Residential Space A creative outlet during residency, turned ongoing virtual soap box

Oil Prices  2

Posted on January 30th, 2006. About Money, News and Politics.

As many of you who know me are probably well aware, the rise in oil prices over the past few years has not bothered me. (Warning – here comes another list.) This is primarily because: A) I hardly ever drive, B) Gas is not nearly as expensive here as it is in Great Britain, and C) My hope is that expensive gasoline will force people away from gas-guzzling SUVs and towards more energy efficient vehicles and transportation modalities.

I have heard quite a bit from the media recently about Iran, oil hitting $68/barrel, blah blah blah…and then I found this most excellent graphic at http://money.cnn.com :

Oil through the ages

I especially like that the price of a barrel of oil is adjusted for inflation so that I can relate to how much of a burden the price really was. I am discounting the 1864 value since these folks were not dependent on automobiles, but the 1979-1980 value is interesting, isn’t it? Oil has been (when adjusted) higher than $68/barrel before with the masses panicking, and things cooled off. I expect the same may happen this time around as well. Then, perhaps the panic will be over how oil stocks are “tanking.” Too soon to tell, though.

The Perfect Orange  0

Posted on January 30th, 2006. About Uncategorized.

In November, Dr. Stephanie Wheeler, the attending physician for our medicine team at the VA Hospital, brought us a bag full of these small, somewhat shriveled oranges that still possessed their stems and leaves. Hmmm…I inquired as to where she obtained these strange things, and she informed me that they came from the Whole Foods Market. No one touched them the entire night on call. Now, I love oranges, but I hate eating them while working because: A) sticky fingers from peeling them, B) no good place to spit the seeds, and C) I have to peel all of that white stuff off of them to keep them from tasting too stringy.

Anyway, I finally broke down and decided to peel one the following morning. I peeled it in, I’m not kidding, less than ten seconds. Just grab part of the skin, and the whole thing practically peels itself. Inside was the juiciest (but none of the juice got on my fingers), most delicious seedless orange I have ever tasted, and it had minimal white stuff on its exterior. Wow – so all three of the annoying aspects to oranges had been eliminated. I had just consumed the perfect orange.

At this point, in typical Jodi-fashion, it was time to do some research on this most curious fruit. It is a type of mandarin orange, similar to a Clementine, but not quite as sweet, called a Satsuma. They are available during the late fall/winter months here and are grown in California’s San Joaquin Valley. Apparently, there is also a research project at Auburn University in Alabama, and of course some are grown in Florida, but I don’t recall having ever seen them at the grocery stores in South Carolina.

In brief, I am delighted to have found such a perfect fruit that can keep me happy until strawberries are back in season.

In memory of Chris Penn  0

Posted on January 26th, 2006. About Entertainment.

I was saddened to learn of the recent death of actor Chris Penn. He is probably best known for his role in Reservoir Dogs or perhaps as the brother of Sean Penn, but I will always admire him for his role in Footloose. I saw this movie at a very young age and have been a fan of it ever since. Penn’s character, Willard, is adorable – sweet, rural, simple, yet wanting more out of life.

It’s very odd that he was found dead at the age of 40; the autopsy was negative, making the situation even more suspicious. Toxicology reports are still pending.

I think part of what makes his death so sad for me is the sense that I’m getting older. The thought that a young member of the Footloose cast has passed away, potentially from natural causes, is bizarre, because in my mind I still see Penn as the teenager striding alongside Ren McCormick, aiding him in his fight against the town council to legalize dancing in Bomont. How sad to know that he grew up, grew older, and is no longer with us.

Go Seahawks!!!  0

Posted on January 22nd, 2006. About Sports.

Wow.

I am so excited! I have never given a rip about NFL football, but when Evan and I moved to our condo, we found we had a very clear view of Qwest Stadium, home of the Seattle Seahawks. On game days the stadium is lit in a brilliant blue, the team’s color. :-) Towards the end of October the intrigue with this team grew within Seattle – a team that has pretty much been down on its luck for the three decades of its existence was winning. Hmm…

In December the enthusiasm was evident. People (like yours truly) who traditionally hated NFL football were talking about the Seahawks. Seattlites were psyched! On December 24th the Seahawks defeated the Colts, and suddenly talk turned to – what if we made it to the Super Bowl? We won home field advantage, a boost for the city as thousands were sure to flood in through the Sea-Tac airport on the weekends (and they have!). I watched Seattle overtake Washington (how ironic) last weekend, and this weekend, a group of eight of us yelled for our team as they defeated the Carolina Panthers in a 34-14 victory.

So now it’s on to the Super Bowl. Some of you are probably saying - but who cares about football? I cannot describe it properly, but there is a sense of pride in knowing that a team unexpected to do anything significant has given my new town a reason to be excited.

And by the way – it did not rain today. It was a gorgeous day full of sun! :-D

Book #4: Prince Caspian  0

Posted on January 19th, 2006. About Books.

Book #4: Prince Caspian by: C.S. Lewis, the fourth in the Chronicles of Narnia series; pages: 101.

This was my favorite of the first four Narnia books. The four children reappear on a deserted island and stumble across ruins that stimulate sad, nostalgic discussions of their days as kings and queens of Narnia. They venture out to assist the rightful heir King Caspian in his claim for the throne. The transition at the end for the older children into young adulthood is smooth and believeable.

Stats:

  • 19/365 – 5.20% of 2006 complete
  • Books Read – 4/50 – 8.0%
  • Pages Read – 398/15000 – 2.65%

Oregon’s “Death with Dignity” Law Upheld  2

Posted on January 18th, 2006. About News and Politics.

I learned from NPR upon awakening this morning that Oregon’s “Death with Dignity” law was upheld in a 6-3 decision by the U.S. Supreme Court this week. I have been intrigued by this law ever since I declared my medical humanities minor at the University of South Carolina in 1999. It is now interesting to be practicing medicine in a city three hours from Portland, Oregon, as the issue seems even closer.

In 1994 Oregon citizens approved the Death with Dignity Act in the form of a state-wide ballot initiative. The law allows physicians to prescribe lethal doses of medication to patients who A) are terminally ill and are assessed by two different physicians to have less than a six month life expectancy, and B) make the formal request, are found to be of sound mind, and repeat the request at least two weeks from the initial date. The same initiative was reintroduced on the ballot in 1997, and again Oregonians approved it. Physicians who feel uncomfortable with the law are not obligated to participate in this practice.

President Bush took the state of Oregon to court over the issue, claiming that the law violates federal drug regulations (ie, drugs are not approved by the FDA for the purpose of killing patients, therefore prescribing drugs for this purpose embodies an off-label use). I think many of us recognize that the actual purpose behind the lawsuit was to keep patients from being able to end their lives; the motive is obviously of a strongly religious overtone consistent with the president’s self-proclaimed fundamentalist Christian beliefs. In any case, the Supreme Court disagreed with the president. Justice Anthony Kennedy stated in writing the majority opinion that federal regulations are to prevent drug trafficking, and that the state of Oregon’s practices are not in conflict with this federal regulations.

My views on this issue have changed somewhat over my past seven months as a physician. Before my residency began, I was in favor of the Death with Dignity Act, believing that patients should have the right to say “enough is enough” and bow out gracefully. I always claimed that *I* would never do it, but who was I to say that others couldn’t? I also believed that, as a physician, my role was to “do no harm,” and that I would not participate in such practice, despite my support of the law’s principle.

At this point, I have spent a month on the University of Washington’s oncology service. Every fourth night, I was the sole physician in charge of 40+ cancer patients, entrusted with the duty of keeping everyone alive and comfortable throughout the night until their primary teams returned in the morning. The first patient I ever pronounced dead was a leukemic woman I met during that difficult month. I thought I knew suffering until I spent sleepless nights with these people. It is pain beyond what is imaginable - needing to cough because one can’t breath well, but being too weak to do so; intense oral and gingival burning and bleeding because the tissue in the mouth is destroyed from radiation therapy, and being mostly unable to stop it because the body’s platelet stores are wiped out; around-the-clock vomiting from chemotherapy; being unable to speak because yeast has completely overtaken the throat and esophagus; infections involving the eyes and vagina and skin. I once had a patient that did not sleep for seven days because of an unremitting severe headache that would not respond to even our strongest narcotics. Who among us can begin to empathize with what it must be like to live like this not for hours or days, but months and perhaps years? Several patients told me they were just waiting to die, if only the process could be sped along. The best option I could offer them was “comfort care,” to keep them sedated with heavy doses of medications while withholding food and hydration (at their request), allowing them to die slowly over two weeks.

As one might imagine, I am now not only a supporter of Oregon’s law, but were I practicing medicine in Oregon, I believe I would be doing my patients a service by honoring their wishes. I have never even withdrawn care on a patient without discussing it with at least two other physicians, going back through all of the patient’s legal documents, and having a lengthy discussion with the patient to ensure that he fully understands the consequences of deciding to remove life-sustaining medications. At times, if I have had the slightest doubt as to decision-making capacity of a patient, I always call the psychiatry team to evaluate the his mental status formally before withdrawing care. The decision to assist a patient in ending his life is not one I would take lightly, but I can say with confidence that I would save him the despair of wasting away painfully if he requested this of me.

One time I investigated the meaning behind “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect” in the Hippocratic Oath, and what I found was this: physicians used to be hired assassins in ancient Greece. A wealthy family would pay a physician to assassinate a member of a rival family when the sick person had believed the doctor was giving medication. Physicians also mixed poisonous substances using their knowledge of plants and would sell these concoctions to interested parties. Physicians were used to induce abortions in the wives of rivals under the false pretense of providing care. Hippocrates was not thrilled with this, and it motivated him to create his now famous Oath for physicians as a means of establishing a code of conduct. We are not talking about assassinating people in the Death with Dignity law. Besides, I believe it is doing a great deal of harm to a patient to strip him of self-determination during the final days of his life and force him to endure pain beyond what any of us know.

So I send a relieved “thank you” to six of our Supreme Court justices for ensuring that terminally ill people can maintain a sliver of dignity during the dying process, an experience that is quite personal and, I believe, really not the business of the powers-that-be in DC.

 

My beef with Columbia House  1

Posted on January 17th, 2006. About Ramblings.

I have been meaning to blog about this for months, but was awaiting a semi-conclusion to the story before burdening you with another one of my tirades.

When I was in my second year of medical school, I got a DVD player and decided to buff up my DVD library by joining Columbia House. Sure, we are all familiar with the online/mail order music/video club – get a gazillion DVDs for $.99, then you’re only obligated to purchase x number of DVDs at y price over the next z years. Like a fool, when I registered I asked the company to bill my American Express card (huge mistake – never give your credit card number to this company). Anyway, I received a bunch of DVDs, purchased my however-many I was required to purchase in order to fulfill my obligation, and then I called in 2003 and cancelled my membership. I probably would have remained a member, but I would receive these annoying emails on a monthly basis telling me that I would automatically receive a “Director’s Selection” DVD if I did not opt-out of receiving it by a certain date. On several occasions suddenly a DVD would show up at my apartment and the charge would show up on my Amex card. I would have to return it and wait for the credit to appear on my credit card statement. Anyway, this got to be more than irritating and I cancelled my membership. Case closed…

 …until October 2005. During this two year period between closing the account and October 2005, I: A) got married and changed my last name, B) lost my wallet and cancelled my American Express card, receiving a new card with a new number, C) moved from Charleston, SC to Seattle, WA, and D) never communicated with Columbia House.

On October 28, 2005 a charge in the amount of $46.52 to “Columbia House Video” appeared on my Amex statement. I called Amex, and they opened an investigation of the disputed charge; they also suspended the charge. After about a week, though, I decided to call CH and see if they could credit back the amount. The sales rep at CH could not find any record of the transaction. He also could not find any record that I had ever been a member when I gave him my maiden name and former address. When I gave him my OLD Amex card number, though, someone with my maiden name for a Florida address and with an open CH account popped up in their system. I insisted that I had never lived in Florida and asked to have the account closed. Get this – he told me that he could only close the account if I could CONFIRM THE ADDRESS. I told him I could not confirm the address because I had never lived in Florida, but whoever this was in Florida was using my old account and my old Amex number, and somehow charges were appearing on my NEW Amex card! He still refused to close the account or credit back the charge, but told me he would open an investigation.

I was absolutely livid. This was so stupid! First of all, why was my Amex account being charged when I had a new number even though the charge was made to my old number? Isn’t that the purpose of cancelling a credit card? So that if you lose a credit card someone can’t steal it and use the number? And second of all, I was outraged that I could not close my own account (which had been closed supposedly two years earlier) because I could not confirm an address where I had never lived. Still, I felt I had no choice but to wait for the Amex investigation to finish.

Of course, despite faxing my Amex statement to CH, the charge was not credited back. Then, on November 19th, another charge in the amount of $26.44 to CH Video appeared. Again, I called Amex, and then I had Evan call Columbia House for me because I was too angry to speak civilly to them. Of course, they refused to speak to Evan because it was my account, but when I spoke to them they refused to allow me to close the account because – again, I could not confirm the Florida address under my maiden name.

Anyway, to make this painfully long story a little less long, the first charge was credited back, but not the second. I had to make a total of two more calls to CH, each time explaining what was going on with the charges, the account in Florida, how my old Amex number seemed to result in charges to my new Amex – and each time the guy on the other end did not give a crap. Eventually the charge was credited back because of Amex’s investigation, not because of anything CH did.

So while both charges have been credited now and the CH account is suspended, the account still has not been closed. I could be 90 years old and still have an account open with CH, unless I were to guess the correct address in Florida before then.

On a brighter note, I just bought a beautiful container of strawberries at the grocery store for $2.50! I have waited months for a good, inexpensive quart of strawberries. How is that for random?

Book #3: The Horse and His Boy  1

Posted on January 17th, 2006. About Books.

Yet, another book in the Chronicles of Narnia is complete (or has been for decades, but now *I* have completed my read of it). The Horse and His Boy by: C.S. Lewis was a decent read, but at times it seemed a bit silly and unrealistic. Yes, I am aware that it is fantasy and that talking horses may seem that way, but I have read fantasy before where I was able to successful undergo “the suspension of disbelief.” In any case, I did like one particular scene where Aslan reappears and explains his omnipresent existence throughout the book. I got sick of the scenes in Tashbaan. I much preferred The Lion, the Witch, and the Wardrobe.

Anyway, another brief read finished, and still I am ahead with total books but behind in number of pages read. Once I am through with the Narnia books I will embark on lengthier reads – my plan is to go next to Team of Rivals by: Doris Kearns Goodwin, a book I received for Christmas about Abraham Lincoln.

Progress toward goals:

17/365 = 4.66% days of the year completed

3/50 = 6.0% number of books completed
297/15000 = 1.98% number of pages read

There are stupid people everywhere.  0

Posted on January 13th, 2006. About Ramblings.

Yes, even in Seattle, which was recently named the most literate city in the United States, stupid people are able to infiltrate the general population and irritate those around them. Case in point:

I stopped by the post office this afternoon on my way home from work, and to my delight there were THREE windows open and only FIVE people in line. Sweet, I thought, this should take five minutes, tops. A 25-ish year old woman/girl goes to the middle counter with a gift-wrapped box (and a ribbon tied around it) and says she would like a larger box in which to put her pretty little present. The postal clerk goes to the back and returns with a box slightly larger than hers.

She puts the small box inside the larger one, addresses the package, and then, just as she goes to pay, she says, “So what happens if it’s delivered and she isn’t home?” to which he replies, “She will receive a postal slip in her mailbox and will have to go to the post office to pick it up.” Her response is, “Are you serious? She has to go PICK IT UP HERSELF?” to which he answers, “Yes, that is typically how it works.” She then begins inquiring as to how she can arrange for the package to be left on her friend’s doorstep. The postal clerk informs her that there is no way to guarantee that the package can be left, and most of the time the package should NOT be left on a doorstep.

She grows more upset by the moment. “But I just think that’s so unreasonable that my friend should have to go to the post office to pick up her package.” Meanwhile, the postal clerk at the adjacent window gets involved in this fascinating discussion, explaining that she knows postal employees down in Oregon who are willing to leave packages on doorsteps and she thinks there are different policies from state to state. Of course, the THIRD (and only other available postal clerk working) has to add his two cents, that the U.S. Postal Service is a federal body and is run by federal policies, so it should be irrelevant in which state the person resides. No, insists Postal Clerk #2, because she has a friend in Oregon who leaves packages on the front doorsteps all of the time. Well, claims Clerk #3, he probably shouldn’t, because he’s not supposed to. But they can do that in Oregon, Clerk #2 says, it’s just in Washington that it’s against policy. But we’re federal, insists Clerk #3, so it doesn’t matter what state you’re in…it got exhausting to stand in such a short line, but watching all three postal clerks furiously debate this earth-shaking dilemma.

Yes, all three available postal clerks are determined to get involved in this non-issue while the rest of us stand helplessly in line, waiting for someone, ANYONE, to assist us. Now, the postal clerk initially helping this moron notices that there is an apartment number on the package, and says, “Oh, well, if your friend lives in an apartment building, the postal carrier will drop her package off at her leasing office and she can pick it up there.” Again, the girl nearly goes hysterical. “But what if the office is closed and she can’t get to it?!” Postal clerk #2 asks how large her friend’s mailbox at the apartment complex is – that perhaps the box will fit inside. Moron insists that the mailbox is small and that the package will not fit. At this point, she says, “I’ve changed my mind. I don’t want to send it in a bigger box. I’ll send it in a way that I can just put a big envelope around it and maybe they can squeeze it into the mailbox.” So she TAKES THE PRESENT OUT OF THE BOX and tells the postal clerk that, since she won’t be needing it now, she doesn’t have to pay for the box upon which she has JUST WRITTEN HER FRIEND’S ADDRESS. Postal clerk #1 brings her a Priorty Mail envelope and puts it around the package, and it is large enough to fit easily. She asks if he has anything smaller, and he says he will have to check. He disappears again and returns with three different envelopes for three different ways of shipping the package. I thought the person in front of me was going to have a nervous breakdown if she didn’t get out of there. It was taking every bit of reserve she could muster to keep from yelling obscenities at Moron.

Finally, the woman being neglected by postal clerk #2 says, “Can you help me? I need to be somewhere soon.” Postal clerk #2 reluctantly returns to the dull simple transaction of selling a book of stamps.

I ended up at postal clerk #2 and shipped my package before moron and postal clerk #1 were finished with her transaction.

My question is – how did Moron end up inside of my city’s limits? Who let her in without a Visa? This experience was not unlike my journey down the stairs of the Arc d’Triumph in Paris and hearing the two loud American girls at the top going, “Oh my God, I would kill for KFC right now! I mean, what do these people eat?!” Wow, it is amazing Parisians did not starve to the point of extinction before American fast-food chains entered their humble city. It is remarkable when a group of people blend well, and then the ugly voice of ignorance towers above all.

So Seattle, most literate city or not, we clearly have work to do.

In response to James’ new country…  2

Posted on January 11th, 2006. About Ramblings.

James recently replied to my post about eliminating states with his own about using one of them to start his own country (a Galt’s Gorge of sorts, it seems). :) I tried adding a comment to his blog, but the computer here does not like MSN for some reason. So I will post my response here.

I can understand his desire to go to a consumption tax rather than a graduated federal income tax. Here are my concerns though:

- Initially, it benefits me because I am sharing the tax burden with the lower class.

- Then, I realize, being the frugal-to-a-fault person that I am, that I can get by with paying less tax if I never spend any money. I stop eating at nice restaurants because I can pay minimal tax by preparing meals at home. I do not purchase a new television because the idea of paying that much tax makes me cringe. Anything non-essential, I refuse to buy.

- Retail businesses begin hurting due to decreased sales. Eventually, if it continues, they begin laying people off. Stocks are down.

- My uncle, who owns his own building company in Austin, TX, now hurts because no one wants a new house. Other builders are in the same situation. Because he is hurting, the lumber and plumbing companies are hurting.

- The country enters a recession, stocks are down, and eventually it does hurt me, because in my efforts to save money my investment portfolio has now taken a dive.

Of course, this may be a bit melodramatic, but it is something to consider. People in Europe pay high consumption taxes and it doesn’t necessarily stop them from spending, but then again they are funding healthcare and education through the government, and I know James is not in favor of bigger government controlling these sorts of things.

You may say – yes, but most people are not that frugal and will continue to spend money. I would agree, but then I think the idea of paying tax results in a psychological aversion to spending. Look at the “tax-free” days just prior to the new school year starting each year. In Charleston, SC, sales tax is 6.0%. The stores are FLOODED with people during the tax-free weekend. I mean, they are flooded to the point of chaos at times. Now, if I were to run a tv ad stating: “Everything is SIX PERCENT OFF for ONE DAY ONLY!!!” people would say, “Yeah, right. It’s not worth it.” But I would argue that because they are not having to pay TAX on items, something compels them to spend money. So I do believe consumption taxes on every day items, other than those that are expected to be heavily taxed, will lead to less spending.

I like the happy medium the state of Washington has attempted to create. We have no state income tax (a beautiful thing, I must admit!), and there is no sales tax on essentials, such as groceries. Items that are very heavily taxed, though, include tobacco, alcohol, gasoline, property, and vehicle registrations. Heavy taxation provides the extra incentive away from driving cars when public transportation is available too, so it helps to keep the city clean! :-D

Finally, though – the biggest reason I have difficulty getting behind eliminating the federal income tax in favor of a consumption tax is because Jim DeMint, R-SC is strongly in favor of it. Since he heavily supports the consumption-only tax, and he’s just a huge douche-bag, I cannot help but see red flags.

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