Monday, October 30, 2006

Infection Control

One of the nursing students told this story about their day at another hospital in which they went around with the wound care nurse specialist.

They were working on a patient with a large abdominal wound, maybe their belly had dehisced, requiring absorptive dressings or a WoundVac. While they had the wound exposed the patient's regular nurse came in with oral medications for them to take.

The patient was a little shakey, and one of the pills spilled out of the medication cup which the nurse had handed to her. The pill fell into the open abdominal wound.

Okay. Yuck.

Then the nurse picked the pill up out of the wound and handed it to the patient, who swallowed it.

That is wrong on so many levels.

Sunday, October 29, 2006

MacEachern Mouths Myths (Say that three times fast)

Some of the windows are open, allowing in the sound of the little waterfall that aerates our koi pond running between the windows and the outside wall. Cool morning air has me reaching for the warmth of the coffee cup. Baroque music on the radio, its polyphonic lines emanating from the Martin-Logans and I notice the existential pun: it's Handel's "Water Music."

Though we've worked hard for this, I feel gratitude rather than entitlement.

But wait, there's even more to this lovely Sunday morning. To my delight (but no surprise) the inimitable Doug MacEachern has provided another ignorant snot-filled eruption of paranoid and inverted class-warfare strict-father-morality conservative talking point for us to consider.

From the opinion pages of the third-rate-and-not-even trying-for-better Arizona Repubic, MacEachern warms our hearts with this little homily:

"Proposition 202 won't make much of a wave. Not because it isn't a wretched idea. It is. An indexed minimum wage will cost entry-level jobs, no matter how union activists twist the facts. But it won't matter because the veil of good intentions lies so heavily over Proposition 202. Few will hear of the lost low-wage jobs, the training cuts or the rise in youth unemployment. It's all about feeling good about yourself."

This, of course, is theoretical nonsense. So-called conservatives have been repeating the mantra "increased minimum wages costs jobs" for all the years they've been building their right-wing noise machine. But that doesn't make it true.

David Card and Alan B. Krueger head up the reality-based arguments against the conventional (as in "oft-repeated") assertions regarding this issue.

"In a work that has important implications for public policy as well as for the direction of economic research, the authors put standard economic theory to the test, using data from a series of recent episodes, including the 1992 increase in New Jersey's minimum wage, the 1988 rise in California's minimum wage, and the 1990-91 increases in the federal minimum wage. In each case they present a battery of evidence showing that increases in the minimum wage lead to increases in pay, but no loss in jobs."

But that can't be right, can it? I mean, if company upper management raises their own income by multiples of millions of dollars each year, then employment at lower levels doesn't... oh, never mind.

Anyways, C&K have had their critics. From the Vermont Legislative Research Shop:

"Card and Krueger have received some criticism for their study from a number of conservative think tanks that published their commentaries in opinion-editorial fashion rather than in peer-reviewed journals. Critics claim that the Princeton Study looked specifically at minimum wage issues in the fast food industry, which leaves out a significant population of the minimum wage work force. They also claim that the Card and Krueger data is inconsistent with the actual payroll records of the Burger King franchises; Card and Kreuger chose to rely on the Bureau of Labor Statistics for their data. Richard Berman of the Employment Policies Institute also disagreed with the methodology of the Card and Kruger study. He argues that the analysis should have focused on the number of hours worked instead of the number of employees (Berman 1998). Despite the claims of these critics, there has been no peer-reviewed research to date that contradicts the findings of Card and Kreuger or supports the claim that an increase in the minimum wage increases unemployment."

There you go.

Other economists, hundreds of them actually, have weighed in on the increased-minimun-wage issue and have found conclusions similar to those of C&K. But that doesn't fit MacEachern's frame through which he sees his altered reality, and as Lakoff says, "When the facts don't fit the frames, the frames are kept and the facts ignored." It's on page 73.

So MacEachern rumbles on with his fact-defying newspeak. You can easily imagine the maggots crawling out of his facial orifices.

I suppose I could try to take him head-on and maybe send him a link like say maybe one from the Economic Policy Institute, but I'm sure he'd stay true to form and probably just attack the messenger or blame it all on Clinton.

"Minimum wage opponents often say that higher minimum wages will yield substantial job losses, but empirical evidence does not support this claim. A 1998 Economic Policy Institute study failed to find job loss associated with the 1996-97 minimum wage increase.3 In fact, following that minimum wage increase, the low-wage labor market performed better than it had in decades (e.g., lower unemployment rates, increased average hourly wages, increased family income, decreased poverty rates).

This reality is leading many economists to support minimum wage increases as a useful policy measure, especially in an era of increasing economic inequality. In October 2004, 526 economists signed a statement that said, in part, that "a modest increase in the minimum wage would improve the well-being of low-wage workers and would not have the adverse effect that critics have claimed." This list of economists included four Nobel Prize winners in economics and three past presidents of the American Economics Association.4"

Facts and footnotes. These are on our side, that of the reality-based nurturant-parent-morality community. But for the MacEacherns of this world, the deserving rich must prosper while the undeserving poor remain poor, or his entire internal concept of moral order explodes inside his follicle-challenged pointy little head.

Tuesday, October 24, 2006


On the radio Al suggested this exercise for a Republican aquaintance:

Go over the Democratic keynote speech by Barack Obama.

"In the end, that's what this election is about. Do we participate in a politics of cynicism or a politics of hope? John Kerry calls on us to hope. John Edwards calls on us to hope. I'm not talking about blind optimism here — the almost willful ignorance that thinks unemployment will go away if we just don't talk about it, or the health care crisis will solve itself if we just ignore it. No, I'm talking about something more substantial. It's the hope of slaves sitting around a fire singing freedom songs; the hope of immigrants setting out for distant shores; the hope of a young naval lieutenant bravely patrolling the Mekong Delta; the hope of a millworker's son who dares to defy the odds; the hope of a skinny kid with a funny name who believes that America has a place for him, too. The audacity of hope!

In the end, that is God's greatest gift to us, the bedrock of this nation; the belief in things not seen; the belief that there are better days ahead. I believe we can give our middle class relief and provide working families with a road to opportunity. I believe we can provide jobs to the jobless, homes to the homeless, and reclaim young people in cities across America from violence and despair. I believe that as we stand on the crossroads of history, we can make the right choices, and meet the challenges that face us. America!"

Then compare it to the belligerent, frothing, bilious nonsense of Zell Miller's Republican call to the legions of the crazed. Yeah, I know his party affiliation. And Hitler was a Catholic. Whatever.

"Now, while young Americans are dying in the sands of Iraq and the mountains of Afghanistan, our nation is being torn apart and made weaker because of the Democrat's manic obsession to bring down our Commander in Chief. "

Not exactly.

There are, after all, matters of responsibility and competence.

Monday, October 23, 2006


Famous and immdiately identifiable riffs:

"Take Five" by the Dave Brubeck Quartet (it's actually a Paul Desmond composition. Check out Joe Morello, the Alan Watts of jazz drumming. Love that guy. This is the single-most effing coolest jazz drummer video ever. Morello was an avatar.)

"Money" by Pink Floyd. But betterer.

"Rapture" by Blondie.

"Sunshine of Your Love" by Cream, later fabulously deconstructed by Fudge Tunnel. Until you hear that you have not sufficiently lived. Stop what you're doing and go for it right now.

Everybody's been reading Lakoff lately, and I think that is a sign of looming turnaround. He discusses "framing" of issues, and I have begun to think, in loose analogy, of "frames" as "riffs."

Republicans, under the tutelage of Rove and earlier under the notorious and thankfully no longer operative Lee Atwater, have inadvertantly mastered the art of framing, and now that Democrats and progressives have begun to understand this, the playing field tilts. Big time.

I had the day off. Such is the life of a nurse, who slaves away weekends when the nine-to-fivers are off to their retreats and amusements, only then myself to have the luxury of a mild Monday morning unassigned to wage accumulation. So I went to Tempe to see and hear Barack Obama and a host of other really good Democratic political candidates.

We have excellent candidates.

Obama's speech was well-crafted and fine-tuned to the modern media predeliction for topical sound-bites, but the recurring notion was "we can do better."

We Can Do Better.

Of course we can. Freakin' idiots could do better than this Bush cabal. But I like the frame.

"We" as in us-versus-them. It triangulates out the Bushistas, which leaves the majority who oppose his policies in a position of inclusiveness.

By saying that we can do better, the implication is that they are not doing so well. We all understand that, even if we are supporters of this Administration. "Better" can always be done, so even Bush die-hards get caught in this frame.

Phil Gordon aquitted himself very well, dynamism intact.

Pederson speaks like an established and relaxed talk-radio host.

Though the crowd murmured when J.D.Hayworth and Jon Kyl were mentioned, the tone of the whole event was positive.

We Can Do Better.

Heck yeah. And we will.

Friday, October 20, 2006

Honest to God Real Conversation

The spouse and I were going an early dinner at a hip local place and while we were mulling over the kisras on the menu we overheard the two gentlemen at the next table.

"I for one," said a balding bespectacled mousey guy, "Am sick and tired of the gays in this country thinking that they can just shove their agenda right down our throats."

His dinner guest harumphed in agreement through a mouthful of lamb and greens.

My spouse leaned in to me and said "They're a little loud, don't you think?"

"That's the guy at the newspaper who makes fun of my blog name," I said, "And that's J.D.Hayworth with him."

"Foghorn Leghorn himself?" asked my soul mate.

"Thet boy ain't raght," I drawled in a sad mimicry of the famous cartoon character. We couldn't help but overhear them as they continued their rude discussion, probably inspired by their phobic observations of the waitstaff and some of the restaurant clientele.

The red-faced politician replied "They think they can just jerk us around anytime they want."

It seemed to us that they were entirely unaware of the ironic homoeroticism of their remarks.

"We shouldn't take this sitting down," said MacEachern. I watched his head slowly turn after he stared over the tight jeans of the passing waiter.

"We can't remain passive as they continue to try to stick it to us," said MacEachern.

"After this election I'll be giving them something to chew on," Hayworth said.

"We'll show them a thing or two," added MacEachern.

We tried hard to pretend that we were unaware of their remarks, but it was too much and I may have actually spewed a sip or two while holding back a full-blown guffaw.

"Full-blown." Heheheh.

"I'll be happy to lend you a hand," replied Hayworth, who went on to say "And when Prop 107 gets rammed through, they can just suck on it."

Then MacEachern misspoke, I think. He probably meant to say it was "time to take our country back" but his tongue slipped and he left off the final syllable of the word "country," which caused spasms in my spouse. On the way out we kept saying that he said he "wants their c#nt back," over and over, like they're going to share it once it is retrieved. As if they only had one between the two of them.

Well, who could blame them for their righteous concern?

Certainly not I.

Somehow, by Pat's brother Kevin Tillman

"Somehow back at home, support for the soldiers meant having a five-year-old kindergartener scribble a picture with crayons and send it overseas, or slapping stickers on cars, or lobbying Congress for an extra pad in a helmet. It’s interesting that a soldier on his third or fourth tour should care about a drawing from a five-year-old; or a faded sticker on a car as his friends die around him; or an extra pad in a helmet, as if it will protect him when an IED throws his vehicle 50 feet into the air as his body comes apart and his skin melts to the seat."

Please read the whole thing posted here.

We need to keep such things in mind come November.

Sunday, October 15, 2006

Canadian Health Care vs. Daddy MacEachern

Please go read Sara's first-hand account over at the always-fine Orcinus.

"As a health-care-card-carrying Canadian resident and uninsured American citizen who regularly sees doctors on both sides of the border, I'm in a unique position to address the pros and cons of both systems first-hand. If the health-care debates are going to begin again in the US -- and it's way past high time they should -- then let's please start with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here." [snip]

I have been arguing the case for a single-payer system for a couple decades; since I began working in the system oh-so-long ago.

The puffy-faced and bespectacled Arizona Republic conservative "editorialist" (he pulls the Karl Rove talking points off the fax machine each morning,) Doug MacEachern once asserted the superiority of our system here in the U.S. by citing a case in which he also claimed first-hand knowledge: one time his father needed an MRI and got one.

Alrighty then, that settles it.

Everybody knows Canadians have to wait 22 months to get an MRI if they sprain their ankle.

The illustrious Tom Tomorrow tells it straight here, with dripping irony either dismissed or misunderstood by the MacEacherns that inhabit the world. This Modern World, that is.


Hat tip to Naum at AZ Place.

Friday, October 13, 2006

Book List

Today in radio The Fat Drug-Addled Liar pined for the old days, like when Kennedy threatened to glass the entire USSR if Cuba "tested" a missle.

Later on Air America, Dr. Justin A. Frank, author of Bush on the Couch, discussed the cowardice of Bush, which is so extensive that Secret Security agents set up exit routes through the White House so that Bush need not inadvertantly run into visiting dignitaries in and about our imperial palace. Bush does not like to face people eye-to-eye. It stresses him out.

Bush ridicules people. I heard him say "Nice suit" to a press person recently, forcing the questioner to take a humbled position even before asking. Bush is mean like that. He likes to put people down, because they threaten him.

He doesn't like to think. "I don't do nuance," he has proclaimed. In his traumatized school-boy mindset, thinking causes great discomfort by unsettling his black-and-white notions of infantile simplicity. "You're either with us or against us," he proclaims, but how can you be with a person who only considers himself and has no regard for the lives of others?


So we have a president who is damaged goods, a 7-year-old psychopath in an adult body. With a government full of appointed fellow monsters. On the verge of taking over the entire world, what is it that these soulless theocrats have planned next?

Why, raising more soulless theocrats to continue the good work, of course. Like the young zealots portrayed in Righteous, Dispatches from the Evangelical Youth Movement.

The book kinda reminds me of the movie The Boys from Brazil, in the sense that breeding and unbringing are fostering a whole new class of people tasked to exert political power. And not in a really good way.

The basic premise of the book, as I understand it, is that younger people are more propagandized and beholden to religious rightwing ideology than even their immediate forebears.

That's scary.

About as scary as a team of mutant Hitlers bent on world dominion, yet there they are, not on the silver screen but right there in front of us all, plain to see; indeed, shouting to be heard and seen. Tattooed young people, outwardly displaying common cultural insignia but inwardly tied up in knots of conservative religious ideology, without support, except from those very same people as would have them instead be left behind when their lord comes down from the sky to retrieve them.

If there was a god these people would change, really change.

Saturday, October 07, 2006

62 Hours

Sunday was long enough ago that I have to dig, with a square shovel, to uncover the memories of that day. I wore dark blue scrubs. My assigned patients were all "normal;" no psychopaths nor Republicans among them.

One gal did schiz out on me. In an anesthesia-induced haze she thought I disapproved of her non-traditional marriage arrangement. Later she got better and it all slid away unmemorably like a bit of Brie on a cracker.

I'll tell you about my own wedding someday.

Monday I wore black scrubs and all my assigned patients were either sent home or transferred off to skilled nursing facilities by 5 p.m. Hints to my clinical lead nurse were shut down without pity.

Another nurse offered to report off her own patients so she herself could go home a couple hours early. She got swatted down like a bug in July. After an hour of just keeping busy helping other nurses, they flew in a new patient from Kingman, just for me.

After two busy days at work I had a short nightmare that awoke me from my shallow sleep. Godzilla was outside our sliding-glass door peering in at the cats, who were staring and hissing back, ears flattened. I thought, in my dream, "That sliding-glass door isn't going to be much of an obstacle" for the giant lizard outside.

Tuesday I napped and played through a guitar transcription of the "L'Infidele" sonata by Sylvius Leopold Weiss. I have a wonderful Renaissance 10-course lute made by the notable Richard Berg of Ottawa, but mostly I just struggle through guitar transcriptions, though my lute would allow me to play most any Renaissance work, if only I could. Someday I'd like to obtain an 11 or even a 13-course Baroque lute, in D-minor flat tuning, to see how things like Weiss feel under original conditions.

The lute sounds like the brain.

The guitar sounds like the heart.

And on Wednesday my nurse heart was broken by a patient who aquired a nasty case of Valley Fever which had settled into their spine and pelvis.

Valley Fever typically takes away a piece of lung, but it can attack any body tissue, including brain. Brain fever. Necrosis.

My particular patient needed new spine tissue cemented in to replace bone material eaten away by cocci. I gave antibiotics and we got the pain issues straightened out with the help of the nurse specialist. That was good. The patient awaits another surgery soon. The surgeons here are amazing.

Thursday and Friday blurred together. I wore black again on Thursday. It's a tradition.

One of my assigned patients was a young adult who required an AICD implant. They shared a condition with their own progeny, known as prolonged QT syndrome, which can cause ventricular tachycardia or fibrillation and sudden death. So now thay have an implanted device that will sense and shock if the deadly heart rhythm occurs. Their 2-year-old child also has one.

You don't see that every day.

I ran a strip of their rhythm and showed them what runs of V-tach and V-fib look like, using a textbook that was lying around, and explained that their AICD would reset the pacer node of their heart with a not-so-gentle shock.

People always do better when you explain things. They were very thankful.

Once in a while I get that "I wish the nurse would shut up" look, but most people say to me "why didn't anybody tell us this before?"

They had been well-prepped because the procedure and device had been applied to their young child, but by doing a little show-and-tell they came to a fuller understanding of this.

I recall an episode Thursday in which I was so tired that I was dreaming while awake.

Sitting at the computer I had charted that one of my patients had refused their stool softener "because of Hitler's disingenuous overtures to the Russians early in World War Two." I deleted that as soon as I was awake enough to realize where I was and then I walked to get a cup of coffee. I should have left that entry in the chart. Somebody may have later gotten a laugh out of it.

Friday drizzled by like the moderate rain that started the day. I wore dark blue scrubs. My cocci patient looked better, and they said they felt better too. Another patient had orders to wean their Dobutamine drip, and without the IV attached to them they did a lot more walking around, which is always good.

The dobutamine was only going at 2mcgs/kg/min. It didn't take long to "wean" it off.

Saturday I wandered around the bookstore where I saw an elderly couple who noted that a book they had special-ordered for themselves was available out on the shelves; Chomsky's "Imperial Ambitions." I told them that they had just made my day.

"How so?" the gentleman asked, smiling in recognition of a member of the reality-based community.

"I had a long week," I said, "And seeing somebody special order Chomsky makes me happy."

"My favorite thing," said the man, "was seeing Hugo Chavez at the U.N. holding up this book and telling people to read it."

I had seen that. It was great. And I picked up a copy, too.