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).

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.