Nickolepsy

Song of the Day — Neil Young

April 30, 2010
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Neil Young wrote a song about the Tea Partiers back in 1974.  Very impressive, and a little scary.

Revolution Blues

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Song of the Day — Aretha Franklin

April 30, 2010
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While I write the next post, please listen to this Oh-My-God-It’s-Even-Better-Than-The-Original cover of (Simon and Garfunkel’s) “Bridge Over Troubled Water”, by the lady who wore the funny hat at Obama’s inauguration.  It’s not as if Aretha Franklin ever does herself in, but she so outdoes herself with this one:

Bridge Over Troubled Water

Oh, wow, and I can’t help but include her fabulous version of this Burt Bacharach song:

I Say A Little Prayer


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Really?

April 29, 2010
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I suddenly started feeling tired of my current (chlamydia) joke on the way home from work today.  Usually by the time I am sated, people have secretly been praying for ages for me to stop.  But then I logged into the administrative section of this blog and found an orgy of oglers.  A venereum of viewers.  A crazy Cupid’s cluster of chlamydiaphiliacs.

A lot of people who had checked out those posts.

People, PEOPLE, I know that this is a good place to come and expose yourself to chlamydia, but I didn’t realize that chlamydia was so attractive to so many of my fine frisky friends.  I was planning to turn down the music and dim the lights for a while and let the chlamydia joke get some sleep, but if you all want instead for me to put on a nice Beatles record and keep this baby awake, just let me know.


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Chlamydiamania! (Scene 4)

April 29, 2010
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Lucy explains a few things to Paul, to the tune of “In My Life”

In My Life

Of diseases I have weathered

From my life before I slept with you

Some have lingered, some got better

Some I keep suppressed with capsules blue

~

Some were treated with injections

And some needed pills, a few linger still

And damn that human papilloma virus

For the twice yearly paps that break my will.

~

But of all my countless lovers

You’re the first who’s passed Chlamydia

These diseases have their nicknames

I’ll refer to this as Lydia

~

There’s Sy-Phylis, whom I got from that guy Willis

Whose chancre was small, just like his thing

And Thea Gonorrhea hurts when peein’

But her treatment carries much less sting

~

Oh I know about that nasty hepatitis

And herpes and AIDS, and genital warts

I know I’ll often stop and think about them

In my life, and in my shorts.

~

In my life and in my shorts


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Song of the Day — Rimsky-Korsakov

April 28, 2010
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I used to wonder how Scheherazade found 1001 stories to tell.  I used to think she could only do so because she herself was a fictional character.  But sometimes I have felt like a fictional character in my own life, and those were the times when I had the fewest stories to tell.  My friend Kenny used to tell me when we were in college together, “Nick, you seem like an actor playing a part sometimes.  And not just that — you’re a LOUSY ACTOR.”

Lousy actors create impoverished stories.

I can act now, some.  Doctor Nick is a role I enjoy, because he pulls so much from my real life.  Writer Nick is the role I rehearse these days.  I can create a richer story than I used to.  I can also chat at parties.  Speak in front of a class of grad students, like I did last week.  Talk sports, as if I were a real guy.

But mostly my life is real, and this real life stuff makes storywriting easy.  It creates stories for me!  In profusion.  Way more than 1001.  All I have to do is pay attention.

Today, for instance — no, how about just the end of my workday?  Shall I tell you what happened with a can of liquid nitrogen, a syringe full of anesthetic, a scalpel, and a patient of mine who wanted a skin tag removed from a very personal place yet could not hold still because she kept giggling?  How I forgot to take my phone out of my pocket, and how it rang at the exact wrong time?  How we made it through successfully despite all that, only to find that the bandaid I had brought was a child’s bandaid with soccer balls on it?  Which, as I tried to decide whether to leave and get a normal one, she grabbed from my hand and put on herself, proudly announcing, “Now I have balls too!”  And cracked up.  As did I.

Shall I tell you this story?

Nah.

Here.  Listen to the second movement of Rimsky-Korsakov’s Scheherazade, instead.  I could listen to Scheherazade’s theme (is what the solo violin plays at the beginning here) forever.  You can imagine the details of the story while you listen to the music if you want.  Scheherazade’s theme.  Awkward social situation.  The Prince’s theme.  Phone rings.  The Prince and Scheherazade meet.  Soccer ball bandaid.  Take it away, Herbert von Karajan:

Rimsky-Korsakov_ Scheherazade, Op. 35 – 2. The Story Of The Calendar Prince


Song of the Day — Led Kaapana & Bob Brozman

April 27, 2010
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My thinking today feels like shoes in a dryer.  Thoughts are thumping, unpredictable.  Annoying.  Distracting.  Loud.

I hate this.

Days like today call for drastic measures.  Luckily, like me, my sister has a musical bad ex-boyfriend (MBEB).  This distant, long-time-ago ex left some of his CDs at her house after she made him go away.  (Love how she did that.  Poof.)  Years pass, she meets Shahin, whom I absolutely adore, and who did an excellent job of marrying her and becoming my brother-in-law.  (Love how he did that.  Poof.)  She moves, leaving behind in her old house only the things she does not care much about.  Like MBEB’s music CDs.

Comes 2008, when, in town for Diana and Shahin’s wedding, I stay at her now-vacant house.  Find MBEB’s CDs.  I realize it’s been decades since I last fulfilled my role as Bratty Little Brother Who Steals Diana’s Stuff.  Whoa.  Lots of lost time to make up for.  I am a caring brother, though, and decide to do my best.  Is an amazing opportunity to make her feel my fraternal devotion AND remove unpleasant residue of MBEB!

Think of it as a wedding present.  Welcome to the family, Shahin.  Don’t worry, I’ll steal your things too — just as soon as your status is official.

So, CDs go in my bag.  (Loved how they did that.  Poof!)  I burn them on computer into iTunes.  Offer to mail them back to her, knowing that she would feel guilty about demanding her stuff back, and decline my offer.  This is part of her role as “Long-Suffering Older Sister Who Wishes Nick Would Grow Up.”

One of the CDs I almost sent back anyway.  Hawaiian music?  Unworthy stuff, that.  String instruments either too slidey or ridiculously small.  Then I remembered that George Harrison (boy, that guy makes an outsized number of appearances in this blog) had a ukelele addiction, and I thought of my old friend Kurt Bell getting silly with a uke and having a great time.  I decided to give it a listen.

It’s great.  Kika Kila Meets Ki Ho’alu is an album of duets, played by Led Kaapana and Bob Brozman, on string instruments both slidey and ridiculously small.  You don’t have to visualize a luau, or hula dancers, or leis.  You can sit moping in your apartment in Cambridge, MA, visualizing a shoe tumbling in a clothes dryer, and still get carried away by the smooth, playful, slidey, ridiculously small string conversation between these two happy happy men.

Love how they do that.

Poof!

Ua Like No A Like


Song of the Day — Stewart Copeland

April 26, 2010
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I’ve never been an S.E. Hinton fan.  It’s a bit unfair, because I haven’t actually read any of her books.  Just saw the movie versions of The Outsiders, and Rumblefish, long ago.  “Bad boyfriends” is the way I would characterize her characters.  Unpleasant, insecure, inarticulate, potentially violent guys.   If I’m wrong about this, blame Matt Dillon.  I loathe him, and think of him as the ultimate bad boyfriend.  If he’s so perfect for the starring roles in those movies, then please let me take care of your two-year-old triplets while you go out and watch him.  Triplets have a stomach bug and keep vomiting?  No problem.  I must play Barney DVDs at full volume to keep them from fussing?  Done.

I had my very own bad boyfriend once, back in high school.  Maybe that’s a misleading way to describe what he was to me.  We were friends, not lovers.  Both of us craved nothing more intensely than a girlfriend, though neither of us had a clue how to pursue such a thing.

Even so, the descriptor fits.  I was insecure, and he expressed admiration of me.  Sometimes.  I was depressed, and he provided excitement.  But only on his terms.  I had a fragmented sense of self, and he defined clearly for me what I should be.  And what I should not be.  He was vicious in his judgments, tongue tied with his idols, cruel towards those who lacked status.

I will not name him.  My loathing a distant public figure like Matt Dillon does little worse than scuff my soul.  Hating this insecure, conflicted old bad boyfriend of mine would gouge me.  My soul is already pockmarked enough.  Besides which, bad boyfriends cannot exist in isolation.  I chose him, stayed with him.  I was a barnacle,  and he was my passing ship.

I joke sometimes about feeling hungover without having gotten drunk, as a metaphor for uncompensated pain, but knowing him was actually not a purely bad thing in my life.  Mostly I learned useful negative lessons, like don’t decide to like something just because someone else does, and don’t tolerate a bully even when it’s your friend who’s being mean, and don’t base your self worth on anyone else’s opinion.

One positive thing stays with me, though.  My bad boyfriend had excellent musical taste, and an enthusiasm almost magnetic in its ability to draw me in.  I owe him gratitude for introducing me to the whole Bowie/Eno/Talking Heads circle, and Elvis Costello, and many other, more minor, figures.

I saw Rumblefish with this bad boyfriend.  He was the one who noticed the soundtrack, and bought it, then made me listen to it.  It was Stewart Copeland’s masterpiece.  He had been the drummer for The Police, which was disintegrating as a band around that time. This soundtrack featured mostly instrumental music, some of which was fascinating but not so accessible, and some of which was just great, like this:

Our Mother Is Alive

There was one clear best song from this album, though.  One whose lyrics my teenaged sons live everyday, sung by Stan Ridgway (from Wall of Voodoo).  Though I kept myself boxed in with my bad boyfriend even after hearing this, the words and images stuck.  Eventually I jumped out of the goldfish jar and into a brand new skin.  Swam in the ocean, and acquired this piece of chalk that I’m using now.  This will make sense to you if you listen to the song.

Don’t Box Me In


Chlamydiamania! (Scene 3)

April 26, 2010
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Hey, Chlamydiamaniacs!  Bad news!  Someone must have slipped a Z-Pak into my drink, because I’ve suddenly lost touch with my inner Chlamydia.  Oh well.  Sometime I’ll get myself liquored up and rediscover it.  In the meantime, here’s the last song in the bank for the moment.  Needs a few repairs, but works well enough for now.

Background: Paul gave Lucy Chlamydia on their first date.  Lucy got diagnosed and called Paul to yell at him.  He likes her, though, and now he’s starting to wonder if maybe they can work it out.

To the tune of this song:

I’ve Just Seen a Face

~

I’ve just had a test,

I won’t forget the pain of hearing this result

She’s just a girl I met.  No, not a girl —

A fully grown adult

God damn.  Argh!  God damn shit.

~

Had I not had feet of clay

I might have called her back today

But as it is she called me first

And told me that I may just be the worst

Jerkwad, self-centered git.

~

Lucy, how I do pity ya

Gave you Chlamydia.  That’s all (I hope).

~

I just didn’t know

I had no symptoms

Even when I took a whiz.  Ain’t been with

All that many girls before, but boy is this one pissed.

Wish that condom had fit.

~

Lucy, we nearly broke the bed

And though you feel misled, I’m just a dope.

~

I’ve just had a taste

Don’t want to let this go to waste

She’s quite a dish.  If I could only have

One wish, would be to stop, rewind, erase

Get her out of her snit.

~

Stalling, cause I keep bawling

Should I try calling her back again?


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Song of the Day — Grateful Dead

April 25, 2010
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How odd.  I assume that rollicking Chlamydia humor will attract people, then I post a story about a small incident from work and it is this story that draws a huge number of site views.  Not sure what that means, but I guess I’ll just keep posting what feels right and let you all sort it out.

Anyway, I heard from a long-lost friend the other day.  Katy Champlin was my first crush, in 4th grade.  A lovely girl who laughed and danced and seemed tremendously alive.  She seems to have lost none of her vividness.  We reconnected via Facebook the other day, and this morning I received what she called a “box of words.”

~

The Grateful Dead is a band that provokes contrary responses.  Some people swear by them.  Others seem disgusted, or annoyed.  I have never been a Deadhead, but do like some of their songs.  This one has a harmony that is particularly evocative.  Wish I knew for sure what it is.  Seem to remember my mom saying something about a fourth harmonic.  I have no idea whether Katy likes the Dead or this song.  No matter.  It is lovely.

Box Of Rain


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The Times They Are A Endin’

April 25, 2010
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I was a bad doctor the other day, and God noticed.

I mean it.  I’m as secular as the next guy (as long as the next guy doesn’t happen to be Christopher Hitchens).  The only reason I call myself an agnostic instead of an atheist is that atheism requires a level of certainly that I can only imagine coming from scripture, or some other divinely revealed source.  Which would perhaps undermine the idea that God does not exist.

My agnosticism is anything but a squishy position.  It is the only framework that fits with MY core belief, which is that I cannot know anything for certain, and must constantly fumble around with successive approximations of the truth.  (Actually, I don’t believe in truth either, or reality, but that would take us on a second order digression.  Which would be undisciplined of me and unfair to you, because you probably want me to get back to being a bad doctor.  Fine.  Let’s just say that life goes more smoothly when I pretend that reality is real.)

One of the countless things that is difficult to know for certain is whether an episode of acute conjunctivitis is caused by a bacterial or a viral infection (or sometimes whether it is an infection at all).  Any primary care provider — particularly those of us who see children — confronts this problem regularly.  When one’s child is sent home from school because her eyes glow a satanic shade of red, it is an understandable response to bring her to the doctor.

Most often the infection is viral — a cold bug gone astray, a runny nose of the eyes.  If both eyes are affected equally, if there is little to no production of eye boogers (sorry, proteinaceous debris), if the child has a concurrent runny nose, if there is not much redness or swelling around the eye(s), then my response is clear.  “This is a virus,” I say, confidently.  (See!  I CAN pretend that objective reality both exists and is definitively knowable!)  “Wash your hands constantly, keep her home until X and such a time, and call me if she develops these other symptoms or does not improve within a week.”  Then I wash MY hands compulsively and move on.

Usually this involves a discussion with the parent.  “Why is my child not being treated?”  Reasonable question.  We have no antibiotics that help with cold viruses.  “How can you be sure she does not need antibiotics?”  Another reasonable question.  I point out what I see.  Often, we talk about when she can return to school, and the parent stresses about missing time from work.  Sometimes the school has sent a note via the parent saying the child cannot return until treated with antibiotics.  This used to drive me berserk, because sometimes that is just the wrong thing to do.

Often, I prescribe a “backup” prescription for antibiotic drops or ointment.  This is actually a valid approach, because having a viral conjunctivitis puts you at risk for developing a superimposed bacterial infection, which SHOULD be treated.  However, it is also one way to deal with a parent who is convinced that the child needs antibiotics, and who often will continue bringing the child to see other doctors until the child receives “treatment.”

None of which helped me avoid God’s attention.

This past Tuesday*, Luisa brought her daughter Annabella to see me about an eye infection.  Luisa is one of my more frustrating patients.  She always comes with a range of concerns, some of them important to address because they are potentially critical to her health.  She speaks extremely slowly and constantly backtracks and revises, gets lost, then remembers her point just as I am on the verge of despair.   She then often completely rejects the tests I think are crucial for her health, and demands others that are completely uncalled for.

I girded myself when I saw Annabella’s name on my schedule.  Noted the chief complaint of “eye infection.”  Darted in, took control of the conversation immediately and didn’t let go.  Annabella had conjunctivitis.  Fairly classic viral conjunctivitis.  A little worse on the left, a little more boogery and inflamed on that side than you usually see in a viral infection, but the right thing to do would have been to have the conversation with her mother and send her out with at most a backup prescription.

Instead, I thought about my schedule, this visit pinched between double bookings and complicated diagnoses.  I thought about Luisa, and how hard it is to talk to her about important things, let alone this self-limiting infection.  I thought about erythromycin ophthalmic ointment, and how benign it is.

And caved.  To myself.

I walked out of the room, printed a prescription for the ointment, came back in and handed it to Luisa, reviewing the standard precautions and caveats.

“Thank you, doctor,” she said.

“You’re welcome,” I mumbled.  My little seed of shame floated in a warm bath of relief, and I decided that this was an acceptable lapse that would help me avoid burning out before the end of the day.  I turned to walk out of the room.

“Oh, doctor — one more thing,” Luisa said.  (This, in medicine, is called the [hand on the] Doorknob moment, the moment after the visit is over when the patient says, “I have a lump on my breast.  Can you just check it quickly?” or “I forgot to mention my crushing substernal chest pain that started 2 hours ago and is worse when I exert myself.”  It is a dreaded, and fairly regular occurrence.)

I turned.  Braced myself.  Planned to be firm with her.

“I know it’s off the subject,” she said.  I nodded.

She paused.

Her pauses are really long.

“Do you know that we are in end times?” she asked, finally.

“I’m sorry?” I said.

“End times,” she said.  “The end of days.”

This was not the kind of health-related question I had expected.  My mind raced, but I could think of no answer.  If I were to say, “no, I didn’t know that,” then that would be an implied invitation for her to impart more information to me.  By handing her the prescription I had reached my maximum tolerable level of unprofessionalism, so did not feel able to lie and say, “yes, I know that already,” then walk out the door.  On top of this, I rarely discuss nonmedical topics such as this with my patients.  I am there to be their doctor, and religion and politics could only interfere with that.  I have a few pat answers that I pull out when asked if I have accepted Jesus Christ as my Lord and Savior, or whether I know that God works through me, for instance.

None of my usual answers fit here, so a conversational hole appeared.  Luisa quickly began to fill it.  “I mean, you see the volcanoes exploding, and… airplanes can’t fly, and…”  She paused.  I began to recover, but before I could say anything, she went on.  “We have all these things that the scientists don’t understand, and it means we are living in the end times, that Jesus Christ is coming.  You read about this, I’m sure,” she said, smiling.  “I just wanted to make sure you were getting ready.  It will be very bad for you if you are not.  You should think about your family, too, and prepare them.”

I must thank God, if He exists, for making His warning about my erythromycin prescription so gentle.  That really was all that she felt she had to say, although she made it clear that she would be happy to continue.  My first response seemed to mollify her.  “Well, all any of us can do is to be the best person we can be today, isn’t it?  And tomorrow be the best person then, too.  And so on.  That’s what I focus on, myself.”  I tried to ignore the hypocrisy of saying this after having just been distinctly Unbest.

She smiled.  “You must pray constantly, to Jesus Christ, as well,” she told me, and took Annabella’s hand in hers.

I shook her other hand.  “Thank you,” I said.  “Do call if Annabella’s eyes don’t improve.”

“Oh, I will,” she said, and walked out.

After she left, I washed my hands very carefully.

~

*As always, the names and dates have been altered to protect confidentiality.


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