I usually use a little micro-hard disk in my MP3 player, and while I love the amount of music it lets me keep at any one time, one of the frustrating things is that it has a tendency to skip if I jiggle it a little too much. Right before I flew out to Seattle, though, SLC filled a CompactFlash card with music for me — a card without any moving parts, and I’ve been listening to it since. Yesterday, though, I realized that I sort of miss the little micro-hard disk — it forced me to slow down a bit, not rush around as much, pay attention to everything around me. And in thinking about that more, I realize now how important that concept’s been in almost everything in my life lately, and how much happier I am right now because of that seemingly little change.

OK, so I’ve found another place in Seattle that I love — the Elliott Bay Bookstore, in Pioneer Square. Wow; this is my favorite bookstore, ever. All old wood bookshelves, level after level, and every sign of a staff that pores over the store with immense care. The best part is that there are staff suggestion signs on every single bookcase, each with reasons why you’ll love the book. After spending a few hours inside the store yesterday (I read an entire book there!), I understand why people worry about the spread of Borders and Barnes & Noble superstores, and the rise of Amazon and its ilk online — stores like Elliott Bay may disappear in the near future. That would suck.

In other Seattle news, the inherent goodness of all mankind was on full display Tuesday morning when a woman was threatening to jump off of a bridge on Interstate 5, and motorists who were delayed by the police activity began screaming at her to jump. She eventually did jump (although that’s not to say that they were the cause); she’s in serious condition at a local hospital. The whole thing was a bit depressing. (As always, there’s a MetaFilter thread going already.)

OK, if you’re ever in Seattle, you have to go to the Experience Music Project. What a phenomenal place. I spent six hours there yesterday, and could easily spend another few days without exhausting everything. (I spent nearly three hours in the jazz sections, and nearly two hours in the hip-hop/rap sections alone.) It’s a true multimedia experience — they give you this little handheld/wearable computer, and as you walk around, it gives you audio clips on everything that you see. You can bookmark things, and then go to their website, type in your ticket number, and see all your bookmarks. (My bookmarks, however, didn’t get uploaded, which throws a monkey wrench in that whole concept. Bummer.) Trust me — dedicate a day to it, and enjoy. (And I can’t let the thanks to Kiehl go unsaid for the recommendation.)

It’s amazing how things can change in the blink of an eye. There’s a lot more to say; I’ll get to it. It’s good. smiley:

I’m off to Seattle today for a 12-day vacation… but never fear, chances are good I’ll be checking in here, since I have stuff I need to do online while I’m there, and I’ll have pictures from the hiking and whatnot.

How much did I love Buena Vista Social Club? So much. I’ve been listening to the CD for a few years now, but after having seen the movie for the first time last night, I realize how little I understood about the monumental effort and significance of it all. What an amazing group of people.

Meg is kicking ass, and reminding me why I like reading her and chatting with her whenever I get the opportunity.

What a weird story — a girl goes missing a month ago, after being assaulted and then being temporarily hospitalized in a psychiatric unit, and now she turns up and calls home. The nice part of the story is how people have rallied to help the family out and bring the girl home.

So, I’m finished in the peds ICU, and I’m sad to say that I don’t go back there this year again. It was a tough rotation, but honestly, the best way for me to learn is by doing, and the kids in the ICU need a lot of hands-on work. I’ve also gained an appreciation for just how resilient kids can be — I got to see them go from overwhelmingly sick to rock-stable in much shorter amounts of time than I thought possible. All in all, I’ll miss it a lot.

I have been immersed in Ninjai, a stunning animated cartoon about a young little Ninja trying to figure out his place in the world. It’s a bit gory, but the animation is only surpassed by the voices of the characters. It’s a bookmark, for sure.

Anil is a damn funny little teetotaler. Trust me, you gotta go read this; hell, then, cut-and-paste it into your mail program as an automated reply to your friends who forward a few too many “funny” emails.

Something to jot into your dayplanner: September 22nd through 29th is the American Library Association’s Banned Books Week. Take a stroll through the list of most-frequently challenged books of the last decade, and choose a few to read over the course of that week; encourage your kids to do the same. (I’ve started early. In honor of its fiftieth birthday, I bought Catcher in the Rye a few weeks ago, and started rereading it a few nights ago. Anyone out there have any other appropriate suggestions to enrich my end-of-September reading list?)

Something to remember during my upcoming hiking trip to Seattle: it appears that the glaciers around Mt. Rainier are acting up. Apparently, during hot weather, water melts within and underneath glaciers, and after it reaches a critical pressure, it breaks free in what’s called a glacial outburst. Seeing that Noah and I are planning (at least as of the last time I asked) to hike the Blue Glacier, maybe we should be a little careful.

shuttle gliding into a landing

What a great picture of the Shuttle coming in to land today. It always stuns me when I see pictures like this, because it’s right about then that I remember that the Shuttle glides into landing — no power, no engines, nothing. I’d imagine that that puts a little fear into the hearts of the astronauts onboard…

A definition of humbling: watching a child go through full respiratory arrest right in front of you. A definition of inspiring: participating in a smooth, successful resuscitation, and as a team, bringing the child back from the brink of the arrest. That was a long night, but I wouldn’t trade it for the world.

Good luck on the move to Seattle, Gael!

Ummm…. does anyone care to explain this one to me?

“One of the interesting initiatives we’ve taken in Washington, D.C., is we’ve got these vampire-busting devices. A vampire is a — a cell deal you can plug in the wall to charge your cell phone.”

I don’t understand why everyone’s up in arms about Microsoft removing support for older Netscape-style plugins from the latest upgrade to Internet Explorer. Yes, it’s annoying, I’ll grant you that; now, I have to download QuickTime movies in order to watch them. But strangely, other plugins haven’t been broken (like RealPlayer and Acrobat, at least on my machine), so I’m finding it hard to blame Microsoft, rather than Apple, for this one. And has anyone ever demanded that Netscape add support for ActiveX components? Once again, it smells like hatred, rather than logic, is driving this outrage.

It doesn’t seem right that such a beautiful picture comes out of something that’s causing so much damage.

Yesterday, the New York Times brought us a pretty depressing story about a Kansas City pharmacist who, in the name of saving money, dispensed diluted chemotherapy to doctors and patients. How completely disgusting. Interestingly, the article says that the pharmacist admitted doing it “out of greed,” but that he plans to plead not guilty to the charges — I don’t understand that. (In case you don’t want to sign up for NYT access, here’s the Kansas City Star story, as well as the AP story and the Reuters version.)

Last week, I had dinner with my parents, and one of the topics of conversation was how idiotic someone has to be, in this day and age, to open an attachment without explicitly knowing what it is. Today, I got a call from my parents, asking how to fix the damage that occurred when my dad opened up an attachment that was infected with SirCam. I’m truly stunned — the man can operate on someone’s abdomen, but he can’t figure out comptuer viruses. (For future reference, Symantec has a removal tool that seems to do its job quickly and well.)

I’m trying out the News Items feature today. This means that each posting has an independent link for discussion, if any of you out there feel so inclined; the same link serves as the permanent link to that specific item. (The circled P in the date bar above each day’s entries still is the permalink for an entire day of postings.)

I don’t like that the News Items style is all or none — my home page doesn’t show the older-style postings when I’m in the News Items format — but I’m willing to give it a shot for now. I also don’t like that I tell Manila how many items to show, rather than how many days to show; I wonder if there’s a way to make the number of days the priority.

If you’re looking for the posts from the past few days, you can find them by clicking through the calendar on the upper right, or you can read Friday here, Wednesday here, Tuesday here, and Monday here.

Well then. Today, my pager went off during rounds in the PICU, and when I returned the call, I found out exactly who the secret visitors to Q from my hospital are. Wow… I’m perfectly willing to say that I’m a bit freaked out, but also very glad to have the new readers.

Thanks go out to Lawrence for sending me notice that my prediction was right — Q is now the third site listed if you’re hunting for a replacement penis. (And, by the way… holy crap, is Google indexing sites quickly these days.)

I’m glad to see that Edward Felten finally plans to speak on how his Princeton team defeated the SDMI music watermarks. I’d hate to think that the threats of the music industry would continue to prevent people from openly talking about these things.

There are two new Microsoft security updates to be aware of: a cumulative patch for IIS that actually includes a few new fixes, and an Outlook component fix. Just in case you don’t get these security updates automatically

There’s a new free website provider out there, but with a special bent: websites that help people in the hospital keep in touch with those close to them. It’s an interesting idea; I found out about them because my hospital just set up a co-branded site that offered the services to our inpatients.

I’m glad to see that there are new studies showing that all cellphones impair driving ability; maybe now the states that specifically exempt people from responsibility for accidents if they were using a hands-free phone will rethink the wisdom of those laws.

Genius, sheer genius.

Can anyone make heads or tails of this support article? This bug is biting me, preventing me from being able to save some attachments from my secure WebMail server, and I can’t figure out what the article is trying to tell me to do.

my best yankee seats ever

Tonight, I had, bar none, the best seats I’ve ever had at Yankee Stadium — the first row off the field, about twenty feet to the third base side of home plate. But, as always, there was a downside. (“What possible downside could there be?”, you ask incredulously.) The tickets were courtesy of the owner of the Tampa Bay Devil Rays, so that meant that I couldn’t root for the Yanks — and it damn near killed me. The Yanks went and won it, though.


My stomach hurts in a bad way. Either something I ate at Yankee Stadium doesn’t like me, or this is my psyche’s way of telling me something.

Hmmmm… from perusing my log files, I now have a clandestine new reader in the hospital that employs me (and if I can trust the hostname of the computer, in the actual building in which I work). Who are you, new visitor?

Honestly, I wasn’t going to post today, but how can you not post when you run across an article about Russian doctors growing a replacement penis on some guy’s arm? Freeeeeeeaaaaaky. (Great… it just hit me that now, I’m going to get search engine hits for people who are hunting for that perfect replacement penis.)

The NASA Helios plane is just damn, damn cool. The thing is up there, flying at nearly 100,000 feet above the surface of the Earth, and because it’s solar-powered, it can stay up for a long damn time. I wonder how easy it is to manage via remote-control, though… hell, those little Radio Shack jobbies are hard enough, and they’re only about 50 feet above your head and you can see them while you’re flying them.

Oh my god — it looks like there’s going to be a Facts of Life reunion show. I’d be embarrassed to find out exactly how much time I wasted watching FoL as a kid (and, likewise, Diff’rent Strokes, Good Times, and The Jeffersons, since they were on in a two-hour block).

Why is it that, despite the fact that I subscribe to Salon Premium, I still get the little essays on my Salon home page that describe why I should subscribe to Salon Premium? Seems idiotic.

“Other things may change us, but we start and end with the family.” (Anthony Brandt, 1984)


Good luck, Noah; you’ll kick ass tomorrow (of course), and the rest of it will pass.


You’d figure that there would be some karmic balance, that spending this much time in the peds ICU would mean that my life outside the hospital would be nice and uncomplicated. Alas, that’s not what’s in the cards, apparently; between people getting sick in my family, confusion and tension in my personal life, and a general feeling of unsettledness, I can’t help but peek around every corner wondering what’s next. And in general — and I know this will shock you all — I don’t like that feeling, especially given the big things that are coming up over the next few weeks.

This weekend seems to have been all about finding sites that are going to manage to make it onto my daily read list. The latest entry: designweenie, which seems to combine randomness and geekiness as much as I do. Have a read; I’ve found it as satisfying as a cold front in August.

Thanks go out to Dr. Herschel Lessin for his good article on pediatric health-related old wives’ tales. The prevalence of beliefs like these in my patient population is pretty high; the first time I had a mother bring her child into the ER with tomato sauce smeared all over a burn, I almost seized trying to hold in my giggles.

My heartfelt congratulations to Derek, who has finished his book on designing community spaces on the Internet. The proud papa of three community sites — {fray}, City Stories, and Kvetch — Derek knows of which he speaks. I’m anxious to get my copy of the book.

And speaking of community, I’m thinking of converting Q over to use the News Items feature of Manila; it would allow every entry to generate its own independent discussion, which may encourage people to contribute their thoughts whenever I start talking out of my ass. There are things about the feature that I don’t like, but I think that I can work around them to make it what I want it to be. (Obviously, if you have any opinions on the matter, please feel free to share them with me.)


Today, I received an email response to my posting about the septic child who died in the ICU, and it made me think a lot. The email was both an expression of fear — what if that were my kid? — and a question — what can I do if that’s my kid? The question is a tough one to answer, mainly because I really do feel that it’s a rare event when a medical or surgical team isn’t completely on top of a child who’s getting sicker. But if it’s your child and you feel it is happening, then become the strongest advocate your child has ever had. Tell the nurse and the doctor; tell them until they do something to satisfy you, whether it’s explaining how things are under control, or doing something to get the situation under control. Listen to the explanations offered to you, accept those which make sense, and question those that don’t. Put your fears about being labeled a difficult parent behind you, and advocate for your child’s health.

Unfortunately, though, just because something bad happens in a hospital doesn’t mean that something could be done to prevent it. Part of my training as a pediatrician has been to understand that there are times when we can’t catch up to the damage being done by an illness. In the case of the little boy, there is a very good chance that this was the case. Sepsis is a terrible thing, and there are good reasons to believe that he was in the progressive stages of sepsis even at the moment that eyes were first laid on him in the emergency room. I know that that’s an empty concept to parents who have lost their child; one of my strongest motivations as a doctor is to help figure out what we can do to prevent them from ever having to face it.

Yeah, buddywe all feel your pain.

Flipping through the recent Astronomy Picture of the Day entries, I came across a great one of a warped spiral galaxy. It’s nearly unfathomable to me that things exist on this scale; every time my mind wanders in that direction, I have to sit down and get my bearings lest my head explode.

For all you people using Internet Explorer on Windows, service pack 2 for Internet Explorer 5.5 is now out. (Here’s a list of the fixes, if you’re into reading that sorta thing.)

I have to admit, I fell off the wagon for a little while, but I’m back to reading Beth on a nearly-daily basis. Add Mena to the mix, and sprinkle a healthy dose of Lia, and you have a nice casserole from my too-entertaining-to-not-read cookbook, made from the freshest ingredients.

Holy fuck, it’s hot out. It’s the kind of hot that makes your muscles ache, makes your eyes burn, makes your inner ears feel like they’re boiling and about to burst forth in an effort to find someplace, anyplace cool to go. Even the typical over-air-conditioned New York restaurants don’t offer enough respite from the heat. Thank God and all that’s holy that it looks like it’s coming to an end tomorrow.

Good luck to my brother Noah, who will be arguing his first case in front of a Federal District Court in the near future. Awesome.

Oh, what a great story.

Sorry to have to break the news that we can’t blame Microsoft’s leaky security on IIS, Meg — it appears to have been simply a case of a full hard disk. It also appears to be all better now, and I’m keeping an active eye on things.

You know all that press you’ve been reading about GLAAD’s denunciation of Kevin Smith’s newest film, “Jay and Silent Bob Strike Back”? Well, as is usually the case, it turns out that there is an entirely different side to the story — one that seems to involve the GLAAD representative agreeing that he was overcalling issues, getting Smith to donate a big wad of money to the Matthew Shephard Foundation, and then still telling everyone who would listen what a homophobic film it is.

I’m now a part of ScreenShotStart.com. I like the way that the little thumbnail looks…


It’s satisfying to see that people learn lessons. I was on in the ICU for a 24-hour shift yesterday, and in the late afternoon, a senior peds resident on one of the floors of the hospital came up to us to tell us about a patient who was getting sicker — she appeared septic, and they wanted to get her to us immediately. And, unlike the last experience I had with a patient who got septic on the floor, she got to us quickly, and we were able to manage her appropriately. And yeah, she’s still very sick, but she’s going to make it through this.

It’s actually sorta pathetic how happy little toys like these make me. I’ve been looking to get a new, small flashlight to hang on my stethoscope for a while; I all of a sudden realized that my REI dividend from last year could help get me off my ass, and now both those babies are on their way to me.

In a bold — and necessary — move, the editors of four of the biggest medical journals are taking a stand and demanding the guaranteed scientific independence of researchers who publish drug company-sponsored clinical studies. It’s a tricky realm in which to tread. Big pharmaceuticals have become the largest funder of scientific research, and to lose that source of funding would be a big hit to American biomedical researc; that being said, corporate self-interest should not be able to dictate which medications make it onto the market in the U.S., and which are put on the market despite evidence of their failure.

Remember the Space Shuttle mission in February of last year, in which the Shuttle trailed a huge boom that took radar images of most of the Earth’s surface? NASA has begun releasing the images that were generated from that data; there are some amazing topographical pictures, with promises of mucho more to come.


It was a tough end to my first week in the PICU. Friday night, I left at around 8:30 PM, after spending three hours admitting a sick sick infant — manually ventilating him, getting lines into him, running big doses of blood pressure medications into him, and everything else it takes to acutely resuscitate someone as sick as he was. When I got back in yesterday morning (to take a 24-hour call in the unit), I learned that he arrested within ten minutes of me leaving; the team spent over four hours getting him back and losing him again, the surgeons opened his belly at the bedside, and he ultimately died, most likely of overwhelming sepsis. Looking through the chart yesterday, it was moderately clear that the team which had been managing the little boy on the floor could have been much more on top of him than they were, and I spent the rest of the day in a funk.

Otherwise, though, I’m still enjoying the PICU, and it’s serving to remind me that I have this life in the hospital that keeps me occupied and (most of the time) very happy, when other things don’t quite manage to do so.

If Robert Iler (AJ Soprano) is convicted, he could face fifteen years in prison; I wonder how they’ll write him out of the Sopranos if it happens.

Primary pulmonary hypertension of childhood is a nasty disease. (Imagine if the blood pressure in all of the vessels in your lungs skyrocketed, pushing all the blood out of them, and preventing you from getting any oxygen from your lungs into your bloodstream. That’s primary pulmonary hypertension.) Traditionally, it’s treated with a continuous intravenous infusion of a drug called prostacyclin — it’s a medicine that causes the pressure in those vessels to lower, and the people who are on it need to have a permanent IV catheter and a continuously-running IV pump on them at all times. Doctors at Boston Children’s Hospital, however, have come up with a potential new treatment — intravenous sildenafil, otherwise known as Viagra.

Damn, talk about a kick-ass digital camera… (I wonder if Heather will accept any images taken with this one into the Mirror Project.)

For a good review of the extension of typography to the computer screen, check out Alien Typography. The article comes from Digital Web Magazine, which looks to be a sure-fire bookmarkable site (despite the fact that its current home page design leaves me wondering if the site’s designers read the content).


Things that I learned in the PICU today:

  1. It’s possible for a doctor’s arm, an appropriate-sized mask, and an ambu bag to substitute for a child’s diaphragm for a really long time. Two childrens’, in fact.
  2. The minute that you declare that a child is “out of the woods,” the likelihood of that child seizing goes up tenfold.
  3. In times of stress, parents tend to put all their focus on things that they can control; it may mean that they don’t seem to be grasping the seriousness of their child’s condition, but in reality, they are just trying to contribute what they are able to in order to get the child better.

How depressing. This girl doesn’t look to be more than twelve or thirteen years old.

The group which supervises all the greater Boston area Boy Scouts troops has approved a policy which will allow gay scoutmasters to remain as part of the organization. Of course, it’s a don’t-ask-don’t-tell policy, which means that it’s just sweeping the issue under the rug; despite hanging the policy on the notion that “discussions about sexual orientation do not have a place in the Scouts,” I can’t imagine that any heterosexuals will be kicked out of the organization for making references to their straightness.

Meanwhile, this week’s Newsweek cover story (mirror) has some pretty encouraging statistics: 44 United Way chapters have backed away from the Scouts, as have many big companies, cities, and churches. Of course, one prominent person who has not backed away from them is our President; instead, he’s busy holding the Scouts’ values up as “the values of America.” (Please excuse me while I become ill.)

I swear to you all, I think that my digicam starts quivering when it senses a mirror nearby.

I read the story about the young child who was killed in the MRI machine in Westchester, and immediately wondered how often near-miss events happen that avoid tragedy (and notoriety) simply by chance. Every time that I have to bring a child into the MRI rooms, I have mini-nightmares about forgetting to remove something from my pockets or clothes that could fly across the room and hit someone, and it takes everything in me to take that first step across the threshold of the room.

I feel a bit guilty that it’s taken me this long to point to Rob’s words about the suicide of Paul Wayment, the man whose son died after he left the boy in his truck while he was hunting last year. Rob’s a great writer, and his sentiments on this specific issue resonate in me (especially since I’m guilty as charged). The most poignant part is the end:

What’s the lesson? I’m not sure. Perhaps it’s to beware of complacency, or of righteous indignation. YOU would never make a mistake like that? Really? Did you ever make a mistake that didn’t have serious consequences, like turning your back on your baby in the tub for ten seconds while you grab that towel you forgot? You came back and the baby was still sitting there, scooping up the Mister Bubble bubbles and eating them. You didn’t have to call the police and tell them you let your baby die, that you took the most important charge of your life and you fucked it up. And the reason you didn’t have to make that call? It wasn’t your turn to have Bad Luck land on you. Maybe next time. Maybe not. Pay attention, stay sharp and maybe it’ll never happen to you. But be careful of how you judge those for whom stupid mistakes had powerful repercussions. Irony is not a force to be played with.


My first PICU call went well. I had nine patients of my own, four of whom were intubated and on ventilators, and everybody decided to behave relatively well over the duration of the night. Learning to manage the hyperacute changes that can take place in critically ill infants and children is going to take a lot of work and hands-on experience, and I can’t imagine a better place for that than the ICU that I’m in. Next up is a full 24-hour call this weekend; that should provide a few more challenges, and hopefully, some great learning.