metafilter boots up...

Well, I guess Matt has let the cat out of the bag — the newest member of the Queso network will be the MetaFilter server (and all the sites that come along for the ride). Now, it’ll be that much harder to resist my demonic urges to slowly manipulate the backend code to quietly install my minions in positions of influence and importance…

UPDATE: the server arrived and is now back up and running. Between my pictures (alas, a film camera) and Anil’s screen captures from my webcam, there’ll be a picture show soon enough. In the mean time, enjoy, everyone…

In the last two weeks, I’ve dealt with no less than five children who were the victims of sexual abuse — a twelve year-old, an eleven year-old, a ten year-old, and two three month-olds. After all that, it’s much easier for me to look at policies that require sex offenders to identify themselves publicly in a much more sympathetic light.

Regarding yesterday’s mention of the ass who tried to extinguish the Eternal Flame (pun intended), Alex Griessmann reminded me that a group of drunk Mexican soccer fans once succeeded where this guy failed. Undoubtedly, a proud moment in those guys’ lives…

Windows 2000 Magazine has an article pointing out the known issues with the Win2K service pack 2 — it seems that they’re pretty minor, and in my experience so far, the service pack is well-worth the installation.

One fix not included in the service pack is a potentially-exploitable memory leak in the Windows 2000 domain controller code. If you’re running Active Directory servers, Microsoft recommends that you install this hotfix lest crackers have the ability to bring your servers down.

Wanna know how big a geek I am? Today, I was surfing around, came across an atomic radio clock receiver, and began salivating. How cool would it be to have an atomic clock in your very own home? (Wait a second — I just realized that my GPS receiver does the same thing, and I already own it. Now, if I can figure out a way to get it to pick up satellites in this concrete jungle…)

This week, I moved from the inpatient wards to the emergency room; for the next two weeks, I’m on the evening shift, from 5 PM to 2 AM. It’s the first time in my life that my job reflects the hours that my body wants to be awake. If left to my own devices, I’d wake up at noon and go to sleep at 3 AM every day… this rocks.

If you have to read just one account of a woman following a bare-assed, hairy man in chaps around Long Beach, California, let this one be it.

How completely cool — IBM is providing free, unhindered access to the world to Linux running on an S/390 mainframe, so that you can test your applications or just play with Linux on big iron. Pity that registrations are suspended right now “due to heavy enrollments” — I’ll have to check back in soon.

Why have I never heard Opie and Anthony?

More importantly, though, why was it not more well-publicized that someone tried to extinguish the Eternal Flame with his ass?

I’m not too terribly sure how I feel about the Supreme Court’s ruling allowing Casey Martin to use his golf cart on the PGA Tour. Don’t get me wrong — I think that it’s great that the courts recognize that people with disabilities should be given the exact same chances to live out their dreams as everyone else. What keeps going through my mind, though, is how the same doesn’t apply to, say, a runner who suffers from dermatomyositis and uses steroids to bulk up her muscle mass to that of her peers, or a basketball player who suffers from narcolepsy and uses amphetamines to keep himself awake during games. Interesting questions, probably for future courts of law.

I’m excited — this week, we’re scheduled to get a new member of the Queso network family. Expect more information soon.

Jason: Just curious as to why you cheer for the San Antonio Spurs…I live in San Antonio, and for the first time in nearly 15 years, I actually was following a sporting event out of excitement. The loss of the Spurs gave me great pleasure (details if you want them)…but I am puzzled as to why the Spurs is *your* team. Cheers/Dave

Someone remind me to spend a little while looking through William Gedney’s pictures of New York when I get more time.

How badly do you think the world needs a toaster that burns your local weather report into the toast? The scary thing is that Robin Southgate is apparently turning this in as her (his?) major project.

Let’s be perfectly clear about this — the Los Angeles Lakers made my San Antonio Spurs look like a high school pickup team in last night’s 39-point rout. This one is over.

I can’t tell you how saddening it is that advertisements are going to be digitally inserted into the syndicated Law & Order episodes that are going to be run on TNT this year. One of the best shows on TV is going to become one of the most gimmicky stunts on TV — great.

God, I was hoping that the switch of Jim Jeffords to the independent column in the Senate would lead to the failure of Ted Olson’s Solicitor General nomination. Unfortunately, Republicans slid him in under the wire; we now have a man who lied to Congress as the head defender of the United States government in court.

Originally found over at (the on hiatus, sorry Dan!) Lake Effect, I’ve been hanging onto this great way to work around Netscape’s terrible style sheet incompatibilities. (Now, I just need to implement the damn thing.)

I’m sitting here reinstalling Linux (thanks to a hard disk that didn’t didn’t want to go on living), with the constant reminder why I like Microsoft operating systems — the installation is much, much easier. Nevermind the idiotic interface and terrible documentation; the package dependency feature alone is enough to cause my blood pressure to skyrocket.

Sometimes death is not the worst option.

On Sunday morning, I went into work a little early so that I could spend time feeding the abused twins that we’re taking care of on my service. It?s a rare weekend day that I go into the hospital for call early; as it is, I can expect to be on the wards — and actively running around — from 8 AM until at least 10 AM the next day, so even spending an extra 15 or 20 minutes there is a pretty big stretch. But at 7:30 AM on Sunday, I planted myself firmly in the chair between the twins, grabbed one of them, and settled in with a bottle of formula.

It was around 7:45 that I thought that I heard one of the nurses say the word “arrest” in the hallway outside. My ears perked up a little bit, and about 10 seconds later, the same nurse called out over the intercom, “All doctors to room 1032.” I stood up quickly, tossed the twin to the police officer guarding the room, and raced around the corner to see what was going on.

Now, a little background on childhood oncology might be in order here. Most people are familiar with what would be considered standard treatment for cancers — chemotherapy is the mainstay, and for the most part, a typical oncology ward at a children’s hospital is populated with kids who are undergoing chemo. There are, however, children who have forms of cancer which don’t respond to this, and for many of them, the only available option is bone marrow transplantation. BMT is a completely different beast — we use even more toxic medicines to completely remove a child’s native immune system, and then install a new one in the hopes of eradicating the cancerous cells. The children undergoing bone marrow transplantation can get very sick, and any little insult — a viral illness, an ulcer, a urinary tract infection — can overwhelm what little reserve they have left. Most of the time, taking care of children around the time of their transplants involves fighting off every little threat in the hope that their new bone marrow will take hold (“engraft”) and ramp up to normal function. At the time, we had six children on the ward in various stages of transplantation, and three of them were within the couple-month window where anything could happen.

When I heard the room called out over the intercom, I knew the patient immediately. Nancy (not her real name, of course) had had a bone marrow transplant around six weeks prior, and her course had been a particularly hard one. She had experienced the typical set of complications that plague these children — fevers, mucositis, anorexia — but had also developed a few more serious problems, including the one most feared in transplantation, graft-versus-host disease. GVHD occurs when some of the immune cells from the donor’s bone marrow realize that, now transplanted, they are in foreign territory and attack the recipient. Everything possible is done prior to transplant to try to prevent GVHD — certain markers on a patient’s blood type are matched to the donor to make sure that there aren’t incompatibilities, and recipients of bone marrow transplant are maintained on high-dose immunosuppressants during the time when they are most susceptible to GVHD — but nonetheless, there are times when the feared occurs. Nancy had developed the worst grade of GVHD, in which the immune cells were attacking her skin, her liver, and her gut, and we had been spending a significant amount of time fine tuning her therapy to attempt to ameliorate the problem. Despite this, she had been deteriorating, and towards the end of the week, she had developed relatively severe inflammation throughout her GI tract.

I was the third person to arrive in Nancy’s room. Already there was my senior resident, as well as the intern who I was to be relieving that morning; they quickly called out that the nurse had found Nancy unresponsive. We put a monitor onto her and saw that her heart rate was around 30, and she did not appear to have any respiratory effort to speak of; my senior resident began chest compressions, and I grabbed the bag-valve mask to start breathing for Nancy. By that time, the arrest cart had arrived outside the room, and one of the senior residents had arrived from the pediatric ICU; he took control, and started calling for arrest medications. I pushed epinephrine once, then a second time; at that point, her heart rate came up to the 50-60 range, but she still had no palpable pulses. I then pushed atropine and sodium bicarbonate, we hung an epinephrine drip, and (having arrived a few moments prior) the ICU fellow intubated Nancy. We started running fluids into Nancy wide open — first, using just saline, but quickly moving to albumin, a thick protein-filled liquid which helps a patient maintain volume in their arteries and veins. Somewhere in the fray, Nancy was moved onto an arrest board (since doing chest compressions on a soft, cushy bed is next to impossible); it was handed into the room by one of the dozens of people (residents, fellows, students) who had collected outside the doorway to the room.

While one of the residents was placing an arterial line, we quickly reevaluated the situation, and realized that things had gotten better. Nancy had a blood pressure and pulses in her arms and legs; she was also moving a bit and responding appropriately to questions. I placed my hand in hers and asked her to squeeze, and was rewarded with a gentle pressure around my fingers. I asked her if she wanted to see her mom, and she nodded yes, so her mom quickly wiped the tears from her own face and was shepherded through the mass of people to the bedside. Next, though, the ICU nurse who had taken over the ventilation job reassured Nancy that she was going to be OK… and she began nodding her head back and forth. She was clearly miserable — lying naked, a tube down her windpipe, another tube down her throat, terrified about everything that had just happened. Tears were pouring out of her eyes. People were flurrying around her, getting everything ready to move her as fast as possible to the ICU.

After Nancy was moved, my senior resident grabbed the other intern and I, and we decompressed for a little bit. We then started rounds so that they could sign the team over to me, but we all found it very hard to keep from returning to what had gone on for the previous half hour. It was, to say the least, surreal — we had gone from relaxed to 100% adrenaline, and we were all still shaking from the arrest.

About ten minutes into signout rounds, there was a knock on the door to the conference room, and one of the ward nurses came in to tell us that Nancy had just succumbed. She didn’t have any details, though, so we quickly finished up and went down to the ICU. Apparently, within 10 minutes of arriving, Nancy arrested again, and the ICU team began another entire round of resuscitation. A few minutes into the code, however, Nancy had a massive pulmonary bleed, and at that point, it became impossible for her to get enough oxygen to live; within sixty seconds, she died. By the time we got there, the parents had already been brought into the grieving room and told what happened, and the bone marrow transplant team was outside the room, beginning all of the paperwork. I walked into the room, and Nancy was lying in the middle of the bed, as peaceful as I’d ever seen her. The nurses were gently cleaning her up, removing all the catheters and bandaging up her wounds, and for the first time that I had known her, there were no noises of pumps running, no beeps from monitors, no whispers from oxygen masks. There was nothing except the quiet acknowledgement of a life ended by tragedy, but also of pain replaced by peace.

Later in the day, when someone asked me how I was doing, it hit me that it was that last moment that I saw her when I realized that I had been coming into work every day for the past month expecting exactly what had happened. Nancy had been sick — far sicker than any of our other patients, and constantly teetering on the brink between able to fight and willing to give up. She had also been miserable, nearly inconsolable, and over the course of taking care of her, I began to realize that there are times when it is appropriate to acknowledge a basic fact of life: death is not always the worst option. Nancy had endured tortures far worse than anything I can imagine, and Sunday morning, she was at the point where the pain and misery had stopped taking breaks. Finally, she banished them forever.

This weekend, one of my sickest patients finally succumbed to her illness, and made me think about what it is that keeps me going in a job where kids can and do die from their diseases. After thinking about what these kids go through, though, I realized — death is not always the worst option.

Oh… my… GOD.

Everyone, click on this photo link. Not because it’s a terribly great picture; it isn’t. Not because it’ll enlighten you to something about which you need to know; it won’t. Instead, do it to prove a point.

I really don’t think that this mathmatical proof of the true nature of women could have come at a more appropriate time for me. (It appears that the site that hosts the image is down; in the mean time, I mirrored the image locally.)

Oh, what a great Bushism:

For every fatal shooting, there were roughly three non-fatal shootings. And, folks, this is unacceptable in America. It’s just unacceptable. And we’re going to do something about it.

I know it’s gonna shock everyone that the stories about the rampant White House vandalism by the outgoing Clintonites were untrue.

More Windows 2000 Service Pack 2 information: there’s now a list of the security bulletins which have been rolled into SP2. An important detail that this page mentions is that security fixes to Internet Explorer 5.5 are not part of SP2; go here to get these patches.

Once again, my time in the hospital has turned into dealing with abuse, and it’s making me incredibly ambivalent about going in in the mornings. Wednesday night, I admitted a set of twins who were brought in by their aunt after she noticed bruises and abrasions all over their bodies. A few days later, the catalog of damage includes: one broken femur, one broken humerus, at least fourteen broken ribs, two skull fractures, a dozen bruises, a half-dozen bite marks, and a couple things that I can’t even begin to describe. The only part of the case I look forward to is going in a little early each morning and feeding them.

Hello Noah! (For the uninitiated, that’s a picture of my brother and I on our vacation to Alaska last year; we’re in front of a lake that was off the side of the road on our drive back from the Kenai Peninsula.)

And as for why I’m saying hello, it’s because he’s the first family member of mine to discover Q Daily News (I’d bet from this search query that showed up in my referrer logs today). I don’t know why I’ve kept it hidden — perhaps because it’s just ramblings, not really meant for anyone much less for those closest to me, but it’s cool knowing that now the secret’s sorta out. (And, being that he’d probably keep a great site, maybe now I can coax him to let me set him up with an online home of his own.) Does anyone else hide their sites from their family? Their loved ones? Discuss amongst yourselves (you’ve got to log in to talk).

And a link for Noah — David Neiwert’s article, The First Ted Olson Scandal. I haven’t read every word of it yet (being that it’s incredibly long for an online piece), but it seems to be a pretty detailed glimpse into some nasty doings by the person who stands a good chance of being confirmed as our country’s next Solicitor General.

Everyone does know that Windows 2000 Service Pack 2 is now available, right? The W2Knews folks have made the readme file available, as well, and the Microsoft knowledge base articles about the service pack are slowly coming to life on the MS support site. So far, the list of fixes is available (in four parts — one, two, three, and four), but the release notes aren’t yet up.

There are also a few new knowledge base articles related to Service Pack 2: installation information, updates to the Win2K support tools, and enabling app compatibility mode are those that I’ve found so far.

Unlike a couple others out there, I’m not on an official posting hiatus, I’m just getting my ass kicked at work. Only a week and a half left of this rotation, though, and then I’m on evenings for a little while, leaving plenty of time awake to play on the web.

There’s only a week left to apply for the MetaFilter scholarships, people, and Matt says that only a few people have submitted their essays. What, is it really that hard to give away money?

The House International Relations Committee voted 26-22 last week to overturn Dubya’s gag order on foreign organizations which engage in abortion counseling. Unfortunately, it’s just a House vote, which is now subject to debate on the floor of the House, the floor of the Senate, a compromise committee, and then (almost assuredly) a Bush veto. (Once again, I am reminded how completely idiotic it is that this man feels that we can’t give aid to organizations engaged in family planning and abortion counseling, but we can give aid to religious groups.)

Has anyone else added SmarterChild to their AIM buddy list? (Oops. It appears that AOL has disabled the bot for now, probably in anticipation of a more public launch soon.)

Jamie, of the New Orleans Real World cast, bungee jumped off of the Golden Gate Bridge over the weekend, but got tangled in his cords and had to be rescued (and arrested). He claims that he jumped in order to draw attention “to the need for a positive movement of personal growth and social healing” — or, more likely, because the voices in his head told him to.

A man filed a lawsuit for “hundreds of millions of dollars” against McDonald’s for lacing their french fries with beef flavoring, claiming that they are deceiving people by not telling them that the fries are not vegetarian. All I know is, if this guy’s lawsuit manages to raise the prices of McDonald’s fries by one cent, I’ll personally seek him out and punish him in the manner he so desperately deserves.

WOW, do I need to exercise more. Today, there was a pediatric arrest called in the hospital, but it was going on in a radiology suite that’s about five buildings from the actual children’s hospital — about a quarter mile away, including seven flights of stairs, two above-ground crosswalks, and two-dozen fire doors. By the time I got there, I was completely out of breath, and I swear that there was some substernal chest pain raring to rush forth. Thankfully, the child was fine (he was an outpatient who was being worked up for a known seizure disorder and had a seizure); unfortunately, three of us ended up in the pediatric pulmonology fellow’s office, opening up our airways with the help of a little albuterol. Because of this, when I got home tonight, I promptly strapped on my rollerblades and did the six-mile Central Park loop… I feel a bit better now.

I apologize for the silence here… I’ve been distracted, in a GOOD way.

An update on Jenny, for those of you who asked how she was doing: she was admitted to the hospital yesterday for preliminary imaging studies, and she’s booked in the operating room to have the tumor removed on Monday. Today, she went to angiography in order to visualize the blood vessels which feed the tumor — the neurosurgeons are looking to both predict any tricky parts of the surgery, and embolize any vessels which look to be a major problem. The embolization carries with it a pretty big risk, so Jenny’s going to be in the ICU from here on out.

I’m headed to the Poconos this weekend for my intern class retreat… kayaking, hiking, and the inevitable beer or twelve. It’s beautiful here in New York right now, and I cannot wait to get some sun exposure for the first time in who-knows-how-long.

While I’m gone, enjoy the wit and wisdom of some of my current faves: