitler...

Friday, February 19, 2010

Update, Again

On the 22nd of January I wrote about two couples who I saw frequently in my clinic. (See "A Difficult Week") It might interest you to know that the first couple have had their child, safe and sound, at 36 weeks, and they brought her to see us, a real little charmer. It's always nice when the parents bring in the kid, especially if we've followed them through fertility treatment, and the subsequent pregnancy.

The second couple I mentioned are still getting injections to help maintain the twin pregnancy, and the pregnancy is continuing, but they aren't out of the woods yet, so I've got fingers, toes, and my eyes crossed.

Sent another woman to hospital this week, who is in her 22nd week of pregnancy. She has had problems in previous pregnancies at about this time, and she is exhibiting some worrisome symptoms now. She has been something of a nudnik since the beginning of this pregnancy (who can blame her?) and some of the nurses get a bit exasperated with the lists of questions and complaints she brings to every clinic visit but when she walked in the door of my office this week, all my mental alarm bells began ringing. Sometimes all it takes is a glance to see that, this time, the complaints are real.

Whenever I read some "birthin's naatural, man" nonsense, I think of people like these. The percentage of women who can deliver on the kitchen table and an hour later go hoe the garden is really very low; the percentage who need every iota of medical technology to conceive and carry a pregnancy to viability is also relatively small. The majority fall somewhere in the middle --but anyone who works in obstetrics and thinks the potential for catastrophe isn't always lurking in the shadows, is a fool.

A Conversation or Two

A sample of typical telephone calls I get at work:

The phone rings, I pick up the receiver: "Women's Clinic, hello."

(Breathless voice on the other end, usually calling from a mobile phone with bad reception or she is in the noisiest intersection in town, and it is obvious she is holding an infant, since the baby's screaming is considerably louder than the woman's voice): "Hello, is this the Women's Clinic?"

I affirm that it is, thinking that it has hardly changed from my greeting not five seconds before, but too wise to say that, as it would lead to impossible complications in explaining why it was the same clinic it was five seconds ago.

Patient: Well, what I wanted to know…my doctor is overseas/on vacation/not available/only has office hours once a week and it isn't for a few days yet…what I wanted to know…you are a nurse, aren't you? You see, I did a pregnancy test today and I want the result, what I mean is that I've got the result from the internet but I don't understand it…" (This is said usually without pausing for breath, which is one problem, since it is usually very hard to understand what she is saying, as if the bad connection and the screaming kid isn't enough)

For reasons known only to the kupah lawyers, who work out of Tel Aviv and have never had any contact with patients, we are not supposed to give lab results over the phone. Kupah members can download results from the internet, but no one ever understands them, which is predictable, since they are patients, not medical professionals. Most of the names of the tests are either abbreviations or in Latin or English, and all are written in the Latin alphabet, which also poses a problem for certain sectors of the Israeli population. Hence, the need to call us, even if they do have the results in their hot little hands. I tell the woman I cannot give her the results over the phone (this often provokes a discussion in which I have to defend the kupah's ostensible regard for patient privacy. That can waste 10 minutes right there, and, btw, shows just how misguided the policy is, as some doctors give their patients instructions to go to hospital, etc. depending on certain lab values) But this lady to whom I am talking has her results in front of her, although I suspect she's probably finding it difficult to juggle her cell phone, her baby, and the page with the results.

Me: All right. Look for the line that begins H.C.G., followed by the word Q.U.A.N.T., 'quant' …

Patient: What? Where? Oh, I see it says " if less than three, negative, if more than 25"…

Me: No, above that.

Patient: What's the "less than three"?

Me: Those are the normal parameters. A result of less than three units means a negative result, more than 25 units means a positive result. Look for the line immediately above that".

Patient: Where it is written 'HCG'?"

Me: Yes. (I'm beginning to get pressure behind my eyeballs) After 'HCG QUANT' and 'S' in parentheses, what is written?

Patient: Negative.

Me: Negative means you are not pregnant.

Patient: Are you sure?

Me: Yes. (the headache is definite by now)

Patient: Why not?

Well, madam (or miss), I'm sure I don't know (no, I don't really say that)

Repeat this conversation, or a variant thereof, at least 5 times a shift. Another interesting fact is that I now know exactly how badly math is taught in Israeli schools. Unless there is no human chorionic gonadotropin to measure at all, the result is given in numbers. A perfectly incredible number of women do not understand the meaning of a decimal point, and vehemently insist that they ARE pregnant, because the result is 0.69 and "69 is more than 25". I've actually been told that I don't know what I'm talking about when I insist that 0.69 is less than 1. I would attribute this to a natural desire to have a positive result, except that I've gotten the same response from women who are anxious not to be pregnant.

Here's another:

The caller has an elderly sort of voice, combined with a strong Middle Eastern or North African accent. She wants to know if her daughter is pregnant. After going through a whole "we can't give results over the phone" spiel, the woman triumphantly says that she has the results in front of her, and her daughter is standing by, but is "unwilling" to come to the phone. The woman also says that she can't read the results, but after mangling several abbreviations, it is apparent that she does indeed have some lab results in front of her. I pull up the exam on my computer, since I don't know precisely to what she is referring. I note that the young lady who had the tests done is 18 years old. I also notice that no pregnancy test was done, only a blood count, which is normal. I tell her mother that. Officially I shouldn't, since I'm talking to a third party, but there's no harm in telling her that her daughter is healthy.

Mother: Why can't you tell if she is pregnant? She had blood drawn.

Me: But not for a pregnancy test.

Mother: What's the big deal? You can't tell from the lab results? Blood is blood, after all.

Me: There are several hundred different kinds of tests that need blood. The doctor did not order a pregnancy test. He ordered a blood count, which tells him several things, such as if your daughter needs to take iron, which she does not.

Mother: You can't tell if she is pregnant from a blood count?

Me: No, I can't. And Madam, I wouldn't tell anyone but your daughter if I did have that result. So why don't you either put her on the line, or ring off? Obviously, I don't say that out loud, either.

Mother: Make a guess. Surely you can tell something from the results. Why else would the doctor order a blood test?

Oh Lord, give me strength. Or give them some intelligence. For a long time, my idea of purgatory was being locked in a room with Elizabeth Schwarzkopf singing lieder endlessly. I'm beginning to reconsider that, in favor of an unending stream of such telephone calls. I think that might be a lot worse than La Schwarzkopf.

Oh, Goody!

It seems that quite a few of my favorite "light" novelists will be publishing new books soon.

Lindsey Davis has a novel about the English Civil War, as well as the 20th Falco novel on the way.

Deanna Raybourn is offering "The Dead Travel Fast", but it is unclear (to me, anyway) whether it will feature Lady Julia Grey and Nicholas Brisbane. I rather hope so; I quite like him, even if he occasionally becomes just a little too much like Sherlock Holmes. But maybe marriage has mellowed him (I prefer him unmellowed, however)

Speaking of Holmes, Laurie R. King's Mary Russell will be present in "The God of the Hive". Ms. King's last book, "The Language of Bees", was not one of her best, partly because it seemed truncated at an odd point, and "The God of the Hive" is largely considered by her fans to be its completion -- or so we hope. Ms. King seems to want to make Mary more independent of Holmes, but it is the interaction between the two that is the main attraction, in my opinion.

Amelia Peabody returns! Sensibly, the new novel will take place before the "Tomb of the Golden Bird", which saw Peabody and Emerson, in their late 60s [possibly, in Amelia's case, at 70, although her "editor" has claimed that Amelia fudged her age at some point] present at what was the end of an era in Egyptology, the opening of Tutankhamun's tomb. This novel is supposed to take place during the period in 1910 when Ramses was excavating in Palestine. Living, as I do, in one of the places that features in the novel, I eagerly await it. I'm currently listening to all the series in audiobook form again (why are three of the novels only available in abridged form??) and am finding them delightful all over again. It's not just the way Elizabeth Peters writes, but the way Barbara Rosenblat "performs" them.

Diana Gabaldon has an Outlander-connected short story, called "A Leaf in the Wind of All Hallows", appearing soon in an anthology, a Lord John Grey short story in another anthology, and in the autumn will publish the Outlander graphic novel. None of these projects fills me with unalloyed enthusiasm; I really want to read the short stories but mildly resent having to buy fairly expensive books full of lots of other stories that do not (probably) interest me, and I have no interest in adult comic books, especially when the art work looks to me like typical "manga" type of illustration (albeit beautifully colored). But since the story line will expand on the text of the first book in the Outlander series, I'm probably going to have to buy it, just to see what twists DG has come up with.

By the way, I've recently listened to "The Whiskey Rebels" by David Liss, which was very well done -- he's an author I've come to enjoy quite a bit. I heartily recommend the audio version of Dennis Lehane's "The Given Day" as well. Generally speaking, I choose audiobooks which have quite a lot of dialogue and can benefit from a dramatic reading; books with long narrative sections seem to fare badly in audiobook form (despite repeated attempts, I could not get into A.S. Byatt's "The Possession", which has lots of "extracts" from works of the fictional author at the center of the novel, for just that reason) When buying books for Kindle, I tend to go for non-fiction (history, mostly), since I like books with lots of "meat" (the fatter, the better, IMO -- or, to be crass about it, more bangs for my bucks). For the time being, I've got both audiobooks I haven't yet listened to, and a few books to read on my Kindle...together with my iPod, I'm all right, Jack, for the nonce.

Wednesday, February 03, 2010

Pass the Nausea Antagonist, Please

Mike Lester
Rome News Tribune
Feb 3, 2010

Amazing. A few weeks ago I didn't know who Tim Tebow is. Now I wish I didn't. I really hope he doesn't get drafted into the NFL, or he's likely to be the victim of some of his teammates. Of course, with an IQ as low as his obviously is, another concussion might actually jog the brain cells and improve his intelligence.

Fortunately, since the Superbowl airs here in Israel in the middle of the night, and I tape it and watch it the morning after, I will be able to skip hearing about his miraculous life, along with all the other commercials.

Sunday, January 31, 2010

I Suppose the Next Step is an iWallet Full of iMoney...

Nate Beeler
Washington Examiner
Jan 31, 2010

To be honest, I didn't think of "feminine hygiene products" since a different term entirely is used in British English, and anyway, I'm so far past the time when I needed such stuff, it has pretty much slipped my mind.

But I do wonder about the possible confusion between iPOD and iPAD. In certain accents, the words sound almost the same.

For the time being, the iPad is eminently resistable [just as I don't have an iPhone, either]. But my 160 GB iPod Classic is nearly full, and if the iPod Touch gets a bigger memory, I might think about getting one...

Friday, January 22, 2010

If This Young Man Had Been a Moslem

A few days ago a flight was diverted because of strange behavoir deemed possibly the prelude to an act of terror.

It turned out that the young man who was behaving oddly was davvening with tefillin.

The incident was quickly brought to a close since the boy cooperated with the authorities, explaining what he had been doing, and showing them his tefillin. Neither his parents nor his grandparents have made an issue of what must have been a major embarrassment and not a little frightening for the 17 year old in question.

They, nor their rabbi, nor American Jews in general, have issued threats, of violence or death, against the airline, the US Government, or indeed anyone at all for "insulting Judaism" or "racism" or abusing the right of freedom of religion. No fatwas, no physical attacks, no paranoia, no attempts to sue for damages, as we have seen ever since Salman Rushdie put his life in danger by writing a book, or a Scandinavian cartoonist attempted to poke fun at Islamic extremism, or a Dutch filmmaker who tried to show what lies behind Islamic misogyny. This shows very clearly the difference between the Moslem mentality, and the Jewish mentality. Moslems seem to need to be provocative, "in your face", to demand not just equality under the law but to be superior to the local civil code [witness calls for Shari'a law in the UK for Moslems], and to behave like thwarted, but heavily armed, children when their demands aren't met for complete capitulation.

The Jewish response: “I would suggest, pray on the plane and put the tefillin on later on,” the boy's rabbi said. “Pray, and fulfill the ritual later.” That is called being civilized, something Islam has yet to understand.

A Difficult Week

It's been a somewhat difficult week. Sunday I felt a cold coming on. Colds, with me, run a predictable course. First I get a bad sore throat, then my nose starts running but the throat feels less tight, and lastly it all goes to my chest, and sits there for up to 10 days.

I doubled my dose of antidepressants for the nonce. I've found the main effect of my particular little blue pill isn't to make me happier, just to make me care less about all the s**t going down, and a cold is one of those things you've just got to last out: "treat it, and it will go away in a week; don't treat it, and it goes away in 7 days". So I faced the next few days, sneezing, sniffling, and coughing, with equanimity.

Of course, I couldn't take any time off work. Right now I work with two other nurses, who work from 8 a.m. to 2-3 p.m. One has 4 children under six years of age at home, which is a commute of over an hour. The other, who can do the occasional evening, has 5 children and is currently attending university in order to upgrade her nursing diploma to a nursing degree. I've created the closest thing to an indispensable position for myself, and while it will be very difficult for the organization to retire me against my will, it means it is also a real problem if I need some time off because either of those nurses will have to put in 11 hour days.

So, with notices plastered everywhere about how vulnerable pregnant women are to both ordinary and H1N1 flu, and how they ought to be inoculated, there I was, pockets filled with tissues, and trying hard not to breathe on anyone. Every medical institution I've ever worked for has made it difficult for nurses to take sick leave; obviously the profession doesn't take its own advice.

For some weeks our completely inadequate facilities ["don't fuss; this clinic is only temporary; no point in doing renovations since in 6 months/a year/2 years/5 years/when the Messiah comes there will be a super-duper new clinic"] have had an additional problem: suddenly both our fetal monitors began to produce static so loud that sometimes the microphones were recording the static rather than the fetal heart rate. When we first complained, we were told it wasn't so bad, and to carry on. When it became obvious that it WAS bad, we were told to "cope somehow". The maintenance folks came around, fiddled with the electrical sockets, said it must be the machines. The technicians from the company that makes the fetal monitors came around, and demonstrated that, when taken to another part of the building and plugged in, there was no noise at all, and told the building maintenance crew it was THEIR problem. Meanwhile we are wrestling with up to 8 women an hour--nearly all with multiple or high risk pregnancies, or who claim not to have felt fetal movements for some time--whose fetal hearts only occasionally can be heard above the static. And at least one of the "emergency walk-in" doctors (we have one doctor specifically for non-scheduled patients all day until midnight) orders an NST on anyone and everyone more than 26 weeks pregnant, no matter what the reason they came ["ran out of prenatal vitamins and need a new prescription"]. He's from the FSU and was so appalled, and terrified, by the stories he heard about doctors in the West being sued for malpractice, he wants to absolutely sure he's missed NOTHING. If a woman wants a prescription for birth control pills he's perfectly capable of sending her to the dentist if he thinks her teeth need cleaning.

[Yesterday one of the medical secretaries plugged in her electric kettle and caused a short circuit. It not only knocked out all the computers in the clinic, it also knocked out all the electronics in the adjoining, very large, pharmacy. I find it immensely fascinating that so much stuff -- nearly one half of an entire floor in the building is on one electrical line. But hey, this is Israel. I wonder if this could be part of our problem...]

But I soldiered on. Old Florence would be proud. I probably only infected a dozen women with my cold, and sent another dozen to the hospital for no good medical reason because I couldn't get a decent FHR tracing. After 42 years I really ought to let this kind of stupidity wash over me; after more than 30 years in Israel I ought to shrug and say "Yiheyeh b'seder" [it'll be all right in the end], or "Hashem yishmor" [God will take care of it]. But my inability to do so is one of the reasons I take little blue pills.

There is a high-risk couple we see on a weekly basis. They are both ex-Americans and extremely ultra-Orthodox, I suspect they are converts, although perhaps the wife is merely a born-again Jew; both are considerably past child-bearing age, and since the husband has a number of fairly severe chronic conditions he may just look like he's in his sixties but might be much younger. I know this is the second marriage for the husband, who speaks freely of his grown children in the US, but it is the first marriage for his wife. She's 40-ish, has gestational diabetes, and only got pregnant after extensive fertility treatment. They came on Thursday for their weekly appointment, and all was well. She's now in her 34th week. An hour later she phoned me to say she was bleeding. I, of course, told her to come back immediately, and our on-call doctor sent her straight into hospital. I hope she can hold the pregnancy for another couple of weeks. While a 34 week premature isn't such a bad situation, it's all relative, and they can still have a rocky course. This is not only a high risk pregnancy, it is a very precious one. She will not be able to try again.

I also give progesterone injections to a woman in her middle thirties who is pregnant, after IVF, with twins. Until the 12th week, progesterone, which maintains the pregnancy, is made by the open wound on the ovary where the egg cell erupted [the corpus luteum]. From the 12th week onwards the placenta produces it. Since several previous pregnancies, also IVF, ended in miscarriage, her doctor has ordered the daily injections this time, and all has seemed to go well. She being now in her 12th week, the dosage is being reduced gradually, and everything was fine until today, when she began bleeding and cramping. The doctor immediately ordered the higher dosage resumed, and we've all got our fingers crossed, but I don't have a good feeling about the outcome. I sat and talked with her and her husband for a while; there really wasn't a lot more I could do. She is highly intelligent -- a psychologist -- who simply left off starting a family early, and then it became apparent that both she and her husband have fertility problems [which is why they had more than one embryo implanted; it seems unlikely that another round of IVF will succeed].

I hate ending the work week like this, with two "cliffhangers". I don't blog often about work, because while it might seem exciting and glamorous to an outsider, most of what I do is really very repetitive and mundane. For every intelligent and knowledgeable patient -- and many of the women in fertility treatment are extremely so -- there is at least one dumb bunny who has, as we nursing professionals are wont to say, an IQ lower than her BUN [blood urea nitrogen, which normally is almost zero]. They ask questions it takes 5 minutes to understand, and since the answer needs to be repeated at least three time for it to sink in, takes 15 minutes of my precious time [the gynecologic equivalent of "Who is buried in Grant's Tomb?" is "My doctor prescribed vaginal suppositories for me. Where do I put them?" This ranks close to "My boyfriend swears he didn't come inside me. How did I get pregnant?"